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Sample records for acute gi bleeding

  1. [Gastric schwannoma: rare differenzial diagnosis of acute upper gastrointestinal (GI) bleeding].

    Science.gov (United States)

    Lyros, Orestis; Schickel, Stephan; Schierle, Katrin; Hoffmeister, Albrecht; Gockel, Ines

    2017-08-01

    Schwannomas are benign tumors derived from Schwann cells and their typical site of origin is the subcutaneous tissue of the extremities. Gastrointestinal localization of Schwannomas is extremely rare and the stomach is the prevalent site. Gastric schwannomas primarily occur in the gastric submucosa and are usually asymptomatic.We present a rare case of a solitary gastric schwannoma in a 51-year old male, which initially manifested with hematemesis by acute upper gastrointestinal (GI) bleeding. The upper GI-Endoscopy revealed a gastric submucosal tumor, 7 cm in size, located in the proximal corpus and fundus. In the endoscopical Ultrasound (EUS-Examination), the lesion appeared to arise from the fourth proper muscle layer (Muscularis propria). The fourth layer origin and the isoechogenicity, as compared to the normal muscle layer, are endoscopic ultrasonographic characteristics of gastric schwannomas and help in distinguishing them from gastrointestinal tumors (GIST). Because of the unclear histological identity, the patient underwent a "rendezvous" endoscopic-laparoscopic surgical resection of the tumor in toto. The histomorphological features of the lesion and the strong expression of S100 in combination with absence of DOG1 expression indicated the diagnosis of gastric schwannoma. There was no evidence of malignancy. The postoperative course was uncomplicated.This is a very rare manifestation of gastric schwannoma, representing a rare differenzial diagnosis in a case of acute upper GI-Bleeding. Only 14 % of gastric schwanommas are presented with gastrointestinal bleeding, including mainly melena rather than hematemesis. This case is considered to be worthy of presentation owing to the rare and unusual cause of upper GI bleeding implied in it. © Georg Thieme Verlag KG Stuttgart · New York.

  2. 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

    Directory of Open Access Journals (Sweden)

    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

  3. Approach to upper gastrointestinal bleeding - Upper GI bleeding is ...

    African Journals Online (AJOL)

    Approach to upper gastrointestinal bleeding - Upper GI bleeding is the most common complication of peptic ulceration and portal hypertension. SR Thomson. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals ...

  4. Clinical approach to obscure GI bleeding - Diagnostic testing and management

    Directory of Open Access Journals (Sweden)

    Prashanth Prabakaran

    2013-01-01

    Full Text Available Obscure gastrointestinal bleeding (OGIB can present as a diagnostic dilemma and management can be challenging. The search for causes of OGIB is usually centered on visualizing the small bowel, and in the past decade, the technology to visualize the entire small bowel has significantly advanced. Moreover, small bowel endoscopic imaging has replaced, in many instances, prior radiographic evaluation for obscure GI bleeding. These new modalities, such as small bowel capsule endoscopy (CE, balloon-assisted deep enteroscopy [double balloon enteroscopy (DBE and single balloon enteroscopy (SBE], and overtube-assisted deep enteroscopy (spiral enteroscopy, are paving the way toward more accurately identifying and treating patients with OGIB. We will review the diagnostic modalities available in evaluating a patient with OGIB and also propose the management based on clinical and endoscopic findings.

  5. Familial Abdominal and Intestinal Lipomatosis Presenting with Upper GI Bleeding

    Directory of Open Access Journals (Sweden)

    Yilmaz Bilgic

    2015-01-01

    Full Text Available Although lipomas are encapsulated benign tumors, systemic lipomatosis defines infiltrative nonencapsulated tumors resembling normal adipose tissue. Abdominal lipomatosis and intestinal lipomatosis are different clinicopathological entities with similar clinical symptoms. We describe here a case presenting with upper gastrointestinal bleeding from eroded submucosal lipoma at duodenum secondary to intestinal lipomatosis and abdominal lipomatosis.

  6. Artificial neural networks accurately predict mortality in patients with nonvariceal upper GI bleeding.

    Science.gov (United States)

    Rotondano, Gianluca; Cipolletta, Livio; Grossi, Enzo; Koch, Maurizio; Intraligi, Marco; Buscema, Massimo; Marmo, Riccardo

    2011-02-01

    Risk stratification systems that accurately identify patients with a high risk for bleeding through the use of clinical predictors of mortality before endoscopic examination are needed. Computerized (artificial) neural networks (ANNs) are adaptive tools that may improve prognostication. To assess the capability of an ANN to predict mortality in patients with nonvariceal upper GI bleeding and compare the predictive performance of the ANN with that of the Rockall score. Prospective, multicenter study. Academic and community hospitals. This study involved 2380 patients with nonvariceal upper GI bleeding. Upper GI endoscopy. The primary outcome variable was 30-day mortality, defined as any death occurring within 30 days of the index bleeding episode. Other outcome variables were recurrent bleeding and need for surgery. We performed analysis of certified outcomes of 2380 patients with nonvariceal upper GI bleeding. The Rockall score was compared with a supervised ANN (TWIST system, Semeion), adopting the same result validation protocol with random allocation of the sample in training and testing subsets and subsequent crossover. Overall, death occurred in 112 cases (4.70%). Of 68 pre-endoscopic input variables, 17 were selected and used by the ANN versus 16 included in the Rockall score. The sensitivity of the ANN-based model was 83.8% (76.7-90.8) versus 71.4% (62.8-80.0) for the Rockall score. Specificity was 97.5 (96.8-98.2) and 52.0 (49.8 4.2), respectively. Accuracy was 96.8% (96.0-97.5) versus 52.9% (50.8-55.0) (Pperformance of the ANN-based model for prediction of mortality was significantly superior to that of the complete Rockall score (area under the curve 0.95 [0.92-0.98] vs 0.67 [0.65-0.69]; P<.001). External validation on a subsequent independent population is needed, patients with variceal bleeding and obscure GI hemorrhage are excluded. In patients with nonvariceal upper GI bleeding, ANNs are significantly superior to the Rockall score in predicting the

  7. New predictive model for acute gastrointestinal bleeding in patients taking oral anticoagulants: A cohort study.

    Science.gov (United States)

    Shimomura, Akira; Nagata, Naoyoshi; Shimbo, Takuro; Sakurai, Toshiyuki; Moriyasu, Shiori; Okubo, Hidetaka; Watanabe, Kazuhiro; Yokoi, Chizu; Akiyama, Junichi; Uemura, Naomi

    2018-01-01

    The study developed a predictive model of long-term gastrointestinal (GI) bleeding risk in patients receiving oral anticoagulants and compared it with the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratios, Elderly, Drugs/alcohol concomitantly) score. The study periodically followed a cohort of 508 patients taking oral anticoagulants (66 direct oral anticoagulants users and 442 warfarin users). Absence of GI bleeding at an initial examination and any subsequent GI bleeding were confirmed endoscopically. The bleeding model was developed by multivariate survival analysis and evaluated by Harrell's c-index. During a median follow-up of 31.4 months, 42 GI bleeds (8.3%) occurred: 42.8% in the upper GI tract, 50.0% in the lower GI tract, and 7.1% in the middle GI tract. The cumulative 5 and 10-year probability of GI bleeding was 12.6% and 18.5%, respectively. Patients who bled had a significantly higher cumulative incidence of all-cause mortality (hazard ratio 2.9, P ulcer disease, and liver cirrhosis predicted GI bleeding. The c-statistic for the new predictive model using these five factors was 0.65 (P acute GI bleeding risk based on five factors (no-proton pump inhibitor use, chronic kidney disease, chronic obstructive pulmonary disease, history of peptic ulcer disease, and liver cirrhosis), which was superior to the HAS-BLED score. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  8. Gastric cirsoid aneurysm: Uncommon cause of death from upper GI bleed

    Directory of Open Access Journals (Sweden)

    Tatiana Bihun, BA

    2017-11-01

    Full Text Available Gastric cirsoid aneurysm is an arterial malformation found in the submucosa of the stomach. It is a rare, but potentially life-threatening cause of gastrointestinal bleed. We present a case of a 48 year old male who presented to the ER unconscious, unresponsive, pale, and tachycardic. Patient expired and an autopsy was performed. Upon examination blood was found in the GI tract. During examination an arterial malformation was found in the body of the stomach. Histological samples were taken and the findings were consistent with gastric cirsoid aneurysm. Diagnosis can be made through endoscopy, angiography, or red cell scanning. Current treatment is hemostasis achieved by either thermal, regional injection or mechanical therapies. Multiple therapies are found to be more successful than monotherapy. Gastric cirsoid aneurysms are thought to make up <5% of upper GI bleeds, however clinicians should be mindful when working up a differential diagnosis.

  9. Portal Hypertensive Colopathy with Pelvic Varices presenting as Severe Lower GI Bleed treated with TIPSS

    LENUS (Irish Health Repository)

    Murphy, SF

    2018-02-01

    We present the case of a 71-year-old lady with a background of significant alcohol intake who presented with frank lower gastrointestinal (GI) bleeding, lower abdominal pain and haemoglobin 6.3g\\/dL. CT abdominal angiogram showed right-sided colonic thickening, atrophic liver and enlarged superior mesenteric vein (SMV) and right-sided pelvic varix. This lead to a diagnosis of portal hypertensive colopathy secondary to alcoholic liver cirrhosis. The patient failed conservative management and underwent a Transjugular Intrahepatic Portosystemic Shunt (TIPSS) procedure. This lead to an immediate resolution of her lower-GI bleeding. Repeat CT at three weeks showed a decompressed SMV and resolution of the right-sided pelvic varix. The patient was discharged after three months following optimization of medical condition and social circumstances.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Science.gov (United States)

    Wu, Lian-Ming; Xu, Jian-Rong; Yin, Yan; Qu, Xin-Hua

    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 they compared CT angiography to a reference standard of upper GI endoscopy, colonoscopy, angiography or surgery in the diagnosis of acute GI bleeding. Meta-analysis methods were used to pool sensitivity and specificity and to construct summary receiver-operating characteristic. RESULTS: A total of 9 studies with 198 patients were included in this meta-analysis. Data were used to form 2 × 2 tables. CT angiography showed pooled sensitivity of 89% (95% CI: 82%-94%) and specificity of 85% (95% CI: 74%-92%), without showing significant heterogeneity (χ2 = 12.5, P = 0.13) and (χ2 = 22.95, P = 0.003), respectively. Summary receiver operating characteristic analysis showed an area under the curve of 0.9297. CONCLUSION: CT angiography is an accurate, cost-effective tool in the diagnosis of acute GI bleeding and can show the precise location of bleeding, thereby directing further management. PMID:20712058

  12. Transarterial embolization of acute intercostal artery bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Jae Ik; Park, Auh Whan; Lee, Seon Joo [Inje University College of Medicine, Busan (Korea, Republic of); Ko, Gi Young; Yoon, Hyun Ki [University of Ulsan College of Medicine, Seoul (Korea, Republic of); Yoon, Chang Jin [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Shin, Tae Beom [Donga University College of Medicine, Busan (Korea, Republic of); Kim, Young Hwan [Kyimyung University School of Medicine, Daegu (Korea, Republic of)

    2005-09-15

    To report our experiences of transarterial embolization for acute intercostal artery bleeding. A retrospectively analysis of the causes, clinical manifestations, angiographic findings and transarterial embolization technique in 8 patients with acute intercostal artery bleeding, with a review of the anatomical basis. The causes of intercostal artery bleeding were iatrogenic and traumatic in 88 and 12% of cases, respectively. Active bleeding from the collateral intercostal or posterior intercostal arteries was angiographically demonstrated in 75 and 25% of cases, respectively. Transarterial embolization successfully achieved hemostasis in all cases. However, two patient with hypovolemic shock expired due to a massive hemothorax, despite successful transarterial embolization. Intercostal access should be performed through the middle of the intercostal space to avoid injury to the collateral intercostal artery. Transarterial embolization is an effective method for the control of intercostal artery bleeding.

  13. Monitoring and treatment of acute gastrointestinal bleeding.

    Science.gov (United States)

    Lenjani, Basri; Zeka, Sadik; Krasniqi, Salih; Bunjaku, Ilaz; Jakupi, Arianit; Elshani, Besni; Xhafa, Agim

    2012-01-01

    Acute gastrointestinal bleeding-massive acute bleeding from gastrointestinal section is one of the most frequent forms of acute abdomen. The mortality degree in emergency surgery is about 10%. It's very difficult to identify the place of bleeding and etiology. The important purpose of this research is to present the cases of acute gastrointestinal bleeding from the patients which were monitored and treated at The University Clinical Center of Kosova-Emergency Center in Pristina. These inquests included 137 patients with acute gastrointestinal bleeding who were treated in emergency center of The University Clinical Center in Pristina for the period from January 2005 until December 2006. From 137 patients with acute gastrointestinal bleeding 41% or 29% was female and 96% or 70.1% male. Following the sex we gained a high significant difference of statistics (p < 0.01). The gastrointestinal bleeding was two times more frequent in male than in female. Also in the age-group we had a high significant difference of statistics (p < 0.01) 63.5% of patients were over 55 years old. The mean age of patients with an acute gastrointestinal bleeding was 58.4 years SD 15.8 age. The mean age for female patients was 56.4 age SD 18.5 age. The patients with arterial systolic pressure under 100 mmHg have been classified as patients with hypovolemic shock. They participate with 17.5% in all prevalence of acute gastrointestinal bleeding. From the number of prevalence 2 {1.5%} patients have been diagnosed with peptic ulcer, 1 {0.7%} as gastric perforation and 1 {0.7%} with intestine ischemia. Abdominal Surgery and Intensive Care 2 or 1.5% died, 1 at intensive care unit and 1 at nephrology. As we know the severe condition of the patients with gastrointestinal bleeding and etiology it is very difficult to establish, we need to improve for the better conditions in our emergency center for treatment and initiation base of clinic criteria.

  14. Treatment of acute variceal bleeding

    DEFF Research Database (Denmark)

    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...

  15. Somatostatin analogues for acute bleeding oesophageal varices

    DEFF Research Database (Denmark)

    Gøtzsche, Peter C.; Hrobjartsson, A.

    2008-01-01

    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...

  16. Endoscopic management of acute peptic ulcer bleeding.

    Science.gov (United States)

    Lu, Yidan; Chen, Yen-I; Barkun, Alan

    2014-12-01

    This review discusses the indications, technical aspects, and comparative effectiveness of the endoscopic treatment of upper gastrointestinal bleeding caused by peptic ulcer. Pre-endoscopic considerations, such as the use of prokinetics and timing of endoscopy, are reviewed. In addition, this article examines aspects of postendoscopic care such as the effectiveness, dosing, and duration of postendoscopic proton-pump inhibitors, Helicobacter pylori testing, and benefits of treatment in terms of preventing rebleeding; and the use of nonsteroidal anti-inflammatory drugs, antiplatelet agents, and oral anticoagulants, including direct thrombin and Xa inhibitors, following acute peptic ulcer bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. An approach to acute lower gastrointestinal bleeding.

    Science.gov (United States)

    Frost, John; Sheldon, Faye; Kurup, Arun; Disney, Benjamin R; Latif, Sherif; Ishaq, Sauid

    2017-07-01

    Lower gastrointestinal bleeding (LGIB) is a common problem that can be treated via a number of endoscopic, radiological and surgical approaches. Although traditionally managed by the colorectal surgeons, surgery should be considered a last resort given the variety of endoscopic and radiological approaches available. This article provides an overview on the common causes of acute LGIB and the various techniques at our disposal to control it.

  18. The role of nuclear medicine in acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    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).

  19. Emergency readmission following acute upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Strömdahl, Martin; Helgeson, Johan; Kalaitzakis, Evangelos

    2017-01-01

    OBJECTIVE: To assess the occurrence, clinical predictors, and associated mortality of all-cause emergency readmissions after acute upper gastrointestinal bleeding (AUGIB). PATIENTS AND METHODS: All patients with AUGIB from an area of 600 000 inhabitants in Sweden admitted in a single institution...... in 2009-2011 were retrospectively identified. All medical records were scrutinized and relevant data (such as comorbid illness and medications, endoscopy, rebleeding, inhospital mortality, and 30-day emergency readmission) were extracted. The Charlson comorbidity index was calculated. RESULTS: A total...... of 174 out of 1056 patients discharged alive following AUGIB (16.5%) had an emergency readmission within 30 days. Nineteen percent of readmissions were because of rebleeding, whereas the rest were because of other reasons, mainly bacterial infections (9.8%) and cardiovascular events (8%). Inhospital...

  20. Rockall score of the acute upper gastrointestinal bleeding patients ...

    African Journals Online (AJOL)

    Rockall score of the acute upper gastrointestinal bleeding patients the experience in Sudan. ... subjective evaluation of outcome of patient treatment. Objectives: To predict the morbidity and mortality in patients presenting with acute upper gastrointestinal bleeding at Ibn-Sina Hospital using the Rockall score. Patients and ...

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

    DEFF Research Database (Denmark)

    Krag, Mette; Perner, Anders; Wetterslev, Jørn

    2015-01-01

    PURPOSE: To describe the prevalence of, risk factors for, and prognostic importance of gastrointestinal (GI) bleeding and use of acid suppressants in acutely ill adult intensive care patients. METHODS: We included adults without GI bleeding who were acutely admitted to the intensive care unit (ICU...... 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 patients with clinically important GI bleeding, crude and adjusted odds for mortality were 3.7 (1.7-8.0) and 1.7 (0.7-4.3), respectively. CONCLUSIONS: In ICU patients clinically important GI bleeding is rare, and acid suppressants are frequently used. Co-existing diseases, liver failure, coagulopathy...

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

    Energy Technology Data Exchange (ETDEWEB)

    Roesch, J.; Kozak, B.E.; Keller, F.S.; Dotter, C.T.

    1986-05-01

    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.

  3. Esophageal variceal ligation for hemostasis of acute variceal bleeding

    African Journals Online (AJOL)

    Esophageal variceal ligation for hemostasis of acute variceal bleeding: efficacy and safety. Mounia Lahbabi, Mounia Elyousfi, Nouredine Aqodad, Mohammed Elabkari, Ihssane Mellouki, Sidi Adil Ibrahimi, Dafr Allah Benaja ...

  4. Massive upper GI bleeding: A rare complication of Zenker′s diverticulum

    Directory of Open Access Journals (Sweden)

    Haas I

    2008-01-01

    Full Text Available Bleeding from a Zenker′s diverticulum is rare. A 71-year-old man was urgently admitted with massive hematemesis. It was known that he had a Zenker′s diverticulum, but on emergency endoscopy, the source of bleeding was not detected due to large blood clots in the esophagus, hypo-pharynx and also into the tracheal-bronchial tree. Computerized tomography angiography demonstrated a blush of intravenous contrast arising from the diverticulum. The patient was operated upon urgently; the diverticle had a deep ulceration which was the source of the bleeding. The cause of the ulceration is unknown but it is possible that it was caused by the direct effect of an aspirin pill within the diverticle. A similar case with the same conclusion has been published in the past and since the use of aspirin has become common, especially in the elder population, we present this case report to highlight this possible life-threatening complication of Zenker′s diverticulum in patients receiving aspirin.

  5. FilmArray™ GI panel performance for the diagnosis of acute gastroenteritis or hemorragic diarrhea

    National Research Council Canada - National Science Library

    Antonio Piralla; Giovanna Lunghi; Gianluigi Ardissino; Alessia Girello; Marta Premoli; Erika Bava; Milena Arghittu; Maria Rosaria Colombo; Alessandra Cognetto; Patrizia Bono; Giulia Campanini; Piero Marone; Fausto Baldanti

    2017-01-01

    .... In the present bicentric study, the diagnostic value of FilmArray™ GI panels was assessed in unformed stool samples of patients with acute gastroenteritis and in a series of samples collected from pediatric patients with heamorragic diarrhea...

  6. Relationship of time to presentation after onset of upper GI bleeding with patient characteristics and outcomes

    DEFF Research Database (Denmark)

    Laine, Loren; Laursen, Stig B; Dalton, Harry R

    2017-01-01

    BACKGROUND & AIMS: We performed a prospective multi-national study of patients presenting to the emergency department with upper gastrointestinal bleeding (UGIB) and assessed the relationship of time to presentation after onset of UGIB symptoms with patient characteristics and outcomes. METHODS...... of transfusion. Other outcomes are similar with rapid versus delayed presentation. Time to presentation should not be used as an indicator for poor outcome. Patients with delayed presentation should be managed with the same degree of care as those with rapid presentation.......: Consecutive patients presenting with overt UGIB (red-blood emesis, coffee-ground emesis and/or melena) from March 2014 to March 2015 at 6 hospitals were included. Multiple pre-defined patient characteristics and outcomes were collected. Rapid presentation was defined as ≤6 hours. RESULTS: Among 2944 patients...

  7. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

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

    2008-01-01

    . 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...

  8. Multidetector computed tomography in acute lower gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    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

  9. Acute radiologic intervention in gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Lesak, F.

    1986-01-01

    A case of embolization of the gastroduodenal artery in a 38-year old man with chronic pancreatitis and uncontrollable bleeding is presented. The advantage of this interventional radiologic procedure is discussed and in selective cases it seems to be the choice of treatment.

  10. Multidetector CT angiography for acute gastrointestinal bleeding: technique and findings.

    Science.gov (United States)

    Artigas, José M; Martí, Milagros; Soto, Jorge A; Esteban, Helena; Pinilla, Inmaculada; Guillén, Eugenia

    2013-01-01

    Acute gastrointestinal bleeding is a common reason for emergency department admissions and an important cause of morbidity and mortality. Factors that complicate its clinical management include patient debility due to comorbidities; intermittence of hemorrhage; and multiple sites of simultaneous bleeding. Its management, therefore, must be multidisciplinary and include emergency physicians, gastroenterologists, and surgeons, as well as radiologists for diagnostic imaging and interventional therapy. Upper gastrointestinal tract bleeding is usually managed endoscopically, with radiologic intervention reserved as an alternative to be used if endoscopic therapy fails. Endoscopy is often less successful in the management of acute lower gastrointestinal tract bleeding, where colonoscopy may be more effective. The merits of performing bowel cleansing before colonoscopy in such cases might be offset by the resultant increase in response time and should be weighed carefully against the deficits in visualization and diagnostic accuracy that would result from performing colonoscopy without bowel preparation. In recent years, multidetector computed tomographic (CT) angiography has gained acceptance as a first-line option for the diagnosis and management of lower gastrointestinal tract bleeding. In selected cases of upper gastrointestinal tract bleeding, CT angiography also provides accurate information about the presence or absence of active bleeding, its source, and its cause. This information helps shorten the total diagnostic time and minimizes or eliminates the need for more expensive and more invasive procedures. © RSNA, 2013.

  11. Acute Leukemia Presenting with Gingival Bleeding. A Case Report ...

    African Journals Online (AJOL)

    This is a case report of a five year-old girl with acute lymphoblastic leukaemia who presented in our clinic with gingival bleeding. Sepcific highlights were focused on the management of the patient and current trends in the treatment of the disease with emphasis on early diagnosis of the disease in other to improve the ...

  12. Computed tomography evaluation of gastrointestinal bleeding and acute mesenteric ischemia.

    Science.gov (United States)

    Lee, Seung Soo; Park, Seong Ho

    2013-01-01

    Gastrointestinal bleeding and acute mesenteric ischemia are conditions that generally require an urgent and accurate diagnosis. In this setting, multidetector computed tomography (MDCT) can play an important role. This article discusses current techniques, the findings in correlation with pathophysiology, and the proper use of MDCT in the diagnostic evaluation and management of these patients. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Gastrointestinal (GI) Bleeding

    Science.gov (United States)

    ... Intestinal Pseudo-obstruction Irritable Bowel Syndrome (IBS) Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Irritable Bowel Syndrome (IBS) in Children Lactose Intolerance Ménétrier’s Disease Microscopic Colitis Ostomy Surgery of the ...

  14. Acute Gastric Bleeding Due to Giant Hyperplastic Polyp

    Directory of Open Access Journals (Sweden)

    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.

  15. Complex endoscopic treatment of acute gastrointestinal bleeding of ulcer origin

    Directory of Open Access Journals (Sweden)

    V. V. Izbitsky

    2013-06-01

    Full Text Available Gastrointestinal bleeding (GIB is determined in 20-30% of patients with peptic ulcer disease. Acute gastrointestinal bleeding is on the first place as the main cause of deaths from peptic ulcer ahead of the other complications. Rebleeding occurs in 30-38% of patients. Materials and Methods For getting of the objective endoscopic picture in patients with bleeding gastroduodenal ulcers we used the classification of J.A. Forrest in our study: Type I - active bleeding: • I a - pulsating jet; • I b - stream. Type II - signs of recent bleeding: • II a - visible (non-bleeding visible vessel; • II b - fixed thrombus - a clot; • II c - flat black spot (black bottom ulcers. Type III - ulcer with a clean (white down. Integrated endoscopic hemostasis included: irrigation of ulcer defect and area around it with 3% hydrogen peroxide solution in a volume of 10 - 30ml; Injection of 2-4 mL of diluted epinephrine (1:10000 for hemostasis; use of Argon plasma coagulation. Results and Discussion Integrated endoscopic stop of bleeding was performed in 57 patients who were examined and treated at the Department of Surgery from 2006 to 2012. In 16 patients bleeding was caused by gastric ulcer. Gastric ulcer type I localization according to classification (HD Johnson, 1965 was determined in 9 patients, type II - in 2 patients, type III – in 5 patients. In 31 patients bleeding was caused by duodenal peptic ulcer, in 4 patients - erosive gastritis, 1 - erosive esophagitis, and in 5 patients - gastroenteroanastomosis area peptic ulcer. Final hemostasis was achieved in 55 (96.5% patients. In 50 (87.7% patients it was sufficient to conduct a single session of complex endoscopic treatment. In 5 (8.8% patients – it was done two times. In 2 (3.5% cases operation was performed due to the recurrent bleeding. The source of major bleeding in these patients was: chronic, duodenal ulcer penetrating into the head of the pancreas in one case complicated by subcompensated

  16. WITHDRAWN: Proton pump inhibitor treatment for acute peptic ulcer bleeding.

    Science.gov (United States)

    Leontiadis, Grigorios I; Sharma, Virender Kumar; Howden, Colin W

    2010-05-12

    Randomised controlled trials (RCTs) evaluating the clinical effect of proton pump inhibitors (PPIs) in peptic ulcer (PU) bleeding yield conflicting results. To evaluate the efficacy of PPIs in acute bleeding from PU using evidence from RCTs. We searched CENTRAL, The Cochrane Library (Issue 4, 2004), MEDLINE (1966 to November 2004), EMBASE (1980 to November 2004), proceedings of major meetings to November 2004, and reference lists of articles. We contacted pharmaceutical companies and experts in the field. RCTs of PPI treatment (oral or intravenous) compared with placebo or H(2)-receptor antagonist (H(2)RA) in acute bleeding from PU. Two reviewers extracted data independently, assessed study validity, summarised studies and undertook meta-analysis. The influence of study characteristics on the outcomes was examined by subgroup analyses and meta-regression. Twenty-four RCTs comprising 4373 participants in total were included. Statistical heterogeneity was found among trials for rebleeding (P = 0.04), but not for all-cause mortality (P = 0.24) or surgery (P = 0.45). There was no significant difference in all-cause mortality rates between PPI and control treatment; pooled rates were 3.9% on PPI versus 3.8% on control (odds ratio (OR) 1.01; 95% CI 0.74 to 1.40). PPIs significantly reduced rebleeding compared to control; pooled rates were 10.6% with PPI versus 17.3% with control treatment (OR 0.49; 95% CI 0.37 to 0.65). PPI treatment significantly reduced surgery compared with control; pooled rates were 6.1% on PPI versus 9.3% on control (OR 0.61; 95% CI 0.48 to 0.78). There was no evidence to suggest that results on mortality and rebleeding were dependent on study quality, route of PPI administration, type of control treatment or application of initial endoscopic haemostatic treatment. PPIs significantly reduced surgery compared with placebo but not when compared with H(2)RA. There was no evidence to suggest that study quality, route of PPI administration or application

  17. Genetic predisposition to acute gastrointestinal bleeding after NSAIDs use

    OpenAIRE

    Martínez, Carmen; Blanco, Gerardo; Ladero, José M; García-Martín, Elena; Taxonera, Carlos; Gamito, Francisco G; Diaz-Rubio, Manuel; Agúndez, José A G

    2004-01-01

    Impaired drug metabolism is a major cause of adverse drug reactions, and it is often caused by mutations at genes coding for drug-metabolising enzymes. Two amino-acid polymorphisms of cytochrome P4502C9 (CYP2C9), an enzyme involved in the metabolism of several nonsteroidal anti-inflammatory drugs (NSAIDs), were studied in 94 individuals with acute bleeding after NSAIDs use and 124 individuals receiving NSAIDs with no adverse effects. The frequency of CYP2C9 variant alleles was increased in ov...

  18. Acid-base Balance in Acute Gastrointestinal Bleeding*

    Science.gov (United States)

    Northfield, T. C.; Kirby, B. J.; Tattersfield, Anne E.

    1971-01-01

    Acid-base balance has been studied in 21 patients with acute upper gastrointestinal bleeding. A low plasma bicarbonate concentration was found in nine patients, accompanied in each case by a base deficit of more than 3 mEq/litre, indicating a metabolic acidosis. Three patients had a low blood pH. Hyperlactataemia appeared to be a major cause of the acidosis. This was not accompanied by a raised blood pyruvate concentration. The hyperlactataemia could not be accounted for on the basis of hyperventilation, intravenous infusion of dextrose, or arterial hypoxaemia. Before blood transfusion it was most pronounced in patients who were clinically shocked, suggesting that it may have resulted from poor tissue perfusion and anaerobic glycolysis. Blood transfusion resulted in a rise in lactate concentration in seven patients who were not clinically shocked, and failed to reverse a severe uncompensated acidosis in a patient who was clinically shocked. These effects of blood transfusion are probably due to the fact that red blood cells in stored bank blood, with added acid-citrate-dextrose solution, metabolize the dextrose anaerobically to lactic acid. Monitoring of acid-base balance is recommended in patients with acute gastrointestinal bleeding who are clinically shocked. A metabolic acidosis can then be corrected with intravenous sodium bicarbonate. PMID:5313902

  19. Effect of Ramadan fasting on acute upper gastrointestinal bleeding

    Science.gov (United States)

    Amine, El Mekkaoui; Kaoutar, Saâda; Ihssane, Mellouki; Adil, Ibrahimi; Dafr-Allah, Benajah

    2013-01-01

    Background: Prolonged fasting may precipitate or exacerbate gastrointestinal complaints. The aim of this study was to evaluate the relation between Ramadan fasting and acute upper gastrointestinal bleeding (AUGIB), and to assess characteristics of those occurred in the holly month. Materials and Methods: Retrospective analysis was conducted for all patients, who underwent endoscopy for AUGIB in Ramadan (R) and the month before Ramadan (BR). Epidemiological, clinical and etiological characteristics and outcome of patients having AUGIB were compared between the two periods from 2001 to 2010. Results: Two hundred and ninety-one patients had endoscopy for AUGIB during the two periods study. There was an increasing trend in the overall number of patients in Ramadan period (n = 132, 45.4% versus n = 159, 54.6%), especially with duodenal ulcer (n = 48, 37.2% versus n = 81, 62.8%). The most frequent etiology was peptic ulcer but it was more observed in group R than in group BR (46.2% versus 57.9%, P = 0.04), especially duodenal ulcer (36.4% versus 50.3%, P = 0.01); this finding persisted in multivariable modeling (adjusted odds ratio: 1.67; 95% confidence interval, 1.03-2.69, P = 0.03). In contrast, there was a decreasing trend in rate of variceal bleeding from BR period (26.5%) to R period (18.9%; P = 0.11). Regarding the outcome, there were no significant differences between the two periods of the study: Recurrent bleeding (10.6% versus 7.5%, P = 0.36) and mortality rate (5.3% versus 4.4%, P = 0.7). Conclusion: The most frequent etiology of AUGIB was peptic ulcer during Ramadan. However, Ramadan fasting did not influence the outcome of the patients. Prophylactic measures should be taken for people with risk factors for peptic ulcer disease. PMID:23930121

  20. Effect of Ramadan fasting on acute upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    El Mekkaoui Amine

    2013-01-01

    Full Text Available Background: Prolonged fasting may precipitate or exacerbate gastrointestinal complaints. The aim of this study was to evaluate the relation between Ramadan fasting and acute upper gastrointestinal bleeding (AUGIB, and to assess characteristics of those occurred in the holly month. Materials and Methods: Retrospective analysis was conducted for all patients, who underwent endoscopy for AUGIB in Ramadan (R and the month before Ramadan (BR. Epidemiological, clinical and etiological characteristics and outcome of patients having AUGIB were compared between the two periods from 2001 to 2010. Results: Two hundred and ninety-one patients had endoscopy for AUGIB during the two periods study. There was an increasing trend in the overall number of patients in Ramadan period (n = 132, 45.4% versus n = 159, 54.6%, especially with duodenal ulcer (n = 48, 37.2% versus n = 81, 62.8%. The most frequent etiology was peptic ulcer but it was more observed in group R than in group BR (46.2% versus 57.9%, P = 0.04, especially duodenal ulcer (36.4% versus 50.3%, P = 0.01; this finding persisted in multivariable modeling (adjusted odds ratio: 1.67; 95% confidence interval, 1.03-2.69, P = 0.03. In contrast, there was a decreasing trend in rate of variceal bleeding from BR period (26.5% to R period (18.9%; P = 0.11. Regarding the outcome, there were no significant differences between the two periods of the study: Recurrent bleeding (10.6% versus 7.5%, P = 0.36 and mortality rate (5.3% versus 4.4%, P = 0.7. Conclusion: The most frequent etiology of AUGIB was peptic ulcer during Ramadan. However, Ramadan fasting did not influence the outcome of the patients. Prophylactic measures should be taken for people with risk factors for peptic ulcer disease.

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

    Directory of Open Access Journals (Sweden)

    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. Desmopressin acetate (DDAVP) for preventing and treating acute bleeds during pregnancy in women with congenital bleeding disorders.

    Science.gov (United States)

    Karanth, Laxminarayan; Barua, Ankur; Kanagasabai, Sachchithanantham; Nair, Sreekumar

    2015-09-09

    Congenital bleeding disorders can cause obstetric haemorrhage during pregnancy, labour and following delivery. Desmopressin acetate is found to be an effective drug which can reduce the risk of haemorrhage and can also stop bleeding in certain congenital bleeding disorders. Its use in pregnancy has been controversial. Hence beneficial and adverse effects of desmopressin acetate in these groups of pregnant women should be evaluated.This is an update of a Cochrane review first published in 2013. To determine the efficacy of desmopressin acetate in preventing and treating acute bleeds during pregnancy in women with congenital bleeding disorders. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coaguopathies Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant and abstract books of conferences proceedings. We also searched for any randomised controlled trials in a registry of ongoing trials and the reference lists of relevant articles and reviews.Date of most recent search: 18 June 2015. Randomised and quasi-randomised controlled trials investigating the efficacy of desmopressin acetate versus tranexamic acid or factor VIII or rFactor VII or fresh frozen plasma in preventing and treating congenital bleeding disorders during pregnancy were eligible. No trials matching the selection criteria were eligible for inclusion. No trials matching the selection criteria were eligible for inclusion. The review did not identify any randomised controlled trials investigating the relative effectiveness of desmopressin acetate for bleeding during pregnancy in women with congenital bleeding disorders. In the absence of high quality evidence, clinicians need to use their clinical judgement and lower level evidence (e.g. from observational trials) to decide whether or not to treat women with congenital bleeding disorders with desmopressin acetate.Given the ethical considerations, future

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  4. Use of Ulipristal Acetate for the Management of Fibroid-Related Acute Abnormal Uterine Bleeding.

    Science.gov (United States)

    Arendas, Kristina; Leyland, Nicholas A

    2016-01-01

    Episodes of acute abnormal uterine bleeding related to uterine fibroids can cause significant morbidity. Traditional management with high-dose hormonal regimens may not be as effective when used in women with fibroids. A 32-year-old woman with a 12 cm uterine fibroid presented with an episode of acute abnormal uterine bleeding requiring blood transfusion. In lieu of using a hormonal maintenance regimen after the bleeding had stabilized, the patient was treated with ulipristal acetate 5 mg daily for three months. Amenorrhea was induced rapidly and the patient had no further episodes of acute excessive uterine bleeding. She subsequently underwent a laparoscopic myomectomy with a satisfactory outcome. Ulipristal acetate has been shown to induce amenorrhea rapidly in women with uterine fibroids, and it can be a useful treatment in the emergency management of fibroid-related acute abnormal uterine bleeding. Copyright © 2016 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

  5. FilmArray® Gastrointestinal (GI) Panel for Viral Acute Gastroenteritis Detection in Pediatric Patients

    Science.gov (United States)

    Kanwar, Neena; Jackson, Jami; Duffy, Susan; Chapin, Kimberle; Cohen, Daniel; Leber, Amy; Daly, Judy a; Pavia, Andrew; Larsen, Chari; Baca, Tanya; Bender, Jeffery; Bard, Jennifer Dien; Festekjian, Ara; Holmberg, Kristen; Bourzac, Kevin; Selvarangan, Rangaraj

    2017-01-01

    Abstract Background Acute viral gastroenteritis is one of the leading causes of diarrheal diseases. The FilmArray GI Panel is a PCR based assay that detects 22 different enteric pathogens including five viruses (Adenovirus F 40/41, Astrovirus, Norovirus GI/GII, Rotavirus A, and Sapovirus (I, II, IV, and V)) in an hour. The epidemiology and management of acute viral gastroenteritis is described. Methods Children with acute gastroenteritis were prospectively enrolled at emergency departments of five geographically different pediatric facilities during 2015–2016. Stool specimens were collected and tested by the FilmArray GI Panel. Results A total of 1157 subjects were enrolled in the study. Stool specimens from 961 subjects were collected. Subjects with viral, bacterial, and parasitic etiology as identified by the FilmArray GI Panel were 429 (44.6%), 392 (40.8%), and 41 (4.3%), respectively. Viral AGE was common in winter months from October through March (274/429; 63.9%); norovirus was the leading viral agent (205/429; 47.8%) and was more commonly detected in winter months (147/205; 71.7%). Other viruses detected include Adenovirus F 40/41, Astrovirus, Rotavirus, and Sapovirus in 94 (9.8%), 49 (5.1%), 28 (2.9%), and 97 (10.1%) specimens, respectively. Co-infections with multiple pathogens was found in 244 (25.4%) of all specimens tested. Only 39/961 subjects received a viral standard of care (SOC) test result. The FilmArray GI panel detected viruses in higher percentage of stool specimens when SOC was not requested 45% (415/922) vs. requested 36% (14/39) [P = 0.32]. Viral infections were the highest among 148 hospitalizations: virus (26.4%), bacteria (22.9%), bacteria and virus (16.9%), and parasite (0.6%) and norovirus was the leading viral etiology associated with hospitalizations (n = 27; 69.2%). AGE due to viral (24.6%) or bacterial (27.6%) causes had similar repeat visits to hospital [P = 0.45]. Conclusion Viruses are leading cause of AGE resulting in ED

  6. Transcatheter arterial embolization in gastric cancer patients with acute bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Joo; Shin, Ji Hoon; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong-Il; Song, Ho-Young; Sung, Kyu-Bo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Seoul (Korea)

    2009-04-15

    The safety and clinical effectiveness of transcatheter arterial embolization for bleeding associated with unresectable gastric cancer was evaluated. Twenty-three patients with bleeding from unresectable gastric cancer underwent transcatheter arterial embolization. Of the 23 patients, eight showed signs of active bleeding, such as contrast extravasation or pseudoaneurysm, seven showed only tumor staining, and the remaining eight patients showed negative angiographic findings. All embolization procedures were successful without procedure-related complications. In all eight active bleeding patients, immediate hemostasis was achieved. The overall clinical success rate was 52% (12/23). Recurrent bleeding within 1 month occurred in one (8%) in 12 patients with initial clinical success. One patient showed partial splenic infarction after embolization of the splenic artery for active bleeding from the short gastric artery. Overall 30-day mortality rate was 43% (10/23). The median overall survival period was 38 days. In patients with bleeding from unresectable gastric cancer, transcatheter arterial embolization was found to be safe and effective for achieving immediate hemostasis for active bleeding. Although the clinical success rate was not high, the recurrent bleeding rate was low at 1 month post procedure. (orig.)

  7. Lower GI Series

    Science.gov (United States)

    ... bleeding from the anus • changes in bowel habits • chronic diarrhea • unexplained weight loss A lower GI series can ... bleeding from the anus –– changes in bowel habits –– chronic diarrhea –– unexplained weight loss • A person prepares for a ...

  8. Acute gastroenteritis outbreak associated to norovirus GI.9 in a Portuguese army base.

    Science.gov (United States)

    Lopes-João, António; Mesquita, João R; de Sousa, Rita; Oleastro, Mónica; Penha-Gonçalves, Carlos; Nascimento, Maria Sao José

    2017-05-01

    Gastroenteritis is considered a major illness within the military settings being caused by foodborne enteric pathogens that are particularly easily spread in the crowded conditions of military camps. Gastroenteritis outbreaks caused by norovirus usually affect a great number of soldiers due to the low infectious dose, copious viral shedding, and environmental stability. The present study describes the investigation of an outbreak of acute gastroenteritis that occurred in April 2015 in a Portuguese army base, focusing on the study of the epidemiological curve, symptoms experienced by the affected soldiers, and results of food, water, and stool microbiological analysis. From a total of 938 military personnel stationed on the base 46 soldiers developed acute gastroenteritis. Stool analysis of seven cases showed to be positive for norovirus GI.9 that was the probable cause of the outbreak. This report shows that genogroup I norovirus can also cause considerable morbidity in healthy young soldiers, affecting the operational effectiveness on the military forces. J. Med. Virol. 89:922-925, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  9. Bleeding due to acquired hemophilia A in acute pancreatitis: a case report.

    Science.gov (United States)

    Shimizu, Tomoki; Tsunoda, Yuya; Ito, Tsuyoshi; Imamura, Satoshi; Nagakubo, Shuichi; Morohoshi, Yuichi; Koike, Yuji; Fujita, Yuriko; Komatsu, Hirokazu

    2016-01-01

    Acquired hemophilia A leads to severe bleeding and is known to be related to many underlying diseases; however, it has not been reported to occur as a complication of pancreatitis. We present a case of acquired hemophilia A secondary to severe acute pancreatitis. A 76-year-old female developed a hematoma in the lower leg muscle while being treated for severe acute pancreatitis. Blood tests revealed prolonged activated partial thromboplastin time (APTT) and the presence of an autoantibody to factor VIII. The bleeding diathesis was successfully controlled by immunosuppressive therapy. This case highlights the need for careful differential diagnosis for successful management of bleeding disorders as complications of pancreatitis.

  10. Ulipristal acetate for the management of acute heavy menstrual bleeding without fibroids.

    Science.gov (United States)

    Estadella, Josep; Español, Pia; Ascencio, Fiorella; Perelló, Josep; Calaf, Joaquim

    2017-12-20

    Heavy menstrual bleeding is a common condition among women of childbearing age. Although hysterectomy was the usual approach in acute cases in the past, other minimally invasive therapies or pharmacological alternatives, such as the levonorgestrel intrauterine device have shown to be highly effective. This case report presents the case of a pluripathological patient with acute heavy menstrual bleeding and severe anemia, who was successfully managed with ulipristal acetate, a selective progesterone receptor modulator. Bleeding control was achieved in 6 d without side effects, avoiding the need for surgery. This report suggests that ulipristal acetate could be useful in the treatment of acute uterine bleeding even in a structurally normal uterus without fibroids.

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

    Directory of Open Access Journals (Sweden)

    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

  12. Acute Management and Secondary Prophylaxis of Esophageal Variceal Bleeding: A Western Canadian Survey

    Directory of Open Access Journals (Sweden)

    Justin Cheung

    2006-01-01

    Full Text Available BACKGROUND: Acute esophageal variceal bleeding (EVB is a major cause of morbidity and mortality in patients with liver cirrhosis. Guidelines have been published in 1997; however, variability in the acute management and prevention of EVB rebleeding may occur.

  13. [Digestive bleeding and acute abdomen caused by jejunal diverticulosis. Case report].

    Science.gov (United States)

    Nari, Gustavo A; Azar, Ricardo; Feliu, Luis; Moreno, Eduardo; Bonaparte, Fernando

    2012-03-01

    We present a patient with acute abdomen and digestive bleeding caused by jejunal diverticulosis. Jejunal diverticulosis, mainly asymptomatic, when is symptomatic have a wide clinical spectrum, ranging from chronic anemic syndrome to acute abdomen. In this communication, we reviewed the clinical presentation, the pathogenesis and the treatment this infrequent pathology.

  14. Risk factors and management for massive bleeding of an acute hemorrhagic rectal ulcer.

    Science.gov (United States)

    Hotta, Tsukasa; Takifuji, Katsunari; Tonoda, Shigehiko; Mishima, Hideo; Sasaki, Masakazu; Yukawa, Hirofumi; Mori, Kazunari; Fuku, Akito; Yamaue, Hiroki

    2009-01-01

    An acute hemorrhagic rectal ulcer (AHRU) is considered to be a potentially life-threatening illness requiring urgent identification and management because of massive bleeding. It is therefore important to clarify the factors associated with the massive bleeding of an AHRU and the best management. The factors associated with the massive bleeding of 14 patients with AHRU were determined by comparing the clinicopathologic features, laboratory data, and treatment between four patients with more transfusions (> or = 12 U) and 10 patients with less transfusions (oral food intake, total parenteral nutrition, and hospital stay from bleeding day than those of the less transfusion group. Thus, the factors associated with the massive bleeding of AHRU were identified.

  15. Esophageal variceal ligation for hemostasis of acute variceal bleeding

    African Journals Online (AJOL)

    Our aim was to evaluate the effectiveness and safety of endoscopic variceal ligation in the management of oesophageal variceal bleeding in cirrhosis in a located population in Morocco. Methods: Via a retrospective study over 118 months (December 2001- October 2011), cirrhotic patients with endoscopically proven ...

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

    NARCIS (Netherlands)

    Berend, Kenrick; Levi, Marcel

    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

  17. Prediction of Outcome in Acute Lower Gastrointestinal Bleeding Using Gradient Boosting.

    Directory of Open Access Journals (Sweden)

    Lakshmana Ayaru

    Full Text Available There are no widely used models in clinical care to predict outcome in acute lower gastro-intestinal bleeding (ALGIB. If available these could help triage patients at presentation to appropriate levels of care/intervention and improve medical resource utilisation. We aimed to apply a state-of-the-art machine learning classifier, gradient boosting (GB, to predict outcome in ALGIB using non-endoscopic measurements as predictors.Non-endoscopic variables from patients with ALGIB attending the emergency departments of two teaching hospitals were analysed retrospectively for training/internal validation (n=170 and external validation (n=130 of the GB model. The performance of the GB algorithm in predicting recurrent bleeding, clinical intervention and severe bleeding was compared to a multiple logic regression (MLR model and two published MLR-based prediction algorithms (BLEED and Strate prediction rule.The GB algorithm had the best negative predictive values for the chosen outcomes (>88%. On internal validation the accuracy of the GB algorithm for predicting recurrent bleeding, therapeutic intervention and severe bleeding were (88%, 88% and 78% respectively and superior to the BLEED classification (64%, 68% and 63%, Strate prediction rule (78%, 78%, 67% and conventional MLR (74%, 74% 62%. On external validation the accuracy was similar to conventional MLR for recurrent bleeding (88% vs. 83% and therapeutic intervention (91% vs. 87% but superior for severe bleeding (83% vs. 71%.The gradient boosting algorithm accurately predicts outcome in patients with acute lower gastrointestinal bleeding and outperforms multiple logistic regression based models. These may be useful for risk stratification of patients on presentation to the emergency department.

  18. 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

    Energy Technology Data Exchange (ETDEWEB)

    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

  19. Bleeding in acute pancreatitis treated by transcatheter arterial embolization with ethylene-vinyl alcohol copolymer (Onyx).

    Science.gov (United States)

    Zelenák, Kamil; Sinák, Igor; Janík, Ján; Laca, Ludovít; Talapková, Renáta

    2012-09-01

    Hemorrhagic complications are usually manifestations of the progress of severe pancreatitis. In major arterial hemorrhage resulting from pancreatic inflammatory disease, visceral angiography is valuable in localizing the site of bleeding, and hemostasis can be achieved by transcatheter arterial embolization. Successful transcatheter embolization of bleeding in the anterior superior pancreaticoduodenal artery using ethylene-vinyl alcohol copolymer (Onyx) was performed in a 38-year-old woman with acute biliary necrotic-hemorrhagic pancreatitis.

  20. An Unusual Cause of Acute Upper Gastrointestinal Bleeding: Acute Esophageal Necrosis

    Directory of Open Access Journals (Sweden)

    Nikhil R. Kalva

    2016-01-01

    Full Text Available Acute esophageal necrosis (AEN, also called “black esophagus,” is a condition characterized by circumferential necrosis of the esophagus with universal distal involvement and variable proximal extension with clear demarcation at the gastroesophageal junction. It is an unusual cause of upper gastrointestinal bleeding and is recognized with distinct and striking mucosal findings on endoscopy. The patients are usually older and are critically ill with shared comorbidities, which include atherosclerotic cardiovascular disease, diabetes mellitus, hypertension, chronic renal insufficiency, and malnutrition. Alcoholism and substance abuse could be seen in younger patients. Patients usually have systemic hypotension along with upper abdominal pain in the background of clinical presentation of hematemesis and melena. The endoscopic findings confirm the diagnosis and biopsy is not always necessary unless clinically indicated in atypical presentations. Herein we present two cases with distinct clinical presentation and discuss the endoscopic findings along with a review of the published literature on the management of AEN.

  1. Extramedullary Relapse of Acute Lymphoblastic Leukemia Presenting as Abnormal Uterine Bleeding: A Case Report.

    Science.gov (United States)

    Robillard, Diana T; Kutny, Matthew A; Chewning, Joseph H; Arbuckle, Janeen L

    2017-06-01

    Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Relapse of ALL occurs in 15%-20% of patients, with 2%-6% occurring exclusively in extramedullary sites. Relapse of ALL in gynecologic organs is extremely rare. We present a case of a 12-year-old girl with a history of ALL who was referred to the pediatric gynecology clinic with abnormal uterine bleeding. She was determined to have an extramedullary uterine relapse of her ALL. Abnormal uterine bleeding in the setting of childhood malignancy is a frequent reason for consultation to pediatric and adolescent gynecology services. This bleeding is commonly attributed to thrombocytopenia due to bone marrow suppressive chemotherapeutic agents. However, as shown in this report, abnormal uterine bleeding might be a manifestation of an extramedullary relapse. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  2. Management of acute nonvariceal upper gastrointestinal bleeding: Current policies and future perspectives

    Science.gov (United States)

    Holster, Ingrid Lisanne; Kuipers, Ernst Johan

    2012-01-01

    Acute upper gastrointestinal bleeding (UGIB) is a gastroenterological emergency with a mortality of 6%-13%. The vast majority of these bleeds are due to peptic ulcers. Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease. Endoscopy has become the mainstay for diagnosis and treatment of acute UGIB, and is recommended within 24 h of presentation. Proton pump inhibitor (PPI) administration before endoscopy can downstage the bleeding lesion and reduce the need for endoscopic therapy, but has no effect on rebleeding, mortality and need for surgery. Endoscopic therapy should be undertaken for ulcers with high-risk stigmata, to reduce the risk of rebleeding. This can be done with a variety of modalities. High-dose PPI administration after endoscopy can prevent rebleeding and reduce the need for further intervention and mortality, particularly in patients with high-risk stigmata. PMID:22468083

  3. Balancing the risk of spontaneous ischemic and major bleeding events in acute coronary syndromes.

    Science.gov (United States)

    Ducrocq, Gregory; Schulte, Phillip J; Budaj, Andrzej; Cornel, Jan H; Held, Claes; Himmelmann, Anders; Husted, Steen; Storey, Robert F; Cannon, Christopher P; Becker, Richard C; James, Stefan K; Katus, Hugo A; Lopes, Renato D; Sorbets, Emmanuel; Wallentin, Lars; Steg, Philippe Gabriel

    2017-04-01

    Evaluation of antithrombotic treatments for acute coronary syndromes (ACS) requires balancing ischemic and bleeding risks to assess net benefit. We sought to compare the relative effects of ischemic and bleeding events on mortality. In the PLATelet inhibition and patient Outcomes (PLATO) trial, we compared spontaneous ischemic events (myocardial infarction or stroke) with spontaneous major bleeding events (PLATO major, Thrombolysis In Myocardial Infarction [TIMI] major, Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries [GUSTO] severe) with respect to risk of mortality using time-dependent Cox proportional hazards models. The comparison was performed using ratio of hazard ratios for mortality increase after ischemic vs bleeding events. A total of 822 patients (4.4%) had ≥1 spontaneous ischemic event; 485 patients (2.6%), ≥1 spontaneous PLATO major bleed, 282 (1.5%), ≥1 spontaneous TIMI major bleed; and 207 (1.1%), ≥1 spontaneous severe GUSTO bleed. In patients who had both events, bleeding occurred first in most patients. Regardless of classification, major bleeding events were associated with increased short- and long-term mortality that were not significantly different from the increase associated with spontaneous ischemic events: ratio of hazard ratios (95% CIs) for short- and long-term mortality after spontaneous ischemic vs bleeding events: 1.46 (0.98-2.19) and 0.92 (0.52-1.62) (PLATO major); 1.26 (0.80-1.96) and 1.19 (0.58-2.24) (TIMI major), 0.72 (0.47-1.10) and 0.83 (0.38-1.79) (GUSTO severe) (all P>0.05) CONCLUSIONS: In patients with ACS on dual antiplatelet therapy, spontaneous major bleeding events seem "prognostically equivalent" to spontaneous ischemic complications. This result allows quantitative comparisons between both actual and predicted bleeding and ischemic risks. Our findings help to better define net clinical benefit of antithrombotic treatments and more accurately estimate mortality

  4. Bilateral foot drop, weight loss and rectal bleeding as an acute presentation of Crohn's disease.

    OpenAIRE

    Gariballa, S. E.; Gunasekera, N. P.

    1994-01-01

    We report a 71 year old lady who presented with weight loss, rectal bleeding and bilateral foot drop having been previously fit and well. Clinical examination, laboratory investigation and postmortem examination confirmed the diagnosis of active Crohn's disease and acute peripheral neuropathy. The clinical course of this patient suggests that the peripheral neuropathy might have resulted from the common pathogenesis for Crohn's disease.

  5. Solitary tubercular caecal ulcer causing massive lower gastrointestinal bleed: a formidable diagnostic challenge.

    Science.gov (United States)

    Ram, Duvuru; Karthikeyan, Vilvapathy Senguttuvan; Sistla, Sarath Chandra; Ali, Sheik Manwar

    2014-03-06

    Gastrointestinal (GI) haemorrhage is a common surgical emergency accounting for approximately 1% of acute hospital admissions. Lower GI bleed is less common and less severe than upper GI bleed and is usually caused by diverticulosis, neoplasms, angiodysplasia and inflammatory bowel disease. A 51-year-old man presented with massive lower GI bleed. He had no history of tuberculosis. He underwent colonoscopy and an isolated caecal ulcer was noted. Segmental ileocaecal resection was performed and no specific cause was identifiable on histopathology. PCR was performed on this specimen and it was positive for Mycobacterium tuberculosis. This case reports the unusual presentation of tuberculosis as solitary caecal ulcer with massive lower GI bleed and highlights the role of PCR as an adjuvant diagnostic tool for its diagnosis when characteristic histopathological findings are absent.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Antifibrinolytic amino acids for upper gastrointestinal bleeding in people with acute or chronic liver disease.

    Science.gov (United States)

    Martí-Carvajal, Arturo J; Solà, Ivan

    2015-06-09

    Upper gastrointestinal bleeding is one of the most frequent causes of morbidity and mortality in the course of liver cirrhosis. People with liver disease frequently have haemostatic abnormalities such as hyperfibrinolysis. Therefore, antifibrinolytic amino acids have been proposed to be used as supplementary interventions alongside any of the primary treatments for upper gastrointestinal bleeding in people with liver diseases. This is an update of this Cochrane review. To assess the beneficial and harmful effects of antifibrinolytic amino acids for upper gastrointestinal bleeding in people with acute or chronic liver disease. We searched The Cochrane Hepato-Biliary Controlled Trials Register (February 2015), Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2 of 12, 2015), MEDLINE (Ovid SP) (1946 to February 2015), EMBASE (Ovid SP) (1974 to February 2015), Science Citation Index EXPANDED (1900 to February 2015), LILACS (1982 to February 2015), World Health Organization Clinical Trials Search Portal (accessed 26 February 2015), and the metaRegister of Controlled Trials (accessed 26 February 2015). We scrutinised the reference lists of the retrieved publications. Randomised clinical trials irrespective of blinding, language, or publication status for assessment of benefits and harms. Observational studies for assessment of harms. We planned to summarise data from randomised clinical trials using standard Cochrane methodologies and assessed according to the GRADE approach. We found no randomised clinical trials assessing antifibrinolytic amino acids for treating upper gastrointestinal bleeding in people with acute or chronic liver disease. We did not identify quasi-randomised, historically controlled, or observational studies in which we could assess harms. This updated Cochrane review identified no randomised clinical trials assessing the benefits and harms of antifibrinolytic amino acids for upper gastrointestinal bleeding in people with acute or

  8. Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel

    NARCIS (Netherlands)

    James, Andra H.; Kouides, Peter A.; Abdul-Kadir, Rezan; Dietrich, Jennifer E.; Edlund, Mans; Federici, Augusto B.; Halimeh, Susan; Kamphuisen, Pieter Willem; Lee, Christine A.; Martínez-Perez, Oscar; McLintock, Claire; Peyvandi, Flora; Philipp, Claire; Wilkinson, Jeffrey; Winikoff, Rochelle

    2011-01-01

    Acute menorrhagia is a common gynecological disorder. Prevalence is high among women with inherited bleeding disorders and recent guidance for optimal management is lacking. Following a comprehensive review of the literature, an international expert panel in obstetrics, gynecology and hematology

  9. 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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  10. Is urgent CT angiography necessary in cases of acute lower gastrointestinal bleeding?

    Science.gov (United States)

    Díaz, A Martín; Rodríguez, L Fernández; de Gracia, M Martí

    Acute lower gastrointestinal bleeding usually presents as hematochezia, rectal bleeding or melena and represents 1-2% of the medical appointments in the Emergency Services. Mortality reaches the 30-40% and it is highly related with the severity and associated comorbidity. Most clinical practice guidelines include colonoscopy at some point in the diagnostic and therapeutic process (urgent for severe cases and ambulatory for mild ones) and look for predictors of severity. In the last years, there have been numerous studies where is clear the relevance and complementarity of advanced diagnostic imaging techniques, gradually incorporated as an alternative or second step in severe cases. Therefore, we have made a review of current scientific evidence to establish a clinical prediction rule for optimal indication of CT angiography in these patients. However, future studies providing greater robustness and level of evidence are necessary. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

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

    DEFF Research Database (Denmark)

    Fabricius, Rasmus; Svenningsen, Peter; Hillingsø, Jens

    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......-existing medical conditions. RESULTS: 5107 patients received 10783 therapeutic endoscopic interventions. Units of PRBC transfused were identified as a predictor of re-endoscopy, surgery, and 30-day mortality with odds ratio (OR) 1.08 (1.06-1.09, p

  12. Interventions for treating acute bleeding episodes in people with acquired hemophilia A.

    Science.gov (United States)

    Zeng, Yan; Zhou, Ruiqing; Duan, Xin; Long, Dan; Yang, Songtao

    2014-08-28

    Acquired hemophilia A is a rare bleeding disorder caused by autoantibodies to coagulation factor VIII (FVIII). In most cases, bleeding episodes are spontaneous and severe at presentation. The optimal hemostatic therapy is controversial. To determine the efficacy of hemostatic therapies for acute bleeds in people with acquired hemophilia A; and to compare different forms of therapy for these bleeds. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 4) and MEDLINE (Ovid) (1948 to 30 April 2014). We searched the conference proceedings of the: American Society of Hematology; European Hematology Association; International Society on Thrombosis and Haemostasis (ISTH); and the European Association for Haemophilia and Allied Disorders (EAHAD) (from 2000 to 30 April 2014). In addition to this we searched clinical trials registers. All randomised controlled trials and quasi-randomised trials of hemostatic therapies for people with acquired hemophilia A, with no restrictions on gender, age or ethnicity. No trials matching the selection criteria were eligible for inclusion. No trials matching the selection criteria were eligible for inclusion. No randomised clinical trials of hemostatic therapies for acquired hemophilia A were found. Thus, we are not able to draw any conclusions or make any recommendations on the optimal hemostatic therapies for acquired hemophilia A based on the highest quality of evidence. GIven that carrying out randomized controlled trials in this field is a complex task, the authors suggest that, while planning randomised controlled trials in which patients can be enrolled, clinicians treating the disease continue to base their choices on alternative, lower quality sources of evidence, which hopefully, in the future, will also be appraised and incorporated in a Cochrane Review.

  13. Upper gastrointestinal bleeding: audit of a single center experience in Western India

    Directory of Open Access Journals (Sweden)

    Jignesh B. Rathod

    2011-11-01

    Full Text Available Upper gastrointestinal (GI bleeding is defined as bleeding proximal to the ligament of Treitz. The most important aspect of management of GI bleeding is to locate the site and cause of bleeding. The aim of the study is to find out the common etiology, presentation and management, including the role of upper GI endoscopy. Recent advances have meant that endoscopic hemostatic methods are now associated with a reduced rate of re-bleeding, cost, blood transfusion, length of hospital stay and mortality. A prospective study of 50 cases was carried out between August 2001 and July 2003. Patients with signs and symptoms suggestive of upper GI bleeding (UGIB such as hematemesis, melena, aspirated blood from nasogastric tubes, profuse hematochezia, etc., were included in the study. The patients were selected randomly. The most common cause of UGIB in the present study was acute erosive gastritis (34% followed by portal hypertension (24% and peptic ulcer (22%. All 50 patients underwent upper GI endoscopy, of whom 39 patients were treated conservatively and 11 patients underwent endotherapy to control bleeding. Out of 39 patients treated non-endoscopically, 6 cases required laparotomy to control UGIB. 8 of 50 cases had past history of UGIB, 5 of whom had a previous history of endotherapy. One case was treated with devascularization as routine hemostatic methods failed. So, initial method of choice to control the bleeding was endotherapy and surgery was undertaken if an endoscopic method failed. The most common cause of hematemesis in our setting was acute erosive gastritis followed by portal hypertension. Endoscopy is a valuable minimal invasive method to diagnose and treat upper GI bleeding.

  14. ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women.

    Science.gov (United States)

    2013-04-01

    Initial evaluation of the patient with acute abnormal uterine bleeding should include a prompt assessment for signs of hypovolemia and potential hemodynamic instability. After initial assessment and stabilization, the etiologies of acute abnormal uterine bleeding should be classified using the PALM-COEIN system. Medical management should be the initial treatment for most patients, if clinically appropriate. Options include intravenous conjugated equine estrogen, multi-dose regimens of combined oral contraceptives or oral progestins, and tranexamic acid. Decisions should be based on the patient's medical history and contraindications to therapies. Surgical management should be considered for patients who are not clinically stable, are not suitable for medical management, or have failed to respond appropriately to medical management. The choice of surgical management should be based on the patient's underlying medical conditions, underlying pathology, and desire for future fertility. Once the acute bleeding episode has been controlled, transitioning the patient to long-term maintenance therapy is recommended.

  15. Low platelet count is potentially the most important contributor to severe bleeding in patients newly diagnosed with acute promyelocytic leukemia

    Directory of Open Access Journals (Sweden)

    Song Y

    2017-10-01

    Full Text Available Yu-hua Song,1,2 Peng Peng,3 Chun Qiao,1 Run Zhang,1 Jian-yong Li,1 Hua Lu1 1Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, 2Department of Hematology, 3Department of Oncology, The Second Hospital of Nanjing, Nanjing, People’s Republic of China Abstract: The objective of the current study was to provide more appropriate therapeutic strategies for reducing severe hemorrhaging by assessing the recovery of abnormal coagulation indexes in patients with acute promyelocytic leukemia (APL during induction therapy. Retrospective analyses of 112 patients newly diagnosed with APL were performed during initial treatment. In our study, the early death rate was 5.36%. Hemorrhage was the leading cause of death during the induction period (4/6. The values of white blood cell count, lactate dehydrogenase, prothrombin time (PT, fibrinogen (Fbg, hemoglobin, and bone marrow leukemic promyelocytes were significantly different in the high-risk group compared to the low/intermediate-risk groups. There were significant differences in the white blood cell count, bone marrow leukemic promyelocytes, platelet (PLT count, and the levels of lactate dehydrogenase, d-dimer, PT, and Fbg, as well as in FLT3-ITD mutations between patients with major bleeding and those with minor bleeding. Hemostatic variables significantly improved over time during induction therapy. The recovery times of the PLT, PT, and Fbg values were significantly slower in patients with major bleeding than in those with minor bleeding. Specifically, the PLT level in patients with major bleeding was not similar to that in the minor bleeding group until after 4 weeks of treatment. Hemorrhages were the most common cause of induction death in this study. High-risk patients were more prone to serious clinical bleeding symptoms. Patients with major bleeding had more rapid proliferation characteristics and an increased incidence of FLT3-ITD

  16. Cardiovascular and Bleeding Risks in Acute Myocardial Infarction Newly Treated With Ticagrelor vs. Clopidogrel in Taiwan.

    Science.gov (United States)

    Lee, Cheng-Han; Cheng, Ching-Lan; Kao Yang, Yea-Huei; Chao, Ting-Hsing; Chen, Ju-Yi; Li, Yi-Heng

    2017-10-27

    There are few data on ticagrelor in Asian patients. This study evaluated clinical outcomes with ticagrelor and clopidogrel in Taiwanese patients with acute myocardial infarction (AMI).Methods and Results:We used the Taiwan National Health Insurance Research Database to identify 27,339 AMI patients aged ≥18 years between January 2012 and December 2014, and only patients who survived greater than or equal to 30 days after AMI and took dual antiplatelet therapy were included. Cohorts of ticagrelor and clopidogrel were matched 1:8, based on propensity score matching, to balance baseline covariates. The primary efficacy endpoints were death from any cause, AMI, or stroke. The safety endpoints consisted of major gastrointestinal bleeding or intracerebral hemorrhage. Following propensity matching, the primary efficacy endpoint rate was 22% lower in the ticagrelor group than in the clopidogrel group (10.6% and 16.2%, respectively; adjusted HR, 0.779; 95% CI: 0.684-0.887). The safety endpoint rate was similar between the ticagrelor and clopidogrel groups (3.2% and 4.1% respectively; adjusted HR, 0.731; 95% CI: 0.522-1.026). In real-world AMI Taiwanese patients, ticagrelor seemed to offer better anti-ischemic protection than clopidogrel, without an increase in the rate of major bleeding. A large-scale randomized trial is needed to assess the efficacy and safety of ticagrelor in East Asian AMI patients.

  17. Primary aortoesophageal fistula: a rare cause of acute upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Samira Ineida Morais Gomes

    2011-12-01

    Full Text Available Acute upper gastrointestinal bleeding is a potentially life-threateningemergency, especially in the elderly. This condition accounts for approximately1% of all emergency room admissions. Among the causes of such bleedingis aortoesophageal fistula, a dreaded but apparently rare condition, firstrecognized in 1818. The great majority of cases are of primary aortoesophagealfistula, caused by atheromatous aortic aneurysms or, less frequently, bypenetrating aortic ulcer. The clinical presentation of aortoesophageal fistulais typically characterized by the so-called Chiari’s triad, consisting of thoracicpain followed by herald bleeding, a variable, short symptom-free interval,and fatal exsanguinating hemorrhage. The prognosis is poor, the in-hospitalmortality rate being 60%. Conservative treatment does not prolong survival,and the in-hospital mortality rate is 40% for patients submitted to conventionalsurgical treatment. Here, we report the case of a 93-year-old woman whopresented to the emergency room with a history of hematemesis. The patientwas first submitted to upper gastrointestinal endoscopy, the findings of whichwere suggestive of aortoesophageal fistula. The diagnosis was confirmedby multidetector computed tomography of the chest. Surgery was indicated.However, on the way to the operating room, the patient presented with massivebleeding and went into cardiac arrest, which resulted in her death.

  18. Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel.

    Science.gov (United States)

    James, Andra H; Kouides, Peter A; Abdul-Kadir, Rezan; Dietrich, Jennifer E; Edlund, Mans; Federici, Augusto B; Halimeh, Susan; Kamphuisen, Pieter Willem; Lee, Christine A; Martínez-Perez, Oscar; McLintock, Claire; Peyvandi, Flora; Philipp, Claire; Wilkinson, Jeffrey; Winikoff, Rochelle

    2011-10-01

    Acute menorrhagia is a common gynecological disorder. Prevalence is high among women with inherited bleeding disorders and recent guidance for optimal management is lacking. Following a comprehensive review of the literature, an international expert panel in obstetrics, gynecology and hematology reached consensus on recommendations regarding the management of acute menorrhagia in women without a diagnosed bleeding disorder, as well as in patients with von Willebrand disease, platelet function disorders and other rare hemostatic disorders. The causes and predictors of acute menorrhagia are discussed and special consideration is given for the treatment of women on anticoagulation therapy. This review and accompanying recommendations will provide guidance for healthcare practitioners in the emergency management of acute menorrhagia. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  19. Determinants of fatal bleeding during induction therapy for acute promyelocytic leukemia in the ATRA era.

    Science.gov (United States)

    Mantha, Simon; Goldman, Debra A; Devlin, Sean M; Lee, Ju-Whei; Zannino, Diana; Collins, Marnie; Douer, Dan; Iland, Harry J; Litzow, Mark R; Stein, Eytan M; Appelbaum, Frederick R; Larson, Richard A; Stone, Richard; Powell, Bayard L; Geyer, Susan; Laumann, Kristina; Rowe, Jacob M; Erba, Harry; Coutre, Steven; Othus, Megan; Park, Jae H; Wiernik, Peter H; Tallman, Martin S

    2017-03-30

    Acute promyelocytic leukemia (APL) is commonly complicated by a complex coagulopathy. Uncertainty remains as to which markers of bleeding risk are independent predictors. Drawing from 5 large clinical trials that included all-trans retinoic acid (ATRA) as part of induction, we assessed known determinants of bleeding at baseline and evaluated them as potential predictors of hemorrhagic death (HD) in the first 30 days of treatment. The studies included were ALLG APML3 (single arm of ATRA + idarubicin ± prednisone), ALLG APML4 (single arm of ATRA + idarubicin + arsenic trioxide + prednisone), CALGB C9710 (single arm of ATRA + cytarabine + daunorubicin), Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) E2491 (intergroup I0129, consisting of daunorubicin + cytarabine vs ATRA), and SWOG S0521 (single-arm induction of ATRA + cytarabine + daunorubicin). A total of 1009 patients were included in the original trials, of which 995 had sufficient data to be included in our multivariate analysis. In this final cohort, there were 37 HD cases during the first 30 days following induction, for an estimated cumulative incidence of 3.7% (95% confidence interval [CI], 2.6% to 5.0%). Using multivariate Cox proportional hazards regression, the hazard ratio of HD in the first 30 days was 2.17 (95% CI, 0.84-5.62) for an ECOG performance status of 3-4 vs 0-2 and 5.20 (95% CI, 2.70-10.02) for a white blood cell count of ≥20 000/μL vs <20 000/μL. In this large cohort of APL patients, high white blood cell count emerged as an independent predictor of early HD. © 2017 by The American Society of Hematology.

  20. Improved outcomes following implementation of an acute gastrointestinal bleeding multidisciplinary protocol.

    Science.gov (United States)

    Loftus, Tyler J; Go, Kristina L; Hughes, Steven J; Croft, Chasen A; Smith, Robert Stephen; Efron, Philip A; Moore, Frederick A; Brakenridge, Scott C; Mohr, Alicia M; Jordan, Janeen R

    2017-07-01

    Effective multidisciplinary management of gastrointestinal bleeding (GIB) requires effective communication. We instituted a protocol to standardize communication practices with the hypothesis that outcomes would improve following protocol initiation. We performed a retrospective cohort analysis of 442 patients who required procedural management of acute GIB at our institution during a 50-month period spanning 25 months before and 25 months after implementation of a multidisciplinary communication protocol. The protocol stipulates that when a patient with severe GIB is identified, a conference call is coordinated among the gastroenterology, interventional radiology, and acute care surgery teams. A consensus plan is generated and then reassessed following procedural interventions and changes in patients' status. Patients' characteristics, management strategies, and outcomes were compared before and after protocol initiation. Patient populations before and after protocol initiation were similar in age, comorbidities, outpatient use of antiplatelet/anticoagulant medications, admission vital signs, and admission laboratory values. The median interval between admission and the first procedure was significantly shorter in the protocol group (40 vs 47 hours, p = 0.046). The proportion of patients who received packed red blood cell transfusions decreased following protocol initiation (41% vs 50%, p = 0.018). Median hospital length of stay was significantly shorter in the protocol group (5.0 vs 6.0 days, p = 0.014). Readmissions with GIB were decreased after protocol implementation (8% vs. 15%, p = 0.023). Implementation of a multidisciplinary protocol for management of acute GIB was associated with earlier intervention, fewer packed red blood cell transfusions, shorter hospital length of stay, and fewer readmissions with GIB. Future research should seek to establish causal relationships between communication practices and outcomes. Therapeutic study, level III.

  1. Clinical and Economic Impact of a Multisciplinary Intervention to Reduce Bleeding Risk in Patients With Acute Coronary Syndrome.

    Science.gov (United States)

    de Lorenzo-Pinto, Ana; Herranz-Alonso, Ana; Cuéllar-Basterrechea, Begoña; Bellón-Cano, José María; Sanjurjo-Sáez, María; Bueno, Héctor

    2017-10-01

    To evaluate the clinical and economic impact of a multidisciplinary program to reduce bleeding events in patients with acute coronary syndrome through optimization of antithrombotic therapy. We designed a preintervention (PRE) and postintervention (POST) quasi-experimental study using a retrospective analysis of 2 cohorts. The first cohort was analyzed to detect correctable measures contributing to bleeding (PRE). Afterward, a quality improvement intervention with a bundle of recommendations was implemented. Finally, a second cohort of patients was evaluated to investigate the impact of the measures on bleeding reduction (POST). The impact on health outcomes was evaluated through comparison of the percentage of in-hospital bleeding events and 30-day readmissions between the 2 cohorts. The economic analysis took into account the costs associated with the implementation of the program and the cost-savings associated with the prevention of bleeding events and 30-day readmissions. A total of 677 patients were included (377 in PRE and 300 in POST). The total bleeding rate was reduced after the implementation of the bundled intervention by 29.2% (31.6% in POST vs 22.3% in PRE; OR, 0.62; 95%CI, 0.44-0.88) while 30-day readmission rates were 7.7% in PRE and 5% in POST (P=.20). The estimated avoided cost was €95 113.6 per year, meaning that €10.1 would be obtained in return for each euro invested during the first year and €36.3 during the following years. This multidisciplinary program has proven to be effective in reducing bleeding events and is economically attractive. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  2. A simplified prognostic model to predict mortality in patients with acute variceal bleeding.

    Science.gov (United States)

    Lee, Han Hee; Park, Jae Myung; Han, Seunghoon; Park, Sung Min; Kim, Hee Yeon; Oh, Jung Hwan; Kim, Chang Wook; Yoon, Seung Kew; Choi, Myung-Gyu

    2017-11-24

    Acute variceal bleeding (AVB) is a major cause of death in patients with liver cirrhosis. The aim of this study was to investigate mortality predictors and develop a new simple prognostic model using easily verified factors at admission in AVB patients. Between January 2009 and May 2015, 333 consecutive patients with AVB were included. A simplified prognostic model was developed using multiple logistic regression after identifying significant predictors of 6-week mortality. Mortality prediction accuracy was assessed with area under the receiver operating characteristic (AUROC) curve. We compared the new model to existing models of model for end-stage liver disease (MELD) and Child-Pugh scores. The 6-week overall mortality rate was 12.9%. Multivariate analysis showed that C-reactive protein (CRP), total bilirubin, and the international normalized ratio were independent predictors of mortality. A new logistic model using these variables was developed. This model's AUROC was 0.834, which was significantly higher than that of MELD (0.764) or Child-Pugh scores (0.699). Two external validation studies showed that the AUROC of our model was consistently higher than 0.8. Our new simplified model accurately and consistently predicted 6-week mortality in patients with AVB using objective variables measured at admission. Our system can be used to identify high risk AVB patients. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  3. Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension.

    Science.gov (United States)

    Ríos Castellanos, Eddy; Seron, Pamela; Gisbert, Javier P; Bonfill Cosp, Xavier

    2015-05-12

    In people with portal hypertension, gastric varices are less prevalent than oesophageal varices. The risk of bleeding from gastric varices seems to be lower than from oesophageal varices; however, when gastric varices bleed, it is often severe and associated with higher mortality. Endoscopic sclerotherapy of bleeding gastric varices with N-butyl-2-cyanoacrylate glue (cyanoacrylate) is considered the best haemostasis with a lower risk of re-bleeding compared with other endoscopic methods. However, there are some inconsistencies between trials regarding mortality, incidence of re-bleeding, and adverse effects. To assess the benefits and harms of sclerotherapy using cyanoacrylate compared with other endoscopic sclerotherapy procedures or with variceal band ligation for treating acute gastric variceal bleeding with or without vasoactive drugs in people with portal hypertension and to assess the best dosage of cyanoacrylate. We searched the Cochrane Hepato-Biliary Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and Science Citation Index Expanded from inception to September 2014 and reference lists of articles. We included trials irrespective of trial setting, language, publication status, or date of publication. Randomised clinical trials comparing sclerotherapy using cyanoacrylate versus other endoscopic methods (sclerotherapy using alcohol-based compounds or endoscopy band ligation) for acute gastric variceal bleeding in people with portal hypertension. We performed the review following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and the Cochrane Hepato-Biliary Module.We presented results as risk ratios (RR) with 95% confidence intervals (CI), with I(2) statistic values as a measure of intertrial heterogeneity. We analysed data with both fixed-effect and random-effects models, and reported the results with random-effects models. We performed subgroup, sensitivity, and

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

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    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

  5. Management of acute perioperative myocardial infarction: a case report of concomitant acute myocardial infarction and tumor bleeding in the transverse colon

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    Li YF

    2016-02-01

    Full Text Available Yu-Feng Li,1,* Wen-Qian Gao,2,* Yuan-Xin Li,3,* Quan-Zhou Feng,1,* Ping Zhu2 1The Department of Cardiology, Clinical Division of Medicine, Chinese PLA General Hospital, Beijing, People’s Republic of China; 2The Department of Cardiology, Clinical Division of Nanlou, Chinese PLA General Hospital, Beijing, People’s Republic of China; 3Navy Wangshoulu Clinics, Beijing, People’s Republic of China *These authors contributed equally to this work Abstract: Acute myocardial infarction complicated by bleeding colon tumor is problematic with regard to management, and appropriate balance of antiplatelet or anticoagulation therapy and hemostasis or surgery is crucial for effective treatment. Here, we present a case of concomitant acute myocardial infarction and bleeding tumor in the transverse colon, and share our experience of successfully balancing anticoagulation therapy and hemostasis. Keywords: management, acute myocardial infarction, perioperative, antiplatelet, hemostasis

  6. Risk factors for HBV-related liver cirrhosis complicated by acute upper gastrointestinal bleeding

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    YU Zhirui

    2017-05-01

    Full Text Available ObjectiveTo investigate the risk factors for HBV-related liver cirrhosis complicated by acute upper gastrointestinal bleeding (AUGIB. MethodsA total of 58 patients with HBV-related liver cirrhosis complicated by AUGIB who were hospitalized in our hospital from January to December, 2011 were enrolled as study group, and 100 patients with HBV-related liver cirrhosis who did not experience upper gastrointestinal bleeding during the same period of time were enrolled as control group. Their general clinical data were collected. The t-test was used for comparison of continuous data between groups, the chi-square test was used for comparison of categorical data between groups, the multivariate Cox regression model was used to analyze the risk factors, and the life table method was used to analyze 1-, 2-, and 3-year cumulative survival rates and plot survival curves. ResultsThe 1-, 2-, and 3-year cumulative survival rates in the patients with HBV-related liver cirrhosis complicated by AUGIB were 72.2%, 51.9%, and 35.2%, respectively, with a median survival time of 24.7 months. The univariate analysis showed that AUGIB was associated with bleeding history (χ2=7.128, P=0008, course of disease (t=8.283, P<0.001, bad eating habits (χ2=7.612, P=0.006, Child-Pugh class (χ2=6.045, P=0049, degree of esophageal varices (χ2=46.241, P<0.001, gastric varices (χ2=14.211, P<0.001, and portal hypertension (χ2=6.846, P=0009. The multivariate Cox regression analysis revealed that course of disease (RR=0.745, 95%CI: 0.824-0967, P=0.026, bad eating habits (RR=1.426, 95%CI: 1.033-2.582, P=0.032, Child-Pugh class (RR=2.032, 95%CI: 1.05-2.34, P=0036, degree of esophageal varices (RR=0.796, 95%CI: 1.23-3.37, P=0.015, degree of gastric varices (RR=0825, 95%CI: 2.46-392, P=0.043, and portal hypertension (RR=0.983, 95%CI: 1.26-3.75, P=0.007 were independent risk factors for the prognosis of patients with HBV-related liver cirrhosis

  7. AETIOLOGICAL PROFILE OF PATIENTS PRESENTING WITH UPPER GASTROINTESTINAL BLEEDING

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    Amit Govind Kamat

    2017-06-01

    Full Text Available BACKGROUND In the recent years, the number of studies exclusively examining epidemiologic patterns of Upper Gastrointestinal Bleeding (UGIB has been quite limited. However, most epidemiologic studies have shown a decrease in the incidence of all causes of upper gastrointestinal bleeding. Although, the incidences of peptic ulcers have remained unchanged. Gastrointestinal bleeding is a very common emergency accounting for 7-8% of acute medical admissions. UGIB is 4-5 times more common than the lower GI haemorrhage. Acute erosive gastritis is the most common cause followed by oesophageal varices, peptic ulcer and reflux oesophagitis. Upper GI bleed is more common in men than women (ratio 3:2 and the frequency increases with age. Hence, the present study was designed to study the aetiological profile of patients presenting with upper gastrointestinal bleeding. MATERIALS AND METHODS This one year cross-sectional study was conducted from January 2013 to December 2013. Sample size of 50 was considered. Patients aged 18 years and above presenting with upper gastrointestinal bleeding and who are fit for endoscopy were selected. Endoscopy was performed in all patients within 24 hrs. of admission and data was plotted in terms of rates, ratios and percentages and continuous data was expressed as mean ± standard deviation. RESULTS In the present study, most of the patients reported past history of liver disease and intake of NSAIDs and aspirins. In the present study, on clinical examination, most of the patients had pallor followed by tenderness. In the present study, the commonest diagnosis was cirrhosis of liver due to alcohol-induced with portal hypertension. CONCLUSION Upper GI endoscopy revealed varices as most common cause of upper gastrointestinal bleeding.

  8. Comparison of different regimens of proton pump inhibitors for acute peptic ulcer bleeding.

    Science.gov (United States)

    Neumann, Ignacio; Letelier, Luz M; Rada, Gabriel; Claro, Juan Carlos; Martin, Janet; Howden, Colin W; Yuan, Yuhong; Leontiadis, Grigorios I

    2013-06-12

    Treatment with proton pump inhibitors (PPIs) improves clinical outcomes in patients with peptic ulcer bleeding. However, the optimal dose and route of administration of PPIs remains controversial. To evaluate the efficacy of different regimens of PPIs in the management of acute peptic ulcer bleeding using evidence from direct comparison randomized controlled trials (RCTs).We specifically intended to assess the differential effect of the dose and route of administration of PPI on mortality, rebleeding, surgical intervention, further endoscopic haemostatic treatment (EHT), length of hospital stay, transfusion requirements and adverse events. We searched CENTRAL (in The Cochrane Library 2010, Issue 3), MEDLINE and EMBASE (from inception to September 2010) and proceedings of major gastroenterology meetings (January 2000 to September 2010), without language restrictions. Original investigators were contacted to request missing data. RCTs that compared at least two different regimens of the same or a different PPI in patients with acute peptic ulcer bleeding, diagnosed endoscopically. Two reviewers independently selected studies, extracted data and assessed risk of bias. We synthesized data using the Mantel-Haenszel random-effects method and performed multivariate meta-regression with random permutations based on Monte Carlo simulation. We measured heterogeneity with the I² statistic and Cochrane Q test and assessed publication bias with funnel plots and Egger's test. We graded the overall quality of evidence using the GRADE approach. Twenty two RCTs were included; risk of bias was high in 17 and unclear in 5. The main analysis included 13 studies (1716 patients) comparing "high" dose regimens (72-hour cumulative dose > 600 mg of intravenous PPI) to other doses; there was no significant heterogeneity for any clinical outcome. We found low quality evidence that did not exclude a potential reduction or increase in mortality, rebleeding, surgical interventions or

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

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    Chang, Wei-Chou [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Tsai, Shih-Hung [Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Chang, Wei-Kuo [Division of Gasteroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Liu, Chang-Hsien [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Tung, Ho-Jui [Department of Healthcare Administration, Asia University, Taichung, Taiwan (China); Hsieh, Chung-Bao [Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Huang, Guo-Shu; Hsu, Hsian-He [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Yu, Chih-Yung, E-mail: chougo2002@yahoo.com.tw [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China)

    2011-11-15

    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.

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

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    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.

  11. Selective Serotonin Reuptake Inhibitors and Gastrointestinal Bleeding: A Case-Control Study

    Science.gov (United States)

    Carvajal, Alfonso; Ortega, Sara; Del Olmo, Lourdes; Vidal, Xavier; Aguirre, Carmelo; Ruiz, Borja; Conforti, Anita; Leone, Roberto; López-Vázquez, Paula; Figueiras, Adolfo; Ibáñez, Luisa

    2011-01-01

    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. PMID:21625637

  12. ENDOSCOPIC FINDINGS OF UPPER GASTROINTESTINAL BLEEDING IN PATIENTS WITH LIVER CIRROSIS.

    Science.gov (United States)

    Hadayat, Rania; Jehangiri, Attique-ur-Rehman; Gul, Rahid; Khan, Adil Naseer; Said, Khalid; Gandapur, Asadullah

    2015-01-01

    Acute upper gastrointestinal (GI) bleeding is a common medical emergency. A common risk factor of upper GI bleeding is cirrhosis of liver, which can lead to variceal haemorrhage. 30-40% of cirrhotic patients who bleed may have non-variceal upper GI bleeding and it is frequently caused by peptic ulcers, portal gastropathy, Mallory-Weiss tear, and gastroduodenal erosions. The objective of this study was to determine the frequency of upper gastrointestinal endoscopic findings among patients presenting with upper gastrointestinal bleeding with liver cirrhosis. This descriptive cross-sectional study was carried out in Gastroenterology & Hepatology Department of Ayub Teaching Hospital, Abbottabad from February 2012 to June 2013. 252 patients diagnosed with cirrhosis, presenting with upper GI bleed, age 50 years of either gender, and were included in the study. Non-probability consecutive sampling was used, Endoscopy was performed on each patient and the findings documented. The mean age was 57.84 +/- 6.29 years. There were 158 (62.7%) males and 94 (37.3%) females. The most common endoscopic finding was oesophageal varices (92.9%, n=234) followed by portal hypertensive gastropathy (38.9%, n=98) with almost equal distribution among males and females. Gastric varices were found in 33.3% of patients (n=84). Among other non-variceal lesions, peptic ulcer disease was seen in 26 patients (10.3%) while gastric erosions were found in 8 patients (3.2%). In patients with acute upper GI bleeding and liver cirrhosis, the most common endoscopic finding is oesophageal varices, with a substantially higher value in our part of the country, apart from other non-variceal causes.

  13. Randomized controlled study of 3 different types of hemoclips for hemostasis of bleeding canine acute gastric ulcers.

    Science.gov (United States)

    Jensen, Dennis M; Machicado, Gustavo A; Hirabayashi, Ken

    2006-11-01

    Mechanical closure of bleeding vessels is clinically appealing, and several types of hemoclips are now marketed for endoscopic hemostasis of nonvariceal lesions. No comparative data have been reported on ease of clip placement, hemostasis efficacy, or clip retention rates on bleeding ulcers. To compare 3 different types of hemoclips for hemostasis of bleeding ulcers. Randomized controlled study. Seven adult dogs with prehepatic portal hypertension were heparinized, and acute gastric ulcers were made with jumbo biopsy forceps. Animals had oral proton pump inhibitors daily and weekly endoscopies to quantitate clip retention and ulcer healing. Bleeding ulcers were randomized in pairs (2 for each treatment/dog) to endoscopic hemoclip treatment or control. Initial times and success of deployment, hemostasis efficacy, clip retention rates, and ulcer healing during endoscopic follow-ups. There was no difference in initial hemostasis rates of hemoclips, and no major complications occurred. Ulcer healing times were faster (Resolution Clip [RC] or TriClip [TC]) or similar (QuickClip2 [QC]) to controls. Clip retention at 1 week was significantly less with TC and, at 3 to 7 weeks, was significantly higher with RC. (1) For the 3 hemoclip devices, initial hemostasis rates were 100%, but all devices required similar learning time to place clips successfully. (2) Short-term retention rates of TC were significantly less than QC or RC. (3) Long-term clip retention was significantly higher with RC. (4) All 3 hemoclips were safe, and none interfered with ulcer healing.

  14. Association of spontaneous and procedure-related bleeds with short- and long-term mortality after acute coronary syndromes: an analysis from the PLATO trial.

    Science.gov (United States)

    Ducrocq, Gregory; Schulte, Phillip J; Becker, Richard C; Cannon, Christopher P; Harrington, Robert A; Held, Claes; Himmelmann, Anders; Lassila, Riitta; Storey, Robert F; Sorbets, Emmanuel; Wallentin, Lars; Steg, Philippe Gabriel

    2015-11-01

    We sought to describe the differential effect of bleeding events in acute coronary syndromes (ACS) on short- and long-term mortality according to their type and severity. The PLATO trial randomised 18,624 ACS patients to clopidogrel or ticagrelor. Post-randomisation bleeding events were captured according to bleeding type (spontaneous or procedure-related), with PLATO, TIMI, and GUSTO definitions. The association of bleeding events with subsequent short-term (30 days) all-cause mortality was assessed using time-dependent Cox proportional hazard models. A model was fitted to compare major and minor bleeding for mortality prediction. Of 18,624 patients, 2,189 (11.8%) had at least one PLATO major bleed (mean follow-up 272.2±123.5 days). Major bleeding was associated with higher short-term mortality (adjusted hazard ratio [HR] 9.28; 95% confidence interval [CI]: 7.50-11.48) but not with long-term mortality (adjusted HR 1.28; 95% CI: 0.93-1.75). Spontaneous bleeding was associated with short-term (adjusted HR 14.59; 95% CI: 11.14-19.11) and long-term (adjusted HR 3.38; 95% CI: 2.26-5.05) mortality. Procedure-related bleeding was associated with short-term mortality (adjusted HR 5.29; 95% CI: 4.06-6.87): CABG-related and non-coronary-procedure-related bleeding were associated with a higher short-term mortality, whereas PCI or angiography-related bleeding was not associated with either short- or long-term mortality. Similar results were obtained using the GUSTO and TIMI bleeding definitions. Major bleeding is associated with high subsequent mortality in ACS. However, this association is much stronger in the first 30 days and is strongest for spontaneous (vs. procedure-related) bleeding.

  15. Increased risk of minor bleeding and antiplatelet therapy cessation in patients with acute coronary syndromes and low on-aspirin platelet reactivity. A prospective cohort study.

    Science.gov (United States)

    Huczek, Zenon; Filipiak, Krzysztof J; Kochman, Janusz; Michalak, Marcin; Grabowski, Marcin; Opolski, Grzegorz

    2013-07-01

    Bleeding negatively affects prognosis and adherence to antiplatelet therapy after acute coronary syndromes (ACSs). The potential association of on-aspirin platelet reactivity and bleeding is not established. We sought to determine whether low on-aspirin platelet reactivity (LAPR) is associated with bleeding events and antiplatelet therapy compliance in patients with ACSs receiving coronary stenting. On-aspirin platelet reactivity was measured by the VerifyNow™ Aspirin assay (Accumetrics Inc., San Diego, CA, USA) in 531 patients with ACS. Cut-offs for LAPR were calculated by receiver-operating characteristic curve (ROC) analysis. Bleeding was reported according to Bleeding Academic Research Consortium (BARC) definition. The endpoints were minor bleeding (BARC types 1 or 2), major bleeding (BARC types 3 or 5) and antiplatelet therapy cessation during 6-months follow-up. By ROC analysis the VerifyNow™ Aspirin assay was able to distinguish between patients with and without minor bleeding (area under the curve [AUC] 0.66, 95 % confidence interval [CI] 0.62-0.70, P Antiplatelet therapy discontinuation was more frequent in patients with LAPR as compared to those with no LAPR (21.6 vs. 9.1 %, P = 0.0008). In conclusion, early point-of-care on-aspirin platelet reactivity testing in ACS may identify patients with increased risk of minor bleeding events and subsequent discontinuation of antiplatelet therapy. The possible impact of LAPR on major bleeding needs to be determined in larger trials.

  16. Comparing Adrenaline with Tranexamic Acid to Control Acute Endobronchial Bleeding: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Mitra Samareh Fekri

    2017-03-01

    Full Text Available Background: Hemoptysis occurs due to either pulmonary diseases or bronchoscopy interventions. The aim of the present study was to compare the efficacy of the endobronchial instillation of adrenaline with that of tranexamic acid. Methods: Fifty patients were randomly selected as 2 double-blinded sample groups (n=25. In these patients, bleeding could not be controlled with cold saline lavage during bronchoscopy and they, therefore, required prescription of another medicine. Adrenaline (1 mg in one group and tranexamic acid (500 mg in the other group were diluted in 20 mL of normal saline and instilled through the bronchoscope. This technique was repeated 3 times at 90-second intervals, if necessary. In the case of persistent bleeding, 90 seconds after the last dose, a second medicine was given for bleeding control. Observation of clot through the bronchoscope meant that the bleeding had stopped. The efficacy of tranexamic acid and adrenaline was evaluated and then compared using the Mann–Whitney test. Results: The time of bleeding control had no significant difference between tranexamic acid and adrenaline (P=0.908. Another analysis was done to evaluate bleeding control with a second medicine; the results showed that 1 (4% patient in the tranexamic acid and 8 (32% in the adrenaline group needed the second medicine and there was no significant difference between the 2 groups (P=0.609. Conclusion: Our results suggested that tranexamic acid by endobronchial instillation was as efficient as adrenaline in controlling hemoptysis and required less frequent use of a second medicine. Trial Registration Number: IRCT2014120220188

  17. Evaluation of Results in Patients with Acute Upper Gis Bleeding: A Goverment Hospital Experience

    Directory of Open Access Journals (Sweden)

    Bilge Bas

    2016-01-01

    Full Text Available Aim: The aim was to assess the characteristics of patients with upper gastrointestinal system (GIS bleeding in our clinic. Material and Method: The patients who admitted to Usak State Hospital Gastroenterology Department with upper gastrointestinal system bleeding were retrospectively evaluated between May 2009 and March 2012. The patients were assessed for age, sex, complaints, history of medication, management, history of bleeding, laboratory findings, endoscopic findings, need for transfusion, hospitalization duration and mortality. Results: 392 patients admitted to our department with upper gastrointestinal system bleeding. 263 (67.1% of the patient were male and 129 (32.9% were female. It was presented only melena in 120 (%30.6 patients, hematemesis in 140 (%35.7 patients and both hematemesis and melena in 132 (%33.7 patients at admission. The mean hemoglobin level was 7.8±1.5 g/dl, and the mean hematocrit level was 27.4±4%. It was established coronary artery disease in 50 (12.8% patients, diabetes mellitus in 20 (5.1% patients, cerebrovascular disease in 8 (2% patients and peripheral arterial disease in 4 (1% patients. We presented 194 (49.5% bulbus ulcer, 117 (29.8% erosive gastritis, 35 (8.9% gastric ulcer in patients at upper gastrointestinal system endoscopy. We established Helicobacter pylori infection in 264 (67.3 % patients. Discussion: Duodenal ulcer and eritematous gastritis are the most common causes of upper GIS bleedings. In addition, Helicobacter pylori infection is keep in mind as a important bleeding cause in that patients. It is useful to give stomach acid suppressor therapy to the patients who have coronary heart disease, cerebrovascular disease and diabetes mellitus, especially if they have gastric complaints.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  19. Upper gastrointestinal bleed in a post menopausal woman due to combination of high first dose aspirin and clopidogrel prescribed for acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Vishal R Tandon

    2015-01-01

    Full Text Available Combination of aspirin, clopidogrel and enoxaparin remains the standard treatment for acute coronary syndrome (ACS but is known to increase the incidence of upper gastrointestinal bleed (UGIB. We hereby report an unusual case of gastrointestinal bleed (GIB as it resulted inspite of proton pump inhibitor (PPI prophylaxis within the second day of treatment in a post-menopausal woman (PMW with high first dose of aspirin clopidogrel dual combination in a patient of ACS.

  20. Esophageal variceal ligation for hemostasis of acute variceal bleeding: efficacy and safety

    OpenAIRE

    Lahbabi, Mounia; Elyousfi, Mounia; Aqodad, Nouredine; Elabkari, Mohammed; Mellouki, Ihssane; Ibrahimi, Sidi Adil; Benajah, Dafr Allah

    2013-01-01

    Introduction Endoscopic variceal ligation is widely accepted as the optimum endoscopic treatment for esophageal variceal hemorrhage. In Morocco, there are no data regarding the efficacy of this technique. Our aim was to evaluate the effectiveness and safety of endoscopic variceal ligation in the management of oesophageal variceal bleeding in cirrhosis in a located population in Morocco. Methods Via a retrospective study over 118 months (December 2001- October 2011), cirrhotic patients with en...

  1. Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes).

    Science.gov (United States)

    Easton, J Donald; Aunes, Maria; Albers, Gregory W; Amarenco, Pierre; Bokelund-Singh, Sara; Denison, Hans; Evans, Scott R; Held, Peter; Jahreskog, Marianne; Jonasson, Jenny; Minematsu, Kazuo; Molina, Carlos A; Wang, Yongjun; Wong, K S Lawrence; Johnston, S Claiborne

    2017-09-05

    Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute ischemic stroke or transient ischemic attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)-defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definitions. The definitions of ICrH and major bleeding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population. A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83; 95% confidence interval, 0.52-1.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2

  2. Abnormal Uterine Bleeding

    OpenAIRE

    Benetti-Pinto, Cristina Laguna; Rosa-e-Silva, Ana Carolina Japur de Sá; Yela, Daniela Angerame; Soares Júnior,José Maria

    2017-01-01

    Abstract Abnormal uterine bleeding is a frequent condition in Gynecology. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. In cases of acute and severe bleeding, women may need urgent treatment with volumetric replacement and prescription of hemostatic substances. In some specific cases with more intense and prolonged bleeding, surgical treatment may be necessary. The objective of this chapter is to describe the main evi...

  3. Lactic Acidosis Induced by Linezolid Mimics Symptoms of an Acute Intracranial Bleed: A Case Report and Literature Review.

    Science.gov (United States)

    Zuccarini, Nichole Suzzanne; Yousuf, Tariq; Wozniczka, Daniel; Rauf, Anis Abdul

    2016-10-01

    Lactic acidosis is common and most often associated with disturbed acid-base balance. Rarely, it can be a life-threatening medication side effect. Hence, determining the etiology of lactic acidosis early in patients is paramount in choosing the correct therapeutic intervention. Although lactic acidosis as an adverse drug reaction of linezolid is a well-recognized and documented clinical entity, the occurrence of such mimicking an acute intracranial bleed has not been reported to our knowledge. The following case is presented as an example of such an occurrence. A 67-year-old woman presented to the emergency department for lethargy, nausea and syncope. The head CT did not demonstrate any bleeding or mass effect, but lab results were significant for elevated lactic acid. The patient recently underwent left total hip replacement surgery, which was complicated by a methicillin-resistant Staphylococcus aureus (MRSA) infection. She received 6 weeks of oral linezolid therapy. And upon learning that key part of her history, the linezolid was discontinued. Her lactic acid rapidly normalized and she was discharged home. Several publications demonstrate that linezolid induces lactic acidosis by disrupting crucial mitochondrial functions. It is essential that clinicians are aware that linezolid can cause lactic acidosis. And, the important reminder is that adverse drug reactions can often mimic common diseases. If it is not recognized early, ominous clinical consequences may occur. In conclusion, linezolid should be suspected and included in the differential diagnosis if lactic acidosis exists with an uncommon clinical picture.

  4. Esophageal variceal ligation for hemostasis of acute variceal bleeding: efficacy and safety.

    Science.gov (United States)

    Lahbabi, Mounia; Elyousfi, Mounia; Aqodad, Nouredine; Elabkari, Mohammed; Mellouki, Ihssane; Ibrahimi, Sidi Adil; Benajah, Dafr Allah

    2013-01-01

    Endoscopic variceal ligation is widely accepted as the optimum endoscopic treatment for esophageal variceal hemorrhage. In Morocco, there are no data regarding the efficacy of this technique. Our aim was to evaluate the effectiveness and safety of endoscopic variceal ligation in the management of oesophageal variceal bleeding in cirrhosis in a located population in Morocco. Via a retrospective study over 118 months (December 2001- October 2011), cirrhotic patients with endoscopically proven esophageal variceal hemorrhage were treated by endoscopic variceal ligation. We studied the rate of haemostasis, rebleeding, complications and mortality. 360 cirrhotic patients were included and 378 haemostatic variceal ligations were performed. Primary haemostasis was obtained in 96.5 % (N=365) of cases. Thirty three patients (8.7%) bled during follow-up. The rate of minor complications was 15.3 % (N=58). Retrosternal pain, fever, dysphagia and Overtube's migration developed in 8.4 % (N=32); 2.6 % (N=10); 3,7 % (N=14) and 0.5 % (N=2) of the patients respectively. Severity of these complications was mild and transient. The rate of oesophageal ulcers was 5 % (N=19), while the mortality rate by haemorrhage was 5 % (N=18). Our data showed that band ligation is an effective and safe treatment modality of esophageal variceal bleeding with low rates of rebleeding and complications.

  5. Effect of Bleeding Risk on Type of Stent Used in Patients Presenting With Acute Coronary Syndrome.

    Science.gov (United States)

    Alraies, M Chadi; Lee, Sang Yeub; Lipinski, Michael J; Buchanan, Kyle; Steinvil, Arie; Rogers, Toby; Koifman, Edward; Gai, Jiaxiang; Torguson, Rebecca; Ben-Dor, Itsik; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

    2017-10-15

    Patients at high bleeding risk (HBR) are at increased risk of bleeding following percutaneous coronary intervention (PCI) with drug-eluting stents (DES) due to the need for longer dual antiplatelet duration. We sought to evaluate the likelihood of receiving DES during PCI in HBR populations and to characterize DES utilization trends over time. Consecutive patients who underwent PCI from April 2003 to September 2015 were identified. HBR is defined as patients fulfilling 1 or more of the HBR criteria: age ≥75 years, anticoagulation use at discharge, history of stroke, cancer in previous 3 years, glucocorticoid use, hemoglobin (Hgb) HBR definition. When adjusting for known risk factors, HBR patients were less likely to receive a DES compared with non-HBR patients (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.54 to 0.62, p HBR patients, having 3 or more HBR criteria versus HBR criteria had lower likelihood of receiving a DES (OR 0.50, 95% CI 0.44 to 0.57, p HBR has a significant impact upon the decision to use DES. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Impact of INR monitoring, reversal agent use, heparin bridging, and anticoagulant interruption on rebleeding and thromboembolism in acute gastrointestinal bleeding.

    Directory of Open Access Journals (Sweden)

    Naoyoshi Nagata

    Full Text Available Anticoagulant management of acute gastrointestinal bleeding (GIB during the pre-endoscopic period has not been fully addressed in American, European, or Asian guidelines. This study sought to evaluate the risks of rebleeding and thromboembolism in anticoagulated patients with acute GIB.Baseline, endoscopy, and outcome data were reviewed for 314 patients with acute GIB: 157 anticoagulant users and 157 age-, sex-, and important risk-matched non-users. Data were also compared between direct oral anticoagulants (DOACs and warfarin users.Between anticoagulant users and non-users, of whom 70% underwent early endoscopy, no endoscopy-related adverse events or significant differences were found in the rate of endoscopic therapy need, transfusion need, rebleeding, or thromboembolism. Rebleeding was associated with shock, comorbidities, low platelet count and albumin level, and low-dose aspirin use but not HAS-BLED score, any endoscopic results, heparin bridge, or international normalized ratio (INR ≥ 2.5. Risks for thromboembolism were INR ≥ 2.5, difference in onset and pre-endoscopic INR, reversal agent use, and anticoagulant interruption but not CHA2DS2-VASc score, any endoscopic results, or heparin bridge. In patients without reversal agent use, heparin bridge, or anticoagulant interruption, there was only one rebleeding event and no thromboembolic events. Warfarin users had a significantly higher transfusion need than DOACs users.Endoscopy appears to be safe for anticoagulant users with acute GIB compared with non-users. Patient background factors were associated with rebleeding, whereas anticoagulant management factors (e.g. INR correction, reversal agent use, and drug interruption were associated with thromboembolism. Early intervention without reversal agent use, heparin bridge, or anticoagulant interruption may be warranted for acute GIB.

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

    DEFF Research Database (Denmark)

    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...

  8. Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors

    NARCIS (Netherlands)

    Connolly, Stuart J.; Milling, Truman J.; Eikelboom, John W.; Gibson, C. Michael; Curnutte, John T.; Gold, Alex; Bronson, Michele D.; Lu, Genmin; Conley, Pamela B.; Verhamme, Peter; Schmidt, Jeannot; Middeldorp, Saskia; Cohen, Alexander T.; Beyer-Westendorf, Jan; Albaladejo, Pierre; Lopez-Sendon, Jose; Goodman, Shelly; Leeds, Janet; Wiens, Brian L.; Siegal, Deborah M.; Zotova, Elena; Meeks, Brandi; Nakamya, Juliet; Lim, W. Ting; Crowther, Mark; Connolly, S. C.; Crowther, M.; Eikelboom, J.; Gibson, M.; Milling, T. J.; Albaladejo, P.; Cohen, A.; Lopez-Sendon, J.; Schmidt, J.; Verhamme, P.; Beyer-Westendorf, J.; Wyse, D. G.; Garcia, D.; Prins, M. [=Martin H.; Nakamya, J.; Büller, H. R.; Mahaffey, K.; Alexander, J.; Demchuk, A.; Raskob, G.; Schulman, S.; Meeks, B.; Zotova, E.; Holadyk-Gris, I.; Pinto, T.; Behr, M.; Lim, T.; Anand, R.; Bastani, A.; Caterino, J.; Clark, C.; Concha, M.; Cornell, J.; Eriksson, E.; Fermann, G.; Fulmer, J.; Goldstein, J.; Kereiakes, D.; Lotfipour, S.; Milling, T.; Moll, S.; Pallin, D.; Patel, N.; Refaai, M.; Rehman, M.; Schmaier, A.; Schwarz, E.; Shillinglaw, W.; Sinert, R.; Singer, A.; Takata, T.; Venkat, A.; Weinstein, D.; Welker, J.; Welsby, I.; Wiener, S.; Wilson, J.; Blostein, M.; van Keer, L.; Verschuren, F.; Coppens, M.; van Wissen, S.; Alikhan, R.; Breen, K.; Hall, R.

    2016-01-01

    Background Andexanet alfa (andexanet) is a recombinant modified human factor Xa decoy protein that has been shown to reverse the inhibition of factor Xa in healthy volunteers. Methods In this multicenter, prospective, open-label, single-group study, we evaluated 67 patients who had acute major

  9. Determination of correlation of Adjusted Blood Requirement Index with outcome in patients presenting with acute variceal bleeding

    Science.gov (United States)

    Akhtar, Naheed; Zuberi, Bader Faiyaz; Hasan, Syed Riazul; Kumar, Raj; Afsar, Salahuddin

    2009-01-01

    AIM: To determine the correlation of Adjusted Blood Requirement Index (ABRI) with the 7th day outcome in patients presenting with acute variceal bleeding. METHODS: All patients presenting with acute variceal hemorrhage (AVH) were included. Patients with previous band ligation, sclerotherapy, gastrointestinal or hepatic malignancies were excluded. Patients were managed as per standard protocol for AVH with terlipressin and band ligation. ABRI scores were calculated using the formula outcome of alive or expired up to the 7th day after treatment. The correlation between ABRI and mortality was estimated and a receiver operative characteristic (ROC) curve was plotted. RESULTS: A total of 113 patients (76 male; 37 female) were included. On assessment, 18 were in Child’s Pugh Class A, 82 in Class B and 13 were in Class C. The median number of blood units transfused ± inter-quartile range was 3.0 ± 2.0. The median ± inter-quartile range for ABRI was 1.3 ± 1.1. The ROC curve of ABRI for expiry showed a significantly large area of 0.848 (P < 0.0001; 95% CI: 0.75-0.95). A significant correlation of log transformation of ABRI with an outcome of mortality was present (P < 0.0001). CONCLUSION: ABRI correlates strongly with mortality. PMID:19452581

  10. Chronic kidney disease and bleeding complications after intravenous thrombolytic therapy for acute ischemic stroke.

    Science.gov (United States)

    Ovbiagele, Bruce; Smith, Eric E; Schwamm, Lee H; Grau-Sepulveda, Maria V; Saver, Jeffrey L; Bhatt, Deepak L; Hernandez, Adrian F; Peterson, Eric D; Fonarow, Gregg C

    2014-11-01

    The safety of intravenous thrombolysis in ischemic stroke (IS) patients with chronic kidney disease (CKD) is uncertain. We assessed whether CKD is associated with bleeding complications after intravenous tissue-type plasminogen activator administration to patients with IS. Data were analyzed from 44 410 patients with IS treated with intravenous tissue-type plasminogen activator in the Get With The Guidelines-Stroke Program. Glomerular filtration rate based on admission serum creatinine was categorized as dichotomous (presence of CKD as intravenous tissue-type plasminogen activator-treated IS patients with CKD. Presence of CKD (versus no CKD) was not associated with risk-adjusted symptomatic intracranial hemorrhage (adjusted odds ratio, 1.0; 95% confidence interval: 0.91-1.10) or serious systemic hemorrhage (adjusted odds ratio, 0.97; 95% confidence interval: 0.80-1.18) and did not significantly vary by kidney dysfunction stage for either of these primary end points in multivariable analyses. Compared with patients with normal kidney function, those with CKD were more likely to die in the hospital (adjusted odds ratio, 1.22; 95% confidence interval: 1.14-1.32) and have an unfavorable discharge functional status (adjusted odds ratio, 1.13; 95% CI: 1.07-1.19). Presence of CKD among patients with IS treated with intravenous tissue-type plasminogen activator is associated with higher unadjusted odds of symptomatic intracranial hemorrhage or serious systemic hemorrhage, but this is explained by non-CKD related factors. © 2014 American Heart Association, Inc.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  12. [Early evaluation of anaemia in patients with acute gastrointestinal bleeding: venous blood gas analysis compared to conventional laboratory].

    Science.gov (United States)

    Benítez Cantero, José Manuel; Jurado García, Juan; Ruiz Cuesta, Patricia; González Galilea, Angel; Muñoz García-Borruel, María; García Sánchez, Valle; Gálvez Calderón, Carmen

    2013-10-19

    Evaluation of patients with acute gastrointestinal bleeding (AGB) requires early clinical evaluation and analysis. The aim of this study is to evaluate early concordance of hemoglobin (Hb) and hematocrit (HTC) levels determined by conventional venous blood gas analysis (VBG) and by conventional Laboratory in Emergencies (LAB). Observational and prospective study of patients admitted in the Gastrointestinal Haemorrhage Unit with both high and low AGB. Demographic and clinical variables and simultaneous venous blood samples were obtained to determine Hb and HTC by VBG and LAB. Concordance in both methods was analysed by intra-class correlation coefficient (ICC) and Bland-Altman analysis. One hundred and thirty-two patients were included: 87 (65.9%) males, average age 66.8 years. VBG overestimated Hb in 0.49 g/dl (95% confidence interval: 0.21-0.76) with respect to LAB. Concordance was very high in Hb (ICC 0.931) and high in HTC (0.899), with the Bland-Altman graphs showing both concordance and overestimation of Hb levels determined by VBG. In 19 patients (14.39%), Hb by VBG exceeded in more than 1g/dL the final determination obtained by LAB. Early determination of Hb and HTC in patients with AGB by VBG provides reliable results in the initial evaluation of anaemia. VBG systematically overestimates Hb values by less than 0.5 g/dl, and therefore clinical and hemodynamic evaluation of the bleeding patient should prevail over analytical results. Copyright © 2012 Elsevier España, S.L. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    Christo J. Van Rensburg

    2012-01-01

    Full Text Available 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 with acid-suppressing therapy has been increasingly recommended in intensive care units (ICUs. This review evaluates the evidence for the efficacy of IV pantoprazole, a PPI, in preventing ulcer rebleeding after endoscopic hemostasis, and in controlling gastric pH and protecting against upper gastrointestinal (GI bleeding in high-risk ICU patients. The review concludes that IV pantoprazole provides an effective option in the treatment of upper GI bleeding, the prevention of rebleeding, and for the prophylaxis of acute bleeding stress ulcers.

  15. Platelet Count and Major Bleeding in Patients Receiving Vitamin K Antagonists for Acute Venous Thromboembolism, Findings From Real World Clinical Practice

    Science.gov (United States)

    Giorgi-Pierfranceschi, Matteo; Di Micco, Pierpaolo; Cattabiani, Chiara; Guida, Anna; Pagán, Barbara; Morales, Maria del Valle; Salgado, Estuardo; Suriñach, José Maria; Tolosa, Carles; Monreal, Manuel

    2015-01-01

    Abstract The outcome of patients with acute venous thromboembolism (VTE) and abnormal platelet count (PlC) at baseline has not been consistently studied. In real-world clinical practice, a number of patients with abnormal PlC receive vitamin K antagonists (VKAs) to treat acute VTE despite their higher risk of bleeding. We used the Registro Informatizado de Enfermedad TromboEmbólica registry database to compare the rate of major bleeding in patients receiving VKA for long-term therapy of acute VTE according to PlC levels at baseline. Patients were categorized as having very low (450,000/μL) PlC at baseline. Of 55,369 patients recruited as of January 2015, 37,000 (67%) received long-term therapy with VKA. Of these, 611 patients (1.6%) had very low PlC, 4006 (10.8%) had low PlC, 25,598 (69%) had normal PlC, 5801 (15.6%) had high PlC, and 984 (2.6%) had very high PlC at baseline. During the course of VKA therapy (mean, 192 days), there were no differences in the duration or intensity (as measured by international normalized ratio levels) of treatment between subgroups. The rate of major bleeding was 3.6%, 2.1%, 1.9%, 2.1%, and 3.7%, respectively, and the rate of fatal bleeding was 0.98%, 0.17%, 0.29%, 0.34%, and 0.50%, respectively. Patients with very low or very high PlC levels were more likely to have severe comorbidities. We found a nonlinear “U-shaped” relationship between PlC at baseline and major bleeding during therapy with VKA for VTE. Consistent alteration of PlC values at baseline suggested a greater frailty. PMID:26632687

  16. Bleeding Disorders

    Science.gov (United States)

    ... 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. Impact of chronic kidney disease on long-term ischemic and bleeding outcomes in medically managed patients with acute coronary syndromes: Insights from the TRILOGY ACS Trial.

    Science.gov (United States)

    Melloni, Chiara; Cornel, Jan H; Hafley, Gail; Neely, Megan L; Clemmensen, Peter; Zamoryakhin, Dmitry; Prabhakaran, Dorairaj; White, Harvey D; Fox, Keith Aa; Ohman, E Magnus; Armstrong, Paul W; Roe, Matthew T

    2016-10-01

    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. 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 function/mild (creatinine clearance >60 mL/min); moderate (creatinine clearance 30-60 mL/min); severe (creatinine clearance 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 kidney disease vs. normal/mild chronic kidney disease were estimated. Platelet reactivity at 30 days was assessed in a subset of patients (n = 1947). The majority of patients were in the normal/mild chronic kidney disease group (67%), followed by moderate chronic kidney disease (29%) and severe chronic kidney disease (4%). The incidence of ischemic and bleeding outcomes increased sharply across chronic kidney disease stages and no significant treatment interactions were observed. The adjusted risk of the primary end point increased across chronic kidney disease stages (moderate vs. normal/mild: hazard ratio 1.26; 95% confidence interval 1.09-1.46; severe vs. normal/mild: hazard ratio 1.60; 95% confidence interval 1.25-2.04). Platelet reactivity was lower in patients treated with prasugrel compared with clopidogrel, across all three chronic kidney disease stages. Among medically managed acute coronary syndrome patients, the long-term risks of ischemic and bleeding outcomes increased markedly with worse chronic kidney disease stages. Despite lower platelet reactivity of prasugrel compared with

  18. Upper GI Endoscopy

    Science.gov (United States)

    ... to diagnose conditions such as cancer celiac disease gastritis Doctors also use upper GI endoscopy to treat ... Management Liver Disease Urologic Diseases Endocrine Diseases Diet & Nutrition Blood Diseases Diagnostic Tests La información de la ...

  19. Intravenous versus high-dose oral proton pump inhibitor therapy after endoscopic hemostasis of high-risk lesions in patients with acute nonvariceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Murthy, Sanjay; Keyvani, Leila; Leeson, Shauna; Targownik, Laura E

    2007-07-01

    Intravenous proton pump inhibitors (IV PPIs) decrease rebleeding following endoscopic hemostasis of bleeding peptic ulcers. Oral PPIs may be equally efficacious and may significantly reduce health care costs. This study aimed to compare outcomes in patients receiving oral versus IV PPI therapy following endoscopic hemostasis in patients with acute nonvariceal upper gastrointestinal bleeding (ANVUGIB). We performed a retrospective review of all patients who received PPI therapy following endoscopic hemostasis for ANVUGIB. The primary outcome was the adverse gastrointestinal event rate. One hundred sixty-two patients met the entry criteria (72 oral PPIs, 90 IV PPIs). The difference in the rate of adverse gastrointestinal events between the two groups was 1% (P = 0.85). Postendoscopic IV PPI use was associated with an odds ratio of 1.01 for developing an adverse outcome versus oral PPIs (95% CI: 0.44-2.33). We conclude that oral PPIs are probably equivalent to IV PPIs for preventing rebleeding in ANVUGIB patients.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. Growth differentiation factor-15 level predicts major bleeding and cardiovascular events in patients with acute coronary syndromes: results from the PLATO study.

    Science.gov (United States)

    Hagström, Emil; James, Stefan K; Bertilsson, Maria; Becker, Richard C; Himmelmann, Anders; Husted, Steen; Katus, Hugo A; Steg, Philippe Gabriel; Storey, Robert F; Siegbahn, Agneta; Wallentin, Lars

    2016-04-21

    Growth differentiation factor-15 (GDF-15) predicts death and composite cardiovascular (CV) events in patients with acute coronary syndrome (ACS). We investigated the independent associations between GDF-15 levels and major bleeding, the extent of coronary lesions and individual CV events in patients with ACS. Growth differentiation factor-15 was analysed at baseline ( ITALIC! n = 16 876) in patients with ACS randomized to ticagrelor or clopidogrel in the PLATO (PLATelet inhibition and patient Outcomes) trial. Growth differentiation factor-15 levels were related to extent of coronary artery disease (CAD) and to all types of non-coronary artery bypass grafting (CABG)-related major bleeding, spontaneous myocardial infarction (MI), stroke, and death during 12-month follow-up. In Cox proportional hazards models adjusting for established risk factors for CV disease and prognostic biomarkers (N-terminal pro B-type natriuretic peptide, cystatin C, high-sensitive C-reactive protein, and high-sensitive troponin T), 1 SD increase in ln GDF-15 was associated with increased risk of major bleeding with a hazard ratio (HR) 1.37 (95% confidence interval: 1.25-1.51) and with a similar increase in risk across different bleeding locations. For the same increase in ln GDF-15, the HR for the composite of CV death, spontaneous MI, and stroke was 1.29 (1.21-1.37), CV death 1.41 (1.30-1.53), all-cause death 1.41 (1.31-1.53), spontaneous MI 1.15 (1.05-1.26), and stroke 1.19 (1.01-1.42). The ITALIC! C-statistic improved for the prediction of CV death and non-CABG-related major bleeding when adding GDF-15 to established risk factors. In patients with ACS, higher levels of GDF-15 are associated with raised risks of all types of major non-CABG-related bleeding, spontaneous MI, and stroke as well as CV and total mortality and seem to improve risk stratification for CV-mortality and major bleeding beyond established risk factors. www.clinicaltrials.gov; NCT00391872. Published on behalf of the

  2. Splenosis: a rare cause of gastrointestinal bleeding successfully treated with transarterial embolization.

    Science.gov (United States)

    Leitz, Evan M; Kwan, Sharon W

    2015-06-01

    Splenosis, the ectopic implantation of splenic tissue, most commonly occurs in the peritoneal cavity following traumatic splenic injury with subsequent splenectomy. This entity is asymptomatic in a vast majority of patients. Occult gastrointestinal (GI) bleeding is a relatively rare presentation of splenosis. Previous cases of splenosis resulting in refractory GI bleeding have been treated with surgical excision of the ectopic splenic implant. We report a case of splenosis presenting as occult GI bleeding that was eventually treated with transarterial embolization. This presents an alternative minimally invasive approach to treating a patient with refractory GI bleeding secondary to splenosis.

  3. Osteoprotegerin Is Associated With Major Bleeding But Not With Cardiovascular Outcomes in Patients With Acute Coronary Syndromes: Insights From the PLATO (Platelet Inhibition and Patient Outcomes) Trial.

    Science.gov (United States)

    Ueland, Thor; Åkerblom, Axel; Ghukasyan, Tatevik; Michelsen, Annika E; Aukrust, Pål; Becker, Richard C; Bertilsson, Maria; Himmelmann, Anders; James, Stefan K; Siegbahn, Agneta; Storey, Robert F; Kontny, Frederic; Wallentin, Lars

    2018-01-12

    Elevated levels of osteoprotegerin, a secreted tumor necrosis factor-related molecule, might be associated with adverse outcomes in patients with coronary artery disease. We measured plasma osteoprotegerin concentrations on hospital admission, at discharge, and at 1 and 6 months after discharge in a predefined subset (n=5135) of patients with acute coronary syndromes in the PLATO (Platelet Inhibition and Patient Outcomes) trial. The associations between osteoprotegerin and the composite end point of cardiovascular death, nonprocedural spontaneous myocardial infarction or stroke, and non-coronary artery bypass grafting major bleeding during 1 year of follow-up were assessed by Cox proportional hazards models. Event rates of the composite end point per increasing quartile groups at baseline were 5.2%, 7.5%, 9.2%, and 11.9%. A 50% increase in osteoprotegerin level was associated with a hazard ratio (HR) of 1.31 (95% confidence interval [CI], 1.21-1.42) for the composite end point but was not significant in adjusted analysis (ie, clinical characteristics and levels of C-reactive protein, troponin T, NT-proBNP [N-terminal pro-B-type natriuretic peptide], and growth differentiation factor-15). The corresponding rates of non-coronary artery bypass grafting major bleeding were 2.4%, 2.2%, 3.8%, and 7.2%, with an unadjusted HR of 1.52 (95% CI, 1.36-1.69), and a fully adjusted HR of 1.26 (95% CI, 1.09-1.46). The multivariable association between the osteoprotegerin concentrations and the primary end point after 1 month resulted in an HR of 1.09 (95% CI, 0.89-1.33); for major bleeding after 1 month, the HR was 1.33 (95% CI, 0.91-1.96). In patients with acute coronary syndrome treated with dual antiplatelet therapy, osteoprotegerin was an independent marker of major bleeding but not of ischemic cardiovascular events. Thus, high osteoprotegerin levels may be useful in increasing awareness of increased bleeding risk in patients with acute coronary syndrome receiving

  4. Small bowel metastasis from lung cancer: a possible cause of acute abdomen. Case report and literature review.

    Science.gov (United States)

    Bugiantella, W; Cavazzoni, E; Graziosi, L; Valiani, S; Franceschini, M S; Donini, A

    2011-03-01

    Lung cancer represents the leading cause of tumor death in the world with 50% of patients presenting metastatic disease at the time of diagnosis. Gastrointestinal (GI) lung cancer metastasis were thought to be extremely rare, but a much higher incidence has been noted in several autoptic reports. Clinical relevance of GI metastasis is low, but can increase with the higher number of newly diagnosed patients and with the efficacy of systemic chemotherapy in advanced stages. Prognosis of complicated GI lung cancer metastasis seems to be worse than the natural course of the disease and acute bleeding or perforation of metastatic site can be accelerated by chemotherapy. We describe the clinical case of a patient presenting with acute abdomen due to small bowel perforation from GI lung cancer metastasis. A review of the most recent published literature on GI lung cancer metastasis was performed. GI metastasis from lung cancer may occur within the clinical course of the disease and require surgical treatment followed by a poor outcome. Percentage of lung cancer patients with GI metastasis can reach level of 14%. Large cells carcinomas causing kidney and adrenal metastasis are more likely associated with GI localization of the disease. Complications of GI metastases, although rare, must be considered as possible cause of acute abdomen in patients with lung cancer. Identification of clinical indicators of GI metastasis may help in the therapeutic strategy.

  5. Preface Gi4DM

    NARCIS (Netherlands)

    Zlatanova, S.; Sithole, G.; Nakagawa, M.; Zhu, Q.

    2015-01-01

    Gi4DM 2015 marks the 10th edition of the Geoinformation for Disaster Management series of conferences. The first conference in 2005 was held in the aftermath of the 2004 Indian Ocean earthquake and tsunami which claimed the lives of over 220000 civilians. While Geoinformatics has a long been used in

  6. Emergency laparoscopic conversion from mini/one anastomosis gastric bypass to modified Roux-en-Y-gastric bypass due to acute bleeding from a recurrent marginal ulcer.

    Science.gov (United States)

    Godina, Mario; Nagliati, Carlo; Menegon, Paola; Caruso, Valentina

    2017-09-01

    Our aim is to present the laparoscopic technique of an emergency revisional procedure performed to convert a mini/one anastomosis gastric bypass (MGB/OAGB) to a modified Roux-en-Y-gastric-bypass (RYGB) due to recurrent bleeding from a marginal ulcer. A 43 year old woman presented unstable conditions due to acute bleeding from a marginal ulcer after a MGB/OAGB performed 3 years before. After three failed endoscopic haemostasis attempts, she underwent a laparoscopic conversion to a modified RYGB in emergency setting. The patient had an uneventful recovery. She maintained heamodynamical stability after the procedure. She was eventually discharged in the seventh postoperative day after restarting oral feeding on chronic proton pump inhibitors. To our knowledge, there are few descriptions of emergency surgical conversion from a MGB/OAGB to a modified laparoscopic RYGB due to a recurrent marginal ulcer bleeding not responsive to endoscopic treatment. A regular post-operative follow-up is mandatory after bariatric surgery. We advocate performing revisional surgery in an experienced Bariatric Center.

  7. Refrigerated Platelets for the Treatment of Acute Bleeding: A Review of the Literature and Reexamination of Current Standards

    Science.gov (United States)

    2014-01-01

    circulation (10). Platelets participate in immunomodulation, maintenance and repair of vessel structures , and, their best-known function, clot forma...adults taking aspirin demonstrated that 4C-PLTs had significantly improved bleeding times in contrast to those at RT, which had little or delayed effects...1974. 20. Valeri CR: Circulation and hemostatic effectiveness of platelets stored at 4 C or 22 C: studies in aspirin -treated normal volunteers

  8. Outcome of holiday and nonholiday admission patients with acute peptic ulcer bleeding: a real-world report from southern Taiwan.

    Science.gov (United States)

    Wu, Tsung-Chin; Chuah, Seng-Kee; Chang, Kuo-Chin; Wu, Cheng-Kun; Kuo, Chung-Huang; Wu, Keng-Liang; Chiu, Yi-Chun; Hu, Tsung-Hui; Tai, Wei-Chen

    2014-01-01

    Recent findings suggest that patients admitted on the weekend with peptic ulcer bleeding might be at increased risk of adverse outcomes. However, other reports found that there was no "holiday effect." The purpose of this study was to determine if these findings hold true for a real-life Taiwanese medical gastroenterology practice. We reviewed the medical files of hospital admissions for patients with peptic ulcer bleeding who received initial endoscopic hemostasis between January 2009 and March 2011. A total of 744 patients were enrolled (nonholiday group, n = 615; holiday group, n = 129) after applying strict exclusion criteria. Holidays were defined as weekends and national holidays in Taiwan. Our results showed that there was no significant difference in baseline characteristics between the two groups. We also observed that, compared to the nonholiday group, patients in the holiday group received earlier endoscopy treatment (12.20 hours versus 16.68 hours, P = 0.005), needed less transfused blood (4.8 units versus 6.6 units, P = 0.02), shifted from intravenous to oral proton-pump inhibitors (PPIs) more quickly (5.3 days versus 6.9 days, P = 0.05), and had shorter hospital stays (13.05 days versus 17.36 days, P = 0.005). In the holiday and nonholiday groups, the rebleeding rates were 17.8% and 23.41% (P = 0.167), the mortality rates were 11.63% versus 13.66% (P = 0.537), and surgery was required in 2.11% versus 4.66% (P = 0.093), respectively. Patients who presented with peptic ulcer bleeding on holidays did not experience delayed endoscopy or increased adverse outcomes. In fact, patients who received endoscopic hemostasis on the holiday had shorter waiting times, needed less transfused blood, switched to oral PPIs quicker, and experienced shorter hospital stays.

  9. Gastrointestinal Bleeding in Patients With Atrial Fibrillation Treated With Rivaroxaban or Warfarin: ROCKET AF Trial.

    Science.gov (United States)

    Sherwood, Matthew W; Nessel, Christopher C; Hellkamp, Anne S; Mahaffey, Kenneth W; Piccini, Jonathan P; Suh, Eun-Young; Becker, Richard C; Singer, Daniel E; Halperin, Jonathan L; Hankey, Graeme J; Berkowitz, Scott D; Fox, Keith A A; Patel, Manesh R

    2015-12-01

    Gastrointestinal (GI) bleeding is a common complication of oral anticoagulation. This study evaluated GI bleeding in patients who received at least 1 dose of the study drug in the on-treatment arm of the ROCKET AF (Rivaroxaban Once-daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) trial. The primary outcome was adjudicated GI bleeding reported from first to last drug dose + 2 days. Multivariable modeling was performed with pre-specified candidate predictors. Of 14,236 patients, 684 experienced GI bleeding during follow-up. These patients were older (median age 75 years vs. 73 years) and less often female. GI bleeding events occurred in the upper GI tract (48%), lower GI tract (23%), and rectum (29%) without differences between treatment arms. There was a significantly higher rate of major or nonmajor clinical GI bleeding in rivaroxaban- versus warfarin-treated patients (3.61 events/100 patient-years vs. 2.60 events/100 patient-years; hazard ratio: 1.42; 95% confidence interval: 1.22 to 1.66). Severe GI bleeding rates were similar between treatment arms (0.47 events/100 patient-years vs. 0.41 events/100 patient-years; p = 0.39; 0.01 events/100 patient-years vs. 0.04 events/100 patient-years; p = 0.15, respectively), and fatal GI bleeding events were rare (0.01 events/100 patient-years vs. 0.04 events/100 patient-years; 1 fatal events vs. 5 fatal events total). Independent clinical factors most strongly associated with GI bleeding were baseline anemia, history of GI bleeding, and long-term aspirin use. In the ROCKET AF trial, rivaroxaban increased GI bleeding compared with warfarin. The absolute fatality rate from GI bleeding was low and similar in both treatment arms. Our results further illustrate the need for minimizing modifiable risk factors for GI bleeding in patients on oral anticoagulation. Copyright © 2015 American College of Cardiology Foundation. Published by

  10. Outcome of acute nonvariceal gastrointestinal haemorrhage after nontherapeutic arteriography compared with embolization

    Energy Technology Data Exchange (ETDEWEB)

    Defreyne, Luc; Vanlangenhove, Peter [Department of Vascular and Interventional Radiology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent (Belgium); Decruyenaere, Johan [Department of Intensive Care, Ghent University Hospital, De Pintelaan 185, 9000, Ghent (Belgium); Van Maele, Georges [Department of Medical Informatics and Statistics, Ghent University Hospital, De Pintelaan 185, 9000, Ghent (Belgium); De Vos, Martine [Department of Gastroenterology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent (Belgium); Troisi, Roberto [Department of Hepatobiliary Surgery, Ghent University Hospital, De Pintelaan 185, 9000, Ghent (Belgium); Pattyn, Piet [Department of Gastrointestinal Surgery, Ghent University Hospital, De Pintelaan 185, 9000, Ghent (Belgium)

    2003-12-01

    In acute nonvariceal gastrointestinal (GI) bleeding, immediate arteriographic haemostasis is presently assumed to be a therapeutic advantage. This study assesses whether the risk of a delayed haemostasis, caused by arteriographic findings precluding embolization, might influence patient outcome. We performed a 5.5-year retrospective database search to find all patients referred for arteriography to arrest acute nonvariceal GI bleeding with embolization. The embolized and nonembolized patients were compared for differences in baseline characteristics and bleeding parameters. In both groups the outcome of all endoscopic or surgical interventions after catheterization was included in the follow-up. Clinical success (at 30 days, after all therapy) and in-hospital mortality in the embolized and nonembolized group were compared. We retrieved 63 nonembolized bleedings in 58 patients and 49 embolized bleedings in 49 patients. In the nonembolized group, transfusion need and haemodynamic instability were significantly less severe. Forty-two of 63 (66%) nonembolized bleedings persisted requiring haemostasis by surgery (n=23), endoscopy (n=13) or supportive transfusions. Thirteen of 49 (27%) embolized bleedings recurred and were managed by surgery (n=7), endoscopy (n=3) or transfusion. Overall clinical success rate was 88.9% (56 of 63) in the nonembolized and 87.8% (43 of 49) in the embolized group. Mortality rate was 17.2% (10 of 58) in the nonembolized vs 30.6% (15 of 49) in the embolized patients (P=0.115). Whether or not arteriographic findings afforded the opportunity to embolize, outcome of acute nonvariceal GI bleeding did not differ significantly; however, patients undergoing embolization were more critically bleeding and ill. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Moon Han Choi

    2013-09-01

    Full Text Available Background/AimsThe 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.MethodsNinety-three patients at Soonchunhyang University Hospital with acute GVB who received GVO using Histoacryl® were enrolled between June 2001 and March 2010. Among these, 42 patients underwent GVO alone (GVO group and 51 patients underwent GVO with adjuvant BB therapy (GVO+BB group. This study was intended for patients in whom a desired heart rate was reached. The rates of rebleeding-free survival and overall survival were calculated for the two study groups using Kaplan-Meyer analysis and Cox's proportional-hazards model.ResultsThe follow-up period after the initial eradication of gastric varices was 18.14±25.22 months (mean±SD. During the follow-up period, rebleeding occurred in 10 (23.8% and 21 (41.2% GVO and GVO+BB patients, respectively, and 39 patients died [23 (54.8% in the GVO group and 16 (31.4% in the GVO+BB group]. The mean rebleeding-free survival time did not differ significantly between the GVO and GVO+BB groups (65.40 and 37.40 months, respectively; P=0.774, whereas the mean overall survival time did differ (52.54 and 72.65 months, respectively; P=0.036.Conclusions Adjuvant BB therapy after GVO using Histoacryl® for the first acute episode of GVB could decrease the mortality rate relative to GVO alone. However, adjuvant BB therapy afforded no benefit for the secondary prevention of rebleeding in GV.

  12. Menorrhagia (Heavy Menstrual Bleeding)

    Science.gov (United States)

    Menorrhagia (heavy menstrual bleeding) Overview Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. Although heavy menstrual bleeding is a common concern, ...

  13. Effect of omeprazole dose, nonsteroidal anti-inflammatory agents, and smoking on repair mechanisms in acute peptic ulcer bleeding.

    Science.gov (United States)

    Rantanen, Tuomo; Udd, Marianne; Honkanen, Teemu; Miettinen, Pekka; Kärjä, Vesa; Rantanen, Lassi; Julkunen, Risto; Mustonen, Harri; Paavonen, Timo; Oksala, Niku

    2014-11-01

    Peptic ulcer bleeding (PUB) is a major cause of upper gastrointestinal bleeding. The effect of omeprazole on mucosal repair is unknown. We studied the effect of omeprazole, nonsteroidal anti-inflammatory agents, and smoking on PUB. There were 43 PUB patients who received regular or high dose of omeprazole for 72 h. Biopsies from antrum and corpus were taken before and after treatment. Biopsy samples from 20 celiac disease patients worked as controls. The expression of Ki-67, Bcl-2, COX-2, Hsp27, and Hsp70 was analyzed from patients and controls. Bcl-2 expression in PUB patients was lower than in controls. However, Bcl-2 increased significantly from 5.0 (SD 4.5) to 9.1 % (SD 6.7), p = 0.0004, in the antrum after omeprazole. In univariate analysis, a high omeprazole dose caused a more profound increase in Ki-67 expression in the corpus: 35.3 % (SD 54.8) than a regular dose: -10.1 % (SD 40.6), p = 0.022. In multivariate analysis, Ki-67 decreased significantly in the corpus between the pre- and posttreatment period (p = 0.011), while a high omeprazole dose (p = 0.0265), the use of NSAIDs (p = 0.0208), and smoking (p = 0.0296) significantly increased Ki-67 expression. Bcl-2 in the corpus increased significantly (p = 0.0003) after treatment. Our findings suggest that Bcl-2 may be an important factor in the pathogenesis of a peptic ulcer and PUB. In addition, high-dose omeprazole increased the expression of Ki-67, which may enhance the healing process of a peptic ulcer.

  14. Increased serum levels of fibrinogen degradation products due to treatment with recombinant tissue-type plasminogen activator for acute myocardial infarction are related to bleeding complications, but not to coronary patency

    NARCIS (Netherlands)

    R.W. Brower (Ronald); D. Collen; G.A. van Es (Gerrit Anne); J. Lubsen (Jacob); P.W.J.C. Serruys (Patrick); M.L. Simoons (Maarten); M. Verstraete (Marc); A.E.R. Arnold (Alfred)

    1989-01-01

    textabstractThe association of increasing serum levels of fibrinogen degradation products after recombinant tissue-type plasminogen activator (rt-PA) therapy with bleeding and early coronary patency was assessed in 242 patients with acute myocardial infarction. After administration of 5,000 IU

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

    DEFF Research Database (Denmark)

    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......, higher age, endothelial cell activation and damage, and leukocytosis. We suggest that platelet dysfunction and leukocytosis in AML causes endothelial perturbation....

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

    Energy Technology Data Exchange (ETDEWEB)

    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. Outcomes following acute nonvariceal upper gastrointestinal bleeding in relation to time to endoscopy: results from a nationwide study.

    Science.gov (United States)

    Jairath, V; Kahan, B C; Logan, R F A; Hearnshaw, S A; Doré, C J; Travis, S P L; Murphy, M F; Palmer, K R

    2012-08-01

    Despite the established efficacy of therapeutic endoscopy, the optimum timeframe for performing endoscopy in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) remains unclear. The aim of the current audit study was to examine the relationship between time to endoscopy and clinical outcomes in patients presenting with NVUGIB. This study was a prospective national audit performed in 212 UK hospitals. Regression models examined the relationship between time to endoscopy and mortality, rebleeding, need for surgery, and length of hospital stay. In 4478 patients, earlier endoscopy ( 24 hours) endoscopy (odds ratio [OR] for mortality 0.98, 95 % confidence interval [CI] 0.88 - 1.09 for endoscopy > 24 hours vs. endoscopy, there was a nonsignificant trend towards an increase in rebleeding associated with later endoscopy (OR 1.13, 95 %CI 0.97 - 1.32 for endoscopy > 24 hours vs. endoscopy (OR 0.83, 95 %CI 0.73 - 0.95 for endoscopy > 24 hours vs. endoscopy ( > 24 hours) was associated with an increase in risk-adjusted length of hospital stay (1.7 days longer, 95 %CI 1.39 - 1.99 vs. endoscopy was not associated with a reduction in mortality or need for surgery. However, it was associated with an increased efficiency of care and potentially improved control of hemorrhage in higher risk patients, supporting the routine use of early endoscopy unless specific contraindications exist. These results may help inform the debate about emergency endoscopy service provision. © Georg Thieme Verlag KG Stuttgart · New York.

  18. The risk of gastrointestinal bleeding in patients receiving dabigatran etexilate: a systematic review and meta-analysis of the literature.

    Science.gov (United States)

    Di Minno, Matteo Nicola Dario; Ambrosino, Pasquale; Di Minno, Alessandro; Tremoli, Elena; Di Minno, Giovanni

    2017-06-01

    Evidence on the risk of gastrointestinal (GI) bleeding associated with dabigatran etexilate (DE) is contrasting. We performed a meta-analysis of literature to address this issue. Studies on GI bleeding risk in patients receiving DE or vitamin-K antagonists (VKA) were systematically searched. Twenty-three studies (26 datasets) showed no difference in the GI bleeding risk between the 250,871 patients treated with DE and the 460,386 receiving VKA (OR: 1.052, 95% CI: 0.815, 1.359). Similar results were obtained when pooling together adjusted ORs/HRs, obtained by means of multivariate analysis (OR: 1.06, 95% CI: 0.914, 1.222). Compared with VKA, DE use was associated with a significantly lower risk of upper GI (OR: 0.742, 95% CI: 0.569, 0.968), but not of lower GI bleedings (OR: 1.208, 95% CI: 0.902, 1.619). Furthermore, no significant difference in the GI bleeding risk was found when data on DE 110 mg and DE 150 mg twice-daily were separately compared with VKA. No difference in GI bleeding risk was found between DE and VKA. These results were confirmed for both dosages of DE and when specifically analyzing lower GI bleeding. In contrast, the risk of upper GI bleeding was lower with DE than with VKA. KEY MESSAGES No difference in the risk of gastrointestinal (GI) bleeding can be found between dabigatran etexilate (DE) and vitamin K-antagonists (VKA). These results are confirmed for both dosages of DE. The risk of upper GI bleeding is lower with DE than with VKA.

  19. Risks of bleeding and thrombosis in intensive care unit patients with haematological malignancies.

    Science.gov (United States)

    Russell, Lene; Holst, Lars Broksø; Kjeldsen, Lars; Stensballe, Jakob; Perner, Anders

    2017-12-11

    Patients with malignant haematological disease and especially those who require intensive care have an increased risk of bleeding and thrombosis, but none of these data were obtained in ICU patients only. We assessed the incidence of bleeding and thrombotic complications, use of blood products and risk factors for bleeding in an adult population of ICU patients with haematological malignancies. We screened all patients with acute leukaemia and myelodysplastic syndrome admitted to a university hospital ICU during 2008-2012. Bleeding in ICU was scored according to the WHO grading system, and risk factors were evaluated using unadjusted and adjusted analyses. In total, 116 of 129 ICU patients were included; their median length of stay was 7 (IQR 2-16) days. Of these, 66 patients (57%) had at least one bleeding episode in ICU; they bled for 3 (2-6) days and most often from lower and upper airways and upper GI tract. Thirty-nine (59%) of the 66 patients had severe or debilitating (WHO grade 3 or 4) bleeding. The median platelet count on the day of grade 3 or 4 bleeding was 23 × 109 per litre (IQR 13-39). Nine patients (8%) died in ICU following a bleeding episode; five of these had intra-cerebral haemorrhage. Platelet count on admission was associated with subsequent bleeding (adjusted odds ratio 1.18 (95% CI 1.03-1.35) for every 10 × 109 per litre drop in platelet count, p = 0.016). Eleven of the 116 patients (9%) developed a clinically significant thrombosis in ICU, which was the cause of death in four patients. The median platelet count was 20 × 109 per litre (15-48) at the time of thrombosis. The patients received a median of 6 units of red blood cells, 1 unit of fresh frozen plasma and 8 units of platelet concentrates in ICU. Severe and debilitating bleeding complications were frequent in our ICU patients with haematological malignancies, but thrombosis also occurred in spite of low platelet counts. Platelet count on ICU admission was associated with

  20. Novel capsules for potential theranostics of obscure gastrointestinal bleedings.

    Science.gov (United States)

    Çolak, Bayram; Şakalak, Hüseyin; Çavuşoğlu, Halit; Yavuz, Mustafa Selman

    2016-09-01

    Obscure gastrointestinal (GI) bleeding is identified as persistent or repeated bleeding from the gastrointestinal tract which could not be defined by conventional gastrointestinal endoscopy and radiological examinations. These GI bleedings are assessed through invasive diagnostic and treatment methods including enteroscopy, angiography and endoscopy. In addition, video capsule endoscopy (VCE) is a non-invasive method used to determine the location of the bleeding, however, this does not provide any treatment. Despite of these successful but invasive methods, an effective non-invasive treatment is desperately needed. Herein, we prepare non-invasive theranostic capsules to cure obscure GI bleeding. An effective theranostic capsule containing endothelin as the targeting agent, thrombin-fibrinogen or fibrin as the treating agent, and fluorescein dye as the diagnostic tool is suggested. These theranostic capsules can be administered orally in a simple and non-invasive manner without a risk of complication. By using these novel capsules, one can diagnose obscure GI bleeding with having a possibility of curing. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Bleeding in children with cancer

    African Journals Online (AJOL)

    Overt bleeding from the oral mucosa, nose and rectum may occur, as well as haematuria. Intracranial haemorrhage is sometimes present at diagnosis and can of .... include allergic reactions, febrile reactions, transfusion-related acute lung injury. (TRALI), graft-versus-host disease (GVHD), anaphylaxis and haemolysis.

  2. Multicenter Evaluation of Octreotide as Secondary Prophylaxis in Patients With Left Ventricular Assist Devices and Gastrointestinal Bleeding.

    Science.gov (United States)

    Shah, Keyur B; Gunda, Sampath; Emani, Sitaramesh; Kanwar, Manreet K; Uriel, Nir; Colombo, Paolo C; Uber, Patricia A; Sears, Melissa L; Chuang, Joyce; Farrar, David J; Brophy, Donald F; Smallfield, George B

    2017-11-01

    Gastrointestinal (GI) bleeding is one of the most common complications after continuous-flow left ventricular assist device implantation. More than one third of patients with incident bleed go on to develop recurrent GI bleeding. Octreotide, a somatostatin analog, is proposed to reduce the risk of recurrent GI bleeding in this population. This multicenter, retrospective analysis evaluated 51 continuous-flow left ventricular assist device patients who received secondary prophylaxis with octreotide after their index GI bleed from 2009 to 2015. All patients had a hospitalization for GI bleed and received octreotide after discharge. Patient demographics, medical and medication history, and clinical characteristics of patients who rebled after receiving octreotide were compared with non-rebleeders. These data were also compared with matched historical control patients previously enrolled in the HMII (HeartMate II) clinical trials, none of whom received octreotide, to provide a context for the bleeding rates. Twelve patients (24%) who received secondary octreotide prophylaxis developed another GI bleed, whereas 39 (76%) did not. There were similar intergroup demographics; however, significantly more bleeders had a previous GI bleeding history before left ventricular assist device placement (33% versus 5%; P=0.02) and greater frequency of angiodysplasia confirmed during endoscopy (58% versus 23%; P=0.03). Fewer patients in this study experienced a recurrent GI bleed compared with a matched historical control group that did not receive octreotide (24% versus 43%; P=0.04). Patients with continuous-flow left ventricular assist device receiving secondary prophylaxis with octreotide had a significantly lower GI bleed recurrence compared with historical controls not treated with octreotide. Additional prospective studies are needed to confirm these data. © 2017 American Heart Association, Inc.

  3. Understanding Minor Rectal Bleeding

    Science.gov (United States)

    ... Understanding Minor Rectal Bleeding What are the possible causes of minor rectal bleeding? Hemorrhoids Anal fissures Proctitis (inflammation of the rectum) Polyps Colon or anal cancer Rectal ulcers Understanding Minor Rectal Bleeding Minor rectal ...

  4. Acute Myocardial Infarction Risk in Patients with Coronary Artery Disease Doubled after Upper Gastrointestinal Tract Bleeding: A Nationwide Nested Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Chia-Jung Wu

    Full Text Available Prior studies of upper gastrointestinal bleeding (UGIB and acute myocardial infarction (AMI are small, and long-term effects of UGIB on AMI have not been delineated. We investigated whether UGIB in patients diagnosed with coronary artery disease (CAD increased their risk of subsequent AMI. This was a population-based, nested case-control study using Taiwan's National Health Insurance Research Database. After propensity-score matching for age, gender, comorbidities, CAD date, and follow-up duration, we identified 1,677 new-onset CAD patients with AMI (AMI[+] between 2001 and 2006 as the case group and 10,062 new-onset CAD patients without (AMI[-] as the control group. Conditional logistic regression was used to examine the association between UGIB and AMI. Compared with UGIB[-] patients, UGIB[+] patients had twice the risk for subsequent AMI (adjusted odds ratio [AOR] = 2.08; 95% confidence interval [CI], 1.72-2.50. In the subgroup analysis for gender and age, UGIB[+] women (AOR = 2.70; 95% CI, 2.03-3.57 and patients < 65 years old (AOR = 2.23; 95% CI, 1.56-3.18 had higher odds of an AMI. UGIB[+] AMI[+] patients used nonsignificantly less aspirin than did UGIB[-] AMI[+] patients (27.69% vs. 35.61%, respectively. UGIB increased the risk of subsequent AMI in CAD patients, especially in women and patients < 65. This suggests that physicians need to use earlier and more aggressive intervention to detect UGIB and prevent AMI in CAD patients.

  5. Feasibility of continuous, catheter-directed thrombolysis using low-dose urokinase in combination with low molecular-weight heparin for acute iliofemoral venous thrombosis in patients at risk of bleeding.

    Science.gov (United States)

    Chen, Guoping; Shi, Wangyin; He, Xu; Lou, Wensheng; Chen, Liang; Gu, Jianping

    2017-02-01

    The present study aimed to examine the feasibility of catheter-directed thrombolysis (CDT) using continuous infusion of low-dose urokinase in combination with low molecular weight heparin (LMWH) for acute iliofemoral venous thrombosis. This retrospective analysis included patients with symptomatic acute iliofemoral venous thrombosis who received CDT using continuous infusion of low-dose urokinase in combination with LMWH within the past four years. Urokinase was administered at 1×104 U/h and 2×104 U/h in patients at high-risk and low-risk of bleeding, respectively. Measurements included urokinase dosage, duration, clinical outcomes and CDT-related complications. A total of 46 patients were included (high-risk, n=17; low-risk, n=29). In the high-risk patients, 64.7% experienced dissolution of ≥50% thrombi after a median CDT duration of 8 days (range, 6-10 days) and median total urokinase dose of 1.92×106 units (range, 1.44-2.4×106 units). In the low-risk patients, 82.8% achieved dissolution of ≥50% thrombi after a median CDT duration of 7 days (range, 4-10 days) and a median total urokinase dose of 3.36×106 units (range, 1.92-4.80×106 units). Remission of clinical symptoms after CDT was achieved in 15 (88.2%) and 28 (96.6%) cases in high-risk and low-risk patients, respectively. No treatment-associated pulmonary embolism or major bleeding was observed. Three (6.5%) subjects (high-risk, n=1; low-risk, n=2) experienced minor bleeding. In conclusion, continuous infusion of low-dose urokinase via CDT in combination with LMWH is effective and safe for acute iliofemoral venous thrombosis in patients with one or more risk factor for bleeding.

  6. Small Bowel Bleeding

    Science.gov (United States)

    ... Patient Education & Resource Center GI Health and Disease Recursos en Español What is a Gastroenterologist Video and ... Education & Resource Center Home GI Health and Disease Recursos en Español What is a Gastroenterologist? Podcasts and ...

  7. ArterioVenous Malformation within Jejunal Diverticulum: An Unusual Cause of Massive Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Jeffrey K. Lee

    2009-01-01

    Full Text Available Massive gastrointestinal (GI bleeding can occur with multiple jejunal diverticulosis. However, significant bleeding in the setting of few diverticulae is very unusual and rare. We report a case of massive gastrointestinal bleeding from an arteriovenous malformation (AVM within a jejunal diverticulum to underscore the significance of such coexisting pathologies. Mesenteric angiogram was chosen to help identify the source of bleeding and to offer an intervention. Despite endovascular coiling, emergent intestinal resection of the bleeding jejunal segment was warranted to ensure definitive treatment. However several reports have shown jejunal diverticulosis as a rare cause of massive GI bleeding. The coexistence of jejunal diverticulum and AVM is rare and massive bleeding from an acquired Dieulafoy-like AVM within a diverticulum has never previously been described. Awareness of Dieulafoy-like AVM within jejunoileal diverticulosis is useful in preventing delay in treatment.

  8. ArterioVenous Malformation within Jejunal Diverticulum: An Unusual Cause of Massive Gastrointestinal Bleeding

    Science.gov (United States)

    Lee, Jeffrey K.; Carethers, John M.; Ghosh, Pradipta

    2009-01-01

    Massive gastrointestinal (GI) bleeding can occur with multiple jejunal diverticulosis. However, significant bleeding in the setting of few diverticulae is very unusual and rare. We report a case of massive gastrointestinal bleeding from an arteriovenous malformation (AVM) within a jejunal diverticulum to underscore the significance of such coexisting pathologies. Mesenteric angiogram was chosen to help identify the source of bleeding and to offer an intervention. Despite endovascular coiling, emergent intestinal resection of the bleeding jejunal segment was warranted to ensure definitive treatment. However several reports have shown jejunal diverticulosis as a rare cause of massive GI bleeding. The coexistence of jejunal diverticulum and AVM is rare and massive bleeding from an acquired Dieulafoy-like AVM within a diverticulum has never previously been described. Awareness of Dieulafoy-like AVM within jejunoileal diverticulosis is useful in preventing delay in treatment. PMID:19753317

  9. A clinically viable capsule endoscopy video analysis platform for automatic bleeding detection

    Science.gov (United States)

    Yi, Steven; Jiao, Heng; Xie, Jean; Mui, Peter; Leighton, Jonathan A.; Pasha, Shabana; Rentz, Lauri; Abedi, Mahmood

    2013-02-01

    In this paper, we present a novel and clinically valuable software platform for automatic bleeding detection on gastrointestinal (GI) tract from Capsule Endoscopy (CE) videos. Typical CE videos for GI tract run about 8 hours and are manually reviewed by physicians to locate diseases such as bleedings and polyps. As a result, the process is time consuming and is prone to disease miss-finding. While researchers have made efforts to automate this process, however, no clinically acceptable software is available on the marketplace today. Working with our collaborators, we have developed a clinically viable software platform called GISentinel for fully automated GI tract bleeding detection and classification. Major functional modules of the SW include: the innovative graph based NCut segmentation algorithm, the unique feature selection and validation method (e.g. illumination invariant features, color independent features, and symmetrical texture features), and the cascade SVM classification for handling various GI tract scenes (e.g. normal tissue, food particles, bubbles, fluid, and specular reflection). Initial evaluation results on the SW have shown zero bleeding instance miss-finding rate and 4.03% false alarm rate. This work is part of our innovative 2D/3D based GI tract disease detection software platform. While the overall SW framework is designed for intelligent finding and classification of major GI tract diseases such as bleeding, ulcer, and polyp from the CE videos, this paper will focus on the automatic bleeding detection functional module.

  10. 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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  11. Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft

    Directory of Open Access Journals (Sweden)

    Nirmit Desai

    2013-01-01

    Full Text Available We present a case of a patient with a failed pancreaticoduodenal allograft with exocrine enteric-drainage who developed catastrophic gastrointestinal (GI hemorrhage. Over the course of a week, she presented with recurrent GI bleeds of obscure etiology. Multiple esophago-gastro-duodenoscopic (EGD and colonoscopic evaluations failed to reveal the source of the hemorrhage. A capsule endoscopy and a technetium-labeled red blood cells (RBC imaging study were similarly unrevealing for source of bleeding. She subsequently developed hemorrhagic shock requiring emergent superior mesenteric arteriography. Run off images revealed an external iliac artery aneurysm with fistulization into the jejunum. Coiled embolization was attempted but abandoned because of hemodynamic instability. Deployment of a covered endovascular stent into the right external iliac artery over the fistula site resulted in immediate hemodynamic stabilization. A high index of suspicion for arterioenteric fistulae is needed for diagnosis of this uncommon but eminently treatable form of GI hemorrhage in this patient population.

  12. Gastrin and upper GI cancers.

    Science.gov (United States)

    Hayakawa, Yoku; Chang, Wenju; Jin, Guangchun; Wang, Timothy C

    2016-12-01

    Gastrin was initially identified as the hormone primarily responsible for gastric acid secretion, but was subsequently shown to be a growth factor for the proximal stomach, acting through the gastrin receptor CCK2R. Studies in the past several decades have explored the role of gastrin, along with its incompletely processed precursors, in cancer development. The growth in long-term PPI use has frequently led to elevations in serum gastrin levels in patients with upper GI disease, including GERD, peptic ulcers, and chronic gastritis. However, while accumulated evidence has shown that gastrin likely does not promote-and may even suppress-distal antral gastric cancer, questions have now arisen regarding possible effects of gastrin on the development of gastric cardia cancer or esophageal adenocarcinoma at gastroesophageal junction. Here, we provide an overview of the possible roles of these gastrin peptides in upper GI cancer. Copyright © 2016. Published by Elsevier Ltd.

  13. Appendicular bleeding: an excepcional cause of lower hemorrhage

    Directory of Open Access Journals (Sweden)

    Marta Magaz-Martínez

    Full Text Available Chronic complications of acute appendicitis managed in a conservative manner are not frequent. We present a case of acute lower gastrointestinal hemorrhage in a young patient with a previous acute appendicitis without surgical intervention. The colonoscopy detected an appendicular bleeding which was surgically treated. The anatomopathological diagnosis was granulomatous appendicitis. The clinical evolution of the patient was favorable without bleeding recurrence. Appendicular hemorrhage can be an unusual complication -however potentially severe- of acute appendicitis not treated surgically.

  14. Treatment of acute bleeding in acquired haemophilia A with recombinant activated factor VII: analysis of 10-year Japanese postmarketing surveillance data.

    Science.gov (United States)

    Amano, K; Seita, I; Higasa, S; Sawada, A; Kuwahara, M; Shima, M

    2017-01-01

    Patients with acquired haemophilia A (AHA) have autoantibodies against factor VIII (FVIII), and may develop spontaneous bleeding that requires treatment with FVIII inhibitor bypassing agents such as recombinant activated FVII (rFVIIa, NovoSeven® ). However, data regarding the use of rFVIIa are limited. To investigate the use, efficacy and safety of rFVIIa for the treatment of AHA by analysis of 10-year multicentre Japanese postmarketing surveillance data. Treatment regimens, haemostatic efficacy and adverse events were recorded for rFVIIa therapy of AHA patients with bleeding episodes. Treatment was evaluated as markedly effective, effective, moderate or ineffective. Data were collected for 371 bleeding episodes in 132 patients. Bleeding improved after rFVIIa therapy in 92% of episodes (markedly effective in 41%, effective in 10%, moderate in 41%). The response rate was significantly better in patients who received an initial dose of ≥90 μg kg-1 than in those who received an initial dose of <90 μg kg-1 . The response rate was also significantly better when rFVIIa was administered earlier after the onset of bleeding. Twelve serious adverse events were recorded in six patients, including five serious thromboembolic events in three patients who were all elderly with significant comorbidities. This is the largest, single-country study of rFVIIa therapy in AHA patients reported to date. The Japanese surveillance data show comparable efficacy and safety to prior multinational studies. Doses of 90-120 μg kg-1 and prompt initiation of treatment may be important to achieve good bleeding control. © 2016 The Authors. Haemophilia Published by John Wiley & Sons Ltd.

  15. Wireless Capsule Endoscopy for Obscure Gastrointestinal Bleeding: Single Center, One Year Experience

    Directory of Open Access Journals (Sweden)

    Shou-jiang Tang

    2004-01-01

    Full Text Available BACKGROUND: Wireless capsule endoscopy (CE is increasingly being used in the investigation of obscure gastrointestinal (GI bleeding, but some studies have found that many of the bleeding lesions recognized by this technique are within the reach of conventional endoscopy.

  16. Bleeding outcomes after routine transradial primary angioplasty for acute myocardial infarction using eptifibatide and unfractionated heparin: a single-center experience following the HORIZONS-AMI trial.

    Science.gov (United States)

    Moody, William E; Chue, Colin D; Ludman, Peter F; Chan, Yik-Ki C; Narayan, Gautam; Millington, Jenna M; Townend, Jonathan N; Doshi, Sagar N

    2013-09-01

    We sought to (1) determine the bleeding rates after primary percutaneous coronary intervention (PPCI) in our institution, where the default strategy has been transradial (TR) access in combination with unfractionated heparin (UFH) plus eptifibatide, and (2) compare these with the outcomes of patients treated with bivalirudin in HORIZONS-AMI. HORIZONS-AMI demonstrated that in PPCI undertaken via the transfemoral route, routine use of bivalirudin was associated with lower bleeding rates and improved mortality compared to routine use of UFH plus glycoprotein IIb/IIIa inhibitor (GPI). This was a single-center prospective registry of consecutive patients undergoing PPCI from January 2009 to August 2011 at the Queen Elizabeth Hospital Birmingham, UK. Thirty-day major bleeding was defined as per the HORIZONS-AMI criteria and also according to TIMI and GUSTO scales. Of the 432 consecutive patients, 350 fulfilled entry criteria for HORIZONS-AMI. In contrast with HORIZONS-AMI, these subjects were older (62.5 ± 13.7 yr vs. 59.8 ± 11.1 yr, P < 0.05) with a higher rate of cardiogenic shock (6.3% vs. 0.8%, P < 0.0001). Despite this higher risk population, the rate of major bleeding was favorable (3.7% [95% CI: 2.0-6.3%] vs. 4.9% [4.0-6.1%], P = 0.32). Similarly, TIMI major bleeding (2.0% [0.8-4.1%] vs. 3.1% [2.3-3.4%], P = 0.10) and GUSTO severe or life-threatening bleeding (0.6% [0.1-2.5%] vs. 0.4% [0.2-0.9%], P = 0.75) were comparable. Routine TR access for PPCI using UFH plus GPI is associated with a low 30-day rate of major bleeding equivalent to the bivalirudin arm of HORIZONS-AMI. Default transradial access for PPCI permits routine use of a GPI without the penalty of high bleeding rates. Copyright © 2013 Wiley Periodicals, Inc.

  17. Heavy Menstrual Bleeding

    Science.gov (United States)

    ... can cause heavy bleeding. • Medications—Blood thinners and aspirin can cause heavy menstrual bleeding. The copper intrauterine ... on the ovaries, fallopian tubes, and other pelvic structures. Endometrium: The lining of the uterus. Fibroids: Growths, ...

  18. Bleeding and cupping.

    OpenAIRE

    Turk, J L; Allen, E.

    1983-01-01

    Bleeding and cupping have been used in medicine since ancient times in the treatment of fevers and local inflammatory disorders. Local bleeding, by 'wet cupping', was effected by a scarificator or by leeches. John Hunter recommended venesection in moderation but preferred leeches for local bleeding. Bleeding as an accepted therapeutic practice went out of vogue in the middle of the nineteenth century as a result of the introduction of modern scientific methods. Dry cupping and the use of leec...

  19. Bleeding Colonic Diverticula

    OpenAIRE

    Mosquera Klinger, Gabriel; Pontificia Universidad Javeriana-Hospital Universitario San Ignacio; Cañadas Garrido, Raúl; Pontificia Universidad Javeriana-Hospital Universitario San Ignacio

    2014-01-01

    The lower gastrointestinal bleeding is between 10 and 30% of all the patients with gastrointestinal bleeding who visit the emergency room. The etiology is clearly related to age group. The most common cause of gastrointestinal bleeding is diverticular disease and the anatomical site where there is more of diverticula is in the left side, but the site that is related bleeding is the right side. Bleeding diverticular disease is a real urgency in gastroenterology. The need for emergency surgery,...

  20. Jejunal Diverticula Causing Unusual Massive Lower Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Chiong-Hee Wong

    2008-09-01

    Full Text Available Jejunal diverticula are rare and difficult to diagnose. They are often asymptomatic, but they may infrequently cause serious acute complications, such as diverticulitis with or without perforation, volvulus, intussusception, or hemorrhage. Hemorrhage of jejunal diverticula usually presents as lower gastrointestinal bleeding. Diverticula with bleeding may be associated with some anticoagulants, antiplatelets or nonsteroidal antiinflammatory agents in the elderly. In our case, upper gastroscopy and colonoscopy could not easily disclose the bleeding. Selective mesenteric angiography is the gold standard for diagnosis of active and fatal bleeding. The management of a bleeding jejunal diverticulum is surgical resection of the involved segment of jejunum.

  1. Bleeding Risk Related to Upper Gastrointestinal Endoscopic Biopsy in Patients Receiving Antithrombotic Therapy: A Multicenter Prospective Observational Study

    Directory of Open Access Journals (Sweden)

    Takafumi Yuki, MD, PhD

    2017-01-01

    Conclusions: We found no significant increase in upper-GI bleeding risk following an EGD biopsy in patients taking antithrombotic agents, suggesting its safety without the need for antithrombotic treatment interruption.

  2. The cost-effectiveness of high-dose oral proton pump inhibition after endoscopy in the acute treatment of peptic ulcer bleeding.

    Science.gov (United States)

    Barkun, A N; Herba, K; Adam, V; Kennedy, W; Fallone, C A; Bardou, M

    2004-07-15

    Recent data suggest a role for high-dose oral proton pump inhibition in ulcer bleeding. To compare the cost-effectiveness of oral high-dose proton pump inhibition to both high-dose intravenous proton pump inhibition and placebo administration. The model adopted a 30-day time horizon, and focused on patients with ulcer haemorrhage initially treated endoscopically for high-risk stigmata. Re-bleeding rates were set a priori based on non-head-to-head data from the literature, and charges and lengths of stay from a national American database. Sensitivity analyses were carried across a broad range of clinically relevant assumptions. Re-bleeding rates for patients receiving intravenous, oral, or placebo therapies were 5.9%, 11.8%, and 27%, respectively. The mean lengths of stay and costs for admitted patients with and without re-bleeding were 4.7 and 3 days; $11,802, and $7993, respectively. High-dose intravenous proton pump inhibition was more effective and less costly (dominant) than high-dose oral proton pump inhibition with incremental savings of $136.40 per patient treated. The oral high-dose strategy in turn dominated placebo administration. Results remained robust according to one- and two-way sensitivity analyses. In patients undergoing endoscopic haemostasis, subsequent high-dose intravenous proton pump inhibition is more cost-effective than high-dose oral proton pump inhibition, which in turn dominates placebo. The results from this exploratory-type cost analysis require confirmation by head-to-head prospective trials performed in Western populations.

  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

    Directory of Open Access Journals (Sweden)

    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. Investigation of the effect of Acute Normovolemic Hemodilution and Tranexamic Acid on the amount of bleeding during off-pump coronary artery bypass graft surgery: a systematic review

    Directory of Open Access Journals (Sweden)

    Reza Jalaeian Taghadoomi

    2017-01-01

    Full Text Available Introduction: Postoperative bleeding and transfusion remain a source of morbidity and cost after open heart operations . To evaluate the effect of ANH method and tranexamic acid on blood transfusion requirements and blood loss after off pump coronary artery bypass surgery (OPCAB. Materials and Methods: The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE from inception to December 2014; reference lists of published guidelines, reviews, and associated articles, as well as conference proceedings.We included articles with available abstract in English language. Manual searching was done within the reference list of articles. Three reviewers independently reviewed and assessed eligibility criteria, assessed quality, and extracted data. Results: Bleeding and hemorrhagic complications and the consequent need for allogeneic transfusion are still major problems after off-pump coronary artery bypass surgery that can reduced in combination of ANH method and tranexamic acid. Conclusion: Tranexamic acid and ANH appear to be effective in reducing postoperative bleeding and the need for allogeneic blood products.

  5. Angiography in gastrointestinal bleeding in children

    Energy Technology Data Exchange (ETDEWEB)

    Meyerovitz, M.F.; Fellows, K.E.

    1984-10-01

    Twenty-seven children aged 1 day to 16 years studied arteriographically for acute or chronic gastrointestinal bleeding were reviewed. Children with known esophageal varices and portal hypertension were excluded. Final diagnoses were made in 25 patients by means of surgery, endoscopy, biopsy, laboratory data, and clinical follow-up. Of these 25 cases, arteriography gave a correct diagnosis in 64% and was falsely negative in 36%. The common causes of bleeding in this study were gastric and duodenal ulcers, gastritis, vascular malformations, and typhlitis. Transcatheter therapy was attempted in six acute bleeders, with success in three (50%).

  6. Tranexamic acid without prophylactic factor replacement for prevention of bleeding in hereditary bleeding disorder patients undergoing endoscopy: a pilot study.

    Science.gov (United States)

    Davis, A; Walsh, M; McCarthy, P; Brown, G; Roberts, S; Tran, H; Street, A; Fong, C Y; Kemp, W

    2013-07-01

    The risk of bleeding in patients with hereditary bleeding disorders (HBD) undergoing gastro-intestinal (GI) endoscopic procedures is unknown but guidelines generally recommend correction of factor deficiency. Investigate the safety of oral tranexamic acid (TA) without prophylactic factor replacement to prevent bleeding complications in patients with HBD undergoing elective GI endoscopic procedures. A prospective single-arm pilot study testing the feasibility of using TA, without prophylactic factor replacement or desmopressin preprocedure, for prevention of bleeding complications following elective standard risk (A/B (n = 12), severe haemophilia A/B (n = 9), von Willebrand disease (n = 5), FXI deficiency (n = 1) and FVII deficiency (n = 1). Procedures performed included 11 gastroscopies, 12 colonoscopies, 8 gastroscopies and colonoscopies and 1 flexible sigmoidoscopy. Fourteen standard risk procedures and two high risk procedures were performed. Two patients experienced Grade 1 bleeding and one patient experienced Grade 2 bleeding. This study suggests that TA without prophylactic factor replacement may be a safe approach for mild and moderate HBD patients undergoing standard risk endoscopic procedures, particularly where no biopsy is performed. These findings should be confirmed in a larger study. © 2013 John Wiley & Sons Ltd.

  7. Bleeding and cupping.

    Science.gov (United States)

    Turk, J L; Allen, E

    1983-03-01

    Bleeding and cupping have been used in medicine since ancient times in the treatment of fevers and local inflammatory disorders. Local bleeding, by 'wet cupping', was effected by a scarificator or by leeches. John Hunter recommended venesection in moderation but preferred leeches for local bleeding. Bleeding as an accepted therapeutic practice went out of vogue in the middle of the nineteenth century as a result of the introduction of modern scientific methods. Dry cupping and the use of leeches, as counter irritants, persisted until the middle of this century.

  8. Transcatheter Arterial Embolization for Gastrointestinal Bleeding Secondary to Gastrointestinal Lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, Lin [Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Department of Radiology (China); Shin, Ji Hoon, E-mail: jhshin@amc.seoul.kr; Han, Kichang; Tsauo, Jiaywei; Yoon, Hyun-Ki; Ko, Gi-Young [University of Ulsan, College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology (Korea, Republic of); Shin, Jong-Soo [Kyunghee University, College of Medicine, Kangdong Kyunghee University Hospital, Department of Radiology (Korea, Republic of); Sung, Kyu-Bo [University of Ulsan, College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology (Korea, Republic of)

    2016-11-15

    PurposeTo evaluate the effectiveness of transcatheter arterial embolization (TAE) for gastrointestinal (GI) bleeding caused by GI lymphoma.Materials and MethodsThe medical records of 11 patients who underwent TAE for GI bleeding caused by GI lymphoma between 2001 and 2015 were reviewed retrospectively.ResultsA total of 20 TAE procedures were performed. On angiography, contrast extravasation, and both contrast extravasation and tumor staining were seen in 95 % (19/20) and 5 % (1/20) of the procedures, respectively. The most frequently embolized arteries were jejunal (n = 13) and ileal (n = 5) branches. Technical and clinical success rates were 100 % (20/20) and 27 % (3/11), respectively. The causes of clinical failure in eight patients were rebleeding at new sites. In four patients who underwent repeat angiography, the bleeding focus was new each time. Three patients underwent small bowel resection due to rebleeding after one (n = 2) or four (n = 1) times of TAEs. Another two patients underwent small bowel resection due to small bowel ischemia/perforation after three or four times of TAEs. The 30-day mortality rate was 18 % due to hypovolemic shock (n = 1) and multiorgan failure (n = 1).ConclusionAngiogram with TAE shows limited therapeutic efficacy to manage GI lymphoma-related bleeding due to high rebleeding at new sites. Although TAE can be an initial hemostatic measure, surgery should be considered for rebleeding due to possible bowel ischemic complication after repeated TAE procedures.

  9. Building a taxonomy of GI knowledge

    DEFF Research Database (Denmark)

    Arleth, Mette

    2004-01-01

    This paper reports on and ongoing study concerning non-professional users` understanding of GI. Online access to GI are offered by many public authorities, in order to make the public able to serve them selves online and gain insight in the physical planning and area administration. The aim...... of this project is to investigate how and how well non-professional users actually understand GI. For that purpose a taxonomy of GI knowledge is built, drawing on Bloom`s taxonomy. The elements of this taxonomy are described after a presentation of the main research question of the study, the applications chosen...

  10. Endoscopic variceal ligation-induced ulcer bleeding

    Science.gov (United States)

    Cho, Eunae; Jun, Chung Hwan; Cho, Sung Bum; Park, Chang Hwan; Kim, Hyun Soo; Choi, Sung Kyu; Rew, Jong Sun

    2017-01-01

    Abstract This study was aimed to determine the risk factors of endoscopic variceal ligation-(EVL) induced ulcer bleeding. The prevalence of EVL-induced ulcer bleeding is reported to be 3.6%. However, there are only limited reports of this serious complication, and the risk factors and the treatment methods are not well established. A total of 430 patients who had undergone EVL in Chonnam National University Hospital from January 2014 to October 2016 were studied. EVL was performed for prophylaxis or acute hemorrhage. The patients were classified into 2 groups: a bleeding group (n = 33) and a non-bleeding group (n = 397). The patients who had endoscopically confirmed EVL-induced ulcer bleeding were included in the bleeding group. EVL-induced ulcer bleeding occurred in 7.7% (n = 33) of the patients. In a multivariate analysis, model for end-stage liver disease (MELD) score >10 (odds ratio [OR]: 3.42, 95% confidence interval [CI]: 1.10–10.64), concomitant GV F3 (OR: 14.1, 95% CI: 2.84–71.43), and detachment of o-ring bands on follow-up endoscopy (OR: 8.06, 95% CI: 2.55–25.64) were independent predictive factors of EVL-induced ulcer bleeding. Various endoscopic modalities were attempted for hemostasis (EVL in 8 cases [24.2%], endoscopic variceal obturation [EVO] with cyanoacrylate in 6 cases [18.2%], argon plasma coagulation [APC] in 1 case (3%), Sengstaken–Blakemore (SB) tube in 3 cases [9.1%]), and proton pump inhibitor therapy only in 15 cases (45.5%). MELD score >10, concomitant GV F3, and detachment of o-ring bands on follow-up endoscopy are risk factors for EVL-induced ulcer bleeding. PMID:28614248

  11. Análise de causalidade da relação entre sangramento e letalidade de Síndromes Coronarianas Agudas Causality analysis of the relationship between bleeding and lethality in Acute Coronary Syndromes

    Directory of Open Access Journals (Sweden)

    Luis Cláudio Lemos Correia

    2012-06-01

    Full Text Available FUNDAMENTO: Eventos hemorrágicos em Síndromes Coronarianas Agudas (SCA apresentam associação independente com óbito em registros multicêntricos internacionais. No entanto, essa associação não foi testada em nosso meio e a verdadeira relação causal entre sangramento e óbito não está plenamente demonstrada. OBJETIVO: Testar as hipóteses de que: (1 sangramento maior é preditor independente de óbito hospitalar em SCA; (2 a relação entre esses dois desfechos é causal. MÉTODOS: Incluídos pacientes com critérios pré-definidos de angina instável, infarto sem supradesnivelamento do ST ou infarto com supradesnivelamento do ST. Sangramento maior durante o internamento foi definido de acordo com os tipos 3 ou 5 da Classificação Universal de Sangramento. Regressão logística e análise da sequência de eventos foram utilizadas para avaliar a associação entre sangramento e óbito. RESULTADOS: Dentre 455 pacientes estudados, 29 desenvolveram sangramento maior (6,4%; 95%IC = 4,3-9,0%. Esses indivíduos apresentaram mortalidade hospitalar de 21%, comparados a 5,6% nos pacientes sem sangramento (RR = 4,0; 95%IC = 1,8-9,1; P = 0,001. Após ajuste para escore de propensão, sangramento maior permaneceu preditor de óbito hospitalar (OR = 3,34; 95%IC = 1,2-9,5; P = 0,02. Houve 6 óbitos dentre 29 pacientes que sangraram. No entanto, análise detalhada da sequência de eventos demonstrou relação causal em apenas um caso. CONCLUSÃO: (1 Sangramento maior é preditor independente de óbito hospitalar em SCA; (2 O papel do sangramento como marcador de risco predomina sobre seu papel de fator de risco para óbito. Essa conclusão deve ser vista como geradora de hipótese a ser confirmada por estudos de maior tamanho amostral. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0BACKGROUND: Hemorrhagic events in Acute Coronary Syndromes (ACS have been independently associated with death in international multicenter registries. However, that

  12. Embolisation of acute abdominal and thoracal bleeding with ethylene-vinyl-alcohol copolymer (Onyx {sup registered}); Embolisation akuter abdomineller und thorakaler Blutungen mit Ethylen-Vinyl-Alkohol-Kopolymer (Onyx {sup registered}). Erste Erfahrungen im arteriellen Gefaessgebiet des Koerperstamms

    Energy Technology Data Exchange (ETDEWEB)

    Adamus, R.; Uder, M.; Kleinschmidt, T.; Detmar, K.; Bolte, R.; Stein, H.; Loose, R.W.

    2010-10-15

    During the last years most embolizations with the liquid agent Onyx have been performed in the field of neuroradiological interventions. There is minimal experience with arterial embolizations of the body trunk. 23 patients suffering from acute abdominal or thoracic bleeding underwent 28 embolizations with Onyx (17 male, 6 female, mean age 69 years). 27 interventions were technically and clinically successful. One patient with rebleeding from a jejunal artery aneurysm underwent surgery. Onyx embolizations were performed in renal, hepatic, iliac and bronchial arteries and esophageal varices. Compared with prior embolisation agents Onyx offers advantages due to good controllability. Fast arterial occlusion improves time management of patients. In comparison with prior techniques we observed a significant reduction of fluoroscopy time. Quantitative measurements demonstrated a significant higher embolisation agent contrast. (orig.)

  13. Emergency double balloon enteroscopy: a feasible and promising diagnostic as well as possible therapeutic option in recurrent midgut bleeding

    Science.gov (United States)

    Büschel, Philip; Mönkemüller, Klaus; von Falkenhausen, Uwe; Fry, Lucia C; Malfertheiner, Peter; Lippert, Hans; Meyer, Frank

    2011-01-01

    Gastrointestinal (GI) tract bleeding, in particular originating within the long segment of the small intestine, remains a diagnostic and therapeutic challenge. The authors describe the potential utility of emergency double balloon enteroscopy (DBE) for small bowel bleeding. An elderly woman was admitted because of a hypertensive crisis to the medical department of a regional hospital. Her medical history was significant for non-steroidal anti-inflammatory drug (NSAID) abuse. While in hospital she had massive obscure GI bleeding. Upper GI endoscopy and colonoscopy for recurrent bleeding showed only thrombotic residuals in two sigmoid diverticuli, which led to segmental resection of the sigmoid colon. However, postoperatively, bleeding recurred leading to transfer to our university hospital. Immediate angiography only revealed a vascular malformation at the upper jejunum but no ongoing bleeding. Subsequent emergency DBE detected an oozing jejunal ulcer, which was coagulated using a argon beamer. Because of recurrent falls in haemoglobin with the need for repeated transfusion, the patient underwent surgical reintervention including segmental resection of the ulcerated upper jejunum with subsequent end-to-end anastomosis. Histopathology revealed NSAID-induced ulcerous jejunopathy. Postoperatively, there was no further bleeding and the patient was discharged home in a stable condition. In conclusion, this is one of the first reports of successful emergency use of DBE in a case of recurrent and occult bleeding within the small bowel which successfully located the source of bleeding and facilitated successful superficial ulcer coagulation with an argon beamer to prevent further bleeding. PMID:22700075

  14. Aetiology of Upper Gastrointestinal Bleeding in North-Eastern Nigeria

    African Journals Online (AJOL)

    Aetiology of Upper Gastrointestinal Bleeding in North-Eastern Nigeria: A Retrospective Review of Endoscopic Findings. SK Mustapha, N Ajayi, YB Jibrin, A Shehu. Abstract. Background : Acute upper gastrointestinal bleeding (UGIB) is a common life threatening emergency resulting in a large number of hospital admissions.

  15. An observational European study on clinical outcomes associated with current management strategies for non-variceal upper gastrointestinal bleeding (ENERGIB-Turkey).

    Science.gov (United States)

    Mungan, Zeynel

    2012-01-01

    This observational, retrospective cohort study assessed outcomes of the current management strategies for nonvariceal upper gastrointestinal bleeding in several European countries (Belgium, Greece, Italy, Norway, Portugal, Spain, and Turkey) (NCT00797641; ENERGIB). Turkey contributed 23 sites to this study. Adult patients (≥18 years old) consecutively admitted to hospital and who underwent endoscopy for overt non-variceal upper gastrointestinal bleeding (hematemesis, melena or hematochezia, with other clinical/laboratory evidence of acute upper GI blood loss) were included in the study. Data were collected from patient medical records regarding bleeding continuation, re-bleeding, pharmacological treatment, surgery, and mortality during a 30-day follow-up period. A total of 423 patients (67.4% men; mean age: 57.8 ± 18.9 years) were enrolled in the Turkish study centers, of whom 96.2% were admitted to hospital with acute non-variceal upper gastrointestinal bleeding. At admission, the most common symptom was melena (76.1%); 28.6% of patients were taking aspirin, 19.9% were on non-steroidal anti-inflammatory drugs, and 7.3% were on proton pump inhibitors. The most common diagnoses were duodenal (45.2%) and gastric (27.7%) ulcers and gastritis/gastric erosions (26.2%). Patients were most often managed in general medical wards (45.4%). A gastrointestinal team was in charge of treatment in 64.8% of cases. Therapeutic procedures were performed in 32.4% of patients during endoscopy. After the endoscopy, most patients (94.6%) received proton pump inhibitors. Mean (SD) hospital stay was 5.36 ± 4.91 days. The cumulative proportions of continued bleeding/re-bleeding, complications and mortality within 30 days of the non-variceal upper gastrointestinal bleeding episode were 9.0%, 5.7% and 2.8%, respectively. In the Turkish sub-group of patients, the significant risk factors for bleeding continuation or re-bleeding were age >65 years, presentation with hematemesis or shock

  16. Bleed caused by varicose veins rupture in a rare site in portal hypertension. Differential diagnosis with causes of acute hypovolemic shock in emergency.

    Directory of Open Access Journals (Sweden)

    Rosarino Procopio

    2011-09-01

    Full Text Available Portal hypertension is the increase in the pressure of the venous portal system, which receives around 1,500 mL/m of blood from the intestinum tenue, colon, spleen, and pancreas. A blocking of the flux or an increase in the resistance at any level of the portal tree results in an increase in the pressure in the system and the appearance of lateral circles between the portal vein and the inferior and superior, thus allowing for varicose veins to spread in the whole system. The present paper reports the case of a woman with liver cirrhosis, great ascites and bleeding out of varicose veins’ rupture at the spleen axis level, which presented the problem of differential diagnosis with other causes of hypovolemic shock. This cases resulted in the patient’s exitus.

  17. Piroxicam-β-Cyclodextrin: A GI Safer Piroxicam

    Science.gov (United States)

    Scarpignato, C

    2013-01-01

    Although NSAIDs are very effective drugs, their use is associated with a broad spectrum of adverse reactions in the liver, kidney, cardiovascular (CV) system, skin and gut. Gastrointestinal (GI) side effects are the most common and constitute a wide clinical spectrum ranging from dyspepsia, heartburn and abdominal discomfort to more serious events such as peptic ulcer with life-threatening complications of bleeding and perforation. The appreciation that CV risk is also increased further complicates the choices of physicians prescribing anti-inflammatory therapy. Despite prevention strategies should be implemented in patients at risk, gastroprotection is often underused and adherence to treatment is generally poor. A more appealing approach would be therefore to develop drugs that are devoid of or have reduced GI toxicity. Gastro-duodenal mucosa possesses many defensive mechanisms and NSAIDs have a deleterious effect on most of them. This results in a mucosa less able to cope with even a reduced acid load. NSAIDs cause gastro-duodenal damage, by two main mechanisms: a physiochemical disruption of the gastric mucosal barrier and systemic inhibition of gastric mucosal protection, through inhibition of cyclooxygenase (COX, PG endoperoxide G/H synthase) activity of the GI mucosa. However, against a background of COX inhibition by anti-inflammatory doses of NSAIDs, their physicochemical properties, in particular their acidity, underlie the topical effect leading to short-term damage. It has been shown that esterification of acidic NSAIDs suppresses their gastrotoxicity without adversely affecting anti-inflammatory activity. Another way to develop NSAIDs with better GI tolerability is to complex these molecules with cyclodextrins (CDs), giving rise to so-called “inclusion complexes” that can have physical, chemical and biological properties very different from either those of the drug or the cyclodextrin. Complexation of NSAIDs with β-cyclodextrin potentially leads

  18. Gastrointestinal bleeding due to an erosion of the superior ...

    African Journals Online (AJOL)

    abp

    2012-07-04

    Jul 4, 2012 ... &Corresponding author: Dr Bouassida Mahdi, Department of Surgery, Mohamed Tahar Maamouri Hospital, 8000 Mrazga, Nabeul, Tunisia, postal address: 8000 Mrazga, Nabeul, Tunisia. Key words: Gastrointestinal bleeding, superior mesenteric artery, pancreatic pseudocyst, acute pancreatitis, emergency.

  19. [Ectopic intestinal varices in cirrhotic patients; an infrequent cause of severe intestinal bleeding].

    Science.gov (United States)

    Mateş, I N; Dinu, Daniela; Popescu, Luminiţa; Iosif, Cristina

    2003-01-01

    We report on a cirrhotic patient, with history of colecistectomy, admitted for acute digestive bleeding. Esogastric causes were excluded by endoscopy; due to continuous hemorrhage, the patient was operated in the next 20 hours. The cause was established during the operation; solitary omfalo-enteric varices, with active vascular fistula. Preoperative etiology of acute intestinal bleeding may be difficult to establish, sometimes even during the surgical intervention. We comment upon rare causes of acute intestinal bleeding, mainly ectopic varices determined by portal hypertension.

  20. Wireless capsule endoscopy: Perspectives beyond gastrointestinal bleeding

    Science.gov (United States)

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

    2014-01-01

    Wireless capsule endoscopy (CE) is a technology developed for the endoscopic exploration of the small bowel. The first capsule model was approved by the Food and Drug Administration in 2001, and its first and essential indication was occult gastrointestinal (GI) bleeding. Over subsequent years, this technology has been refined to provide superior resolution, increased battery life, and capabilities to view different parts of the GI tract. Indeed, cases for which CE proved useful have increased significantly over the last few years, with new indications for the small bowel and technical improvements that have expanded its use to other parts of the GI tract, including the esophagus and colon. The main challenges in the development of CE are new devices with the ability to provide therapy, air inflation for a better vision of the small bowel, biopsy sampling systems attached to the capsule and the possibility to guide and move the capsule with an external motion control. In this article we review the current and new indications of CE, and the evolving technological changes shaping this technology, which has a promising potential in the coming future of gastroenterology. PMID:25400450

  1. Incidence and consequence of major bleeding in primary percutaneous intervention for ST-elevation myocardial infarction in the era of radial access: an analysis of the international randomized Acute myocardial infarction Treated with primary angioplasty and intravenous enoxaparin Or unfractionated heparin to Lower ischemic and bleeding events at short- and Long-term follow-up trial.

    Science.gov (United States)

    Pellaton, Cyril; Cayla, Guillaume; Silvain, Johanne; Zeymer, Uwe; Cohen, Marc; Goldstein, Patrick; Huber, Kurt; Pollack, Charles; Kerneis, Mathieu; Collet, Jean-Philippe; Vicaut, Eric; Montalescot, Gilles

    2015-10-01

    The aims of the study are to compare the outcome with and without major bleeding and to identify the independent correlates of major bleeding complications and mortality in patients described in the ATOLL study. The ATOLL study included 910 patients randomly assigned to either 0.5 mg/kg intravenous enoxaparin or unfractionated heparin before primary percutaneous coronary intervention. Incidence of major bleeding and ischemic end points was assessed at 1 month, and mortality, at 1 and 6 months. Patients with and without major bleeding complication were compared. A multivariate model of bleeding complications at 1 month and mortality at 6 months was realized. Intention-to-treat and per-protocol analyses were performed. The most frequent bleeding site appears to be the gastrointestinal tract. Age >75 years, cardiac arrest, and the use of insulin or >1 heparin emerged as independent correlates of major bleeding at 1 month. Patients presenting with major bleeding had significantly higher rates of adverse ischemic complications. Mortality at 6 months was higher in bleeders. Major bleeding was found to be one of the independent correlates of 6-month mortality. The addition or mixing of several anticoagulant drugs was an independent factor of major bleeding despite the predominant use of radial access. This study shows that major bleeding is independently associated with poor outcome, increasing ischemic events, and mortality in primary percutaneous coronary intervention performed mostly with radial access. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Anesthesia related Complications in Pediatric GI Endoscopy

    Directory of Open Access Journals (Sweden)

    A Sabzevari

    2014-04-01

    Full Text Available Introduction: Elective upper and lower GI endoscopy is usually performed in children on an outpatient basis with the child under sedation or general anesthesia (GA. The objective of this study was to describe Anesthesia related complications in   children undergoing elective GI endoscopy.   Materials and Methods: The study design was descriptive on 1388 patients undergoing elective GI endoscopy in Sheikh Hospital from 2009 to 2013. All patient received propofol or standard inhalational anesthesia. We examined patients’ demographic data  ,  location of GI endoscopy ,  perioperative vital singe ,  recovery time , respiratory and cardiac complications , post operative nausea and vomiting , agitation , diagnosis and outcome   Results: Pediatric patients aged 2 to 17 years. 29 % of elective GI endoscopy was upper GI endoscopy and 70.3 % was lower GI endoscopy and 0.7 was both of them. 47.7 % of Pediatric patients were female and 52.3 % was male. We haven’t significant or fatal anesthesia related respiratory and cardiac complications (no apnea, no cardiac arrest. 8 patients (0.5% have transient bradicardia in post operative care Unit. 83 patients (5.9% have post operative nausea and vomiting controlled by medication.  6 patients (0.4% have post operative agitation controlled by medication.   Conclusions: General anesthesia and deep sedation in children undergoing elective GI endoscopy haven’t significant or fatal anesthesia related complications. We suggest Anesthesia for infants, young children, children with neurologic impairment, and some anxious older children undergoing elective GI endoscopy. Keyword: Anesthesia, Complication, Endoscopy, Pediatric.

  3. Bleeding during cancer treatment

    Science.gov (United States)

    ... barefoot. Use only an electric razor. Use knives, scissors, and other tools carefully. DO NOT blow your ... bowel movements. To further prevent bleeding: Avoid heavy lifting or playing contact sports. DO NOT drink alcohol. ...

  4. Hemorrhagic Acalculous Cholecystitis: An Unusual Location of Uremic Bleeding

    Directory of Open Access Journals (Sweden)

    Yi-Chun Lai

    2009-09-01

    Full Text Available Hemorrhagic acalculous cholecystitis is a rare but potentially fatal disease. An increased bleeding tendency is present in both acute and chronic renal failure with impaired platelet function. We herein present a case of hemorrhagic acalculous cholecystitis in a hemodialysis patient who suffered from acute abdomen and upper gastrointestinal bleeding. The pathogenesis may have been associated with ischemia and reperfusion injury, eventually leading to necrosis of the gall-bladder wall. Abdominal ultrasound can aid in diagnosis. Biliary colic, jaundice, and melena are the typical symptoms of hemorrhagic cholecystitis, particularly in a patient with unexplained gastrointestinal bleeding.

  5. Acquired Inhibitors: A Special Case of Bleeding in Older Adults

    Directory of Open Access Journals (Sweden)

    Richard G. Stefanacci

    2012-01-01

    Full Text Available This literature review is intended to familiarize physicians and healthcare providers of older adults with the potential causes of acute bleeding in older adults and to review diagnostic approaches that can produce prompt identification of acute bleeding and facilitate timely treatment. Adverse events from anticoagulant treatment and nonsteroidal anti-inflammatory drug (NSAID and aspirin use and abuse are among the most common causes of bleeding in older adults. Diagnoses infrequently considered—mild congenital hemophilia, acquired hemophilia, von Willebrand disease, and platelet dysfunction—can contribute to acute bleeding in older adults. The approach to management of bleeding varies. Management of acute bleeding in older adults can be challenging because these patients often have chronic comorbidity and have been prescribed long-term concomitant medications that can complicate diagnosis and treatment. Prompt recognition of acquired hemophilia, referral to an expert hematologist, and timely initiation of treatment could improve outcome in older patients who experience bleeding episodes resulting from this condition.

  6. Diagnostic performance of CT angiography in patients visiting emergency department with overt gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    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. Risk Factors of Gastrointestinal Bleeding After Continuous Flow Left Ventricular Assist Device.

    Science.gov (United States)

    Balcioglu, Ozlem; Kemal, Hatice S; Ertugay, Serkan; Ozturk, Pelin; Engin, Yaprak; Nalbantgil, Sanem; Engin, Cagatay; Yagdi, Tahir; Ozbaran, Mustafa

    2017-09-27

    This study aimed to compare von Willebrand factor (vWF) levels, ristocetin cofactor levels, platelet counts, aortic valve movements, and right heart failure (RHF) as risk factors of gastrointestinal (GI) bleeding in patients with continuous flow left ventricular assist device (cf-LVAD). In a single centre, 90 patients (mean age 52.0 ± 10.5 years), of which 59 were male and 31 were female, had cf-LVAD implantation from October 2010 to November 2012. Seventy-six (84.4%) patients had HeartWare (Medtronic, Mounds View, MN) and 14 (15.5%) had Heartmate II (Thoratec, Pleasanton, CA) implanted. vWF level, ristocetin cofactor level, and platelet count were measured before and after implantation to determine the presence of acquired von Willebrand Syndrome; aortic valve movement and postoperative RHF were evaluated to compare the difference in bleeding and nonbleeding patient groups. Fifteen patients (16.6%) suffered GI bleeding after cf-LVAD implantation. A statistically significant decrease was found in vWF and ristocetin cofactor levels from preoperative period to postoperative period in both bleeding and nonbleeding patient groups (p RHF incidence was significantly high in the bleeding patient group compared with the nonbleeding group (p RHF was an important risk factor for GI bleeding.

  8. Identification and Characterization of Single-Chain Antibodies that Specifically Bind GI Noroviruses.

    Directory of Open Access Journals (Sweden)

    Amy M Hurwitz

    Full Text Available Norovirus infections commonly lead to outbreaks of acute gastroenteritis and spread quickly, resulting in many health and economic challenges prior to diagnosis. Rapid and reliable diagnostic tests are therefore essential to identify infections and to guide the appropriate clinical responses at the point-of-care. Existing tools, including RT-PCR and enzyme immunoassays, pose several limitations based on the significant time, equipment and expertise required to elicit results. Immunochromatographic assays available for use at the point-of-care have poor sensitivity and specificity, especially for genogroup I noroviruses, thus requiring confirmation of results with more sensitive testing methods. Therefore, there is a clear need for novel reagents to help achieve quick and reliable results. In this study, we have identified two novel single-chain antibodies (scFvs-named NJT-R3-A2 and NJT-R3-A3-that effectively detect GI.1 and GI.7 virus-like particles (VLPs through selection of a phage display library against the P-domain of the GI.1 major capsid protein. The limits of detection by each scFv for GI.1 and GI.7 are 0.1 and 0.2 ng, and 6.25 and 25 ng, respectively. They detect VLPs with strong specificity in multiple diagnostic formats, including ELISAs and membrane-based dot blots, and in the context of norovirus-negative stool suspensions. The scFvs also detect native virions effectively in norovirus-positive clinical stool samples. Purified scFvs bind to GI.1 and GI.7 VLPs with equilibrium constant (KD values of 27 nM and 49 nM, respectively. Overall, the phage-based scFv reagents identified and characterized here show utility for detecting GI.1 and GI.7 noroviruses in multiple diagnostic assay formats with strong specificity and sensitivity, indicating promise for integration into existing point-of-care tests to improve future diagnostics.

  9. Identification and Characterization of Single-Chain Antibodies that Specifically Bind GI Noroviruses.

    Science.gov (United States)

    Hurwitz, Amy M; Huang, Wanzhi; Kou, Baijun; Estes, Mary K; Atmar, Robert L; Palzkill, Timothy

    2017-01-01

    Norovirus infections commonly lead to outbreaks of acute gastroenteritis and spread quickly, resulting in many health and economic challenges prior to diagnosis. Rapid and reliable diagnostic tests are therefore essential to identify infections and to guide the appropriate clinical responses at the point-of-care. Existing tools, including RT-PCR and enzyme immunoassays, pose several limitations based on the significant time, equipment and expertise required to elicit results. Immunochromatographic assays available for use at the point-of-care have poor sensitivity and specificity, especially for genogroup I noroviruses, thus requiring confirmation of results with more sensitive testing methods. Therefore, there is a clear need for novel reagents to help achieve quick and reliable results. In this study, we have identified two novel single-chain antibodies (scFvs)-named NJT-R3-A2 and NJT-R3-A3-that effectively detect GI.1 and GI.7 virus-like particles (VLPs) through selection of a phage display library against the P-domain of the GI.1 major capsid protein. The limits of detection by each scFv for GI.1 and GI.7 are 0.1 and 0.2 ng, and 6.25 and 25 ng, respectively. They detect VLPs with strong specificity in multiple diagnostic formats, including ELISAs and membrane-based dot blots, and in the context of norovirus-negative stool suspensions. The scFvs also detect native virions effectively in norovirus-positive clinical stool samples. Purified scFvs bind to GI.1 and GI.7 VLPs with equilibrium constant (KD) values of 27 nM and 49 nM, respectively. Overall, the phage-based scFv reagents identified and characterized here show utility for detecting GI.1 and GI.7 noroviruses in multiple diagnostic assay formats with strong specificity and sensitivity, indicating promise for integration into existing point-of-care tests to improve future diagnostics.

  10. Bleeding from gums: Can it be a dengue

    Directory of Open Access Journals (Sweden)

    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.

  11. Simulating Tail Probabilities in GI/GI.1 Queues and Insurance Risk Processes with Subexponentail Distributions

    NARCIS (Netherlands)

    Boots, Nam Kyoo; Shahabuddin, Perwez

    2001-01-01

    This paper deals with estimating small tail probabilities of thesteady-state waiting time in a GI/GI/1 queue with heavy-tailed (subexponential) service times. The problem of estimating infinite horizon ruin probabilities in insurance risk processes with heavy-tailed claims can be transformed into

  12. Bleeding during Pregnancy

    Science.gov (United States)

    ... FAQ090 “Early Pregnancy Loss”). What is an ectopic pregnancy? An ectopic pregnancy occurs when the fertilized egg does not implant ... vaginal bleeding is the only sign of an ectopic pregnancy. Other symptoms may include abdominal, pelvic, or shoulder ...

  13. Heavy Menstrual Bleeding (Menorrhagia)

    Science.gov (United States)

    ... breaking down once it has formed. Surgical Treatment Dilation and Curettage (D&C). A procedure in which the top layer of the uterus lining is removed to reduce menstrual bleeding. This procedure might need to be repeated over time. Operative hysteroscopy. A surgical procedure, using a special ...

  14. Abnormal Uterine Bleeding

    Science.gov (United States)

    ... could be pregnant, your doctor may order a pregnancy test. If your bleeding is heavy, in addition to ... doctor’s office and causes only mild pain.Another test is a hysteroscopy. A thin tube ... prevent pregnancy. One type of IUD releases hormones, and this ...

  15. Accessibility of GI for Public Participation

    DEFF Research Database (Denmark)

    Arleth, Mette; Campagna, Michele

    2005-01-01

    The paper reports an ongoing comparative study on the accessibility of Geographic Information at public authorities’ websites in Denmark and Italy. The purpose of the study is twofold; to give an idea of the latest development and diffusion of GI on public authorities websites, and to identify...... critical factors for success or failure of the applications. First part of the study therefore consists of a mapping of the level of accessibility of GI in the two countries as a comparative analysis. The focus of the mapping is mainly on the use of geographic information as support to citizens...

  16. Upper Gastrointestinal Bleeding from Gastric Amyloidosis in a Patient with Smoldering Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    Mihajlo Gjeorgjievski

    2015-01-01

    Full Text Available Amyloidosis is a common complication of patients with monoclonal gammopathy of undetermined significance (MGUS, smoldering multiple myeloma (SMM, and multiple myeloma (MM. This proteinaceous material can be deposited intercellularly in any organ system, including the gastrointestinal (GI tract. In the GI tract, amyloidosis affects the duodenum most commonly, followed by the stomach and colorectum. Gastric amyloidosis causes symptoms of nausea, vomiting, early satiety, abdominal pain, and GI bleeding. A case of upper GI bleeding from gastric amyloidosis is presented in a patient with SMM. Esophagogastroduodenoscopy (EGD revealed a gastric mass. Endoscopic biopsies revealed amyloid deposition in the lamina propria, consistent with gastric amyloidosis. Liquid chromatography tandem mass spectrometry performed on peptides extracted from Congo red-positive microdissected areas of paraffin-embedded stomach specimens revealed a peptide profile consistent with AL- (lambda- type amyloidosis. Based on this and multiple other case reports, we recommend that patients with GI bleeding and MGUS, SMM, or MM undergo EGD and pathologic examination of endoscopic biopsies of identified lesions using Congo red stains for amyloidosis for early diagnosis and treatment.

  17. Upper Gastrointestinal Bleeding from Gastric Amyloidosis in a Patient with Smoldering Multiple Myeloma.

    Science.gov (United States)

    Gjeorgjievski, Mihajlo; Purohit, Treta; Amin, Mitual B; Kurtin, Paul J; Cappell, Mitchell S

    2015-01-01

    Amyloidosis is a common complication of patients with monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), and multiple myeloma (MM). This proteinaceous material can be deposited intercellularly in any organ system, including the gastrointestinal (GI) tract. In the GI tract, amyloidosis affects the duodenum most commonly, followed by the stomach and colorectum. Gastric amyloidosis causes symptoms of nausea, vomiting, early satiety, abdominal pain, and GI bleeding. A case of upper GI bleeding from gastric amyloidosis is presented in a patient with SMM. Esophagogastroduodenoscopy (EGD) revealed a gastric mass. Endoscopic biopsies revealed amyloid deposition in the lamina propria, consistent with gastric amyloidosis. Liquid chromatography tandem mass spectrometry performed on peptides extracted from Congo red-positive microdissected areas of paraffin-embedded stomach specimens revealed a peptide profile consistent with AL- (lambda-) type amyloidosis. Based on this and multiple other case reports, we recommend that patients with GI bleeding and MGUS, SMM, or MM undergo EGD and pathologic examination of endoscopic biopsies of identified lesions using Congo red stains for amyloidosis for early diagnosis and treatment.

  18. Thalidomide for treatment of gastrointestinal bleedings due to angiodysplasia : a case report in acquired von Willebrand syndrome and review of the literature

    NARCIS (Netherlands)

    Engelen, E T; van Galen, K P M; Schutgens, R E G

    INTRODUCTION: Acquired von Willebrand syndrome is a rare bleeding disorder and treatment of the associated gastrointestinal (GI) bleeding due to angiodysplasia is challenging. AIM: The aim of this study was to present a new case on the successful use of thalidomide in a patient with acquired von

  19. Endoscopic management of bleeding gastric varices--an updated overview.

    Science.gov (United States)

    Crisan, Dana; Tantau, Marcel; Tantau, Alina

    2014-10-01

    Gastric varices (GVs) are known to bleed massively and often difficult to manage with conventional techniques. This article aims to overview the endoscopic methods for the management of acute gastric variceal bleeding, especially the advantages and limits of GV obliteration with tissue adhesives, by comparison with band ligation and other direct endoscopic techniques of approach. The results of indirect radiological and surgical techniques of GV treatment are shortly discussed. A special attention is payed to the emerging role of endoscopic ultrasound in the therapy of bleeding GV, in the confirmation of its eradication and in follow-up strategies.

  20. Platelet function in bleeding disorders

    NARCIS (Netherlands)

    van Bladel, E.R.

    2013-01-01

    The first bleeding diathesis we studied was hemophilia A. Since FVIII activity level does not always correlate with the bleeding tendency in individual patients, bleeding tendency must also be influenced by other factors. Earlier studies excluded the remaining clotting factors and FVIII genotype as

  1. GI_Forum 2013 – Creating the GISociety: Symposium and Exhibition GIScience & Technology Learning with GI

    Directory of Open Access Journals (Sweden)

    Zlatko Horvat

    2014-06-01

    Full Text Available The University of Salzburg Interfaculty Department for Geoinformatics – Z_GIS, the Commission for GIScience at the Austrian Academy of Science (OeAW-GIScience and the Department of Sustainable Tourism and Regional Development at the German University of Technology in Muscat, Oman have organised interdisciplinary GI_Forum in Salzburg on July 2–5, 2013. The interdisciplinary GI_Forum has become an annual event for a very vibrant international Geoinformatics Community. The GI_forum was held concurrently with the highly regarded German language conference on Applied Geoinformatics – AGIT.

  2. Non-surgical interventions for treating heavy menstrual bleeding (menorrhagia) in women with bleeding disorders.

    Science.gov (United States)

    Ray, Sujoy; Ray, Amita

    2016-11-10

    Heavy menstrual bleeding without an organic lesion is mainly due to an imbalance of the various hormones which have a regulatory effect on the menstrual cycle. Another cause of heavy menstrual bleeding with no pelvic pathology, is the presence of an acquired or inherited bleeding disorder. The haemostatic system has a central role in controlling the amount and the duration of menstrual bleeding, thus abnormally prolonged or profuse bleeding does occur in most women affected by bleeding disorders. Whereas irregular, pre-menarchal or post-menopausal uterine bleeding is unusual in inherited or acquired haemorrhagic disorders, severe acute bleeding and heavy menstrual bleeding at menarche and chronic heavy menstrual bleeding during the entire reproductive life are common. This is an update of a previously published Cochrane Review. To determine the efficacy and safety of non-surgical interventions versus each other, placebo or no treatment for reducing menstrual blood loss in women with bleeding disorders. We searched the Cochrane Cystic Fibrosis Haemoglobinopathies Trials Register (25 August 2016), Embase (May 2013), LILACS (February 2013) and the WHO International Clinical Trial registry (February 2013). Randomised controlled studies of non-surgical interventions for treating heavy menstrual bleeding (menorrhagia) in women of reproductive age suffering from a congenital or acquired bleeding disorder. Two authors independently assessed studies for inclusion, extracted data and assessed the risk of bias. Three cross-over studies, with 175 women were included in the review. All three studies had an unclear risk of bias with regards to trial design and overall, the quality of evidence generated was judged to be poor.Two of the studies (n = 59) compared desmopressin (1-deamino-8-D-arginine vasopressin) with placebo. Menstrual blood loss was the primary outcome for both of these studies. Neither study found clear evidence of a difference between groups. The first of these

  3. Postmenopausal genital bleeding

    Directory of Open Access Journals (Sweden)

    Luiz Cavalcanti de Albuquerque Neto

    Full Text Available The study was conducted on 748 women who reported genital bleeding occurring at least one year after the last menstruation. Benign causes were most frequent than malignant causes. Among the benign causes, the most frequent were cervicitis (19,95%, prolapsed uterus with decubitus ulcer (19,41%, dysfunctional hemorrhage (13,29% and endometrial polyps (12,77%. In the group of malignant causes, cancer of the cervix was the neoplasm most often detected (59,26%; endometrial cancer was next, affecting 29,63%. The cancer of the cervix/ cancer of the body ratio was 2:1. In summary, many causes, both benign and malignant, can provoke abnormal postmenopausal bleeding. Thus, curettage of the uterus should be reserved for doubtful cases, i.e., in situations in which, after all non invasive methods of investigations have been exhausted, the possibility of the occurrence of malignant lesions still persist.

  4. Bleeding pancreatic pseudoaneurysms: management by angioembolization combined with therapeutic endoscopy.

    Science.gov (United States)

    Nykänen, Taina; Udd, Marianne; Peltola, Erno K; Leppäniemi, Ari; Kylänpää, Leena

    2017-02-01

    Bleeding pancreatic pseudocysts (PPCs) are a rare but lethal complication of pancreatitis. Transcatheter arterial embolization (TAE) is the first-line treatment of acute hemorrhage, but consensus on the definitive management of bleeding PPCs is lacking. The aim of this study was to evaluate the safety and efficacy of the combination of TAE and therapeutic endoscopy in the treatment of bleeding PPCs. Patients with acute or chronic pancreatitis treated for bleeding PPCs in Helsinki University Hospital during 2004-2014 comprised the study group. Inpatients with acute necrotizing pancreatitis were excluded. Patients underwent TAE as the primary treatment to control the bleeding. Therapeutic endoscopy performed on an outpatient visit after TAE allowed the definitive treatment of PPCs. A total of 58 patients underwent TAE. Re-bleeding rate (endoscopy, 7 (21.9 %) needed an additional drainage procedure (six non-surgical and one surgical). Overall success rate of non-surgical management was 91.5 %. Post-endoscopy mortality rate (endoscopy and on the role of empirical embolizations.

  5. Match analysis on no-gi Brazilian jiu-jitsu

    OpenAIRE

    Simola, Tuomas

    2017-01-01

    Gi and no-gi Brazilian jiu-jitsu are fast growing sports. The aim of this thesis is to conclude a match analysis on no-gi Brazilian jiu-jitsu. Match analysis is used to identify the most used techniques in no-gi Brazilian jiu-jitsu. There is no sport analysis done for either gi or no-gi Brazilian jiu-jitsu, therefore the match analysis and its results can be utilized later as a base for sport analysis. The goal of this study is to find out the match duration, the type of match ending, the...

  6. Obesity and Energy Balance in GI Cancer.

    Science.gov (United States)

    Brown, Justin C; Meyerhardt, Jeffrey A

    2016-12-10

    The prevalence of overweight (body mass index [BMI], 25 to 29.9 kg/m(2)) and obesity (BMI ≥ 30 kg/m(2)) have increased dramatically in the United States. Because increasing BMI is associated with the development of multiple different cancer types, including most GI cancers, providers will frequently encounter patients with GI cancer who are overweight or obese. Mounting evidence associates overweight and/or obesity with worsened prognosis in multiple GI cancers, including esophageal, gastric, hepatocellular, pancreatic, and colorectal. However, these data are observational and may be subject to bias and/or confounding. Furthermore, in some cancer types, the associations between BMI and outcomes is not linear, where overweight and class I obese patients may have an improvement in outcome. This report provides a brief highlight of existing studies that have linked overweight and/or obesity to prognosis in GI cancer; provides recommendations on best management practices; and discusses limitations, controversies, and future directions in this rapidly evolving area. There are multiple areas of promise that warrant continued investigation: What are the comparative contributions of energy balance, including weight, dietary patterns, and physical activity on cancer prognosis? What are the specific physiologic pathways that mediate the relationship between energy balance and prognosis? What is the relationship between low muscle mass (sarcopenia) or sarcopenic obesity and cancer prognosis? Are there subsets of patients for whom purposefully altering energy balance would be deleterious to prognosis? This area is rich with opportunities to understand how states of energy (im)balance can be favorably altered to promote healthy survivorship.

  7. Obesity and Energy Balance in GI Cancer

    Science.gov (United States)

    Meyerhardt, Jeffrey A.

    2016-01-01

    The prevalence of overweight (body mass index [BMI], 25 to 29.9 kg/m2) and obesity (BMI ≥ 30 kg/m2) have increased dramatically in the United States. Because increasing BMI is associated with the development of multiple different cancer types, including most GI cancers, providers will frequently encounter patients with GI cancer who are overweight or obese. Mounting evidence associates overweight and/or obesity with worsened prognosis in multiple GI cancers, including esophageal, gastric, hepatocellular, pancreatic, and colorectal. However, these data are observational and may be subject to bias and/or confounding. Furthermore, in some cancer types, the associations between BMI and outcomes is not linear, where overweight and class I obese patients may have an improvement in outcome. This report provides a brief highlight of existing studies that have linked overweight and/or obesity to prognosis in GI cancer; provides recommendations on best management practices; and discusses limitations, controversies, and future directions in this rapidly evolving area. There are multiple areas of promise that warrant continued investigation: What are the comparative contributions of energy balance, including weight, dietary patterns, and physical activity on cancer prognosis? What are the specific physiologic pathways that mediate the relationship between energy balance and prognosis? What is the relationship between low muscle mass (sarcopenia) or sarcopenic obesity and cancer prognosis? Are there subsets of patients for whom purposefully altering energy balance would be deleterious to prognosis? This area is rich with opportunities to understand how states of energy (im)balance can be favorably altered to promote healthy survivorship. PMID:27903148

  8. Mild bleeding disorders

    OpenAIRE

    PERROUD, V.

    2011-01-01

    Contrairement aux troubles hémorragiques sévères, les maladies hémorragiques modérées (Mild Bleeding Disorders = MBD) sont difficiles à diagnostiquer chez les enfants, car la limite entre le physiologique et le pathologique est mal définie et l'approche diagnostique est peu systématisée. Qu'entend-on par MBD ? On peut les définir comme des diathèses hémorragiques sans répercussion sévère sur la vie quotidienne et, en principe, sans risque vital : épistaxis, gingivorragies, rect...

  9. Menorrhagia in adolescents with inherited bleeding disorders.

    Science.gov (United States)

    Chi, Claudia; Pollard, Debra; Tuddenham, Edward G D; Kadir, Rezan A

    2010-08-01

    We reviewed the management and treatment outcomes of menorrhagia in adolescents with inherited bleeding disorders and assessed the impact of menorrhagia on their quality of life. Retrospective review of case notes and a questionnaire study. Comprehensive-care hemophilia treatment center. Adolescents with inherited bleeding disorders who had registered at the center and were attending the multidisciplinary hemophilia and gynecology clinic for management of menorrhagia. Review of medical records and assessment of menstrual blood loss using the pictorial blood assessment chart and quality of life measurements during menstruation using a questionnaire. Scores on pictorial blood assessment charts and quality of life measurements before and after treatment. Of 153 girls aged 12 to 19 years who had registered at the center and had an inherited bleeding disorder, 42 (27%) attended the multidisciplinary clinic for management of menorrhagia. The majority (38/42; 90%) had experienced menorrhagia since menarche. Of the group, 5 (12%) required hospital admission for acute menorrhagia and severe anemia. Treatment options for menorrhagia included tranexamic acid, desmopressin, combined oral contraceptive pills, clotting factor concentrate, and the levonorgestrel intrauterine system. These treatment modalities, alone or in combination, were associated with a reduction in menstrual blood loss (median pre- and posttreatment pictorial blood assessment chart scores were 215 and 88, respectively) and improvement in quality of life scores (median pre- and posttreatment were 26 and 44, respectively). Menorrhagia is a common symptom in adolescents with inherited bleeding disorders. It can present acutely, and it adversely affects quality of life. Treatment options include hemostatic and/or hormonal therapies and can improve the quality of life of affected girls. Copyright 2010 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  10. Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding?

    Directory of Open Access Journals (Sweden)

    Pedro Monsanto

    Full Text Available Background: in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20th century, made this technique to be relegated to a second level. Aims: evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding. Patients and methods: we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively. Results: with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleed-ing lesion in 94%. Small bowel findings included: angiodysplasia (n = 6, ulcers (n = 4, small bowel Dieulafoy's lesion (n = 2, bleed-ing from anastomotic vessels (n = 1, multiple cavernous hemangiomas (n = 1 and bleeding ectopic jejunal varices (n = 1. Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively. Conclusions: intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.

  11. Abnormal uterine bleeding.

    Science.gov (United States)

    Whitaker, Lucy; Critchley, Hilary O D

    2016-07-01

    Abnormal uterine bleeding (AUB) is a common and debilitating condition with high direct and indirect costs. AUB frequently co-exists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding complaint. A structured approach for establishing the cause using the Fédération International de Gynécologie et d'Obstétrique (FIGO) PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy (and hyperplasia), Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic and Not otherwise classified) classification system will facilitate accurate diagnosis and inform treatment options. Office hysteroscopy and increasing sophisticated imaging will assist provision of robust evidence for the underlying cause. Increased availability of medical options has expanded the choice for women and many will no longer need to recourse to potentially complicated surgery. Treatment must remain individualised and encompass the impact of pressure symptoms, desire for retention of fertility and contraceptive needs, as well as address the management of AUB in order to achieve improved quality of life. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  12. Nonsteroidal Anti-inflammatory Drug-related Gastrointestinal Bleeding in the Elderly

    Directory of Open Access Journals (Sweden)

    Shou-Chuan Shih

    2007-03-01

    Full Text Available Nonsteroidal anti-inflammatory drug (NSAID could induce gastrointestinal (GI injury by way of topical (mucus, gastric acid and drug interaction and systemic mechanism (decreased prostaglandin synthesis. Compared with non-NSAID users, elderly taking NSAID or aspirin have a higher chance than younger people of developing GI bleeding (5.5-fold vs. 1.65-fold. Endoscopy is the best tool to identify the source and severity of ulcer with bleeding. The use of NSAID or aspirin should be weighed carefully in elderly who have a history of peptic ulcer. If necessary, it is better to choose cyclooxygenase-2 inhibitor since it has been reported that the drug has less than half the risk of non-selective NSAID to ignite GI complications. Eradication of Helicobacter pylori might reduce ulcer risk in new NSAID users, but not in patients with long-term therapy. Proton pump inhibitor is the drug of choice that is effective for both treatment and prevention (taken together with NSAID of NSAID-related GI bleeding.

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    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......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...... are recommended ASA or clopidogrel. With future implementation of new antithrombotic treatment regimens as monotherapy and in combinations with antiplatelet therapy, increased focus on risk of thromboembolic events and bleeding and individual tailoring of antithrombotic therapy is warranted....

  14. Management of severe perioperative bleeding

    DEFF Research Database (Denmark)

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

    2013-01-01

    and stabilisation of the macro- and microcirculations in order to optimise the patient's tolerance to bleeding. Third, targeted procoagulant interventions to reduce the amount of bleeding, morbidity, mortality and costs. The purpose of these guidelines is to provide an overview of current knowledge on the subject......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...

  15. Impact of Bleeding on Mortality After Percutaneous Coronary Intervention Results From a Patient-Level Pooled Analysis of the REPLACE-2 (Randomized Evaluation of PCI Linking Angiomax to Reduced Clinical Events), ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy), and HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) Trials

    NARCIS (Netherlands)

    Mehran, Roxana; Pocock, Stuart; Nikolsky, Eugenia; Dangas, George D.; Clayton, Tim; Claessen, Bimmer E.; Caixeta, Adriano; Feit, Frederick; Manoukian, Steven V.; White, Harvey; Bertrand, Michel; Ohman, E. Magnus; Parise, Helen; Lansky, Alexandra J.; Lincoff, A. Michael; Stone, Gregg W.

    2011-01-01

    This study sought to develop a risk score predictive of bleeding in patients undergoing percutaneous coronary intervention (PCI) and to investigate the impact of bleeding on subsequent mortality. Bleeding complications after PCI have been independently associated with early and late mortality. This

  16. Managing oral bleeding in children with hereditary bleeding disorders

    African Journals Online (AJOL)

    The prevention of traumatic and infective dental conditions is an important part of oral health care in individuals with hereditary bleeding disorders. This would reduce the need for treatment and should reduce the number of emergency visits. Key words: Haemophilia, von Willebrand disease, gingival bleeding, dental ...

  17. Bleeding in children with cancer

    African Journals Online (AJOL)

    Siluan early warning signs of childhood cancer, compiled by the South. African Children's Cancer Study Group (SACCSG). An increased risk of bleeding during the cancer treatment period is almost always present, due to the bone marrow suppressive effect of chemotherapy. Fortunately, death due to bleeding is rare these ...

  18. Effects of GI meals on intermittent exercise.

    Science.gov (United States)

    Hulton, A T; Gregson, W; Maclaren, D; Doran, D A

    2012-09-01

    Pre-exercise meals or single foods containing low glycaemic index (LGI) carbohydrates (CHO) have been shown to enhance performance prior to prolonged steady state exercise compared to high glycaemic index (HGI) CHO. This study investigated the impact of HGI and LGI pre-exercise meals on intermittent high intensity exercise. Nine male recreational football players performed a football specific protocol followed by a 1 km time trial 3.5 h after ingesting 1 of 2 isoenergetic test meals (HGI: 870.3 kcal, LGI: 889.5 kcal), which were either HGI (GI: 80) or LGI (GI: 44). Blood glucose, fatty acids (FA), glycerol, β-hydroxybutyrate, lactate and insulin were assessed before, during, and after the exercise bout, whilst rates of CHO and fat oxidation were determined at 4 time points during the protocol. No significant differences were found for the 1 km time trial (LGI: 210.2 ± 19.1 s: HGI: 215.8 ± 22.6 s) (mean ± SD), nor for any of the other variables measured (P>0.05) apart from a significant condition effect with FA and significant interaction effects observed for glucose, β-hydroxybutyrate and lactate (Pexercise. © Georg Thieme Verlag KG Stuttgart · New York.

  19. The characteristics of adults with upper gastrointestinal bleeding ...

    African Journals Online (AJOL)

    2011-03-07

    Mar 7, 2011 ... of morbidity and mortality worldwide. Of the 928 cases. Table 1. Distribution of acute upper gastrointestinal bleeding by aetiology. Male. Female. Total. Aetiology. Aetiology by site. Number of cases. %. Number of cases. %. Number of cases. %. Peptic ulcera. Duodenal ulcera. 204. 36.4. 81. 22.0. 285. 30.7.

  20. Clinical approach to a patient with abnormal uterine bleeding

    African Journals Online (AJOL)

    Bleeding from rectum or bladder. Table I: Organic causes of abnormal excessive menstruation. Women with acute severe blood loss must be resuscitated. A diagnosis should be made on the basis of history, clinical examination and special testing including a pregnancy test, a hemato- crit, abdominal and pelvic ultrasound.

  1. Ectopic Pregnancy: An unusual cause of lower GIT bleeding. A case ...

    African Journals Online (AJOL)

    Acute massive lower gastrointestinal bleeding, when it occurs, may present a diagnostic and treatment challenge to the surgeon. We report a case an ectopic pregnancy that eroded the colon and presented with severe rectal bleeding. The paper discusses the differential diagnoses, management and outcome of massive ...

  2. 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.

    Science.gov (United States)

    Sørensen, Rikke; Hansen, Morten L; Abildstrom, Steen Z; Hvelplund, Anders; Andersson, Charlotte; Jørgensen, Casper; Madsen, Jan K; Hansen, Peter R; Køber, Lars; Torp-Pedersen, Christian; Gislason, Gunnar H

    2009-12-12

    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. By use of nationwide registers from Denmark, we identified 40 812 patients aged 30 years or older who had been admitted to hospital with first-time myocardial infarction between 2000 and 2005. Claimed prescriptions starting at hospital discharge were used to determine the regimen prescribed according to the following groups: monotherapy with aspirin, clopidogrel, or vitamin K antagonist; dual therapy with aspirin plus clopidogrel, aspirin plus vitamin K antagonist, or clopidogrel plus vitamin K antagonist; or triple therapy including all three drugs. Risk of hospital admission for bleeding, recurrent myocardial infarction, and death were assessed by Cox proportional hazards models with the drug exposure groups as time-varying covariates. During a mean follow-up of 476.5 days (SD 142.0), 1891 (4.6%) patients were admitted to hospital with bleeding. The yearly incidence of bleeding was 2.6% for the aspirin group, 4.6% for clopidogrel, 4.3% for vitamin K antagonist, 3.7% for aspirin plus clopidogrel, 5.1% for aspirin plus vitamin K antagonist, 12.3% for clopidogrel plus vitamin K antagonist, and 12.0% for triple therapy. With aspirin as reference, adjusted hazard ratios for bleeding were 1.33 (95% CI 1.11-1.59) for clopidogrel, 1.23 (0.94-1.61) for vitamin K antagonist, 1.47 (1.28-1.69) for aspirin plus clopidogrel, 1.84 (1.51-2.23) for aspirin plus vitamin K antagonist, 3.52 (2.42-5.11) for clopidogrel plus vitamin K antagonist, and 4.05 (3.08-5.33) for triple therapy. Numbers needed to harm were 81.2 for aspirin plus clopidogrel, 45.4 for aspirin plus vitamin K antagonist, 15.2 for clopidogrel plus vitamin K antagonist, and 12.5 for triple therapy. 702 (37.9%) of 1852 patients with non

  3. Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding

    DEFF Research Database (Denmark)

    Ngu, Jing H.; Laursen, Stig Borbjerg; Chin, YK

    2017-01-01

    Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding: a prospective international multicenter study.......Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding: a prospective international multicenter study....

  4. Vaginal Bleeding: MedlinePlus Health Topic

    Science.gov (United States)

    ... bleeding in pregnancy (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Vaginal Bleeding updates ... late pregnancy Vaginal bleeding in pregnancy Related Health Topics Menstruation Disclaimers MedlinePlus links to health information from ...

  5. Vitamin K deficiency bleeding of the newborn

    Science.gov (United States)

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

  6. Pathophysiology of heavy menstrual bleeding.

    Science.gov (United States)

    Hapangama, Dharani K; Bulmer, Judith N

    2016-01-01

    Heavy menstrual bleeding (HMB) is a common gynecological complaint with multiple etiologies and diverse pathophysiological origins. This review discusses HMB with reference to the recently proposed PALM-COEIN classification system for abnormal uterine bleeding, initially describing the endometrial events in normal menstruation followed by discussion of the perturbations of normal endometrial shedding that can result in HMB. Our present understanding of the mechanisms of menstrual bleeding as well as many of the pathological aberrations of HMB is incomplete. Further research into the pathophysiology of HMB is urgently needed, as clear knowledge of the mechanisms of this disorder will provide new therapeutic targets to formulate more effective treatments.

  7. Acute Idiopathic Thrombocytopenic

    OpenAIRE

    Basavaraj Bhagawati; Rahul Hegde

    2003-01-01

    Acute thrombocytopenic purpura is the most common of thrombocytopenias of the childhood. Clinical Features include petechial lesions on oral mucosa, gingival bleeding and occassionally hemorrhage into tissues. Serious complications like intracranial bleeding are also reported. This paper describes a case, presenting in our dental OPD and reviews on published guidelines.

  8. Side Effects: Bleeding and Bruising

    Science.gov (United States)

    Cancer treatments, such as chemotherapy and targeted therapy, can increase patients’ risk of bleeding and bruising, also called thrombocytopenia. Learn about steps to take if you are at increased risk of a low platelet count.

  9. Evolution of Gi Fi Technology Over Other Technologies

    OpenAIRE

    Jyoti Tewari; Swati Arya

    2013-01-01

    Gi-Fi stands for Gigabit Wireless. Gi-Fi is a wireless transmission system which is ten times faster than other technology and its chip delivers short-range multigigabit data transfer in a local environment. Gi-Fi is a wireless technology which promises high speed short range data transfers with speeds of up to 5 Gbps within a range of 10 meters. The Gi-Fi operates on the 60GHz frequency band. This frequency band is currently mostly unused. It is manufactured using (CMOS) technology. This wir...

  10. Enabling interoperability in Geoscience with GI-suite

    Science.gov (United States)

    Boldrini, Enrico; Papeschi, Fabrizio; Santoro, Mattia; Nativi, Stefano

    2015-04-01

    GI-suite is a brokering framework targeting interoperability of heterogeneous systems in the Geoscience domain. The framework is composed by different brokers each one focusing on a specific functionality: discovery, access and semantics (i.e. GI-cat, GI-axe, GI-sem). The brokering takes place between a set of heterogeneous publishing services and a set of heterogeneous consumer applications: the brokering target is represented by resources (e.g. coverages, features, or metadata information) required to seamlessly flow from the providers to the consumers. Different international and community standards are now supported by GI-suite, making possible the successful deployment of GI-suite in many international projects and initiatives (such as GEOSS, NSF BCube and several EU funded projects). As for the publisher side more than 40 standards and implementations are supported (e.g. Dublin Core, OAI-PMH, OGC W*S, Geonetwork, THREDDS Data Server, Hyrax Server, etc.). The support for each individual standard is provided by means of specific GI-suite components, called accessors. As for the consumer applications side more than 15 standards and implementations are supported (e.g. ESRI ArcGIS, Openlayers, OGC W*S, OAI-PMH clients, etc.). The support for each individual standard is provided by means of specific profiler components. The GI-suite can be used in different scenarios by different actors: - A data provider having a pre-existent data repository can deploy and configure GI-suite to broker it and making thus available its data resources through different protocols to many different users (e.g. for data discovery and/or data access) - A data consumer can use GI-suite to discover and/or access resources from a variety of publishing services that are already publishing data according to well-known standards. - A community can deploy and configure GI-suite to build a community (or project-specific) broker: GI-suite can broker a set of community related repositories and

  11. 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

    DEFF Research Database (Denmark)

    Sørensen, Rikke; Hansen, Morten L; Abildstrom, Steen Z

    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...... according to the following groups: monotherapy with aspirin, clopidogrel, or vitamin K antagonist; dual therapy with aspirin plus clopidogrel, aspirin plus vitamin K antagonist, or clopidogrel plus vitamin K antagonist; or triple therapy including all three drugs. Risk of hospital admission for bleeding...... was 2.6% for the aspirin group, 4.6% for clopidogrel, 4.3% for vitamin K antagonist, 3.7% for aspirin plus clopidogrel, 5.1% for aspirin plus vitamin K antagonist, 12.3% for clopidogrel plus vitamin K antagonist, and 12.0% for triple therapy. With aspirin as reference, adjusted hazard ratios...

  12. Field cancerization in the GI tract.

    Science.gov (United States)

    Graham, Trevor A; McDonald, Stuart Ac; Wright, Nicholas A

    2011-08-01

    The widely accepted paradigm for tumorigenesis begins with rate-limiting mutations in a key growth control gene resulting in immediate lesion growth. Tumor progression occurs as cells within the tumor acquire additional carcinogenic mutations. However, there is clear evidence that the road to cancer can begin long before the growth of a clinically detectable lesion - indeed, long before any of the usual morphological correlates of preneoplasia are recognizable. Field cancerization, the replacement of the normal cell population by a histologically nondysplastic but protumorigenic mutant cell clone, underlies the development of many cancer types, and in this article we review field cancerization in the GI tract. We present the evidence that field cancerization can underpin tumorigenesis in all gastrointestinal compartments, discuss the homeostatic mechanisms that could permit clone spread and highlight how an understanding of the mechanisms driving field cancerization is a means to study human stem cell biology. Finally, we discuss how appropriate recognition of the role of field cancerization in tumorigenesis could impact patient care.

  13. Joint bleeding in von Willebrand disease

    NARCIS (Netherlands)

    Galen, K.P.M. van

    2017-01-01

    Von Willebrand disease (VWD) is the most common inherited bleeding disorder occurring in approximately 1/100 people. Until now, joint bleeds did not get much attention in clinical research on VWD, since mucocutaneous bleeding is predominant. However, recurrent joint bleeds lead to arthropathy, the

  14. The use of transjugular intrahepatic portosystemic stent shunt (TIPS in the management of portal hypertensive bleeding

    Directory of Open Access Journals (Sweden)

    Gin-Ho Lo

    2014-08-01

    Full Text Available Acute esophageal variceal hemorrhage is a terrible complication of portal hypertension and. rebleeding is very common in survivors of acute variceal bleeding. Traditional medical management options include the use of vasoconstrictor, balloon tamponade, and endoscopic therapy. Though endoscopic therapy has achieved successful hemostasis in the majority of acute variceal bleeding episodes, the outcome is usually dismal when such therapy fails. Transjugular intrahepatic portosystemic stent shunt (TIPS was invented to decompress portal hypertension, but is now widely used in Western countries to treat patients with refractory variceal hemorrhage or refractory ascites. By contrast, TIPS has not been commonly used in Asia. In this article, I have reviewed the role of TIPS in the management of portal hypertensive bleeding, which will hopefully be useful for clinicians facing variceal bleeding that is not amenable to endoscopic therapies.

  15. Jaanus Rahumägi : Jüri Pihl ei räägi tõtt / Jaanus Rahumägi ; interv. Raimo Poom

    Index Scriptorium Estoniae

    Rahumägi, Jaanus, 1963-

    2008-01-01

    Riigikogu erikomisjoni juhi Jaanus Rahumägi hinnangul on sõjaväeluure teemas palju otsest valet ning siseminister Jüri Pihli väited sellel teemal ei vasta tõele. Rahumägi kinnitab, et Eestisse ei looda kolmandat julgeolekuasutust ning selgitab, et sõjaväeluuret käsitletakse teabeameti tegevusvaldkonnana, mitte eraldiseisva luureüksusena kaitseväe koosseisus. Kommenteerib Jüri Pihl

  16. Õhuvägi loobus USA pakutud lennukitest

    Index Scriptorium Estoniae

    2016-01-01

    Eesti õhuvägi loobus USA poolt kingituseks pakutud kahest sõjaväe transportlennukist Sherpa C-23B+. Põhjalikuma analüüsi tulemusel on kaalumisel alternatiivsed variandid ja Sherpasid õhuvägi praeguse seisuga kasutusse ei võta, ütles kaitseväe peastaabi pressiesindaja

  17. Internationally recognised armed forces / Urmas Roosimägi

    Index Scriptorium Estoniae

    Roosimägi, Urmas

    1999-01-01

    Eesti Kaitseväe juhataja kohusetäitja kolonel Urmas Roosimägi Eesti kaitseväest, osalemisest NATO-PFP (NATO-Partnership for Peace) programmis ja sõjalisest koostööst NATO partnerriikidega. Urmas Roosimägi biograafia. Programm Partnerlus Rahu Nimel

  18. Computed tomography angiography in patients with active gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    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)

  19. Do statins protect against upper gastrointestinal bleeding?

    DEFF Research Database (Denmark)

    Gulmez, Sinem Ezgi; Lassen, Annmarie Touborg; Aalykke, Claus

    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......) were selected by a 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 ratios (ORs) associating use...... significant protective effect was observed for concurrent users of low-dose aspirin [OR 0.43 (0.18-1.05)]. CONCLUSION: Statins do not prevent UGB, except possibly in users of low-dose aspirin....

  20. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

    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......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......-risk stigmata. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least 3 days after endoscopic hemostasis. Patients with peptic ulcer bleeding who require secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA...

  1. The STOP the Bleeding Campaign.

    Science.gov (United States)

    Rossaint, Rolf; Bouillon, Bertil; Cerny, Vladimir; Coats, Timothy J; Duranteau, Jacques; Fernández-Mondéjar, Enrique; Filipescu, Daniela; Hunt, Beverley J; Komadina, Radko; Maegele, Marc; Nardi, Giuseppe; Neugebauer, Edmund; Ozier, Yves; Riddez, Louis; Schultz, Arthur; Vincent, Jean-Louis; Spahn, Donat R

    2013-04-26

    According to the World Health Organization, traumatic injuries worldwide are responsible for over 5 million deaths annually. Post-traumatic bleeding caused by traumatic injury-associated coagulopathy is the leading cause of potentially preventable death among trauma patients. Despite these facts, awareness of this problem is insufficient and treatment options are often unclear. The STOP the Bleeding Campaign therefore aims to increase awareness of the phenomenon of post-traumatic coagulopathy and its appropriate management by publishing European guidelines for the management of the bleeding trauma patient, by promoting and monitoring the implementation of these guidelines and by preparing promotional and educational material, organising activities and developing health quality management tools. The campaign aims to reduce the number of patients who die within 24 hours after arrival in the hospital due to exsanguination by a minimum of 20% within the next 5 years.

  2. The STOP the Bleeding Campaign

    Science.gov (United States)

    2013-01-01

    According to the World Health Organization, traumatic injuries worldwide are responsible for over 5 million deaths annually. Post-traumatic bleeding caused by traumatic injury-associated coagulopathy is the leading cause of potentially preventable death among trauma patients. Despite these facts, awareness of this problem is insufficient and treatment options are often unclear. The STOP the Bleeding Campaign therefore aims to increase awareness of the phenomenon of post-traumatic coagulopathy and its appropriate management by publishing European guidelines for the management of the bleeding trauma patient, by promoting and monitoring the implementation of these guidelines and by preparing promotional and educational material, organising activities and developing health quality management tools. The campaign aims to reduce the number of patients who die within 24 hours after arrival in the hospital due to exsanguination by a minimum of 20% within the next 5 years. PMID:23635083

  3. Endoscopic Appearance of Oropharyngeal and Upper GI Kaposi’s Sarcoma in an Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Umar Darr

    2017-01-01

    Full Text Available Introduction. Kaposi’s sarcoma (KS usually manifests as a cutaneous disease but GI manifestation is often rare. It is associated with human herpes virus-8 (HHV-8 and seen in immunocompromised patients. In the USA, use of highly active antiretroviral therapy (HAART has drastically reduced incidence of KS in HIV patients. Case Presentation. A 65-year-old male with human immunodeficiency virus (HIV was admitted to the intensive care unit (ICU with cardiopulmonary arrest secondary to hyperkalemia of 7.5 meq/L. Following placement of orogastric and endotracheal tube (ETT, a significant amount of blood was noticed in the ETT. Hemoglobin trended down from 9.6 mg/dL to 6.7 mg/dL over five days. Stool guaiac was positive. Esophagogastroduodenoscopy (EGD was performed and revealed multiple large hypervascularized violaceous submucosal nodular lesions with stigmata of bleeding seen on the soft palate and pharynx and within the cricopharyngeal area close to the vocal cords. Biopsy of the soft palate lesions showed proliferation of neoplastic spindle shaped cells arranged in bundles with slit-like capillary spaces containing erythrocytes consistent with Kaposi’s sarcoma. Biopsy was positive for HHV-8. Colonoscopy was unremarkable. There were no cutaneous manifestations of the disease. Conclusion. GI involvement of Kaposi’s sarcoma must be considered in immunocompromised patients and can be confirmed by endoscopic methods.

  4. Primary duodenal Burkitt lymphoma presenting as sessile, button-like bleeding polyps

    Directory of Open Access Journals (Sweden)

    Ching-Chih Hu

    2015-03-01

    Full Text Available Primary gastrointestinal (GI lymphoma accounts for 30–50% of all extranodal non-Hodgkin’s lymphomas, making the GI tract the most common site of extranodal non-Hodgkin’s lymphomas. Most GI lymphomas belong to the B cell lineage. Burkitt lymphoma (BL is a highly aggressive mature B cell neoplasm that occurs in three forms: endemic, sporadic, and immunodeficiency-associated. Sporadic BL accounts for 1–2% of all adult lymphomas and usually presents as an abdominal manifestation of extranodal disease involving the distal ileum or cecum. Primary BL of the duodenum is rare. However, this report emphasizes the importance of awareness of the malignancy potential of duodenal polyps. We report the case of a 70-year-old woman admitted to our ward with upper GI bleeding due to duodenal polyps. An upper GI endoscopic examination showed button-like polyps with central depression, and an immunohistochemical study of the polyps revealed a high-grade B cell malignancy (BL. Consequently, the patient was treated with aggressive chemotherapy. The tumors regressed after chemotherapy. Although primary duodenal Burkitt lymphoma is very rare, the possibility of malignancy should be considered if a patient presents with duodenal button-like polyps with a central depressed surface.

  5. Coagulation management in massive bleeding.

    Science.gov (United States)

    Griffee, Matthew J; Deloughery, Thomas G; Thorborg, Per A

    2010-04-01

    To update readers on recent literature regarding treatment of coagulopathy for patients with life-threatening bleeding, highlighting emerging therapeutic options, controversial topics, and ongoing clinical trials. Massive transfusion protocols featuring immediate availability of blood products and multidisciplinary communication reduce mortality and conserve resources. There is a growing consensus that immediate administration of plasma and platelet units in a 1: 1: 1 ratio with red cell units reduces early mortality. Lyophilized and recombinant blood product components may have advantages over traditional blood products in certain clinical circumstances. Massive transfusion protocols standardize treatment of the coagulopathy of massive bleeding, leading to rapid restoration of hemostasis and decrease in early mortality.

  6. Validação de um escore para predição de eventos hemorrágicos em síndromes coronarianas agudas Validación de un escore para predicción de eventos hemorrágicos en síndromes coronarios agudos Validation of a score for predicting bleeding events during acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Luis C. L. Correia

    2010-10-01

    validar un escore de riesgo de sangrado para pacientes con SCA. MÉTODOS: Fueron utilizados predictores independientes de sangrado relatados por el Registro GRACE. Variables con odds ratio (OR > 2,5 en ese Registro sumaron 3 puntos (histórico anterior de sangrado, OR=1,5-2,4 sumaron 2 puntos (clearance de creatinina 30, infra o supra-desnivel del segmento ST, enfermedad arterial periférica y tabaco. El escore fue validado en una cohorte de 383 individuos con SCA. Sangrado intrahospitalario fue definido como caída de hematocrito > 10%, transfusión de sangre > 2 unidades, sangrado intracerebral o sangrado fatal. RESULTADOS: La incidencia de eventos hemorrágicos fue de 3,1% y la estadística-C del escore fue 0,66 (IC95% = 0,52-0,80, indicando capacidad predictiva para esos eventos. Aquellos con escore > 7 presentaron 6% de incidencia de sangrado, comparados con 1,9% si el escore era 7 y un mayor riesgo impuesto por el tratamiento con Clopidogrel (P=0,02, bloqueadores IIb/IIIa (P=0,06 y revascularización quirúrgica (PBACKGROUND: Bleeding is a major complication in patients treated for acute coronary syndromes (ACS with antithrombotic and invasive therapies. Consequently, the benefit of such therapies should be balanced against the potential risk of hemorrhagic complications. Therefore, a score to estimate individual risk of bleeding might represent an important tool in clinical decision-making. OBJECTIVE: This study aims to create and validate a bleeding risk score for patients with ACS. METHODS: Independent predictors of bleeding reported by the GRACE Registry were utilized. Variables with odds ratio (OR > 2.5 in that Registry added 3 points (previous history of bleeding, OR = 1.5-2.4 added 2 points (creatinine clearance 30, ST-deviation, peripheral artery disease and smoking. The score was validated in a cohort of 383 individuals with ACS. In-hospital bleeding was defined as hematocrit fall > 10%, blood transfusion > 2 units, intracerebral bleeding or fatal bleeding

  7. Direct Versus Video Laryngoscopy for Intubating Adult Patients with Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Jestin N. Carlson

    2015-12-01

    Full Text Available Introduction: Video laryngoscopy (VL has been advocated for several aspects of emergency airway management; however, there are still concerns over its use in select patient populations such as those with large volume hematemesis secondary to gastrointestinal (GI bleeds. Given the relatively infrequent nature of this disease process, we sought to compare intubation outcomes between VL and traditional direct laryngoscopy (DL in patients intubated with GI bleeding, using the third iteration of the National Emergency Airway Registry (NEARIII. Methods: We performed a retrospective analysis of a prospectively collected national database (NEARIII of intubations performed in United States emergency departments (EDs from July 1, 2002, through December 31, 2012. All cases where the indication for intubation was “GI bleed” were analyzed. We included patient, provider and intubation characteristics. We compared data between intubation attempts initiated as DL and VL using parametric and non-parametric tests when appropriate. Results: We identified 325 intubations, 295 DL and 30 VL. DL and VL cases were similar in terms of age, sex, weight, difficult airway predictors, operator specialty (emergency medicine, anesthesia or other and level of operator training (post-graduate year 1, 2, etc. Proportion of successful first attempts (DL 261/295 (88.5% vs. VL 28/30 (93.3% p=0.58 and Cormack-Lehane grade views (p=0.89 were similar between devices. The need for device change was similar between DL [2/295 (0.7% and VL 1/30 (3.3%; p=0.15]. Conclusion: In this national registry of intubations performed in the ED for patients with GI bleeds, both DL and VL had similar rates of success, glottic views and need to change devices.

  8. Direct Versus Video Laryngoscopy for Intubating Adult Patients with Gastrointestinal Bleeding

    Science.gov (United States)

    Carlson, Jestin N.; Crofts, Jason; Walls, Ron M.; Brown, Calvin A.

    2015-01-01

    Introduction Video laryngoscopy (VL) has been advocated for several aspects of emergency airway management; however, there are still concerns over its use in select patient populations such as those with large volume hematemesis secondary to gastrointestinal (GI) bleeds. Given the relatively infrequent nature of this disease process, we sought to compare intubation outcomes between VL and traditional direct laryngoscopy (DL) in patients intubated with GI bleeding, using the third iteration of the National Emergency Airway Registry (NEARIII). Methods We performed a retrospective analysis of a prospectively collected national database (NEARIII) of intubations performed in United States emergency departments (EDs) from July 1, 2002, through December 31, 2012. All cases where the indication for intubation was “GI bleed” were analyzed. We included patient, provider and intubation characteristics. We compared data between intubation attempts initiated as DL and VL using parametric and non-parametric tests when appropriate. Results We identified 325 intubations, 295 DL and 30 VL. DL and VL cases were similar in terms of age, sex, weight, difficult airway predictors, operator specialty (emergency medicine, anesthesia or other) and level of operator training (post-graduate year 1, 2, etc). Proportion of successful first attempts (DL 261/295 (88.5%) vs. VL 28/30 (93.3%) p=0.58) and Cormack-Lehane grade views (p=0.89) were similar between devices. The need for device change was similar between DL [2/295 (0.7%) and VL 1/30 (3.3%); p=0.15]. Conclusion In this national registry of intubations performed in the ED for patients with GI bleeds, both DL and VL had similar rates of success, glottic views and need to change devices. PMID:26759653

  9. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

    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 D......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...... 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......-risk stigmata. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least 3 days after endoscopic hemostasis. Patients with peptic ulcer bleeding who require secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA...

  10. Approach to upper gastrointestinal bleeding

    African Journals Online (AJOL)

    ese clinical factors, age over 60, and shock on admission are highly predictive.[7] Concurrent medical therapy is particularly important as NSAIDs and anticoagulants, which are commonly prescribed in the elderly, have a direct deleterious effect on coagulation. e. Table 1. Causes of upper gastrointestinal bleeding-related ...

  11. Fibrinogen concentrate in bleeding patients

    DEFF Research Database (Denmark)

    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 def...... deficiencies in several countries, but evidence is lacking regarding indications, dosing, efficacy and safety....

  12. Spontaneous Bleeding Associated with Ginkgo biloba

    Science.gov (United States)

    Bent, Stephen; Goldberg, Harley; Padula, Amy; Avins, Andrew L

    2005-01-01

    BACKGROUND Ginkgo biloba (ginkgo) is a herbal remedy used by over 2% of the adult population in the United States. Several review articles have suggested that ginkgo may increase the risk of bleeding. OBJECTIVE To report a case of bleeding associated with using ginkgo, to systematically review the literature for similar case reports, and to evaluate whether using ginkgo is causally related to bleeding. DATA SOURCES We searched MEDLINE, EMBASE, IBIDS, and the Cochrane Collaboration Database from 1966 to October 2004 with no language restrictions. REVIEW METHODS Published case reports of bleeding events in persons using ginkgo were selected. Two reviewers independently abstracted a standard set of information to assess whether ginkgo caused the bleeding event. RESULTS Fifteen published case reports described a temporal association between using ginkgo and a bleeding event. Most cases involved serious medical conditions, including 8 episodes of intracranial bleeding. However, 13 of the case reports identified other risk factors for bleeding. Only 6 reports clearly described that ginkgo was stopped and that bleeding did not recur. Bleeding times, measured in 3 reports, were elevated when patients were taking ginkgo. CONCLUSION A structured assessment of published case reports suggests a possible causal association between using ginkgo and bleeding events. Given the widespread use of this herb and the serious nature of the reported events, further studies are needed. Patients using ginkgo, particularly those with known bleeding risks, should be counseled about a possible increase in bleeding risk. PMID:16050865

  13. Extending the GI Brokering Suite to Support New Interoperability Specifications

    Science.gov (United States)

    Boldrini, E.; Papeschi, F.; Santoro, M.; Nativi, S.

    2014-12-01

    The GI brokering suite provides the discovery, access, and semantic Brokers (i.e. GI-cat, GI-axe, GI-sem) that empower a Brokering framework for multi-disciplinary and multi-organizational interoperability. GI suite has been successfully deployed in the framework of several programmes and initiatives, such as European Union funded projects, NSF BCube, and the intergovernmental coordinated effort Global Earth Observation System of Systems (GEOSS). Each GI suite Broker facilitates interoperability for a particular functionality (i.e. discovery, access, semantic extension) among a set of brokered resources published by autonomous providers (e.g. data repositories, web services, semantic assets) and a set of heterogeneous consumers (e.g. client applications, portals, apps). A wide set of data models, encoding formats, and service protocols are already supported by the GI suite, such as the ones defined by international standardizing organizations like OGC and ISO (e.g. WxS, CSW, SWE, GML, netCDF) and by Community specifications (e.g. THREDDS, OpenSearch, OPeNDAP, ESRI APIs). Using GI suite, resources published by a particular Community or organization through their specific technology (e.g. OPeNDAP/netCDF) can be transparently discovered, accessed, and used by different Communities utilizing their preferred tools (e.g. a GIS visualizing WMS layers). Since Information Technology is a moving target, new standards and technologies continuously emerge and are adopted in the Earth Science context too. Therefore, GI Brokering suite was conceived to be flexible and accommodate new interoperability protocols and data models. For example, GI suite has recently added support to well-used specifications, introduced to implement Linked data, Semantic Web and precise community needs. Amongst the others, they included: DCAT: a RDF vocabulary designed to facilitate interoperability between Web data catalogs. CKAN: a data management system for data distribution, particularly used by

  14. Risk factors for band-induced ulcer bleeding after prophylactic and therapeutic endoscopic variceal band ligation.

    Science.gov (United States)

    Sinclair, Marie; Vaughan, Rhys; Angus, Peter W; Gow, Paul J; Parker, Frank; Hey, Penelope; Efthymiou, Marios

    2015-08-01

    Endoscopic variceal band ligation (EVBL) aims to eradicate high-risk oesophageal varices. There is a small risk of precipitating bleeding from EVBL-induced oesophageal ulceration, which is associated with significant mortality. We explore the risk factors and outcome of EVBL-induced ulcer bleeding. Retrospective review of our endoscopy database between 2007 and 2012 identified upper endoscopies during which EVBL was performed. Patient demographics, biochemistry and endoscopic findings were recorded as were the complications of EVBL-induced ulcer bleeding and death. A total of 749 episodes of EVBL were performed in 347 patients with a mean Model for End-stage Liver Disease (MELD) score of 15.8. In all, 609 procedures were performed for prophylaxis and 140 for acute haemorrhage. There were 21 episodes (2.8% of procedures) of EVBL-induced ulcer bleeding in 18 patients, five of whom subsequently died (28%). On multivariable analysis, acute variceal haemorrhage was the only significant predictor of EVBL-induced ulcer bleeding [odds ratio (OR) 6.25 (2.57-15.14), Pulcer bleeding rate was 1.5%, with 22% mortality. In this group, higher MELD score and reflux oesophagitis were associated significantly with EVBL-induced ulcer bleeding [OR 25.53 (2.14-303.26), P=0.010 and OR 1.07 (1.01-1.13), P=0.019, respectively]. Our EVBL-induced ulcer bleeding rate was low, but associated with significant mortality. Highest rates were observed following EVBL for acute variceal haemorrhage, for which EVBL is unavoidable. The incidence was lower following prophylactic EVBL, with the MELD score being the predominant risk factor. Reflux oesophagitis requires further investigation as a potentially modifiable risk factor for EVBL-induced ulcer bleeding.

  15. Fatigue and acute/chronic anaemia.

    Science.gov (United States)

    Bager, Palle

    2014-04-01

    Fatigue in patients with gastrointestinal (GI) diseases can be caused by several conditions and anaemia is one of them. Anaemia can be caused by acute GI bleeding, or it can appear in relation to more chronic conditions: iron deficiency anaemia (IDA) and/or anaemia of chronic disease (ACD). Acute anaemia due to acute upper GI bleedings (AUGIB) is often treated with blood transfusions and/or oral iron supplementations. The need for blood transfusions prior to endoscopic intervention has been well described in guidelines. However, guidelines for the monitoring and treatment of anaemia in patients after nonvariceal AUGIB are generally lacking. A retrospective study showed that more than 80% of patients were discharged from hospital with anaemia and less than 20% of them were recommended iron supplementations. Chronic anaemia in inflammatory bowel diseases (IBD) is well known. Anaemia can be caused by deficiency conditions (iron, folic acid or vitamin B12); chronic bleeding; inflammation or medication (or a combination of these). Fatigue in IBD is found in 40% of IBD patients, even with disease in remission. The PhD dissertation is based on two studies. 1. A randomised placebo controlled trial where patients were allocated to iron supplementation (oral or intravenous) or placebo. Patients with nonvariceal AUGIB and anaemia were included in the study (N = 97). The primary follow-up time was 13 weeks, followed by additional three months follow-up. 2. A cross-sectional study including Scandinavian outpatients with IBD. Five hospitals in Denmark, Norway and Sweden included consecutively 5% of their cohort of patients with IBD (N = 429). The aims were: 1. To investigate the effect of iron supplementation in patients who had anaemia after endoscopic intervention for AUGIB. Furthermore, to investigate the health-related quality of life (HRQoL) and fatigue in these patients. 2. To determine the prevalence and type of anaemia, iron deficiency (ID) and fatigue in an unselected

  16. Bleeding diathesis as a cause of menorrhagia: a report of 3 cases.

    Science.gov (United States)

    Suri, Jyotsna; Minocha, Bharti; Dabral, Anjali

    2012-11-01

    Bleeding diathesis as a cause of menorrhagia should not be overlooked at any age even in the perimenopausal woman. Three cases have been presented, wherein bleeding diathesis was the cause of menorrhagia. Two of these patients had acute myeloid leukaemia and the third had immunothrombocytopaenic purpura. A noteworthy point of this series is that one patient was in her teens, the second in the peak reproductive age group and the third in the perimenopausal age.

  17. The Application of Hemospray in Gastrointestinal Bleeding during Emergency Endoscopy

    Directory of Open Access Journals (Sweden)

    Alexander F. Hagel

    2017-01-01

    Full Text Available Introduction. Gastrointestinal bleeding represents the main indication for emergency endoscopy (EE. Lately, several hemostatic powders have been released to facilitate EE. Methods. We evaluated all EE in which Hemospray was used as primary or salvage therapy, with regard to short- and long-term hemostasis and complications. Results. We conducted 677 EE in 474 patients (488 examinations in 344 patients were upper GI endoscopies. Hemospray was applied during 35 examinations in 27 patients (19 males, 33 during upper and 2 during lower endoscopy. It was used after previous treatment in 21 examinations (60% and in 14 (40% as salvage therapy. Short-term success was reached in 34 of 35 applications (97.1%, while long-term success occurred in 23 applications (65.7%. Similar long-term results were found after primary application (64,3% or salvage therapy (66,7%. Rebleeding was found in malignant and extended ulcers. One major adverse event (2.8% occurred with gastric perforation after Hemospray application. Discussion. Hemospray achieved short-term hemostasis in virtually all cases. The long-term effect is mainly determined by the type of bleeding source, but not whether it was applied as first line or salvage therapy. But, even in the failures, patients had benefit from hemodynamic stabilization and consecutive interventions in optimized conditions.

  18. Identification and Molecular Characterization of FKF1 and GI Homologous Genes in Soybean

    OpenAIRE

    Fang Li; Xiaomei Zhang; Ruibo Hu; Faqiang Wu; Jinhua Ma; Ying Meng; Yongfu Fu

    2013-01-01

    In Arabidopsis, FKF1 (FLAVIN BINDING, KELCH REPEAT, F-BOX1) and GI (GIGANTEA) play important roles in flowering pathway through regulating daytime CO (CONSTANS) expression, and such a function is conserved across plants studied. But related reports are limited for soybean. In this study, we cloned FKF1 and GI homologs in soybean, and named as GmFKF1, GmFKF2, GmGI1, GmGI2, and GmGI3, respectively. GmGI1 had two alternative splicing forms, GmGI1α and GmGI1β. GmFKF1/2 transcripts were diurnally ...

  19. Management of severe perioperative bleeding

    DEFF Research Database (Denmark)

    Kozek-Langenecker, Sibylle A; Ahmed, Aamer B; Afshari, Arash

    2017-01-01

    healthcare professionals with an overview of the most recent evidence to help ensure improved clinical management of patients. For this update, electronic databases were searched without language restrictions from 2011 or 2012 (depending on the search) until 2015. These searches produced 18 334 articles. All......: The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia...... articles were assessed and the existing 2013 guidelines were revised to take account of new evidence. This update includes revisions to existing recommendations with respect to the wording, or changes in the grade of recommendation, and also the addition of new recommendations. The final draft guideline...

  20. Endoscopic therapy for gastrointestinal bleeding after liver transplantation

    Directory of Open Access Journals (Sweden)

    LIU Bo

    2016-10-01

    Full Text Available Objective To investigate the clinical effect of endoscopic therapy for patients with esophagogastric variceal bleeding (EVB after liver transplantation. Methods A retrospective analysis was performed for the clinical data of 8 patients who experienced EVB after liver transplantation and underwent endoscopic therapy, especially endoscopic features. The clinical outcome was evaluated, including hemostasis rate, change in varicose veins after treatment, and short-term recurrence and bleeding rate. Results The eight patients had a mean age of 55.00(44.75-61.50 years, and the mean time from liver transplantation to bleeding was 71.50(18.75-107.25 months. As for primary diseases, 6 patients had hepatitis B cirrhosis (among whom one patient each was complicated by liver cancer, alcoholic cirrhosis, and acute liver necrosis, and three were complicated by subacute liver necrosis, one had hepatitis C cirrhosis, and one had unexplained liver cirrhosis. Of all patients, 2 underwent sclerotherapy, 6 underwent endoscopic variceal ligation, and 6 underwent tissue adhesive treatment. The endoscopic therapy achieved successful hemostasis in all patients. No patients experienced rebleeding at discharge or the 12-month follow-up visit. One patient underwent selective endoscopic therapy due to the recurrence of varices. Conclusion Gastrointestinal bleeding remains a serious complication after liver transplantation. Besides antiviral therapy, the presence of varices should be closely monitored.

  1. Bleeding and Thrombosis in a Patient with Secondary Antiphospholipid Syndrome

    Directory of Open Access Journals (Sweden)

    Kaaroud Hayet

    2008-01-01

    Full Text Available Antiphospholipid antibodies have been associated with occurrence of arterial and venous thrombotic events and fetal loss, which together constitute the antiphospholipid syndrome (APS. However, bleeding is rare in this syndrome. We report a case of systemic lupus erythematosus (SLE with APS complicated simultaneously by thrombotic and hemorrhagic events. A 34-year-old woman was a known case of diffuse proliferative lupus nephritis associated with APS, on treatment with corticosteroids, cyclophosphamide and anticoagulants. She presented in February 2004 with severe anemia, menorrhagia, gingival bleeding and acute loss of vision in the left eye. Investigations revealed a hematoma in the psoas muscle with thrombosis of the inferior vena cava and occlusion of the retinal vein. Blood tests revealed a strongly positive lupus anticoagulant, factor XI deficiency (35% and decrease of free protein S (44%. Factor XI inhibitor, anti-prothrombin, and anti-protein S antibodies were absent. The patient was treated with corticosteroids and six pulses of cyclophosphamide, which resulted in a rapid disappearance of bleeding, reduction of hematoma and normalization of hematological abnormalities. She was maintained on corticosteroids, azathioprine and anticoagulant agents were introduced. After a follow-up of 28 months, there was no recurrence of bleeding, the thrombosis had resolved, and there was a decrease in the levels of circulating anticoagulant as well as anticardiolipin antibodies.

  2. Duodenal Histoplasmosis Presenting with Upper Gastrointestinal Bleeding in an AIDS Patient

    Directory of Open Access Journals (Sweden)

    Michael A. Spinner

    2012-01-01

    Full Text Available Gastrointestinal histoplasmosis (GIH is common in patients with disseminated disease but only rarely comes to clinical attention due to the lack of specific signs and symptoms. We report the unusual case of a 33-year-old Caucasian male with advanced AIDS who presented with upper GI bleeding from diffuse erosions throughout the duodenum. Biopsy of the lesions revealed small bowel mucosa with granulomatous inflammation and macrophages with small intracellular yeasts consistent with disseminated histoplasmosis. The patient demonstrated significant clinical improvement following a two-week course of liposomal amphotericin B. To our knowledge, this is the first case report of duodenal histoplasmosis leading to clinically significant bleeding, manifesting with worsening anemia and melanotic stools. Given our findings, we maintain that GIH should be considered on the differential diagnosis for GI bleeding in AIDS patients at risk, specifically those with advanced immunosuppression (i.e., CD4+ cell counts  cells/mm3 who reside in endemic areas (Ohio or Mississippi river valleys and/or have a prior history of histoplasmosis. For diagnostic evaluation, we recommend checking a urine Histoplasma quantitative antigen EIA as well as upper and/or lower endoscopy with biopsy. We recommend treatment with a two-week course of liposomal amphotericin B followed by indefinite itraconazole.

  3. Bleeding

    Science.gov (United States)

    ... gov/pubmed/24641269 . Simon BC, Hern HG. Wound management principles. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 52. ...

  4. Harvesting implementation for the GI-cat distributed catalog

    Science.gov (United States)

    Boldrini, Enrico; Papeschi, Fabrizio; Bigagli, Lorenzo; Mazzetti, Paolo

    2010-05-01

    GI-cat framework implements a distributed catalog service supporting different international standards and interoperability arrangements in use by the geoscientific community. The distribution functionality in conjunction with the mediation functionality allows to seamlessly query remote heterogeneous data sources, including OGC Web Services - e.e. OGC CSW, WCS, WFS and WMS, community standards such as UNIDATA THREDDS/OPeNDAP, SeaDataNet CDI (Common Data Index), GBIF (Global Biodiversity Information Facility) services and OpenSearch engines. In the GI-cat modular architecture a distributor component carry out the distribution functionality by query delegation to the mediator components (one for each different data source). Each of these mediator components is able to query a specific data source and convert back the results by mapping of the foreign data model to the GI-cat internal one, based on ISO 19139. In order to cope with deployment scenarios in which local data is expected, an harvesting approach has been experimented. The new strategy comes in addition to the consolidated distributed approach, allowing the user to switch between a remote and a local search at will for each federated resource; this extends GI-cat configuration possibilities. The harvesting strategy is designed in GI-cat by the use at the core of a local cache component, implemented as a native XML database and based on eXist. The different heterogeneous sources are queried for the bulk of available data; this data is then injected into the cache component after being converted to the GI-cat data model. The query and conversion steps are performed by the mediator components that were are part of the GI-cat framework. Afterward each new query can be exercised against local data that have been stored in the cache component. Considering both advantages and shortcomings that affect harvesting and query distribution approaches, it comes out that a user driven tuning is required to take the best

  5. Preventing perioperative bleeding in patients with inherited bleeding disorders.

    Science.gov (United States)

    Watterson, Colin; Beacher, Nicholas

    2017-03-01

    Data sourcesCochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, a regularly updated database informed by trials identified within electronic databases including MEDLINE. Further defined searches were undertaken in PubMed, Embase, The Cochrane Library, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform. Additional hand searching of relevant journals and books of conference proceedings was undertaken.Study selectionRandomised and quasi-randomised controlled trials in people of all ages with haemophilia or VWD undergoing oral or dental procedures using antifibrinolytic agents (tranexamic acid (TXA) or epsilon aminocaproic acid (EACA)) to prevent perioperative bleeding compared to no intervention with or without placebo.Data extraction and synthesisTwo authors independently assessed identified publications for inclusion based on defined selection criteria. The two authors performed data extraction and risk of bias assessments using standardised forms and the Cochrane risk of bias tools. A third author, deemed to have particular subject expertise, verified eligibility of inclusion.ResultsOne randomised, double-blinded placebo controlled trial and one quasi-randomised trial were included. A total of 59 participants with haemophilia undergoing dental extraction were involved. Both trials evidenced a notable reduction in post-operative bleeding following dental extraction when either TXA or EACA were used, in addition to routine preoperative factor replacement, when compared to placebo. The number of post-operative bleeds, amount of blood loss and the need for additional clotting factors were reduced in the groups receiving antifibrinolytic therapy. No eligible trials in people with VWD were identified.ConclusionsLow quality evidence exists to support the use of adjuvant antifibrinolytic therapy to reduce perioperative bleeding in patients with haemophilia undergoing dental extraction. The limited number of trials

  6. Gastrointestinal bleeding following NSAID ingestion in children

    African Journals Online (AJOL)

    instituted, and following an improved clinical condition, she was discharged home after 40 days of admission. Discussion. GI injury is a major adverse effect of NSAID use. The use of these drugs is known to disrupt GI-protective mechanisms, which include mucosal blood flow and mucus secretion [3]. These disruptions lead ...

  7. Acute mesenteric ischemia: experience in a tertiary care hospital.

    Science.gov (United States)

    Hussain, Dildar; Sarfraz, Shahid Latif; Baliga, Suresh K; Hartung, Rolf

    2009-01-01

    Acute mesenteric ischemia is an abdominal catastrophe. This has been described as a complex of diseases rather than a single clinical entity. The incidence in United States is 1 in 1000 hospital admissions. The objective of this descriptive study was to determine the clinical presentations and out come after surgery of patients with acute mesenteric ischemia. It was conducted at Dubai Hospital, Dubai, United Arab Emirates. All patients having per operative or histopathological diagnosis of acute mesenteric ischemia from 2002 to 2006 were included. There were 16 patients in all. Their mean age was 51 years, 12 were male and 4 were female. Abdominal pain was present in 16 patients, vomiting in 12 and anorexia in 9 patients. Abdominal tenderness was present in 16 patients, abdominal distension and rebound tenderness in 12 patients. Five patients had hypertension, 4 had myocardial infarction and 4 had diabetes mellitus as risk factors. X-Ray abdomen was done in 13 patients, Ultrasound in 9 and CT Scan in one patient. Resection of bowel was done in 14 patients. Post operatively 5 patients developed pneumonia, 3 had wound dehiscence, 3 had sepsis, and 3 had Lower GI bleeding. Five patients were expired after surgery in the hospital. Four patients were lost to follow up. We should have a high index of suspicion for mesenteric ischemia in patients with unexplained abdominal pain. Early diagnosis and prompt surgical intervention improves the outcome.

  8. Etiology of lower gastrointestinal bleeding in children:a single center experience from southern iran.

    Science.gov (United States)

    Zahmatkeshan, Mozhgan; Fallahzadeh, Ebrahim; Najib, Khadijesadat; Geramizadeh, Bita; Haghighat, Mahmood; Imanieh, Mohammad Hadi

    2012-10-01

    This study aimed to determine the common etiologies and characteristics of lower gastrointestinal (GI) bleeding in children from Southern Iran. This five-year prospective cross-sectional study was performed from March 2006 to March 2011 in Nemazee Hospital. All pediatric patients (<18 years of age) who referred to our center with gross lower GI bleeding or two consecutive positive occult blood tests with at least a one-week interval were included in the study. Patients were categorized as neonates, infants, children and adolescents and the findings were reported separately in each group. Each patient underwent a colonoscopy and several mucosal biopsies were taken. Demographic and clinical information as well as colonoscopy and pathology findings were reported. Overall, we included 363 pediatric patients with a mean age of 71.9±58.4 months (range: 1-216 months). There were 215 (59.2%) boys and 148 (40.8%) girls. The most common colonoscopy findings were sigmoid colon polyp in 91 (25.1%) patients followed by descending colon petechia in 78 (21.5%) patients, whitish rectal lesions in 45 (12.4%) patients, and sigmoid and rectal ulcers in 37 (10.2%) patients. Biopsy samples were non-specific in 96 (26.4%) patients. The most common pathological findings were juvenile polyp in 84 (23.1%) followed by lymphoid nodular hyperplasia in 55 (15.2%) and solitary rectal ulcers in 25 (6.9%) patients. We found that lower GI bleeding was more common among 2-10 year-old children and was rarely encountered in neonates. Hematochezia was the most common form of presentation followed by bloody diarrhea and occult blood. The most common colonoscopy finding was sigmoid colon polyp and the most common pathological finding was juvenile polyp.

  9. Harnessing bacteriocin biology as targeted therapy in the GI tract.

    Science.gov (United States)

    Kommineni, Sushma; Kristich, Christopher J; Salzman, Nita H

    2016-11-01

    Recently, our laboratory demonstrated that bacteriocins produced by commensal enterococci provide an advantage in niche maintenance in the highly competitive environment of the gastrointestinal (GI) tract. Bacterial production of bacteriocins is a conserved defense strategy to help establish an ecological niche. Bacteriocin-encoding genes in enterococci are often carried on mobile genetic elements, including conjugative plasmids, enabling the transfer of such traits to other community members in a shared niche. Use of a novel mouse model for enterococcal colonization of the GI tract allowed us to investigate enterococcal dynamics and the role of enterococcal bacteriocins in the mouse GI tract. We examined the role of bacteriocin-21, carried on the pPD1 plasmid, in enterococcal colonization of the gut. We discovered that Enterococcus faecalis (EF) harboring pPD1 effectively colonizes the GI tract by using Bac-21 to eliminate its competition. In our study, we also present evidence for active conjugation in the GI tract, a strategy EF uses to enhance the number of bacteriocin producers in a given niche and eliminate bacteriocin-susceptible populations. Using an engineered strain of EF that is capable of producing Bac-21 but impaired in its conjugation ability, we were able to reduce pre-existing colonization by vancomycin-resistant enterococci in the mouse gut. Thus, our results suggest a novel therapeutic strategy to de-colonize antibiotic-resistant enterococci from the GI tract of patients and thereby prevent the emergence of resistant enterococcal infections that are otherwise difficult, or impossible, to treat.

  10. Vascular gastric anomalies as a cause of relapsing bleeding

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

    Johansen, Mathias; Wikkelsø, Anne; Lunde, Jens

    2015-01-01

    finding a beneficial effect of PCC in reducing the volume of fresh frozen plasma (FFP) transfused to reverse the effect of vitamin K antagonist treatment. The number of new occurrences of transfusion of red blood cells (RBCs) did not seem to be associated with the use of PCC (RR 1.08, 95% CI 0.82 to 1...... other databases. We reran the search in October 2014 and found one potential new study of interest. We added this study to a list of 'Studies awaiting classification', and we will incorporate this study into the formal review findings at the time of the review update. SELECTION CRITERIA: We included......, as 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...

  12. A STUDY ON ENDOSCOPIC EVALUATION OF UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    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

  13. Classification of menstrual bleeding disorders.

    Science.gov (United States)

    Munro, Malcolm G

    2012-12-01

    There exists a spectrum of potential causes of abnormal uterine bleeding (AUB) in nonpregnant reproductive-aged women. In some instances the abnormal bleeding may emanate from definable pathologic entities in the endometrial cavity such as polyps or submucous leiomyomas (fibroids), while in others, it may occur secondary to coagulopathies or disorders of local or systemic hemostasis. If the patient is subjected to a rigorous evaluation more than one potential contributor may be identified, a circumstance that challenges the clinician since entities such as polyps, leiomyomas, and adenomyosis may frequently be asymptomatic, even in women with AUB. The bench or clinical investigator may also be influenced by the existence of the multiplicity of potential causes that could confound the results of research. This paper describes FIGO's (Fédération Internationale de Gynécologie et d'Obstétrique) new PALM-COEIN classification of causes of AUB in the reproductive years (Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia-Coagulopathy, Ovulatory disorder, Endometrial, Iatrogenic, Not yet classified). This system is designed to assist clinicians in the evaluation of patients, investigators in the design and interpretation of research and faculty in the education of medical students and residents/trainees. Additionally, given the longstanding existence of a confusing array of conflicting definitions, the manuscript describes the FIGO standardized terminology for both normal menstruation and AUB symptoms.

  14. Diagnosis and treatment of unexplained anemia with iron deficiency without overt bleeding

    DEFF Research Database (Denmark)

    Dahlerup, Jens Frederik; Eivindson, Martin; Jacobsen, Bent Ascanius

    2015-01-01

    A general overview is given of the causes of anemia with iron deficiency as well as the pathogenesis of anemia and the para-clinical diagnosis of anemia. Anemia with iron deficiency but without overt GI bleeding is associated with a risk of malignant disease of the gastrointestinal tract; upper...... for unexplained anemia with iron deficiency: conduct serological celiac disease screening with transglutaminase antibody (IgA type) and IgA testing and perform bidirectional endoscopy (gastroscopy and colonoscopy). Bidirectional endoscopy is not required in premenopausal women ... are given for the following conditions: a) the paraclinical diagnosis of anemia with iron deficiency; b) the diagnostic work-up for unexplained anemia with iron deficiency without overt bleeding; and c) how to proceed after negative bidirectional endoscopy of the gastrointestinal tract....

  15. Gastric ulcer bleeding: diagnosis by computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Voloudaki, Argyro; Tsagaraki, Kaliopi; Mouzas, John; Gourtsoyiannis, Nickolas

    1999-06-01

    A case of CT demonstration of a bleeding gastric ulcer is presented, in a patient with confusing clinical manifestations. Abdominal CT was performed without oral contrast medium administration, and showed extravasation of intravenous contrast into a gastric lumen distended with material of mixed attenuation. It is postulated that if radiopaque oral contrast had been given, peptic ulcer bleeding would probably have been masked. CT demonstration of gastric ulcer bleeding, may be of value in cases of differential diagnostic dilemmas.

  16. Heavy menstrual bleeding diagnosis and medical management

    OpenAIRE

    Sriprasert, Intira; Pakrashi, Tarita; Kimble, Thomas; Archer, David F

    2017-01-01

    Heavy menstrual bleeding (HMB) is a common gynecological problem that has a significant impact on a woman’s quality of life and the activities of daily living. Due to the difficulty in accurately describing menstrual bleeding abnormalities using older terminology, the PALM-COEIN classification system of the Federation Internationale de Gynecologie et d’Obstetrique was proposed to describe and identify the etiology of abnormal endometrial bleeding. As there is no single pathway that is associa...

  17. 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

    Directory of Open Access Journals (Sweden)

    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.

  18. Lenz, Eestis unustatud geenius / Riina Mägi

    Index Scriptorium Estoniae

    Mägi, Riina, 1957-

    2001-01-01

    Tartus toimunud rahvusvahelise Lenzi-konverentsi (Jakob Michael Reinhold Lenz) publik nägi väljasõidul Põltsamaale Lenzi kirjutatud näidendit "Haavatud peigmees", mis esitati Tartu üliõpilasteatri poolt Põltsamaa lossihoovis. Lav. Kalev Kudu

  19. G.I. Taylor and the Trinity Test

    Science.gov (United States)

    Deakin, Michael A. B.

    2011-01-01

    The story is often told of the calculation by G.I. Taylor of the yield of the first ever atomic bomb exploded in New Mexico in 1945. It has indeed become a staple of the classroom whenever dimensional analysis is taught. However, while it is true that Taylor succeeded in calculating this figure at a time when it was still classified, most versions…

  20. Clenbuterol-Stimulated Glucose Uptake Activates both GS and GI ...

    African Journals Online (AJOL)

    In the later, β2-AR induces PKA-catalysed phosphorylation of the receptor, which intends couples to Gi, at high concentration. We proposed that, clenbuterol ... relieved the inhibitory effect. Keywords: PTX, Pertusis toxin, G-proteins, Guanine nucleotide binding proteins, β-AR, beta adrenoceptor, M2, muscarinic receptors ...

  1. The queue-length in GI/G/s queues

    Directory of Open Access Journals (Sweden)

    Le Gall Pierre

    2000-01-01

    Full Text Available The distribution of the queue-length in the stationary symmetrical GI/G/s queue is given with an application to the M/G/s queue, particularly in the case of the combination of several packet traffics, with various constant service times, to dimension the buffer capacity.

  2. Eesti uued helid / Tristan Priimägi

    Index Scriptorium Estoniae

    Priimägi, Tristan, 1976-

    2009-01-01

    Tristan Priimägi kuulab digitaalselt uusi kodumaiseid demosalvestisi: Nevesis "Demo", Queennaive "My Soul / EuroPop", DND "Den Rozhdenija EP", Uncandy "Lovecool / Diskobliss / Libidinal Economy", S.I.N. "Year Zero EP" (Omblu) / "Steppin Headz" (XDubz), Spice Mouse "Unreleased"

  3. Kaitsevägi parandab soomukite kaitsevõimet

    Index Scriptorium Estoniae

    2013-01-01

    Kaitsevägi võtab sõjalisel operatsioonil Afganistanis kasutusele soomukitele paigaldatava granaadiheitjavastase kaitsesüsteemi. Soomukitele Sisu XA-188 paigaldatav kaitsesüsteem SidePRO-LASSO on kõrgtugev terasvõrk, mis takitsab granaadiheitja RPG-7 granaadi soomustläbistavat laengut plahvatamast

  4. [Diagnostics and treatment of traumatic retroperitoneal bleedings].

    Science.gov (United States)

    Abakumov, M M; Smoliar, A N; Trofimova, E Iu; Sharifullin, V A; Barmina, T G; Bognitskaia, T V

    2013-01-01

    Treatment results of 403 patients with the closed abdominal trauma, complicated by the retroperitoneal bleeding, was performed. Two types of echographic and CT picture of the retroperitoneal bleeding were distinguished - with clot formation and of impregnation type. The diagnostic and treatment algorithm was suggested. The use of the least allowed the location of the bleeding source in 40% of the operated patients and in 100% of those, who were treated conservatively. The indications to the retroperitoneal surgical revision were set basing on the information about the bleeding source or the localization and spreading of the hematoma. The use of the algorithm was successful in 98.9-100% of cases.

  5. A Fibreoptic endoscopic study of upper gastrointestinal bleeding at Bugando Medical Centre in northwestern Tanzania: A retrospective review of 240 cases

    Directory of Open Access Journals (Sweden)

    Jaka Hyasinta

    2012-07-01

    Full Text Available Abstract Background Upper gastrointestinal (GI bleeding is recognized as a common and potentially life-threatening abdominal emergency that needs a prompt assessment and aggressive emergency treatment. A retrospective study was undertaken at Bugando Medical Centre in northwestern Tanzania between March 2010 and September 2011 to describe our own experiences with fibreoptic upper GI endoscopy in the management of patients with upper gastrointestinal bleeding in our setting and compare our results with those from other centers in the world. Findings A total of 240 patients representing 18.7% of all patients (i.e. 1292 who had fibreoptic upper GI endoscopy during the study period were studied. Males outnumbered female by a ratio of 2.1:1. Their median age was 37 years and most of patients (60.0% were aged 40 years and below. The vast majority of the patients (80.4% presented with haematemesis alone followed by malaena alone in 9.2% of cases. The use of non-steroidal anti-inflammatory drugs, alcohol and smoking prior to the onset of bleeding was recorded in 7.9%, 51.7% and 38.3% of cases respectively. Previous history of peptic ulcer disease was reported in 22(9.2% patients. Nine (3.8% patients were HIV positive. The source of bleeding was accurately identified in 97.7% of patients. Diagnostic accuracy was greater within the first 24 h of the bleeding onset, and in the presence of haematemesis. Oesophageal varices were the most frequent cause of upper GI bleeding (51.3% followed by peptic ulcers in 25.0% of cases. The majority of patients (60.8% were treated conservatively. Endoscopic and surgical treatments were performed in 30.8% and 5.8% of cases respectively. 140 (58.3% patients received blood transfusion. The median length of hospitalization was 8 days and it was significantly longer in patients who underwent surgical treatment and those with higher Rockall scores (P  60 years and in patients with higher Rockall scores and those who

  6. Minor Bleeds Alert for Subsequent Major Bleeding in Patients Using Vitamin K Antagonists.

    OpenAIRE

    Veeger, Nic J.G.M.; Piersma-Wichers, Margriet; Meijer, Karina; Hillege, Hans L

    2011-01-01

    Abstract Vitamin K antagonists (VKA) have shown to be effective in primary and secondary prevention of thromboembolism, but the associated risk of bleeding is an important limitation. The majority of the bleeds are clinically mild. In this study, we assessed whether these minor bleeds are associated with major bleeding, when controlling for other important risk indicators, including the achieved quality of anticoagulation. For this, 5898 patients of a specialised anticoagulation cl...

  7. Bleeding complications with the P2Y12 receptor antagonists clopidogrel and ticagrelor in the PLATelet inhibition and patient Outcomes (PLATO) trial.

    Science.gov (United States)

    Becker, Richard C; Bassand, Jean Pierre; Budaj, Andrzej; Wojdyla, Daniel M; James, Stefan K; Cornel, Jan H; French, John; Held, Claes; Horrow, Jay; Husted, Steen; Lopez-Sendon, Jose; Lassila, Riitta; Mahaffey, Kenneth W; Storey, Robert F; Harrington, Robert A; Wallentin, Lars

    2011-12-01

    AIMS More intense platelet-directed therapy for acute coronary syndrome (ACS) may increase bleeding risk. The aim of the current analysis was to determine the rate, clinical impact, and predictors of major and fatal bleeding complications in the PLATO study. METHODS AND RESULTS PLATO was a randomized, double-blind, active control international, phase 3 clinical trial in patients with acute ST elevation and non-ST-segment elevation ACS. A total of 18 624 patients were randomized to either ticagrelor, a non-thienopyridine, reversibly binding platelet P2Y(12) receptor antagonist, or clopidogrel in addition to aspirin. Patients randomized to ticagrelor and clopidogrel had similar rates of PLATO major bleeding (11.6 vs. 11.2%; P = 0.43), TIMI major bleeding (7.9 vs. 7.7%, P = 0.56) and GUSTO severe bleeding (2.9 vs. 3.1%, P = 0.22). Procedure-related bleeding rates were also similar. Non-CABG major bleeding (4.5 vs. 3.8%, P = 0.02) and non-procedure-related major bleeding (3.1 vs. 2.3%, P = 0.05) were more common in ticagrelor-treated patients, primarily after 30 days on treatment. Fatal bleeding and transfusion rates did not differ between groups. There were no significant interactions for major bleeding or combined minor plus major bleeding between treatment groups and age ≥75 years, weight 325 mg on the day of randomization, pre-randomization clopidogrel administration, or clopidogrel loading dose. CONCLUSION Ticagrelor compared with clopidogrel was associated with similar total major bleeding but increased non-CABG and non-procedure-related major bleeding, primarily after 30 days on study drug treatment. Fatal bleeding was low and did not differ between groups.

  8. Rare case of upper gastrointestinal bleeding in achalasia.

    Science.gov (United States)

    Zhang, Wei-Wei; Xie, Xiang-Jun; Geng, Chang-Xin; Zhan, Shu-Hui

    2015-03-16

    Achalasia is a prototypic esophageal motility disorder with complications including aspiration-pneumonia, esophagitis, esophageal-tracheal fistula, spontaneous rupture of the esophagus, and squamous cell carcinoma. However, achalasia is rarely associated with esophageal stones and ulcer formation that lead to upper gastrointestinal bleeding. Here, we report the case of a 61-year-old woman who was admitted to our department after vomiting blood for six hours. Physical examination revealed that the patient had severe anemia and mild palpitation in the upper abdomen. CT revealed lower esophageal dilatation and esophageal wall thickening, and an emergency upper endoscopy showed that the esophagus was substantially expanded by a dark round stone, with multiple ulcers on the esophageal wall and a slit in the cardiac mucosa with a large clot attached. The patient's history included ingestion of 1 kg hawthorn three days prior. The acute upper gastrointestinal bleeding was caused by Mallory-Weiss syndrome associated with achalasia and an esophageal stone. For patients with achalasia, preventing excessive ingestion of tannins is crucial to avoid complications such as bleeding and rupture.

  9. Endoscopic variceal ligation-induced ulcer bleeding: What are the risk factors and treatment strategies?

    Science.gov (United States)

    Cho, Eunae; Jun, Chung Hwan; Cho, Sung Bum; Park, Chang Hwan; Kim, Hyun Soo; Choi, Sung Kyu; Rew, Jong Sun

    2017-06-01

    This study was aimed to determine the risk factors of endoscopic variceal ligation-(EVL) induced ulcer bleeding.The prevalence of EVL-induced ulcer bleeding is reported to be 3.6%. However, there are only limited reports of this serious complication, and the risk factors and the treatment methods are not well established.A total of 430 patients who had undergone EVL in Chonnam National University Hospital from January 2014 to October 2016 were studied. EVL was performed for prophylaxis or acute hemorrhage. The patients were classified into 2 groups: a bleeding group (n = 33) and a non-bleeding group (n = 397). The patients who had endoscopically confirmed EVL-induced ulcer bleeding were included in the bleeding group.EVL-induced ulcer bleeding occurred in 7.7% (n = 33) of the patients. In a multivariate analysis, model for end-stage liver disease (MELD) score >10 (odds ratio [OR]: 3.42, 95% confidence interval [CI]: 1.10-10.64), concomitant GV F3 (OR: 14.1, 95% CI: 2.84-71.43), and detachment of o-ring bands on follow-up endoscopy (OR: 8.06, 95% CI: 2.55-25.64) were independent predictive factors of EVL-induced ulcer bleeding. Various endoscopic modalities were attempted for hemostasis (EVL in 8 cases [24.2%], endoscopic variceal obturation [EVO] with cyanoacrylate in 6 cases [18.2%], argon plasma coagulation [APC] in 1 case (3%), Sengstaken-Blakemore (SB) tube in 3 cases [9.1%]), and proton pump inhibitor therapy only in 15 cases (45.5%).MELD score >10, concomitant GV F3, and detachment of o-ring bands on follow-up endoscopy are risk factors for EVL-induced ulcer bleeding.

  10. Rectal bleeding amongst Medical Students: Prevalence and ...

    African Journals Online (AJOL)

    DELL

    Background: Rectal bleeding can be a symptom of colorectal cancer. Consultation l bleeding can be a symptom of colorectal cancer. Consultation behaviour of health care professionals may influence the attention they give to patients who consult them. who consult them. Objective: To determine the prevalence of rectal ...

  11. Duodenal diverticular bleeding: an endoscopic challenge

    Directory of Open Access Journals (Sweden)

    Eduardo Valdivielso-Cortázar

    Full Text Available Duodenal diverticula are an uncommon cause of upper gastrointestinal bleeding. Until recently, it was primarily managed with surgery, but advances in the field of endoscopy have made management increasingly less invasive. We report a case of duodenal diverticular bleeding that was endoscopically managed, and review the literature about the various endoscopic therapies thus far described.

  12. Massive rectal bleeding from colonic diverticulosis | Olokoba ...

    African Journals Online (AJOL)

    Objectives: This is to describe a case of colonic diverticulosis causing massive rectal bleeding in an elderly Nigerian man. Case report: We highlight a case of a 79 year old man who presented with massive rectal bleeding due to colonic diverticulosis from our centre. Colonoscopy identified multiple diverticula in the ...

  13. Rectal bleeding amongst Medical Students: Prevalence and ...

    African Journals Online (AJOL)

    Background: Rectal bleeding can be a symptom of colorectal cancer. Consultation behaviour of health care professionals may influence the attention they give to patients who consult them. Objective: To determine the prevalence of rectal bleeding among medical students and their consultation behaviour. A Questionnaire ...

  14. Recent advances in the management of peptic ulcer bleeding.

    Science.gov (United States)

    Beales, Ian

    2017-01-01

    Acute upper gastrointestinal haemorrhage due to peptic ulcer bleeding remains an important cause of emergency presentation and hospital admission. Despite advances in many aspects of management, peptic ulcer bleeding is still associated with significant morbidity, mortality, and healthcare costs. Comprehensive international guidelines have been published, but advances as well as controversies continue to evolve. Important recent advances include the evidence supporting a more restrictive transfusion strategy aiming for a target haemoglobin of 70-90 g/l. Comparative studies have confirmed that the Glasgow-Blatchford score remains the most useful score for predicting the need for intervention as well as for identifying the lowest-risk patients suitable for outpatient management. New scores, including the AIMS65 and Progetto Nazionale Emorragia Digestiva score, may be more accurate in predicting mortality. Pre-endoscopy erythromycin appears to improve outcomes and is probably underused. High-dose oral proton pump inhibition (PPI) for 11 days after PPI infusion is advantageous in those with a Rockall score of 6 or more. Oral is as effective as parenteral iron at restoring haemoglobin levels after a peptic ulcer bleed and both are superior to placebo in this respect. Within endoscopic techniques, haemostatic powders and over-the-scope clips can be used when other methods have failed. A disposable Doppler probe appears to provide more accurate determination of both rebleeding risk and the success of endoscopic therapy than purely visual guidance. Non- Helicobacter pylori, non-aspirin/non-steroidal anti-inflammatory drug ulcers contribute an increasing percentage of bleeding peptic ulcers and are associated with a poor prognosis and high rebleeding rate. The optimal management of these ulcers remains to be determined.

  15. Unusual autopsy finding: Simon’s bleeding

    Directory of Open Access Journals (Sweden)

    Bülent Eren

    2013-10-01

    Full Text Available Objective: To determine whether or not hanging had taken place before or after the death of the victim is quite important in the identification of criminal cases pretended to be suicidal attempts. Material and Methods:Evidence for Simon’s bleeding was searched in cases included in the study group after retracting soft tissue and organs away from the field of interest for full exposure of the region of lumbar spinal veretebrae without macroscopic grading of the severity of bleeding, and determining the lumbar level of bleeding. The cases autopsied in Bursa Morgue Department between 2009 and 2011 were retrospectively investigated and evaluated.Results: A total of 848 cases (664 males, and 184 females, male/female ratio, 3.6 : 1 were included in the study. A total of 270 (31.8 % cases had Simon’s bleeding. A significant difference in the frequency of Simon’s bleeding exists among various causes of death. A 28.5 % (n = 77 of the cases with Simon’s bleeding were in the group with hanged death cases (p < 0.001. Conclusion:Splinter bleedings identified originally by Simon on the ventral, and later dorsal aspects of the spinal disci in cases of hanging were also observed later in deaths not related to hanging, however it was concluded that these types of bleeding could not be detected in cases of postmortem hanging. When we evaluated all groups, the results we obtained do not support the assertion that the incidence of Simon’s bleeding decreases with aging. Instead, when compared with all other groups, the incidenceof Simon’s bleeding was also higher in cases of hanging with the highest mean age.

  16. Possible Role of Meckel’s Scan Fused with SPECT CT Imaging: Unraveling the Cause of Abdominal Pain and Obscure-Overt Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    D.Kim Turgeon

    2008-03-01

    Full Text Available A 27-year-old male presented with recurrent abdominal pain and high volume hematochezia despite undergoing extensive testing and a right hemicolectomy 3 years prior for a linear bleeding ulceration in the ascending colon. Studies at the University of Michigan included esophagogastroduodenoscopy (EGD, colonoscopy and video capsule endoscopy (VCE, revealing an arteriovenous malformation (AVM in the terminal ileum. He was hospitalized for recurrent symptoms. His presentation suggested a small bowel source of obscure-overt GI bleeding based on prior non-diagnostic colonoscopy and EGD and a bilious nasogastric lavage. Tagged red blood cell scan localized bleeding to the right lower quadrant. Colonoscopy showed fresh blood in the terminal ileum without a clear source. Angiography showed no evidence of bleeding or terminal ileal AVM. A novel Meckel’s scan fused with SPECT imaging showed focal uptake in the terminal ileum. The patient underwent Meckel’s diverticulectomy with sparing of adjacent bowel and has remained asymptomatic for 19 months. This case illustrates that patients with obscure-overt GI bleeding require a step-wise multi-modality diagnostic work-up. Because Meckel’s scans are false-positive in 28% of adults, Meckel’s scan fused with SPECT imaging may offer an approach to refine diagnostic accuracy of either scan alone, but requires further investigation. Exploratory laparotomy should be reserved as a last option and is best performed with intraoperative endoscopy.

  17. Transcriptional Analyses of Barrett's Metaplasia and Normal Upper GI Mucosae

    OpenAIRE

    Barrett, Michael T.; Yeung, Ka Yee; Ruzzo, Walter L.; Hsu, Li; Blount, Patricia L.; Sullivan, Robert; Zarbl, Helmut; Delrow, Jeffrey; Rabinovitch, Peter S.; Brian J Reid

    2002-01-01

    Over the last two decades, the incidence of esophageal adenocarcinoma (EA) has increased dramatically in the US and Western Europe. It has been shown that EAs evolve from premalignant Barrett's esophagus (BE) tissue by a process of clonal expansion and evolution. However, the molecular phenotype of the premalignant metaplasia, and its relationship to those of the normal upper gastrointestinal (GI) mucosae, including gastric, duodenal, and squamous epithelium of the esophagus, has not been sys...

  18. Acute Esophageal Necrosis in an Alcoholic after Successful Resuscitation from Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Amish Shah

    2017-01-01

    Full Text Available Introduction. We present a patient who presented to the ICU after successful resuscitation from cardiac arrest who was subsequently diagnosed with AEN. Case Presentation. A 66-year-old female presented after cardiac arrest in which return of spontaneous circulation was achieved within 7 minutes after the initiation of CPR. She was intubated on the scene and found to have coffee ground emesis in her bathroom when found unresponsive. Due to the hemodynamically significant GI bleed, patient was started on IV proton pump inhibitor, octreotide, and levophed. Subsequent endoscopy showed diffuse severe mucosal changes characterized by blackness, erythema, friability, granularity, inflammation, and decreased vascular pattern in the middle third of the esophagus and in the lower third of the esophagus. Discussion. AEN is a rare syndrome with a prevalence ranging from 0.001 to 0.2% of EGD. This patient is especially rare as this patient was female and had AEN in the middle esophagus along with lower esophagus. The pathophysiology in this patient is hypothesized that she had cardiac arrest secondary to acute upper GI hemorrhage. Subsequent low-flow state (cardiac arrest in addition to being in the setting of severe alcohol abuse led to esophageal necrosis.

  19. Bochdalek Hernia in an Adult with Upper Gastrointestinal Bleeding.

    Science.gov (United States)

    Al-Dugdugi, Mohammed; Alhazmi, Abdulhameed; Khaliel, Abdulhadi; Perez, Luis

    2017-01-01

    Bochdalek hernia (BH) can be a life-threatening condition in infants. Approximately 85.3% of newborns with a BH are immediately at high risk and have a high mortality rate due to respiratory insufficiency [Kocakusak et al.: Hernia 2005;9: 284-287]. However, BH is almost asymptomatic in adults and discovered only incidentally [Wilkins et al.: Clin Imaging 1994;18: 224-229]. Complicated BH in adults might present with visceral incarceration and lethal complications. Upper gastrointestinal bleeding and acute pancreatitis are rarely reported in the literature as complications of BH in adults. Here we report the case of a 42-year-old male who presented with upper gastrointestinal bleeding and acute pancreatitis. He was found to have abdominal visceral organ herniation to the posterior right thoracic cavity. His diagnosis was achieved early and with a close follow-up, we succeeded in stabilizing the patient's condition. Then he was subjected to reconstructive thoracotomy for hernial repair and restoring abdominal viscera.

  20. Bochdalek Hernia in an Adult with Upper Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Mohammed Al-Dugdugi

    2017-05-01

    Full Text Available Bochdalek hernia (BH can be a life-threatening condition in infants. Approximately 85.3% of newborns with a BH are immediately at high risk and have a high mortality rate due to respiratory insufficiency [Kocakusak et al.: Hernia 2005;9: 284–287]. However, BH is almost asymptomatic in adults and discovered only incidentally [Wilkins et al.: Clin Imaging 1994;18: 224–229]. Complicated BH in adults might present with visceral incarceration and lethal complications. Upper gastrointestinal bleeding and acute pancreatitis are rarely reported in the literature as complications of BH in adults. Here we report the case of a 42-year-old male who presented with upper gastrointestinal bleeding and acute pancreatitis. He was found to have abdominal visceral organ herniation to the posterior right thoracic cavity. His diagnosis was achieved early and with a close follow-up, we succeeded in stabilizing the patient’s condition. Then he was subjected to reconstructive thoracotomy for hernial repair and restoring abdominal viscera.

  1. Universal definition of perioperative bleeding in adult cardiac surgery

    NARCIS (Netherlands)

    Dyke, Cornelius; Aronson, Solomon; Dietrich, Wulf; Hofmann, Axel; Karkouti, Keyvan; Levi, Marcel; Murphy, Gavin J.; Sellke, Frank W.; Shore-Lesserson, Linda; von Heymann, Christian; Ranucci, Marco

    2014-01-01

    Perioperative bleeding is common among patients undergoing cardiac surgery; however, the definition of perioperative bleeding is variable and lacks standardization. We propose a universal definition for perioperative bleeding (UDPB) in adult cardiac surgery in an attempt to precisely describe and

  2. Radiation bleeding of garden plants

    Energy Technology Data Exchange (ETDEWEB)

    Suda, Hirokatsu [Tokyo Metropolitan Industrial Technology Research Inst. (Japan)

    1997-06-01

    Radiation bleeding aims to develop new varieties by inducing mutations using radiation methods. Here, the conditions of radiation which can effectively induce mutations were investigated and further the techniques for proliferation, isolation and stabilization of such mutants were developed. Aiming to make varieties in shape and color of flowers and color of leaves, seedling stocks of Magnolia kobus DC were radiated with {sup 60}Co-{gamma} ray ranging 5-100 Gy/h and the new varieties with mottled leaves or large-sized flower were obtained. Also, a stable mutant of Abelia grandiflora L, a dwarf variety developed marginally variegated and mottled leaves and similar fragrant flowers to the parent. In order to isolate valuable mutants, the following two procedures were developed. One was a cutting method and the other was a method using tissue culture. In most of the mutants induced by radiation, the mutant genes were apt to be expressed in limited regions. Therefore, the varied tissue was resected to generate its indefinite bud on an agar plate, leading to a new mutated individual. For Begonia masoniana Irmcher, Iron Cross hort, four stable mutants were newly obtained by radiation and the properties were compared among them. (M.N.)

  3. Route of children at ulcerative gastroduodenal bleedings

    Directory of Open Access Journals (Sweden)

    Сергій Олександрович Сокольник

    2015-07-01

    Full Text Available Aim. To elaborate the step-by-step differential algorithm of the motion of children with ulcerative gastroduodenal bleedings. Methods. There were examined 45 patients with gastroduodenal bleeding of ulcerative genesis using clinical, sociometric, genealogic, immune-enzyme, biochemical, endoscopic, functional methods. In the complex treatment for stop bleeding 13 patients underwent argon-plasma coagulation and the other – irrigation with aminocapronic acid. An efficiency of treatment was evaluated using epidemiologic and statistical methods.Results. At presence of an appropriate clinical symptomatology, burdened genealogic anamnesis, laboratory changes it is necessary to carry out an emergency endoscopic examination. In the case of continuing bleeding or instable homeostasis it is recommended to carry out an endoscopic hemostasis using argon-plasma coagulation, in conditions of the high risk of relapse of bleeding – the repeated course of argon-plasma coagulation. After stabilization - an examination for helicobacter infection, conservative therapy and dynamic observation with detection of risk of relapse of bleeding and elaboration of individualized medioprophylactic program.Conclusions. The use of step-by-step differentiated diagnostic and treatment algorithm of the motion in patients with ulcerative disease complicated with gastroduodenal bleeding allows detect the main spectrum of diagnostic researches faster and choose the tactics of treatment and therefore improve an efficiency of medical help for patient and shorten the term of inpatient treatment. 

  4. THROMBIN GENERATION AND BLEEDING IN HEMOPHILIA A

    Science.gov (United States)

    Brummel-Ziedins, Kathleen E.; Whelihan, Matthew F.; Gissel, Matthew; Mann, Kenneth G.; Rivard, Georges E.

    2012-01-01

    Introduction Hemophilia A displays phenotypic heterogeneity with respect to clinical severity. Aim To determine if tissue factor (TF)-initiated thrombin generation profiles in whole blood in the presence of corn trypsin inhibitor (CTI) are predictive of bleeding risk in hemophilia A. Methods We studied factor(F) VIII deficient individuals (11 mild, 4 moderate and 12 severe) with a well-characterized five-year bleeding history that included hemarthrosis, soft tissue hematoma and annual FVIII concentrate usage. This clinical information was used to generate a bleeding score. The bleeding scores (range 0–32) were separated into three groups (bleeding score groupings: 0, 0 and ≤9.6, >9.6), with the higher bleeding tendency having a higher score. Whole blood collected by phlebotomy and contact pathway suppressed by 100μg/mL CTI was stimulated to react by the addition of 5pM TF. Reactions were quenched at 20min by inhibitors. Thrombin generation, determined by ELISA for thrombin – antithrombin was evaluated in terms of clot time (CT), maximum level (MaxL) and maximum rate (MaxR) and compared to the bleeding score. Results Data are shown as the mean±SD. MaxL was significantly different (phemophilia A. PMID:19563500

  5. Menorrhagia and bleeding disorders in adolescent females.

    Science.gov (United States)

    Halimeh, S

    2012-01-01

    In women, von Willebrand disease (VWD) is the most common inherited bleeding disorder. Since VWD and other inherited bleeding disorders are autosomal disorders, they affect women and men. Menorrhagia, or heavy menstrual bleeding (HMB), is the most common symptom of women with bleeding disorder experience. Objectively, it is defined as bleeding that lasts for more than seven days or results in the loss of more than 80 ml of blood per menstrual cycle. The prevalence of menorrhagia in a woman with a bleeding disorder ranges from 32 to 100% in patients with VWD, from 5 to 98% in patients with a platelet dysfunction and from 35 to 70% in women with a rare factor deficiency. A detailed history and a careful physical exam are the first steps towards a diagnosis in adolescents, adding a PBAC>100 increased the sensitivity of the screening tool further to 95%. Laboratory testing should be made at the time of menstrual bleeding in an effort to capture the lowest level of VWF:Ag and FVIII:C. Treatment options for menorrhagia in VWD: (1) antifibrinolytic therapy with tranexamic acid, (2) the non-transfusional agent desmopressin (DDAVP), (3) purified blood products that contain factor VIII and VWF concentrated from plasma and (4) hormonal preparations.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Chest wall bleeding with giant intrathoracic meningocele in neurofibromatosis type 1.

    Science.gov (United States)

    Kaneda, Hiroyuki; Saito, Tomohito; Konobu, Toshifumi; Saito, Yukihito

    2011-02-01

    We report the case of a 66-year-old woman with neurofibromatosis type 1 who developed chest wall bleeding with severe scoliosis and a giant intrathoracic meningocele. She was brought to the emergency department with acute-onset of left-sided chest pain and clinical signs of hypovolemia. Bleeding control was difficult in the first operation because the tissue was friable and there were multiple subcutaneous bleeding points. During the first operation, the patient developed disseminated intravascular coagulation, which required immediate management; therefore, the surgery was aborted and a repeat surgery was performed later to stop the bleeding. The major cause of bleeding was presumed to be the mechanical stretching of the intercostal arteries and branches of the internal thoracic artery secondary to the severe deformity of the thoracic vertebra and ribs. The massive bleeding remained as a hematoma and did not lead to development of hemothorax. This was believed to be because the giant intrathoracic meningocele supported the expansion of the hematoma and prevented the perforation of the visceral pleura. After the second operation, the hematoma shrunk gradually; however, the patient required ventilatory support because the decrease in the size of the hematoma was accompanied by the expansion of the meningocele.

  8. Arterial Embolization in the Management of Mesenteric Bleeding Secondary to Blunt Abdominal Trauma

    Energy Technology Data Exchange (ETDEWEB)

    Ghelfi, Julien, E-mail: JGhelfi@chu-grenoble.fr; Frandon, Julien, E-mail: JFrandon2@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Radiologie et Imagerie Médicale (France); Barbois, Sandrine, E-mail: SBarbois@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Chirurgie Digestive et d’Urgences (France); Vendrell, Anne, E-mail: AVendrell@chu-grenoble.fr; Rodiere, Mathieu, E-mail: MRodiere@chu-grenoble.fr; Sengel, Christian, E-mail: CSengel@chu-grenoble.fr; Bricault, Ivan, E-mail: IBricault@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Radiologie et Imagerie Médicale (France); Arvieux, Catherine, E-mail: CArvieux@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Chirurgie Digestive et d’Urgences (France); Ferretti, Gilbert, E-mail: GFerretti@chu-grenoble.fr; Thony, Frédéric, E-mail: FThony@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Radiologie et Imagerie Médicale (France)

    2016-05-15

    IntroductionMesenteric bleeding is a rare but potentially life-threatening complication of blunt abdominal trauma. It can induce active hemorrhage and a compressive hematoma leading to bowel ischemia. Emergency laparotomy remains the gold standard treatment. We aimed to study the effectiveness and complications of embolization in patients with post-traumatic mesenteric bleeding.Materials and MethodsThe medical records of 7 consecutive patients with active mesenteric bleeding treated by embolization in a level-one trauma center from 2007 to 2014 were retrospectively reviewed. All patients presented with active mesenteric bleeding on CT scans without major signs of intestinal ischemia. We focused on technical success, clinical success, and the complications of embolization.ResultsSix endovascular procedures were successful in controlling hemorrhage but 1 patient had surgery to stop associated arterial and venous bleeding. One patient suffered from bowel ischemia, a major complication of embolization, which was confirmed by surgery. No acute renal failure was noted after angiography. For 1 patient we performed combined management as the endovascular approach allowed an easier surgical exploration.ConclusionIn mesenteric trauma with active bleeding, embolization is a valuable alternative to surgery and should be considered, taking into account the risk of bowel ischemia.

  9. Arterial Embolization in the Management of Mesenteric Bleeding Secondary to Blunt Abdominal Trauma.

    Science.gov (United States)

    Ghelfi, Julien; Frandon, Julien; Barbois, Sandrine; Vendrell, Anne; Rodiere, Mathieu; Sengel, Christian; Bricault, Ivan; Arvieux, Catherine; Ferretti, Gilbert; Thony, Frédéric

    2016-05-01

    Mesenteric bleeding is a rare but potentially life-threatening complication of blunt abdominal trauma. It can induce active hemorrhage and a compressive hematoma leading to bowel ischemia. Emergency laparotomy remains the gold standard treatment. We aimed to study the effectiveness and complications of embolization in patients with post-traumatic mesenteric bleeding. The medical records of 7 consecutive patients with active mesenteric bleeding treated by embolization in a level-one trauma center from 2007 to 2014 were retrospectively reviewed. All patients presented with active mesenteric bleeding on CT scans without major signs of intestinal ischemia. We focused on technical success, clinical success, and the complications of embolization. Six endovascular procedures were successful in controlling hemorrhage but 1 patient had surgery to stop associated arterial and venous bleeding. One patient suffered from bowel ischemia, a major complication of embolization, which was confirmed by surgery. No acute renal failure was noted after angiography. For 1 patient we performed combined management as the endovascular approach allowed an easier surgical exploration. In mesenteric trauma with active bleeding, embolization is a valuable alternative to surgery and should be considered, taking into account the risk of bowel ischemia.

  10. Bleeding in advanced CKD patients on antithrombotic medication - A critical appraisal.

    Science.gov (United States)

    Burlacu, Alexandru; Genovesi, Simonetta; Goldsmith, David; Rossignol, Patrick; Ortiz, Alberto; Kalra, Philip A; Małyszko, Jolanta; Banach, Maciej; Kanbay, Mehmet; Covic, Adrian

    2017-12-05

    Patients with advanced chronic kidney disease (CKD) are at an increased risk of bleeding, especially in the context of the complex therapeutic schemes of coronary artery disease (CAD) (from stable angina to acute coronary syndromes), atrial fibrillation or venous thromboembolism. The bleeding issue increases morbidity and mortality, a serious problem in daily medical practice. However, these patients are largely excluded from major randomized clinical trials, which results in the lack of medical evidence-based foundation for specific recommendations regarding antithrombotic treatment in a high bleeding risk setting. Within this framework, the clinician does not benefit from a clear set of algorithms and measures in the exploration and balancing of bleeding and thrombosis risks. We discuss a diversity of scenarios, encompassing all categories of advanced CKD patients with CAD or/and atrial fibrillation, and with various combinations of drugs, such as antiplatelet therapy or/and oral anticoagulation. Our review highlights the most recent research as well as existing gaps in the recommendations of European Society of Cardiology Guidelines. We evaluate the existence or lack of assessment tools for the bleeding risk, strength, reliability and usefulness of the bleeding risk scores. Also, we identify all the measures recommended after risk evaluation, including specific plans, dose adjustments and particular therapeutic approaches. Finally, we provide with suggestions for improving the management of this patient population. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. [The causes of recurrent ulcerative gastroduodenal bleeding].

    Science.gov (United States)

    Lipnitsky, E M; Alekberzade, A V; Gasanov, M R

    To explore microcirculatory changes within the first 48 hours after admission, to compare them with clinical manifestations of bleeding and to define the dependence of recurrent bleeding from the therapy. The study included 108 patients with ulcerative gastroduodenal bleeding who were treated at the Clinical Hospital #71 for the period 2012-2014. There were 80 (74.1%) men and 28 (25.9%) women. Age ranged 20-87 years (mean 54.4±16.8 years). Patients younger than 45 years were predominant (33.4%). J. Forrest classification (1974) was used in endoscopic characterization of bleeding. Roccal Prognostic Scale for gastroduodenal bleeding was applied in all patients at admission to assess the risk of possible recurrence. Patients were divided into 2 groups. Group 1 included 53 (49.1%) patients without recurrent bleeding; group 2-55 (50.1%) patients who had recurrent bleeding within the first two days of treatment. Investigation of microcirculation showed the role of vegetative component including blood circulation centralization, blood flow slowing, blood cells redistribution providing sufficient blood oxygenation. By the end of the first day we observed pronounced hemodilution, decreased blood oxygenation, blood flow restructuring with its acceleration above 1 ml/s, violation of tissue oxygenation, signs of hypovolemia. These changes were significantly different from group 2 and associated with circulatory decentralization with possible pulmonary microcirculation disturbances and interstitial edema. This processes contribute to disruption of tissue oxygenation. We assume that recurrent bleeding in group 2 was caused by fluid therapy in larger volumes than it was necessary in this clinical situation. Infusion therapy should be significantly reduced for the debut of gastroduodenal ulcerative bleeding. Sedative therapy is advisable to reduce the influence of central nervous system.

  12. Heavy menstrual bleeding diagnosis and medical management.

    Science.gov (United States)

    Sriprasert, Intira; Pakrashi, Tarita; Kimble, Thomas; Archer, David F

    2017-01-01

    Heavy menstrual bleeding (HMB) is a common gynecological problem that has a significant impact on a woman's quality of life and the activities of daily living. Due to the difficulty in accurately describing menstrual bleeding abnormalities using older terminology, the PALM-COEIN classification system of the Federation Internationale de Gynecologie et d'Obstetrique was proposed to describe and identify the etiology of abnormal endometrial bleeding. As there is no single pathway that is associated with HMB, there are several therapeutic interventions involving different molecular pathways to reduce HMB. This article will highlight the current evidence as it relates to the etiology of HMB as well as medical modalities of treatment.

  13. Evaluating compliance to a low glycaemic index (GI) diet in women with polycystic ovary syndrome (PCOS)

    OpenAIRE

    Egan, Nicola; Read, Anna; Riley, Paddy; Atiomo, William

    2011-01-01

    Abstract Background A low Glycaemic Index (GI) diet may decrease some long-term health risks in Polycystic Ovary Syndrome (PCOS) such as endometrial cancer. This study was performed to assess compliance to a low GI diet in women with PCOS. Food diaries prospectively collected over 6 months from women on a low GI diet or healthy eating diet were analysed retrospectively. The women were recruited for a pilot randomised control trial investigating whether a low GI diet decreased the risk of Endo...

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  16. The successful endoscopic hemostasis factors in bleeding from advanced gastric cancer.

    Science.gov (United States)

    Koh, Kang Hun; Kim, Kang; Kwon, Dae Hun; Chung, Bum Su; Sohn, Ji Youn; Ahn, Dae Seon; Jeon, Byung Jun; Kim, Seong Hun; Kim, In Hee; Kim, Sang Wook; Lee, Seung Ok; Lee, Soo Teik; Kim, Dae Ghon

    2013-07-01

    When patients with advanced gastric cancer experience active bleeding, gastroenterologists normally choose between two treatment modalities, endoscopic hemostasis and transarterial embolization (TAE). In patients with advanced gastric cancer with bleeding, the predictive factors for endoscopic hemostatic failure are still unknown. Thus, the purpose of this study was to evaluate predictive factors for endoscopic hemostasis failure and to differentiate which hemostasis procedure is more effective for advanced gastric cancer with bleeding. We reviewed the medical records of patients who were diagnosed with advanced gastric cancer and acute non-variceal gastric bleeding from January 2006 to August 2011. Forty-five patients were enrolled in this study and they were divided into a group of 14 patients who had experienced successful endoscopic hemostasis and a group of 31 patients who had had unsuccessful hemostasis with the first endoscopy and then underwent TAE. Lesion size and bleeding condition of Forrest class 1a or 1b were statistically significant predictive factors for endoscopic hemostatic failure (P = 0.023 and P = 0.017, respectively). On multivariate logistic regression analysis, size (lesion >2 cm) was a significant predictive factor for endoscopic hemostatic failure [adjusted odds ratio (aOR) 8.056; 95% confidence interval (CI) 1.329-48.846]. We determined that small bleeding lesions (cancer indicated that endoscopic hemostasis would be an effective hemostatic modality to choose. Particularly, in the opposite condition, the presence of large bleeding lesions (>2 cm) and non-exposed vessel bleeding with a tumor, endoscopic hemostasis failure is predicted and TAE could be recommended.

  17. The effect of desmopressin on bleeding time and platelet aggregation in healthy volunteers administered ticagrelor.

    Science.gov (United States)

    Teng, R; Mitchell, P D; Butler, K

    2014-04-01

    Ticagrelor is a reversibly binding and selective P2Y12 -receptor antagonist approved for the prevention of atherothrombotic events in patients with acute coronary syndromes. As bleeding events remain a hazard with antiplatelet therapy, this study investigated the effect of the vasopressin agonist, desmopressin, on ticagrelor-induced bleeding time prolongation. Desmopressin has previously been shown to improve primary haemostasis and is widely used as first-line therapy for individuals with bleeding disorders. In a randomized, double-blind, 2-period crossover study, healthy volunteers received ticagrelor (270 mg loading dose; 180 mg bid) for 5 days. On Day 5, desmopressin (0·3 μg/kg) or saline intravenous infusions were administered. The impact of desmopressin on bleeding time, inhibition of platelet aggregation (IPA), platelet function and ticagrelor pharmacokinetic parameters was investigated. Twenty-one volunteers (81% male) were enrolled. Median [range] bleeding times were slightly reduced with ticagrelor plus desmopressin compared with ticagrelor alone (7·50 [3-17] vs. 10·50 [3-25] min at 2·5 h). Median reductions in bleeding time from baseline were generally similar between ticagrelor plus desmopressin compared with ticagrelor alone at all time points. Co-administration of desmopressin had no impact on IPA, although platelet reactivity was significantly increased (von Willebrand Factor antigen: GLS mean AUEC was 4667%.h for ticagrelor plus desmopressin compared with 2750%.h for ticagrelor alone). Desmopressin did not influence the pharmacokinetics of ticagrelor. Desmopressin had no significant effect on bleeding time or inhibition of platelet aggregation by ticagrelor, although primary haemostatic activity was significantly increased. Ticagrelor pharmacokinetic parameters were not affected by co-administration with desmopressin. Therefore, desmopressin is unlikely to be an effective therapeutic agent for control of the potential bleeding events

  18. The role of aspirin in post-polypectomy bleeding – a retrospective survey

    Directory of Open Access Journals (Sweden)

    Pan Antony

    2012-10-01

    Full Text Available Abstract Background Bleeding following colonoscopic polypectomy is a common complication and has been reported to occur in up to 6.1% of patients. Several risk factors have been discussed but their overall contribution to post-polypectomy bleeding remains controversial. The aim of the study was to determine the rate of post polypectomy bleeding and to analyse the role of potential risk factors especially the role of aspirin. Methods We conducted a retrospective cohort study of all patients who underwent polypectomy at Dunedin Hospital, New Zealand between January 2007 and June 2009. Results During the study period, 514 patients underwent colonoscopy with polypectomy and a total of 1502 polyps were removed. From further analysis we excluded 21 patients; 15 patients had surgery immediately after colonoscopy for the diagnosis of colorectal carcinoma and 6 patients presented with symptoms of an acute lower gastrointestinal bleed prior to colonoscopy. Of the remaining 493 patients, 11 patients (2.2% presented with post-polypectomy bleeding within 30 days of the investigation of which 8 were on aspirin. In total 145 patients were taking aspirin prior to colonoscopy and 348 patients were not taking aspirin. The use of aspirin was associated with an increased prevalence of post-polypectomy bleeding (OR=6.72, 95% C.I. 1.76 to 25.7. Interestingly, the use of non-steroidal anti-inflammatory drugs (NSAIDs was not associated with risk of bleeding after polypectomy (OR=2.82, 95% C.I, 0.34 to 23.3. Conclusion Our study confirmed a significantly increased risk of lower gastrointestinal bleeding following polypectomy in patients taking aspirin. We would recommend approaching the patient on aspirin coming forward for a colonoscopy with potential polypectomy with caution.

  19. Evaluating compliance to a low glycaemic index (GI) diet in women with polycystic ovary syndrome (PCOS).

    Science.gov (United States)

    Egan, Nicola; Read, Anna; Riley, Paddy; Atiomo, William

    2011-03-08

    A low Glycaemic Index (GI) diet may decrease some long-term health risks in Polycystic Ovary Syndrome (PCOS) such as endometrial cancer. This study was performed to assess compliance to a low GI diet in women with PCOS. Food diaries prospectively collected over 6 months from women on a low GI diet or healthy eating diet were analysed retrospectively. The women were recruited for a pilot randomised control trial investigating whether a low GI diet decreased the risk of Endometrial Cancer. Nine women with PCOS completed 33 food diaries (17 from women on a low GI diet and 16 from women on a healthy eating diet) recording 3023 food items (low GI group:n = 1457; healthy eating group:n = 1566). Data was analysed using Foster-Powell international values inserted into an SPSS database as no scientifically valid established nutrition software was found. The main outcome measures were mean item GI and Glyacemic Load (GL), mean meal GL, percentage high GI foods and mean weight loss. Women allocated the low GI diet had a statistically significant lower GI of food items (33.67 vs 36.91, p PCOS on a low GI diet consumed food items with a significantly lower mean GI and GL compared to the healthy eating diet group. Longer term compliance needs evaluation in subsequent studies to ascertain that this translates to reduced long term health risks. ISRCTN: ISRCTN86420258.

  20. Evaluating compliance to a low glycaemic index (GI diet in women with polycystic ovary syndrome (PCOS

    Directory of Open Access Journals (Sweden)

    Atiomo William

    2011-03-01

    Full Text Available Abstract Background A low Glycaemic Index (GI diet may decrease some long-term health risks in Polycystic Ovary Syndrome (PCOS such as endometrial cancer. This study was performed to assess compliance to a low GI diet in women with PCOS. Food diaries prospectively collected over 6 months from women on a low GI diet or healthy eating diet were analysed retrospectively. The women were recruited for a pilot randomised control trial investigating whether a low GI diet decreased the risk of Endometrial Cancer. Nine women with PCOS completed 33 food diaries (17 from women on a low GI diet and 16 from women on a healthy eating diet recording 3023 food items (low GI group:n = 1457; healthy eating group:n = 1566. Data was analysed using Foster-Powell international values inserted into an SPSS database as no scientifically valid established nutrition software was found. The main outcome measures were mean item GI and Glyacemic Load (GL, mean meal GL, percentage high GI foods and mean weight loss. Findings Women allocated the low GI diet had a statistically significant lower GI of food items (33.67 vs 36.91, p Conclusion Women with PCOS on a low GI diet consumed food items with a significantly lower mean GI and GL compared to the healthy eating diet group. Longer term compliance needs evaluation in subsequent studies to ascertain that this translates to reduced long term health risks. Trial Registration ISRCTN: ISRCTN86420258

  1. Diagnostic role of capsule endoscopy in patients of obscure gastrointestinal bleeding after negative CT enterography

    Directory of Open Access Journals (Sweden)

    Jaswinder Singh Sodhi

    2013-01-01

    Full Text Available Background and Objectives: Computed tomographic enterography (CT-EG has emerged a useful tool for the evaluation of small bowel in patients of obscure gastrointestinal bleeding (OGIB. However, CT-EG may be negative in about 50-60% of patients. We aimed to see the efficacy of capsule endoscopy (CE in patients of OGIB, who had initial negative CT-EG. Materials and Methods: All consecutive patients of OGIB after initial hemodynamic stabilization were subjected to CT-EG. Those having negative CT-EG were further evaluated with CE. Results: Fifty-five patients of OGIB with mean standard deviation age, 52.7 (19.0, range 18-75 years, women 31/55 (56.4% were subjected to CT-EG. Nine (17.6% patients had positive findings on CT-EG, which included mass lesions in six, thickened wall of distal ileal loops, narrowing, and wall enhancement in two and jejunal wall thickening with wall hyperenhancement in one patient. Forty-two patients had negative CT-EG of which 25 underwent CE for further evaluation. CE detected positive findings in 11 of 25 (48% patients which included vascular malformations in three, ulcers in seven, and fresh blood without identifiable source in one. The diagnostic yield of CE in overt OGIB was more compared to occult OGIB ((7/14, 50% vs (4/11, 36.4% P = 0.2 and was higher if performed within 2 weeks of active gastrointestinal (GI bleed (P = 0.08. Conclusions: In conclusion, CE is an additional tool in the evaluation of obscure GI bleed, especially mucosal lesions which can be missed by CT-EG.

  2. Genetic analysis of bleeding disorders.

    Science.gov (United States)

    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. © 2016 John Wiley & Sons Ltd.

  3. Gastrointestinal Bleeding: MedlinePlus Health Topic

    Science.gov (United States)

    ... Spanish Vomiting blood (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Gastrointestinal Bleeding updates ... Vomiting blood Show More Show Less Related Health Topics Hemorrhoids Peptic Ulcer National Institutes of Health The ...

  4. CLSM bleed water reduction test results

    Energy Technology Data Exchange (ETDEWEB)

    Langton, C.A. [Westinghouse Savannah River Company, Aiken, SC (United States); Rajendran, N. [Bechtel Savannah River Company, Aiken, SC (United States)

    1997-04-21

    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.

  5. Facts about Vitamin K Deficiency Bleeding

    Science.gov (United States)

    ... label> Information For… Media Policy Makers Facts about Vitamin K Deficiency Bleeding Recommend on Facebook Tweet Share Compartir ... deficient ” or has a “ vitamin deficiency ”. What is vitamin K and why is it important? Vitamin K is ...

  6. Acute myeloid leukemia presenting as galactorrhea

    OpenAIRE

    Nambiar, K. Rakul; Nair, Sreejith G.; Devi, R. Nandini

    2016-01-01

    Acute myeloid leukemia (AML) presents with symptoms related to pancytopenia (weakness, infections, bleeding diathesis) and organ infiltration with leukemic cells. Galactorrhea is an uncommon manifestation of AML. We report a case of AML presenting with galactorrhea.

  7. Management of nonvariceal upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    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. Helping mothers survive bleeding after birth

    DEFF Research Database (Denmark)

    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 ambul......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...

  9. Engine bleed air reduction in DC-10

    Science.gov (United States)

    Newman, W. H.; Viele, M. R.

    1980-01-01

    An 0.8 percent fuel savings was achieved by a reduction in engine bleed air through the use of cabin air recirculation. The recirculation system was evaluated in revenue service on a DC-10. The cabin remained comfortable with reductions in cabin fresh air (engine bleed air) as much as 50 percent. Flight test verified the predicted fuel saving of 0.8 percent.

  10. A clinicopathological study of dysfunctional uterine bleeding

    Directory of Open Access Journals (Sweden)

    N Katuwal

    2014-09-01

    Full Text Available Background: Dysfunctional uterine bleeding is a form of abnormal uterine bleeding when there is absence of organic disease of the genital tract. The objective of this study was to find out the clinical and pathological aspect of women presenting with dysfunctional uterine bleeding.Materials and Methods: A descriptive study was conducted over a period of one year from April 14th 2010 to April 13th 2011 in the Department of Obstetrics and Gynaecology and Department of Pathology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. A complete history, clinical examination, pelvic scan, hormonal status if required and endometrial biopsy were done to diagnose dysfunctional uterine bleeding.Results: A total of 120 cases were included. The age of the patients diagnosed dysfunctional uterine bleeding were ranging from 24 -63 years. Dysfunctional uterine bleeding was most common in the age group 40-44 yrs (30% followed by 45-49 yrs (27.5%. Menorrhagia (41.7% was the most common presenting sign. Majority histopathology of endometrium revealed anovulatory pattern (61.7% followed by ovulatory (38.3%. Of the cases with an anovulatory pattern 48.6% was proliferative endometrium, 33.8% disordered proliferative endometrium, 6.8%atrophic, 5.4% weakly proliferative and 2.7% each of simple hyperplasia without atypia and complex hyperplasia with atypia. All cases with ovulatory pattern showed secretory endometrium.Conclusion: Dysfunctional uterine bleeding was the most common in the perimenopausal age group and chiefly in the form of an anovulatory endometrium. . Histopathological evaluation of endometrium helps exclude the local causes and establishes the diagnosis of dysfunctional uterine bleeding, its types, and clinical correlation to histopathological findings and finally helps to determine the mode of management.DOI: http://dx.doi.org/10.3126/jpn.v4i8.11500 Journal of Pathology of Nepal; Vol.4,No. 8 (2014 635-638

  11. GI-axe: an access broker framework for the geosciences

    Science.gov (United States)

    Boldrini, E.; Nativi, S.; Santoro, M.; Papeschi, F.; Mazzetti, P.

    2012-12-01

    The efficient and effective discovery of heterogeneous geospatial resources (e.g. data and services) is currently addressed by implementing "Discovery Brokering components"—such as GI-cat which is successfully used by the GEO brokering framework. A related (and subsequent) problem is the access of discovered resources. As for the discovery case, there exists a clear challenge: the geospatial Community makes use of heterogeneous access protocols and data models. In fact, different standards (and best practices) are defined and used by the diverse Geoscience domains and Communities of practice. Besides, through a client application, Users want to access diverse data to be jointly used in a common Geospatial Environment (CGE): a geospatial environment characterized by a spatio-temporal CRS (Coordinate Reference System), resolution, and extension. Users want to define a CGE and get the selected data ready to be used in such an environment. Finally, they want to download data according to a common encoding (either binary or textual). Therefore, it is possible to introduce the concept of "Access Brokering component" which addresses all these intermediation needs, in a transparent way for both clients (i.e. Users) and access servers (i.e. Data Providers). This work presents GI-axe: a flexible Access Broker which is capable to intermediate the different access standards and to get data according to a CGE, previously specified by the User. In doing that, GI-axe complements the capabilities of the brokered access servers, in keeping with the brokering principles. Let's consider a sample use case of a User needing to access a global temperature dataset available online on a THREDDS Data Server and a rainfall dataset accessible through a WFS—she/he may have obtained the datasets as a search result from a discovery broker. Distribution information metadata accompanying the temperature dataset further indicate that a given OPeNDAP service has to be accessed to retrieve it

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

    Science.gov (United States)

    Stunell, H; Buckley, O; Lyburn, I D; McGann, G; Farrell, M; Torreggiani, W C

    2008-01-01

    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.

  13. Observing handoffs and telephone management in GI fellowship training.

    Science.gov (United States)

    Williams, Renee; Miler, Roy; Shah, Brijen; Chokhavatia, Sita; Poles, Michael; Zabar, Sondra; Gillespie, Colleen; Weinshel, Elizabeth

    2011-08-01

    Gastroenterology (GI) training programs are mandated to teach fellows interpersonal communication and professionalism as basic competencies. We sought to assess important skill sets used by our fellows but not formally observed or measured: handoffs, telephone management, and note writing. We designed an Observed Standardized Clinical Examination (OSCE) form and provided the faculty with checklists to rate fellows' performance on specific criteria. We created two new scenarios: a handoff between a tired overnight senior fellow on call and a more junior fellow, and a telephone management case of an ulcerative colitis flare. Fellows wrote a progress notes documenting the encounters. To add educational value, we gave the participants references about handoff communication. Four OSCE stations-handoff communication, telephone management, informed consent, and delivering bad news-were completed by fellows and observed by faculty. Eight faculty members and eight fellows from four GI training programs participated. All the fellows agreed that handoffs can be important learning opportunities and can be improved if they are structured, and that handoff skills can improve with practice. OSCEs can serve as practicums for assessing complex skill sets such as handoff communication and telephone management.

  14. GiSAO.db: a database for ageing research

    Directory of Open Access Journals (Sweden)

    Grillari Johannes

    2011-05-01

    Full Text Available Abstract Background Age-related gene expression patterns of Homo sapiens as well as of model organisms such as Mus musculus, Saccharomyces cerevisiae, Caenorhabditis elegans and Drosophila melanogaster are a basis for understanding the genetic mechanisms of ageing. For an effective analysis and interpretation of expression profiles it is necessary to store and manage huge amounts of data in an organized way, so that these data can be accessed and processed easily. Description GiSAO.db (Genes involved in senescence, apoptosis and oxidative stress database is a web-based database system for storing and retrieving ageing-related experimental data. Expression data of genes and miRNAs, annotation data like gene identifiers and GO terms, orthologs data and data of follow-up experiments are stored in the database. A user-friendly web application provides access to the stored data. KEGG pathways were incorporated and links to external databases augment the information in GiSAO.db. Search functions facilitate retrieval of data which can also be exported for further processing. Conclusions We have developed a centralized database that is very well suited for the management of data for ageing research. The database can be accessed at https://gisao.genome.tugraz.at and all the stored data can be viewed with a guest account.

  15. WWII GI Bill and Its Effect on Low Education Levels: Did the World War II GI Bill Have an Effect on High School Completion, Poverty, and Employment?

    Science.gov (United States)

    Thomas, Megan D.

    2017-01-01

    Did the World War II (WWII) GI Bill increase the probability of completing high school and further affect the probability of poverty and employment for the cohorts for whom it benefited? This paper studies whether the GI Bill, one of the largest public financial aid policies for education, affected low education levels in addition to its…

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

    Directory of Open Access Journals (Sweden)

    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

  17. Minimal effects of acute liver injury/acute liver failure on hemostasis as assessed by thromboelastography

    NARCIS (Netherlands)

    Stravitz, R. Todd; Lisman, Ton; Luketic, Velimir A.; Sterling, Richard K.; Puri, Puneet; Fuchs, Michael; Ibrahim, Ashraf; Lee, William M.; Sanyal, Arun J.

    Background & Aims: Patients with acute liver injury/failure (ALI/ALF) are assumed to have a bleeding diathesis on the basis of elevated INR; however, clinically significant bleeding is rare. We hypothesized that patients with ALI/ALF have normal hemostasis despite elevated INR. Methods: Fifty-one

  18. Management of Acute Gastric Ulcer Bleeding | van Rensburg | South ...

    African Journals Online (AJOL)

    South African Gastroenterology Review. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 10, No 1 (2012) >. Log in or Register to get access to full text downloads.

  19. Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding? ¿Tiene aún sentido la enteroscopia intraoperatoria en pacientes con hemorragia gastrointestinal de origen oscuro?

    Directory of Open Access Journals (Sweden)

    Pedro Monsanto

    2012-04-01

    Full Text Available Background: in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20th century, made this technique to be relegated to a second level. Aims: evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding. Patients and methods: we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively. Results: with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleed-ing lesion in 94%. Small bowel findings included: angiodysplasia (n = 6, ulcers (n = 4, small bowel Dieulafoy's lesion (n = 2, bleed-ing from anastomotic vessels (n = 1, multiple cavernous hemangiomas (n = 1 and bleeding ectopic jejunal varices (n = 1. Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively. Conclusions: intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.

  20. Three gastroenteritis outbreaks in South Korea caused by the consumption of kimchi tainted by norovirus GI.4.

    Science.gov (United States)

    Park, Ji-Hyuk; Jung, Sunyoung; Shin, Jaeseung; Lee, Jeong Su; Joo, In Sun; Lee, Deog-Yong

    2015-03-01

    In April 2013, outbreaks of acute gastroenteritis were reported at three schools in Jeonju, South Korea. Epidemiological investigations were performed to characterize the outbreaks and implement appropriate control measures. Retrospective cohort studies were performed at these schools. Stool and environmental samples were collected for bacterial and viral assessment. A food supplier of the schools, food company X, was inspected, and samples of cabbage kimchi and groundwater were tested for norovirus by real-time reverse-transcriptase polymerase chain reaction. The relatedness of the detected norovirus strains was evaluated by phylogenetic analysis. Of the 3347 questionnaires distributed, 631 (attack rate: 18.9%) met the case definition. Among the consumed food items, kimchi products (i.e., cabbage and fresh kimchi) were significantly associated with illness. The kimchi products were supplied by food company X. Among stool samples from 95 students and 34 food handlers at the 3 schools, 39 (41.1%) and 14 (41.2%) samples, respectively, were positive for norovirus. The samples of groundwater and cabbage kimchi at food company X were positive for norovirus. The predominant genotype of norovirus detected in the patient, groundwater, and cabbage kimchi samples, GI.4, shared high nucleotide identity. Kimchi products tainted with norovirus GI.4 from contaminated groundwater were linked to the acute gastroenteritis outbreaks. Therefore, kimchi manufacturers in South Korea should apply chlorine disinfection when using groundwater. Moreover, more stringent sanitation requirements and strict regulations for food companies are recommended.

  1. Secondary electric power generation with minimum engine bleed

    Science.gov (United States)

    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.

  2. Pantoprazole before Endoscopy in Patients with Gastroduodenal Ulcer Bleeding: Does the duration of Infusion and Ulcer Location Influence the Effects?

    Directory of Open Access Journals (Sweden)

    Istvan Rácz

    2012-01-01

    Full Text Available The aim of this study was to investigate the effect of preemptive pantoprazole infusion on early endoscopic findings in patients with acute ulcer bleeding. Records of 333 patients admitted with acute ulcer bleeding were analyzed. Ulcer bleeders were given either 80 mg bolus of pantoprazole followed by continuous infusion of 8 mg per hour or saline infusion until endoscopy. In 93 patients saline infusion whereas in 240 patients bolus plus infusion of pantoprazole was administrated with mean (±SD durations of 5.45±12.9 hours and 6.9±13.2 hours, respectively (P=0.29. Actively bleeding ulcers were detected in 46/240 (19.2% of cases in the pantoprazole group as compared with 23/93 (24.7% in the saline infusion group (P=0.26. Different durations of pantoprazole infusion (0–4 hours, >4 hours, and >6 hours had no significant effect on endoscopic and clinical outcome parameters in duodenal ulcer bleeders. Gastric ulcer bleeders on pantoprazole infusion longer than 4 and 6 hours before endoscopy had actively bleeding ulcers in 4.3% and 5% compared to the 19.5% active bleeding rate in the saline group (P=0.02 and P=0.04. Preemptive infusion of high-dose pantoprazole longer than 4 hours before endoscopy decreased the ratio of active bleeding only in gastric but not in duodenal ulcer patients.

  3. Predicting outcome in the intensive care unit using scoring systems: is new better? A comparison of SAPS and SAPS II in a cohort of 1,393 patients. GiViTi Investigators (Gruppo Italiano per la Valutazione degli interventi in Terapia Intensiva). Simplified Acute Physiology Score.

    Science.gov (United States)

    Bertolini, G; D'Amico, R; Apolone, G; Cattaneo, A; Ravizza, A; Iapichino, G; Brazzi, L; Melotti, R M

    1998-09-01

    This study sought to compare the performance of the old and new versions of the Simplified Acute Physiology Score, SAPS and SAPS II, in classifying patients according to the risk of hospital mortality. To compare the performance of the two systems, measures of association between the scores and observed mortality were adopted, together with discrimination (area under the Receiver Operating Characteristics curve) and calibration (goodness-of-fit statistics) estimates. Subjects were 1,393 eligible patients recruited during 1 month in 1994. The outcome measure was vital status at hospital discharge. SAPS II was associated more strongly with hospital mortality than the earlier version. SAPS II also had better discrimination ability than SAPS (area under Receiver Operating Characteristics curve 0.80 versus 0.74) and predicted an overall number of deaths (416.5) closer to the observed figure (475) than SAPS (267.7). Conversely, neither SAPS nor SAPS II fitted our data. Both P values derived from goodness-of-fit statistics were lower than 0.05. SAPS II offers a real improvement compared with SAPS in its ability to explain hospital mortality, but its standard parameters do not fit our data from Italy. The role and impact of potential determinants of this lack of fit, such as random errors and confounders related to casemix and/or quality of care should be clarified before this scoring system be used outside formal research projects. Special caution is suggested when SAPS II is adopted to predict mortality to compare intensive care unit performance across different countries and systems of care.

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Bleeding from duodenal ulcer in a patient with bilio-pancreatic diversion.

    Science.gov (United States)

    Garancini, Mattia; Luperto, Margherita; Delitala, Alberto; Maternini, Matteo; Uggeri, Franco

    2011-12-01

    Scopinaro's bilio-pancreatic diversion is considered as an acceptable malabsorptive surgical approach for the treatment of morbid obesity. We describe a case of acute recurrent gastro-intestinal bleeding in a patient with a previous Scopinaro's bilio-pancreatic diversion. At the first admission in our department, gastroscopy, colonoscopy, contrast-enhanced computerized tomography and angiography resulted negative for active bleeding. Hypovolemic shock indicated laparotomy and an intraoperative enteroscopy performed through a small enterotomy showed an ulcerative perforation sourced in an ischemic portion of a distended duodenal stump, with a bleeding branch of gastro-duodenal artery at the bottom. Hemorrhage was stopped with stitches. Two years later a new episode of duodenal bleeding associated with severe malnutrition occurred. A covered chronic ischemic perforation sustained by duodenal distension due to biliopancreatic limb sub-obstruction appeared to be the most probable etiology of the recurrent duodenal bleeding. The patient underwent again to laparotomy and adhesiolysis; hemorrhage was stopped by means of ligation of gastroduodenal artery and bilio-pancreatic diversion was converted into a standard Roux-en-Y gastroenterostomy with an entero-entero anastomosis 40 cm from the Treitz ligament in order to restore an anatomo-functional condition guaranteeing normal absorption and intestinal transit. After Scopinaro's bilio-pancreatic diversion duodenal bleeding can represent a rare serious presentation of biliopancreatic limb obstruction; because of the complex anatomical reconstruction performed during this intervention, the duodenum results unavailable during upper gastro-intestinal endoscopy, and if a duodenal bleeding is suspected laparotomy followed by enteroscopy represents an effective diagnostic approach.

  6. Aerodynamic Control using Distributed Active Bleed

    Science.gov (United States)

    Kearney, John; Glezer, Ari

    2015-11-01

    The global aerodynamic loads on a stationary and pitching airfoil at angles of attack beyond the static and dynamic stall margins, respectively are controlled in wind tunnel experiments using regulated distributed bleed driven by surface pressure differences. High-speed PIV and proper orthogonal decomposition of the vorticity flux on the static airfoil show that the bleed engenders trains of discrete vortices that advect along the surface and are associated with a local instability that is manifested by a time-averaged bifurcation of the vorticity layer near the bleed outlets and alters the vorticity flux over the airfoil and thereby the aerodynamic loads. Active bleed is used on a dynamically pitching airfoil (at reduced frequencies up to k = 0.42) to modulate the evolution of vorticity concentrations during dynamic stall. Time-periodic bleed improved the pitch stability by reducing adverse pitching moment (``negative damping'') that can precipitate structural instabilities. At the same time, the maintains the cycle-average loads to within 5% of the base flow levels by segmenting the vorticity layer during upstroke and promoting early flow attachment during downstroke segments of the pitch cycle. Supported by Georgia Tech VLRCOE.

  7. Intravenous hemostat: nanotechnology to halt bleeding.

    Science.gov (United States)

    Bertram, James P; Williams, Cicely A; Robinson, Rebecca; Segal, Steven S; Flynn, Nolan T; Lavik, Erin B

    2009-12-16

    Blood loss is the major cause of death in both civilian and battlefield traumas. Methods to staunch bleeding include pressure dressings and absorbent materials. For example, QuikClot effectively halts bleeding by absorbing large quantities of fluid and concentrating platelets to augment clotting, but these treatments are limited to compressible and exposed wounds. An ideal treatment would halt bleeding only at the injury site, be stable at room temperature, be administered easily, and work effectively for internal injuries. We have developed synthetic platelets based on Arg-Gly-Asp functionalized nanoparticles, which halve bleeding time after intravenous administration in a rat model of major trauma. The effects of these synthetic platelets surpass other treatments, including recombinant factor VIIa, which is used clinically for uncontrolled bleeding. Synthetic platelets were cleared within 24 hours at a dose of 20 mg/ml, and no complications were seen out to 7 days after infusion, the longest time point studied. These synthetic platelets may be useful for early intervention in trauma and demonstrate the role that nanotechnology can have in addressing unmet medical needs.

  8. Management of menorrhagia in women with inherited bleeding disorders: general principles and use of desmopressin.

    Science.gov (United States)

    Rodeghiero, F

    2008-01-01

    The haemostatic system has a central role in controlling the amount and the duration of menstrual bleeding, thus abnormally prolonged or profuse bleeding does occur in most women affected by inherited bleeding disorders. Whereas irregular, premenarchal or postmenopausal uterine bleeding is unusual in inherited or acquired heamorrhagic disorders, severe acute bleeding and menorrhagia at menarche and chronic menorrhagia during the entire reproductive life are common manifestations. Prevalence and morbidity of menorrhagia in inherited bleeding disorders have been poorly investigated. It can be estimated that 40% to 60% of currently menstruating women with type 1 or 2 and more than 60% of women with type 3 VWD complain of menorrhagia with a significant impact on their quality of life. Menorrhagia may be particularly distressing in adolescents because of their delicate emotional equilibrium. Similar epidermiology has been described in other inherited disorders like factor XI deficiency, platelet functional defects and in carriers of haemophilia A and B. Women presenting with ''isolated'' menorrhagia, that is without significant additional bleeding symptoms, a situation reported by up to 15% of healthy women, do not demand investigation to exclude an occult bleeding disorder. A multidisciplinary approach is required for diagnosis and treatment. Gynaecological supervision is always required to exclude organic causes unmasked by the bleeding disorder. Treatment options are similar to those for menorrhagia in general with the addition of desmopressin and replacement therapy and the exclusion of non-steroidal anti-inflammatory drugs. The therapeutic plan should take into consideration the patient's preferences, age and severity of bleeding. Iron supplementation is of paramount importance. Remedies used in clinical practice for menorrhagia in general (tranexamic acid, combined oral contraceptives [COC], levonorgestrel intrauterine system [LNG-IUS]) are first tried. In case of

  9. Comparing Bleeding Risk Assessment Focused on Modifiable Risk Factors Only to Validated Bleeding Risk Scores in Atrial Fibrillation

    DEFF Research Database (Denmark)

    Guo, Yutao; Zhu, Hang; Chen, Yundai

    2017-01-01

    BACKGROUND: There is uncertainty whether a focus on modifiable bleeding risk factors, offers better prediction of major bleeding or intracranial haemorrhage compared to other existing bleeding risk scores. METHODS: Comparison of a score based on numbers of the modifiable bleeding risk factors....... Decision curve analysis clearly shows that HAS-BLED had better net benefit of predicting major bleeding compared to the European score. CONCLUSION: Relying on bleeding risk assessment using modifiable bleeding risk factors alone is an inferior strategy for predicting atrial fibrillation patients at high...... risk for major bleeding, intracranial haemorrhage or extracranial bleeding. Our observations re-affirm the Asian guideline recommendations on using the HAS-BLED score for bleeding risk assessment in patients with atrial fibrillation....

  10. Severe uterine hemorrhage as first manifestation of acute leukemia

    OpenAIRE

    Bodur, Serkan; Ayaz, Yurdakadim; Topallar, Faruk; Erdem, Galip; GÜN, İsmet

    2013-01-01

    Abstract. Abnormal uterine bleeding is one of the most common presentations in gynecology practice with too many causes. Acute promyelocytic leukemia is one of the serious causes of uterine hemorrhage. Frequency and severity of hemorrage seen in acute promyelocytic leukemia is often associated with disseminated intravascular coagulation which can be life-threatening. A 37-year-old women was admitted to the emergency room with acute severe uterine bleeding, increasing weakness and weight loss....

  11. Incremental Health Care Burden of Bleeding Among Patients with Venous Thromboembolism in the United States.

    Science.gov (United States)

    Amin, Alpesh; Bruno, Amanda; Trocio, Jeffrey; Lin, Jay; Lingohr-Smith, Melissa

    2015-10-01

    The health care and economic burden of venous thromboembolism (VTE) has been evaluated in regard to acute VTE, VTE recurrence, and some VTE complications, such as postthrombotic syndrome, but the cost burden attributed to bleedings is not well understood. To evaluate health care resource utilization and costs associated with major bleeding (MB) and clinically relevant nonmajor bleeding (CRNMB) among a large U.S. commercially and Medicare-insured population with VTE. Patients (≥ 18 years of age, continuously insured) with a diagnosis of VTE between January 1, 2008, and December 31, 2011, were identified from the Truven Health Analytics Commercial and Medicare MarketScan databases. Patients who did not have any bleedings during the study period were grouped into a no-bleedings cohort and a random date after VTE diagnosis was selected as the index date. VTE patients who experienced MB within 1 year of the initial VTE diagnosis were grouped into a MB cohort, and patients without MB but with CRNMB were grouped into a CRNMB cohort. Baseline patient demographics and clinical characteristics were determined for study cohorts. All-cause and bleeding-related health care resource utilization and costs (inflation adjusted to 2013 level) during a 12-month follow-up period after the index date of the initial bleeding event were measured and compared. Descriptive statistics were used to evaluate differences in demographics, clinical characteristics, and unadjusted health care resource utilization and costs of patient cohorts. Multivariable generalized linear models were used to evaluate incremental health care costs of bleedings after adjusting for key patient characteristics.   Among the 112,885 patients identified with a VTE diagnosis, 14% (n = 15,897) had MB and 14% (n = 15,842) had CRNMB; 72% (n = 81,146) had neither of these events occur during the study period. The mean ages of the MB and CRNMB cohorts were both 63.6 years, while the mean age of the no-bleedings

  12. Thrombosis and bleeding in cancer patients

    Directory of Open Access Journals (Sweden)

    Brian Vicuna

    2011-12-01

    Full Text Available It is well recognized that thrombosis and bleeding are two major complications seen in cancer patients. Recent advances in both basic and clinical observations have enhanced our understanding of the pathogenesis of both phenomena. In this article, the significance of thrombotic complications is reviewed first. This is followed by a detailed discussion of the present day concept of thrombogenesis in cancer based on Virchow’s original triad of aberrant blood flow, loss of vascular integrity and altered blood components. While most cancer patients experience bleeding at some time during the course of their illness, there are special situations that increase bleeding diathesis. These include thrombocytopenia, endothelial injury, acquired hemophilia and adverse effects of drugs. Recognition of these factors will assit in the adoption of appropriate preventive and therapeutic measures.

  13. Hemospray application in nonvariceal upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Smith, Lyn A; Stanley, Adrian J; Bergman, Jacques J

    2013-01-01

    in combination with other hemostatic modalities at the endoscopists' discretion. RESULTS: Sixty-three patients (44 men, 19 women), median age 69 (range, 21 to 98) years with NVUGIB requiring endoscopic hemostasis were treated with TC-325. There were 30 patients with bleeding ulcers and 33 with other NVUGIB......BACKGROUND: Hemospray TM (TC-325) is a novel hemostatic agent licensed for use in nonvariceal upper gastrointestinal bleeding (NVUGIB) in Europe. GOALS: We present the operating characteristics and performance of TC-325 in the largest registry to date of patients presenting with NVUGIB in everyday...... pathology. Fifty-five (87%) were treated with TC-325 as monotherapy; 47 [85%; 95% confidence interval (CI), 76%-94%] of them achieved primary hemostasis, and rebleeding rate at 7 days was 15% (95% CI, 5%-25%). Primary hemostasis rate for TC-325 in patients with ulcer bleeds was 76% (95% CI, 59%-93%). Eight...

  14. Pengembangan SMS Gateway Layanan Informasi Akademik di STMIK GI MDP

    Directory of Open Access Journals (Sweden)

    Fransiska Prihatini Sihotang

    2017-08-01

    Full Text Available Information technology can be utilized in education such as e-Learning and Academic Information System. STMIK GI MDP has applied information technology that provides ease for the dissemination of academic information to students. However, the parents of the students have not obtained the academic information of their children due to the lack of internet-related knowledge. Therefore, this study aims to create a service that is able to convey information to parents directly with SMS Gateway service. This research begins with the collection of user needs through observation techniques and interviews to academic staff and parents. Then performed the required feature analysis. Then the design of SMS Gateway application that will be embedded in existing academic applications and coding system. Gammu is used as a link between applications with mobile phones. The result of this research is the application of SMS Gateway service that can give the student academic information to the parents.

  15. Ventilation monitoring during moderate sedation in GI patients.

    Science.gov (United States)

    Ebert, Thomas J; Middleton, Austin H; Makhija, Nikhil

    2017-02-01

    Sedation in locations outside the operating room (OR) is common. Guidelines for safe patient monitoring have been updated by the American Society of Anesthesiology to include monitoring of ventilation and/or carbon dioxide (CO2). Although technologies exist to monitor these variables, the quality and/or availability of these measurements in non-OR settings is not optimal. This quality improvement project assessed the value of impedance technology for monitoring minute ventilation (MV) compared to standard end-tidal monitoring of CO2 (ETCO2). Patients undergoing GI exams with moderate sedation provided by anesthesia providers were monitored for MV with a respiratory volume monitor (ExSpiron 1Xi, Respiratory Motion, Waltham, MA) and ETCO2 via nasal cannula (NC). Calibration and baseline data were collected prior to sedation. Continuous MV and ETCO2 data were collected and averaged, providing minute values after sedation medications throughout the procedure. Stable periods of reduced MV were averaged and used in comparison to ETCO2. Data from 20 patients were evaluated. After sedation, the expected decrease in MV after sedation was observed in 18 of 20 patients (average -47.82 %), while an increase in ETCO2 was observed in just 10 of 20 patients (average -5.17 mm Hg). The correlation coefficient between changes in MV and ETCO2 in response to sedation administration was positive and not significant, r = 0.223. Ventilation monitoring may provide an element of safety for earlier and more reliable detection of reduced ventilation compared to a surrogate for hypoventilation, ETCO2, in patients undergoing sedation for GI procedures outside of the OR.

  16. Factors associated with major bleeding events: insights from the ROCKET AF trial (rivaroxaban once-daily oral direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation).

    Science.gov (United States)

    Goodman, Shaun G; Wojdyla, Daniel M; Piccini, Jonathan P; White, Harvey D; Paolini, John F; Nessel, Christopher C; Berkowitz, Scott D; Mahaffey, Kenneth W; Patel, Manesh R; Sherwood, Matthew W; Becker, Richard C; Halperin, Jonathan L; Hacke, Werner; Singer, Daniel E; Hankey, Graeme J; Breithardt, Gunter; Fox, Keith A A; Califf, Robert M

    2014-03-11

    This study sought to report additional safety results from the ROCKET AF (Rivaroxaban Once-daily oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation). The ROCKET AF trial demonstrated similar risks of stroke/systemic embolism and major/nonmajor clinically relevant bleeding (principal safety endpoint) with rivaroxaban and warfarin. The risk of the principal safety and component bleeding endpoints with rivaroxaban versus warfarin were compared, and factors associated with major bleeding were examined in a multivariable model. The principal safety endpoint was similar in the rivaroxaban and warfarin groups (14.9 vs. 14.5 events/100 patient-years; hazard ratio: 1.03; 95% confidence interval: 0.96 to 1.11). Major bleeding risk increased with age, but there were no differences between treatments in each age category (<65, 65 to 74, ≥75 years; pinteraction = 0.59). Compared with those without (n = 13,455), patients with a major bleed (n = 781) were more likely to be older, current/prior smokers, have prior gastrointestinal (GI) bleeding, mild anemia, and a lower calculated creatinine clearance and less likely to be female or have a prior stroke/transient ischemic attack. Increasing age, baseline diastolic blood pressure (DBP) ≥90 mm Hg, history of chronic obstructive pulmonary disease or GI bleeding, prior acetylsalicylic acid use, and anemia were independently associated with major bleeding risk; female sex and DBP <90 mm Hg were associated with a decreased risk. Rivaroxaban and warfarin had similar risk for major/nonmajor clinically relevant bleeding. Age, sex, DBP, prior GI bleeding, prior acetylsalicylic acid use, and anemia were associated with the risk of major bleeding. (An Efficacy and Safety Study of Rivaroxaban With Warfarin for the Prevention of Stroke and Non-Central Nervous System Systemic Embolism in Patients With Non-Valvular Atrial Fibrillation: NCT00403767

  17. Expression and characterization of duck enteritis virus gI gene

    Directory of Open Access Journals (Sweden)

    Zhu Dekang

    2011-05-01

    Full Text Available Abstract Background At present, alphaherpesviruses gI gene and its encoding protein have been extensively studied. It is likely that gI protein and its homolog play similar roles in virions direct cell-to-cell spread of alphaherpesviruses. But, little is known about the characteristics of DEV gI gene. In this study, we expressed and presented the basic properties of the DEV gI protein. Results The special 1221-bp fragment containing complete open reading frame(ORF of duck enteritis virus(DEV gI gene was extracted from plasmid pMD18-T-gI, and then cloned into prokaryotic expression vector pET-32a(+, resulting in pET-32a(+-gI. After being confirmed by PCR, restriction endonuclease digestion and sequencing, pET-32a(+-gI was transformed into E.coli BL21(DE3 competent cells for overexpression. DEV gI gene was successfully expressed by the addition of isopropyl-β-D-thiogalactopyranoside(IPTG. SDS-PAGE showed that the recombinant protein His6-tagged gI molecular weight was about 61 kDa. Subsequently, the expressed product was applied to generate specific antibody against gI protein. The specificity of the rabbit immuneserum was confirmed by its ability to react with the recombinant protein His6-tagged gI. In addition, real time-PCR was used to determine the the levels of the mRNA transcripts of gI gene, the results showed that the DEV gI gene was transcribed most abundantly during the late phase of infection. Furthermore, indirect immunofluorescence(IIF was established to study the gI protein expression and localization in DEV-infected duck embryo fibroblasts (DEFs, the results confirmed that the protein was expressed and located in the cytoplasm of the infected cells, intensively. Conclusions The recombinant prokaryotic expression vector of DEV gI gene was constructed successfully. The gI protein was successfully expressed by E.coli BL21(DE3 and maintained its antigenicity very well. The basic information of the transcription and intracellular

  18. Successful Management of Neobladder Variceal Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Atwal, Dinesh; Chatterjee, Kshitij, E-mail: kchatterjee@uams.edu [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States); Osborne, Scott [University of Arkansas for Medical Sciences, Division of Interventional Radiology, Department of Radiology (United States); Kakkera, Krishna; Deas, Steven [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States); Li, Ruizong [University of Arkansas for Medical Sciences, Division of Interventional Radiology, Department of Radiology (United States); Erbland, Marcia [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States)

    2016-10-15

    Hematuria from a neobladder can occur due to a variety of pathologies including tumors, stones, and fistulas. Variceal bleeding in a neobladder is a very rare condition with only one case reported in literature. We present a case of a patient with cirrhosis and portal hypertension and an ileocolic orthotopic neobladder presenting with hematuria. Computed tomographic angiography showed dilated varices around the neobladder which were successfully embolized. To the best of our knowledge, this is the first report case of variceal bleeding in a neobladder successfully managed with the combination of TIPS (transjugular intrahepatic portosystemic shunt) procedure and embolization.

  19. [Jejunal GIST with obscure gastrointestinal bleeding].

    Science.gov (United States)

    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.

  20. Comparison of Four Bleeding Risk Scores to Identify Rivaroxaban-treated Patients With Venous Thromboembolism at Low Risk for Major Bleeding.

    Science.gov (United States)

    Kline, Jeffrey A; Jimenez, David; Courtney, D Mark; Ianus, Juliana; Cao, Lynn; Lensing, Anthonie W A; Prins, Martin H; Wells, Philip S

    2016-02-01

    Outpatient treatment of acute venous thromboembolism (VTE) requires the selection of patients with a low risk of bleeding during the first few weeks of anticoagulation. The accuracy of four systems, originally derived for predicting bleeding in VTE treated with vitamin K antagonists (VKAs), was assessed in VTE patients treated with rivaroxaban. All patients treated with rivaroxaban in the multinational EINSTEIN deep vein thrombosis (DVT) and pulmonary embolism (PE) trials were included. Major bleeding was defined as ≥2 g/dL drop in hemoglobin or ≥2-unit blood transfusion, bleeding in critical area, or bleeding contributing to death. The authors examined the incidence of major bleeding in patients with low-risk assignment by the systems of Ruiz-Gimenez et al. (score = 0 to 1), Beyth et al. (score = 0), Kuijer et al. (score = 0), and Landefeld and Goldman. (score = 0). For clinical relevance, the definition of low risk for all scores except Kuijer includes all patients 731 with DVT only, 2,399 with PE with or without DVT) were treated with rivaroxaban for a mean (±SD) duration of 207.6 (±95.9) days. Major bleeding occurred in 1.0% (40 of 4,130; 95% confidence interval [CI] = 0.7% to 1.3%) overall. Rates of major bleeding for low-risk patients during the entire treatment period were similar: Ruiz-Gimenez et al., 12 of 2,622 (0.5%; 95% CI = 0.2% to 0.8%); Beyth et al., nine of 2,249 (0.4%; 95% CI = 0.2% to 0.8%); Kuijer et al., four of 1,186 (0.3%; 95% CI = 0.1% to 0.9%); and Landefeld and Goldman, 11 of 2,407 (0.5%; 95% CI = 0.2% to 0.8%). At 30 days, major bleed rates for low-risk patients were as follows: Ruiz-Gimenez et al., five of 2,622 (0.2%; 95% CI = 0.1% to 0.4%); Beyth et al., five of 2,249 (0.2%; 95% CI = 0.1% to 0.5%); Kuijer et al., three of 1,186 (0.3%; 95% CI = 0.1% to 0.7%); and Landefeld and Goldman, seven of 2,407 (0.3%; 95% CI = 0.1% to 0.6%). No low-risk patient had a fatal bleed. Four scoring systems that use criteria obtained in routine

  1. Effects of Dietary Yogurt on the Healthy Human Gastrointestinal (GI) Microbiome

    OpenAIRE

    Lisko, Daniel J.; G. Patricia Johnston; Johnston, Carl G.

    2017-01-01

    The gastrointestinal (GI) tract performs key functions that regulate the relationship between the host and the microbiota. Research has shown numerous benefits of probiotic intake in the modulation of immune responses and human metabolic processes. However, unfavorable attention has been paid to temporal changes of the microbial composition and diversity of the GI tract. This study aimed to investigate the effects of yogurt consumption on the GI microbiome bacteria community composition, stru...

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  3. Management of Upper Gastrointestinal Bleeding in Children: Variceal and Nonvariceal.

    Science.gov (United States)

    Lirio, Richard A

    2016-01-01

    Upper gastrointestinal (UGI) bleeding is generally defined as bleeding proximal to the ligament of Treitz, which leads to hematemesis. There are several causes of UGI bleeding necessitating a detailed history to rule out comorbid conditions, medications, and possible exposures. In addition, the severity, timing, duration, and volume of the bleeding are important details to note for management purposes. Despite the source of the bleeding, acid suppression with a proton-pump inhibitor has been shown to be effective in minimizing rebleeding. Endoscopy remains the interventional modality of choice for both nonvariceal and variceal bleeds because it can be diagnostic and therapeutic. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Rectal Bleeding Associated With Chronic Pancreatitis

    Directory of Open Access Journals (Sweden)

    Ch. Seiler

    1991-01-01

    Full Text Available Pseudocyst formation, with its attendant complications of compression, rupture, bleeding and fistula formation, is a well known complication of chronic pancreatitis. In 1966 Berne and Edmondson drew attention to the often fatal outcome of pancreatico-colonic fistula complicated by hemorrhage. We present two cases of this rare complication of chronic pancreatitis as defined by the Marseille classification.

  5. Massive rectal bleeding from colonic diverticulosis

    African Journals Online (AJOL)

    ABEOLUGBENGAS

    Objectives: This is to describe a case of colonic diverticulosis causing massive rectal bleeding in an elderly Nigerian man. ... Colonoscopy identified multiple diverticula in the proximal rectum, sigmoid, descending and ... rectum proximal, sigmoïde, descendant et transversal diverticules colons. Les diverticulesétaient plus.

  6. An unusual cause of lower gastrointestinal bleeding: ' '

    African Journals Online (AJOL)

    Summary. This is an unusual case report of a 60-year-old man who presented with massive rectal bleeding due to angiomatous formation. ' He was also found to be cirrhosis and to have an ectopic left kidney in the midline over the roof of the mesenteric vessel. '2. He was treated successfully by performing a right hemi-.

  7. Medical treatment for heavy menstrual bleeding

    Directory of Open Access Journals (Sweden)

    Yi-Jen Chen

    2015-10-01

    Full Text Available Heavy menstrual bleeding, or menorrhagia, is subjectively defined as a “complaint of a large amount of bleeding during menstrual cycles that occurs over several consecutive cycles” and is objectively defined as menstrual blood loss of more than 80 mL per cycle that is associated with an anemia status (defined as a hemoglobin level of <10 g/dL. During their reproductive age, more than 30% of women will complain of or experience a heavy amount of bleeding, which leads to a debilitating health outcome, including significantly reduced health-related quality of life, and a considerable economic burden on the health care system. Although surgical treatment might be the most important definite treatment, especially hysterectomy for those women who have finished bearing children, the uterus is still regarded as the regulator and controller of important physiological functions, a sexual organ, a source of energy and vitality, and a maintainer of youth and attractiveness. This has resulted in a modern trend in which women may reconsider the possibility of organ preservation. For women who wish to retain the uterus, medical treatment may be one of the best alternatives. In this review, recent trends in the management of women with heavy menstrual bleeding are discussed.

  8. Managing Chemotherapy Side Effects: Bleeding Problems

    Science.gov (United States)

    ... very soft toothbrush. l Tell your doctor or nurse if you have hard bowel movements or feel constipated. Don’t do things that could make it easier to bleed. l Don’t use dental floss or toothpicks. l Don’t pick at pimples or scabs. l Don’t play rough sports. l Don’t put anything in your rectum, ...

  9. The Multifactorial Nature of Thromboembolic and Bleeding ...

    African Journals Online (AJOL)

    Background: Thromboembolic and bleeding complications are the main causes of morbidity and mortality in patients with mechanical heart valves1. The risk factors for these complications in Tanzania have not been established. Methods: A retrospective cohort study was conducted among patients with mechanical heart ...

  10. Systemic causes of heavy menstrual bleeding

    NARCIS (Netherlands)

    Verschueren, Sophie

    2017-01-01

    Heavy menstrual bleeding (HMB) is a common problem in fertile women. In addition to local factors, such as a polyp or a uterine fibroid, systemic causes may lead to HMB. These systemic causes are discussed in this thesis. For years, women with HMB were tested underlying thyroid disorder, but our

  11. Red alert – Infant vaginal bleeding

    Directory of Open Access Journals (Sweden)

    Veerabhadra Radhakrishna

    2015-02-01

    Full Text Available Infant vaginal bleeding is an alarming symptom in an infant. Although several causes can be listed, the possibility of malignancy still needs to be ruled out in view of the guarded prognosis of these uncommon infantile tumors. This case report aims to raise the awareness towards the workup and management of infantile malignancies in a baby girl

  12. Approach to upper gastrointestinal bleeding | Thomson | Continuing ...

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 31, No 11 (2013) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Approach to upper gastrointestinal bleeding. SR Thomson. Abstract.

  13. First trimester bleeding and maternal cardiovascular morbidity

    DEFF Research Database (Denmark)

    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...

  14. RESEARCH Endoscopic injection sclerotherapy for bleeding varices ...

    African Journals Online (AJOL)

    respiratory infection, fever and aspirin ingestion.6 These factors directly or indirectly increase portal venous pressure or result in fever-related tachycardia ... and increased availability of liver transplantation (LT), the successful management of bleeding oesophageal varices in these children is required in preparation for.

  15. THERMOELECTRIC SEMICONDUCTOR DEVICE FOR CAUTERY OF BLEEDING

    Directory of Open Access Journals (Sweden)

    Denis V. Yevdulov

    2017-01-01

    Full Text Available Abstract. Objectives The aim of the work is to study the possibilities for using a semiconductor device to cauterise bleeding by means of cooling (cryocautery. Method The study is based on methods for approximate modeling of heat exchange processes. Results The construction of a device for cauterisation of bleeding, the actuating element of which consists of a thermoelectric battery operating in cooling mode at the time of blood flow cautery and in heating mode when removing the device from the damaged area, is considered. A model of a device, realised on the basis of the solution of the problem of solidification of a viscous liquid by the method of L.S. Leibenson, is proposed, taking into account the electro- and thermo-physical characteristics of the thermoelectric battery cold source. As a result of the numerical experiment, the dependence of the duration of the ice crust formation on tissues 1 mm thick (which corresponds to the cauterisation of bleeding is obtained on the value of the supply current of the thermoelectric battery. With increasing current, the duration of the ice crust formation is reduced; this can be of the order of 160 s at 5 A. It was demonstrated that the selection of thermoelectric battery parameters and current should be guided by medical norms and standards in order to avoid frostbite in the tissues adjacent to the bleeding zone. Conclusion The special design of thermoelectric device provides an effective technical means for cauterising bleeding by freezing (cryocautery, providing high intensity of cooling, shortenened thrombus formation duration, and eliminating painful sensations when removing the device from a damaged area. 

  16. The management of critical bleeding in obstetrics

    Directory of Open Access Journals (Sweden)

    Marcus D. Lancé

    2013-08-01

    Full Text Available Post-partum hemorrhage (PPH is one of the most frequent causes of maternal death: worldwide it contributes for a 25% of deaths. The risk of death from pregnancy complications has decreased dramatically over the last few decades, but several evidences show they have not yet been reduced to a minimum. There is therefore the need for a further improvement in the quality of medical care. Purpose of this paper is to briefly outline an overview of the definition of PPH, with an illustration of the possible causes and treatments currently available. WHO defined PPH as excessive bleeding > 500 ml after vaginal delivery and severe PPH as bleeding in excess of 1,000 ml after vaginal delivery, but a variety of definitions for PPH have been proposed, yet no single satisfactory definition exists. Another crucial item regards the estimation of blood loss, too often based on a visual assessment and, therefore, inaccurate and minimized. However, in medical literature there are no specific classifications for severe bleeding in obstetrics. During pregnancy there are several changes in coagulation state: because haemostatic reference intervals are generally based on samples from non-pregnant women, this can cause a further difficulty in doing an accurate diagnosis and treatment of haemostatic disorders during pregnancy. In the treatment of critical bleeding in trauma patients have been developed some new insights that may be applied, at least partially, in the management of bleeding patients in obstetrics. In recent years it has been developed an approach called “Damage control resuscitation”, which combines to the surgery a medical treatment aimed at correcting the underlying coagulopathy. This approach is based on three items: minimise use of crystalloids and colloids; optimise fresh frozen plasma (FFP to red blood cells (RBC ratio; make an appropriate use of antifibrinolitic agents, fibrinogen and cryoprecipitate.http://dx.doi.org/10.7175/rhc.v4i3s.879

  17. Universal definition of perioperative bleeding in adult cardiac surgery

    National Research Council Canada - National Science Library

    Dyke, Cornelius; Aronson, Solomon; Dietrich, Wulf; Hofmann, Axel; Karkouti, Keyvan; Levi, Marcel; Murphy, Gavin J; Sellke, Frank W; Shore-Lesserson, Linda; von Heymann, Christian; Ranucci, Marco

    2014-01-01

    .... We propose a universal definition for perioperative bleeding (UDPB) in adult cardiac surgery in an attempt to precisely describe and quantify bleeding and to facilitate future investigation into this difficult clinical problem...

  18. GI Consequences of Cancer Treatment: A Clinical Perspective.

    Science.gov (United States)

    Andreyev, H Jervoise N

    2016-04-01

    In an era when extensive research is being funded to mitigate the radiation risks of a human traveling to Mars or the potential effects of a nuclear detonation in an urban environment, it is difficult to understand why the medical and research community remains largely uninterested in pelvic radiation disease (PRD), a condition that afflicts half a million patients every year after radiotherapy for pelvic cancer. There has been significant progress in understanding the nature of normal tissue injury, especially as it affects the GI tract. Clear clinical data exist on how best to assess and improve symptoms and there are a number of options for how to modulate the underlying progressive pathophysiology of PRD. Annually, there are more patients who develop PRD than inflammatory bowel disease (IBD). Despite the similarity in PRD and IBD symptoms, the same expertise that promotes assessment, treatment and disease-modifying approaches as standard of care in IBD is almost nonexistent for those suffering from PRD, and as a result the unmet need is enormous. Curing or controlling cancer without addressing quality of life is no longer acceptable when half of all patients diagnosed with cancer live for 10 years after treatment. For those patients afflicted with PRD it can cause significant misery, and this situation is unacceptable; investment in training and research cannot be delayed any longer.

  19. Transcriptional Analyses of Barrett's Metaplasia and Normal Upper GI Mucosae

    Directory of Open Access Journals (Sweden)

    Michael T. Barrett

    2002-01-01

    Full Text Available Over the last two decades, the incidence of esophageal adenocarcinoma (EA has increased dramatically in the US and Western Europe. It has been shown that EAs evolve from premalignant Barrett's esophagus (BE tissue by a process of clonal expansion and evolution. However, the molecular phenotype of the premalignant metaplasia, and its relationship to those of the normal upper gastrointestinal (GI mucosae, including gastric, duodenal, and squamous epithelium of the esophagus, has not been systematically characterized. Therefore, we used oligonucleotide-based microarrays to characterize gene expression profiles in each of these tissues. The similarity of BE to each of the normal tissues was compared using a series of computational approaches. Our analyses included esophageal squamous epithelium, which is present at the same anatomic site and exposed to similar conditions as Barrett's epithelium, duodenum that shares morphologic similarity to Barrett's epithelium, and adjacent gastric epithelium. There was a clear distinction among the expression profiles of gastric, duodenal, and squamous epithelium whereas the BE profiles showed considerable overlap with normal tissues. Furthermore, we identified clusters of genes that are specific to each of the tissues, to the Barrett's metaplastic epithelia, and a cluster of genes that was distinct between squamous and nonsquamous epithelia.

  20. Ghrelin and Motilin Control Systems in GI Physiology and Therapeutics.

    Science.gov (United States)

    Sanger, Gareth J; Broad, John; Callaghan, Brid; Furness, John B

    2017-01-01

    Ghrelin and motilin are released from gastrointestinal endocrine cells during hunger, to act through G protein-coupled receptors that have closely related amino acid sequences. The actions of ghrelin are more complex than motilin because ghrelin also exists outside the GI tract, it is processed to des-acyl ghrelin which has activity, ghrelin can exist in truncated forms and retain activity, the ghrelin receptor can have constitutive activity and is subject to biased agonism and finally additional ghrelin-like and des-acyl ghrelin receptors are proposed. Both ghrelin and motilin can stimulate gastric emptying, acting via different pathways, perhaps influenced by biased agonism at the receptors, but research is revealing additional pathways of activity. For example, it is becoming apparent that reduction of nausea may be a key therapeutic target for ghrelin receptor agonists and perhaps for compounds that modulate the constitutive activity of the ghrelin receptor. Reduction of nausea may be the mechanism through which gastroparesis symptoms are reduced. Intriguingly, a potential ability of motilin to influence nausea is also becoming apparent. Ghrelin interacts with digestive function through its effects on appetite, and ghrelin antagonists may have a place in treating Prader-Willi syndrome. Unlike motilin, ghrelin receptor agonists also have the potential to treat constipation by acting at the lumbosacral defecation centres. In conclusion, agonists of both ghrelin and motilin receptors hold potential as treatments for specific subsets of digestive system disorders.

  1. Medical image of the week: diffuse gastric bleeding and ALL

    Directory of Open Access Journals (Sweden)

    Okolo O

    2016-03-01

    Full Text Available No abstract available. Article truncated at 150 words. A 26-year-old man with a medical history significant for acute lymphoblastic leukemia (ALL presented with hypovolemic shock secondary to large volume hematemesis. The patient was diagnosed with ALL and treated with high dose chemotherapy followed by peripheral blood stem cell transplant from a matched unrelated donor one year prior to presentation. His treatment course was complicated by grade 4 acute graft versus host disease (GVHD and CMV colitis. Blood work on admission showed hemoglobin of 6.4 g/dL and a leukocytosis. Patient was intubated for airway protection, transferred to ICU, and EGD was performed, which revealed diffusely friable mucosa, inflammation, and ulcerations throughout the gastric mucosa with only a few areas of normal appearing mucosa. Additionally, areas of spontaneous bleeding were seen. Selective arteriography within the right gastric and gastroduodenal arteries showed no active extravasation from the stomach or duodenum. However the gastroepiploic and right gastric arteries were prophylactically embolized. Subsequently ...

  2. Methylene Blue injection via superior mesenteric artery microcatheter for focused enterectomy in the treatment of a bleeding small intestinal arteriovenous malformation

    OpenAIRE

    Frydman, James; Bahouth, Hany; Leiderman, Maxim; Ofer, Amos; Kluger, Yoram

    2014-01-01

    Introduction Obscure gastrointestinal bleeding from the small intestine may present the Acute Care Surgeon with a formidable diagnostic and therapeutic challenge. Despite the current array of diagnostic studies, localization of the causative pathology may be elusive, especially when the bleeding is intermittent. When a small intestinal arteriovenous malformation is the responsible lesion, a technique combining super-selective angiography with intra-operative methylene blue injection and focus...

  3. Nad võitlesid oma isamaa eest / Otto Mägi

    Index Scriptorium Estoniae

    Mägi, Otto

    2001-01-01

    Järgneb: 23., 27. veeb. ; 19., 22., 29. juuni : 4., 10., 13., 17., 24. juuli. Vennad Karl Heintalu ja Heino Helimets teine teisel pool rindejoont Teises maailmasõjas. Otto Mägi ja Vidrik Mägi sõjatee

  4. Kalapüügiõiguse tasu on kalurisõbralik / Robert Aps

    Index Scriptorium Estoniae

    Aps, Robert, 1944-

    1997-01-01

    Valitsuse 29. oktoobri 1996. a. ja 7. jaanuari 1997. a. korraldustest, mis on seotud kalapüügi väljamüügimahtudega ja kalapüügiõiguse tasu määradega. Vaata ka Raul Kalevi art. "Kalaamet vaidleb kaluritega kvootide pärast", Äripäev 10. jaan. 1997, lk. 5

  5. Kivimägi : kaotan koha, kui parteisse ei astu / Riina Kuru

    Index Scriptorium Estoniae

    Kuru, Riina

    2003-01-01

    Pärnu maavanema Toomas Kivimägi sõnul on talle antud selgelt mõista, et ta saab jätkata maavanemana, kui ta astub Reformierakonda või Res Publicasse. Reformierakonna liige Meelis Atonen nimetab Kivimägi väiteid hämamiseks

  6. Transcription of gD and gI genes in BHV1-infected cells

    Indian Academy of Sciences (India)

    ) are contiguous genes with 141 bp region between the two open reading frames (ORFs). Expression of gD and gI from a bicistronic construct containing complete gD and gI gene has been reported either through internal ribosome entry site ...

  7. SMV1, an extremely stable thermophilic virus platform for nanoparticle trafficking in the mammalian GI tract

    DEFF Research Database (Denmark)

    Uldahl, Kristine Buch; Walk, S. T.; Olshefsky, S. C.

    2017-01-01

    undetectable inflammatory response. Finally, we used human intestinal organoids (HIOs) to show that labelled SMV1 did not invade or otherwise perturb the human GI tract epithelium. Conclusion: Sulfolobus monocaudavirus 1 appeared stable and safe during passage though the mammalian GI tract. Significance...

  8. Inherited bleeding disorders | Alli | South African Medical Journal

    African Journals Online (AJOL)

    Abnormal bleeding is a common clinical presentation in general practice, and a rational approach to this problem is therefore required. Investigation of a suspected bleeding disorder necessitates a comprehensive history, thorough physical examination and systematic laboratory work-up. Inherited bleeding disorders (IBDs) ...

  9. 14 CFR 23.1111 - Turbine engine bleed air system.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Turbine engine bleed air system. 23.1111 Section 23.1111 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... Induction System § 23.1111 Turbine engine bleed air system. For turbine engine bleed air systems, the...

  10. No increased systemic fibrinolysis in women with heavy menstrual bleeding

    NARCIS (Netherlands)

    Wiewel-Verschueren, S.; Knol, H. M.; Lisman, T.; Bogchelman, D. H.; Kluin-Nelemans, J. C.; van der Zee, A.G.J.; Mulder, A.B.; Meijer, K.

    BackgroundBleeding disorders have been recognized as important etiologic or contributory factors in women with heavy menstrual bleeding. Fibrinolysis in the endometrium plays a role in heavy menstrual bleeding. It is unknown whether increased systemic fibrinolysis might also increase the risk of

  11. Leech as a cause of abnormal vaginal bleeding: Presentation of ...

    African Journals Online (AJOL)

    Bleeding stopped soon. The patient was discharged in a good condition with hemoglobin on 8gm% on iron tablets. Leech as a cause of abnormal vaginal bleeding: Presentation of three cases in adults. Kibreab Asrat MD. Orotta National referral Maternity Hospital, Asmara, Eritrea. Abstract. Vaginal bleeding in women ...

  12. 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?

    Directory of Open Access Journals (Sweden)

    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

  13. Reoperation for bleeding in cardiac surgery

    DEFF Research Database (Denmark)

    Kristensen, Katrine Lawaetz; Rauer, Line Juul; Mortensen, Poul Erik

    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...

  14. Duodenal Bleeding from Metastatic Renal Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Tarun Rustagi

    2011-04-01

    Full Text Available Massive upper gastrointestinal bleeding due to malignancy is relatively uncommon and the duodenum is the least frequently involved site. Duodenal metastasis is rare in renal cell carcinoma (RCC and early detection, especially in case of a solitary mass, helps in planning further therapy. We report a case of intractable upper gastrointestinal bleeding from metastatic RCC to the duodenum. The patient presented with melena and anemia, 13 years after nephrectomy for RCC. On esophagogastroduodenoscopy, a submucosal mass was noted in the duodenum, biopsies of which revealed metastatic RCC. In conclusion, metastasis from RCC should be considered in nephrectomized patients presenting with gastrointestinal symptoms and a complete evaluation, especially endoscopic examination followed by biopsy, is suggested.

  15. Bleeding gums: Duloxetine may be the cause

    Directory of Open Access Journals (Sweden)

    Balhara YPS

    2007-01-01

    Full Text Available Duloxetine is a newly introduced drug. It is being prescribed for the management of diabetic neuropathic pain and major depressive disorder. The most frequently observed adverse events with duloxetine are nausea, dry mouth and somnolence, constipation, diarrhea, decreased appetite, weight loss, feeling of fatigue, dizziness, somnolence, hypohidrosis, decreased libido and erectile dysfunction. One of the patients being prescribed the drug developed bleeding gums on being started with the drug which resolved on stopping it. We hereby report this case.

  16. Relationships of Un and Gi seasons of birth to clinical symptoms and signs.

    Science.gov (United States)

    Park, Young-Jae; Kim, Tae-Hee; Jin, Seng-Hee; Park, Young-Bae

    2013-03-01

    Season of birth (SOB) is a medical term used to describe the relationship between the season in which one is born and his or her physiologic and pathological characteristics. In East Asian medicine, the Un-Gi SOB is based on the Yin-yang-Five Phases theory. The purpose of this study is to examine the relationship between Un-Gi SOB and a multitude of clinical symptoms and signs, and to examine which of the Un and Gi seasons has the greatest impact on these symptoms and signs. Using the Delphi method, three Un-Gi experts formulated a 26-item questionnaire consisting of clinical symptoms and signs, with each item rated on a Likert 7-point scale. A total of 1057 Korean adolescents (583 males, 474 females) completed the 26-item questionnaire. After identifying the Un and Gi seasons of all subjects, item scores were evaluated to determine whether there was a difference between Un and Gi seasons. For Un seasons, males born in the Wood season had greater indigestion and were less physically active, whereas females born in the Earth season were better able to concentrate but had slower rates of growth. For Gi seasons, males born in the Fire season had greater indigestion and morning fatigue, and males born in the Earth season had higher tension. There was no relationship between symptoms, signs, and the Gi SOB in females. This indicates that males born in Wood Un and Gi seasons are susceptible to Earth-related clinical problems, whereas females born in the Earth Un season are susceptible to Earth-related clinical problems. The study results suggest that Un-Gi seasons based on the Yin-yang-Five Phases are related to clinical symptoms and signs, with significant differences between genders.

  17. Oral manifestations of acute leukaemia

    OpenAIRE

    Ivanović Mirjana; Jovičić Olivera; Mandić Jelena; Bogetić Duško; Maddalone Marcello

    2011-01-01

    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 si...

  18. SDH with Bleeding Diathesis-a Management Protocol.

    Science.gov (United States)

    Sawhney, Gurneet Singh; Ross, Cecil R; Chhabra, Manmeet Singh; Varghese, Vineesh K; Tiwari, Ashish; Chand, Ashis K

    2016-04-01

    Chronic subdural hematoma (SDH) is one of the leading causes of morbidity and mortality in elderly. Patients taking antiplatelets and/or anticoagulants have increased risk of bleeding during the perioperative period. Precise dose blood products and specific surgical technique have been effective in preventing hemorrhagic complications perioperatively. From Jan 2010 to Dec 2012, 25 patients who were on antiplatelets and/or oral anticoagulants underwent emergency surgery for chronic or acute on chronic SDH. Patients were divided into three groups: group I-patients on antiplatelets, group II-patients on oral anticoagulants, and group III-patients taking both. Of these, 21 patients underwent minicraniotomy with microsurgical membranectomy and 4 patients underwent burr hole craniostomy. Random donor platelet concentrate (RDPC) and fresh frozen plasma (FFP) were used depending on whether patient was on antiplatelets or oral anticoagulants. Results were evaluated on the basis of ease of intraoperative hemostasis, incidence of rebleeding in postoperative period, postoperative imaging, and reversal of neurological deficits. Group I, group II, and group III had 16, 4, and 5 patients, respectively. Group I received a mean of 7 units of RDPC. Group II received a mean of 4 units of FFP. Group III received a mean of 7 units of RDPC and 4 units FFPs. There was no problem with intraoperative hemostasis and no incidence of rebleeding. We suggest specific dose protocol for reversal of antiplatelet and anticoagulant effect and specific surgical procedure in preventing intraoperative bleeding and postoperative rebleeding in the above group of patients.

  19. Acute Leukaemia: A Case Report

    African Journals Online (AJOL)

    were; temperature of 36.0°C; no pallor; no cyanosis; generalised lymphadenopa- thy; bilateral pitting pedal ... left intercostal space along the midaxillary line. A chest radiograph showed massive right pleural ... to thrombocytopaenia.r> Spontaneous bleeding is the reason for presentation in 10% of .patients with acute.

  20. 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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

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

    DEFF Research Database (Denmark)

    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...

  3. Baseline Renal Function Predicts Hyponatremia in Liver Cirrhosis Patients Treated with Terlipressin for Variceal Bleeding

    Directory of Open Access Journals (Sweden)

    Sung Eun Kim

    2017-01-01

    Full Text Available Objectives. Terlipressin is safely used for acute variceal bleeding. However, side effects, such as hyponatremia, although very rare, can occur. We investigated the development of hyponatremia in cirrhotic patients who had acute variceal bleeding treated with terlipressin and the identification of the risk factors associated with the development of hyponatremia. Design and Methods. This retrospective, case-control study investigated 88 cirrhotic patients who developed hyponatremia and 176 controls that did not develop hyponatremia and were matched in terms of age and gender during the same period following terlipressin administration. Results. The overall change in serum sodium concentration and the mean lowest serum sodium concentration were 3.44 ± 9.55 and 132.44 ± 8.78 mEq/L during treatment, respectively. Multivariate analysis revealed that baseline serum sodium was an independent positive predictor, and the presence of baseline serum creatinine, HBV, DM, creatinine, and shock on admission was independent negative predictors of hyponatremia (P<0.05. Conclusion. The presence of HBV, DM, the baseline serum sodium, shock on admission, and especially baseline creatinine may be predictive of the development of hyponatremia after terlipressin treatment. Therefore, physicians conduct vigilant monitoring associated with severe hyponatremia when cirrhotic patients with preserved renal function are treated with terlipressin for variceal bleeding.

  4. Risk factors for severity and recurrence of colonic diverticular bleeding

    Directory of Open Access Journals (Sweden)

    Joaquim Natércia

    Full Text Available Background: Colonic diverticular bleeding is the most common cause of lower gastrointestinal bleeding. Risk factors related to severity and repeated bleeding episodes are not completely clearly defined. Objective: To characterize a Portuguese population hospitalized due to colonic diverticular bleeding and to identify the clinical predictors related to bleeding severity and rebleeding. Methods: Retrospective analysis of all hospitalized patients diagnosed with colonic diverticular bleeding from January 2008 to December 2013 at our institution. The main outcomes evaluated were bleeding severity, defined as any transfusion support requirements and/or signs of hemodynamic shock, and 1-year recurrence rate. Results: Seventy-four patients were included, with a mean age of 75.7 ± 9.5 years; the majority were male (62.2%. Thirty-six patients (48.6% met the criteria for severe bleeding; four independent risk factors for severe diverticular bleeding were identified: low hemoglobin level at admission (≤ 11 g/dL; OR 18.8, older age (≥ 75 years; OR 4.7, bilateral diverticular location (OR 14.2 and chronic kidney disease (OR 5.6. The 1-year recurrence rate was 12.9%. We did not identify any independent risk factor for bleeding recurrence in this population. Conclusion: In this series, nearly half of the patients hospitalized with diverticular bleeding presented with severe bleeding. Patients with low hemoglobin levels, older age, bilateral diverticular location and chronic kidney disease had a significantly increased risk for severe diverticular bleeding. In addition, a small number of patients rebled within the first year after the index episode, although we could not identify independent risk factors associated with the recurrence of diverticular bleeding.

  5. Frank hematuria as the presentation feature of acute leukemia

    Directory of Open Access Journals (Sweden)

    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.

  6. Self-reported acute health symptoms and exposure to companion animals

    Science.gov (United States)

    Background: In order to understand the etiological burden of disease associated with acute health symptoms (e.g. gastrointestinal [GI], respiratory, dermatological), it is important to understand how common exposures influence these symptoms. Exposures to familiar and unfamiliar ...

  7. [Study on the permeability of the infiltration glass of GI- I slip casting aluminous ceramic core].

    Science.gov (United States)

    Du, C; Wan, Q; Chao, Y

    1997-11-01

    In order to explore the infiltration condition of GI- I slip casting aluminous ceramic core glass material to aluminous ceramic substratum and provide reference for clinical use, the linear change relationship between the minimal infiltration depth and infiltration time was determined by measuring the minimal depth of glass material infiltrated to aluminous ceramic substratum from one to six hours. The result showed: there is a high linear relationship between the minimal infiltration depth for GI- I infiltration glass and the infiltration time. For clinical use, the minimal infiltration time for GI- I slip casting aluminous ceramic core at least 2.5 hrs and 5 hrs for bridge framework.

  8. Gastrointestinal bleedings during therapy with new oral anticoagulants are rarely reported

    DEFF Research Database (Denmark)

    Bay-Nielsen, Morten; Kampmann, Jens Peter; Bisgaard, Thue

    2014-01-01

    INTRODUCTION: Post-marketing surveillance of drugs relies on spontaneous reporting of adverse drug events to the Danish Health and Medicines Authority. A number of new oral anticoagulants (NOAC) have recently been marketed in Denmark. The purpose of this study was to evaluate the reporting......, Surgical Section, Hvidovre Hospital, during a one-year-period. Patients in treatment with NOAC and admitted for gastrointestinal bleeding were identified. Relevant patients were cross-checked for a reported adverse drug event in the Danish Health and Medi-cines Authority's database on adverse medical...... events. RESULTS: A total of 20 patients were acutely admitted for gastrointestinal bleeding while in treatment with a NOAC, an adverse medical event was reported for one of these patients (5%; 95% confidence interval: 0-25%). CONCLUSION: Serious adverse events in patients treated with NOAC...

  9. Acute hepatic encephalopathy with diffuse cortical lesions

    Energy Technology Data Exchange (ETDEWEB)

    Arnold, S.M.; Spreer, J.; Schumacher, M. [Section of Neuroradiology, Univ. of Freiburg (Germany); Els, T. [Dept. of Neurology, University of Freiburg (Germany)

    2001-07-01

    Acute hepatic encephalopathy is a poorly defined syndrome of heterogeneous aetiology. We report a 49-year-old woman with alcoholic cirrhosis and hereditary haemorrhagic telangiectasia who developed acute hepatic coma induced by severe gastrointestinal bleeding. Laboratory analysis revealed excessively elevated blood ammonia. MRI showed lesions compatible with chronic hepatic encephalopathy and widespread cortical signal change sparing the perirolandic and occipital cortex. The cortical lesions resembled those of hypoxic brain damage and were interpreted as acute toxic cortical laminar necrosis. (orig.)

  10. Burden of Acute Gastrointestinal Illness in Gálvez, Argentina, 2007

    Science.gov (United States)

    Perez, Enrique; Majowicz, Shannon E.; Reid-Smith, Richard; Albil, Silvia; Monteverde, Marcos; McEwen, Scott A.

    2010-01-01

    This study evaluated the magnitude and distribution of acute gastrointestinal illness (GI) in Gálvez, Argentina, and assessed the outcome of a seven-day versus 30-day recall period in survey methodology. A cross-sectional population survey, with either a seven-day or a 30-day retrospective recall period, was conducted through door-to-door visits to randomly-selected residents during the ‘high’ and the ‘low’ seasons of GI in the community. Comparisons were made between the annual incidence rates obtained using the seven-day and the 30-day recall period. Using the 30-day recall period, the mean annual incidence rates was 0.43 (low season of GI) and 0.49 (high season of GI) episodes per person-year. Using the seven-day recall period, the mean annual incidence rate was 0.76 (low season of GI) and 2.66 (high season of GI) episodes per person-year. This study highlights the significant burden of GI in a South American community and confirms the importance of seasonality when investigating GI in the population. The findings suggest that a longer recall period may underestimate the burden of GI in retrospective population surveys of GI. PMID:20411678

  11. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding

    DEFF Research Database (Denmark)

    Wikkelsø, Anne; Wetterslev, Jørn; Møller, Ann Merete

    2016-01-01

    cardiac surgery.We found six ongoing trials but were unable to retrieve any data from them. Compared with transfusion guided by any method, TEG or ROTEM seemed to reduce overall mortality (7.4% versus 3.9%; risk ratio (RR) 0.52, 95% CI 0.28 to 0.95; I(2) = 0%, 8 studies, 717 participants, low quality...... with bleeding. However, these results are primarily based on trials of elective cardiac surgery involving cardiopulmonary bypass, and the level of evidence remains low. Further evaluation of TEG- or ROTEM-guided transfusion in acute settings and other patient categories in low risk of bias studies is needed....... and updated in January 2016. OBJECTIVES: We assessed the benefits and harms of thromboelastography (TEG)-guided or thromboelastometry (ROTEM)-guided transfusion in adults and children with bleeding. We looked at various outcomes, such as overall mortality and bleeding events, conducted subgroup...

  12. Postcoital Bleeding: A Review on Etiology, Diagnosis, and Management

    Directory of Open Access Journals (Sweden)

    Christopher M. Tarney

    2014-01-01

    Full Text Available Postcoital bleeding refers to spotting or bleeding that occurs after intercourse and is not related to menstruation. The prevalence of postcoital bleeding ranges from 0.7 to 9.0 percent of menstruating women. There are multiple etiologies for this common complaint in which most are benign such as cervicitis or cervical polyps. However, the most serious cause of postcoital bleeding is cervical cancer. There are currently no recommendations from governing bodies such as the American College of Obstetricians and Gynecologists on evaluating and treating women with postcoital bleeding. The purpose of this paper is to discuss the common causes of postcoital bleeding, the etiologies of postcoital bleeding, and the likelihood that malignancy is the underlying cause. After an extensive literature review, we compiled a paper illustrating the key concepts a practitioner should know when it comes to postcoital bleeding. Finally, this review will conclude with treatment options for women who are found to have an identifiable source for their bleeding and a discussion on the natural history of postcoital bleeding in women who are found to have no identifiable etiology on evaluation.

  13. Controlling the bleeding of carmine colorant in crabstick.

    Science.gov (United States)

    Poowakanjana, Samanan; Park, Jae W

    2009-01-01

    Carmine used to color surimi seafood often seeps or bleeds from red-colored meat to white meat when vacuum-packed products go through high-temperature long-time pasteurization. Various physical and chemical treatments were examined to investigate means to inhibit or minimize carmine bleeding in surimi seafood products. Degree of bleeding was analyzed using L* (lightness) and a* (redness) as affected by carmine concentrations, pH, pasteurization conditions, and added calcium compounds. Bleeding was significantly affected by carmine concentrations. Optimum carmine concentration in color paste was 0.1%. Bleeding increased when pasteurization time and/or temperature increased. Color bleeding was also affected by moisture content of surimi paste. Carmine bleeding was minimized as pH of color solution decreased. The degree of bleeding was controlled as calcium compounds were added in color solution in a descending order of calcium chloride, calcium acetate, and calcium hydroxide. Minimal inhibition was obtained when color solutions contained calcium citrate, tricalcium phosphate, and calcium lactate. Practical Application: This manuscript addresses one of the long time problems in the surimi crabstick industry. Various means to control carmine bleeding or color transfer under high temperature for long time pasteurization were demonstrated. However, further study must continue to stop bleeding completely.

  14. Tranexamic acid for upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

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

    2014-01-01

    tranexamic acid and placebo in the assessment of transfusion (RR 1.02, 95% CI 0.94 to 1.11; I² = 0%), and meta-analyses that compared tranexamic acid versus antiulcer drugs did not identify beneficial or detrimental effects of tranexamic acid for any of the outcomes assessed.Authors' conclusions This review...... with appropriate control of severe bleeding should be performed, as should endoscopic verification of clinically significant rebleeding. In addition, clinical measures of rebleeding should be included. Other important outcome measures include mortality (30-day or in-hospital), need for emergency surgery or blood...... transfusion and adverse events (major or minor)....

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

    Directory of Open Access Journals (Sweden)

    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.

  16. 77 FR 76169 - Increase in Maximum Tuition and Fee Amounts Payable under the Post-9/11 GI Bill

    Science.gov (United States)

    2012-12-26

    ... AFFAIRS Increase in Maximum Tuition and Fee Amounts Payable under the Post-9/11 GI Bill AGENCY: Department... of the increase in the Post-9/11 GI Bill maximum tuition and fee amounts payable and the increase in.... SUPPLEMENTARY INFORMATION: For the 2011-2012 academic year, the Post-9/ 11 GI Bill allowed VA to pay the actual...

  17. 75 FR 66193 - Post-9/11 GI Bill 2010-2011 Tuition and Fee In-State Maximums

    Science.gov (United States)

    2010-10-27

    ... AFFAIRS Post-9/11 GI Bill 2010-2011 Tuition and Fee In-State Maximums AGENCY: Department of Veterans Affairs (VA). ACTION: Notice. SUMMARY: The purpose of this notice is to advise the public of the Post-9/11 GI Bill tuition and fee in-State maximum rates for the 2010- 2011 academic year. The Post-9/11 GI...

  18. 77 FR 39344 - Agency Information (Post-9/11 GI Bill Education Longitudinal Study Survey) Activity Under OMB Review

    Science.gov (United States)

    2012-07-02

    ... AFFAIRS [OMB Control No. 2900-New (Post-9/11 GI Bill Longitudinal Study Survey)] Agency Information (Post-9/11 GI Bill Education Longitudinal Study Survey) Activity Under OMB Review AGENCY: Veterans.... Please refer to ``OMB Control No. 2900-New (Post-9/11 GI Bill Longitudinal Study Survey) in any...

  19. "Nizkii reiting - eto problema" / Taavi Veskimägi ; interv. Tatjana Opekina

    Index Scriptorium Estoniae

    Veskimägi, Taavi, 1974-

    2006-01-01

    Res Publica liidri Taavi Veskimägi suhtumisest president Arnold Rüütli võimalikku jätkamisse, hinnangutest tuntud poliitikute lahkumisele Res Publicast, ühenduse kujunemisest parteiks, partei reitingust, valitseva koalitsiooni kriitika

  20. Kaks musketäri. 20 aastat hiljem / Tristan Priimägi

    Index Scriptorium Estoniae

    Priimägi, Tristan, 1976-

    2007-01-01

    Tristan Priimägi kohtumisest Londoni klubis Hard Rock Cafe ameerika rockansambli Aerosmith liikmetega, intervjuu Steven Tyleriga. Heliplaatidest "Aerosmith", "Toys in the Attic", Run D.M.C & Aerosmith "Walk This Way", Get a Grip"

  1. Standardi juhid maksid 37, 5 miljonit krooni / Aivar Hundimägi

    Index Scriptorium Estoniae

    Hundimägi, Aivar, 1975-

    2004-01-01

    Standardi juhatuse esimees Enn Veskimägi ning juhatuse liikmed Priit Tamm ja Mati Peekma omandasid 58% Standardi aktsiatest, makstes Indoor Group'ile ja riskikapitaliinvestorile BaltCap tehingu eest väidetavalt 37, 5 miljonit krooni

  2. Kalevi juhtfiguur Priimägi lõi ajalehti kirjastava firma / Toivo Tänavsuu

    Index Scriptorium Estoniae

    Tänavsuu, Toivo

    2007-01-01

    Kalevi nõukogu liige Heino Priimägi on ajalehtede ja ajakirjade kirjastamisega tegeleva firma Complus Solutions juhatuse liige. Kalevi pressiesindaja Aire Milli väitel ei ole Complus Solutions Kaleviga seotud firma

  3. Using the gut microbiota as a novel tool for examining colobine primate GI health

    Directory of Open Access Journals (Sweden)

    Katherine R. Amato

    2016-07-01

    Full Text Available Primates of the Colobinae subfamily are highly folivorous. They possess a sacculated foregut and are believed to rely on a specialized gut microbiota to extract sufficient energy from their hard-to-digest diet. Although many colobines are endangered and would benefit from captive breeding programs, maintaining healthy captive populations of colobines can be difficult since they commonly suffer from morbidity and mortality due to gastrointestinal (GI distress of unknown cause. While there is speculation that this GI distress may be associated with a dysbiosis of the gut microbiota, no study has directly examined the role of the gut microbiota in colobine GI health. In this study, we used high-throughput sequencing to examine the gut microbiota of three genera of colobines housed at the San Diego Zoo: doucs (Pygathrix (N=7, colobus monkeys (Colobus (N=4, and langurs (Trachypithecus (N=5. Our data indicated that GI-healthy doucs, langurs, and colobus monkeys possess a distinct gut microbiota. In addition, GI-unhealthy doucs exhibited a different gut microbiota compared to GI-healthy individuals, including reduced relative abundances of anti-inflammatory Akkermansia. Finally, by comparing samples from wild and captive Asian colobines, we found that captive colobines generally exhibited higher relative abundances of potential pathogens such as Desulfovibrio and Methanobrevibacter compared to wild colobines, implying an increased risk of gut microbial dysbiosis. Together, these results suggest an association between the gut microbiota and GI illness of unknown cause in doucs. Further studies are necessary to corroborate these findings and determine cause-and-effect relationships. Additionally, we found minimal variation in the diversity and composition of the gut microbiota along the colobine GI tract, suggesting that fecal samples may be sufficient for describing the colobine gut microbiota. If these findings can be validated in wild individuals, it

  4. Analyste junior en gestion de l'information (GI) (h/f) | CRDI - Centre ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    fournissant un soutien et une formation de base en GI, par exemple en matière de gestion des documents et d'architecture de l'information;; participant à la formation d'employés, du siège comme des bureaux régionaux, en ce qui concerne l'application des lignes directrices et des politiques en matière de GI;; aidant des ...

  5. [Recurrent epidemics of gastroenteritis caused by norovirus GI.3 in a small hotel].

    Science.gov (United States)

    Soini, Jani; Hemminki, Kaisa; Pirnes, Aija; Roivainen, Merja; Al-Hello, Haider; Maunula, Leena; Kauppinen, Ari; Miettinen, Likka; Smit, Pieter W; Huusko, Sari; Toikkanen, Salla; Rimhanen-Finne, Ruska

    2016-01-01

    Recurrent cases of gastroenteritis occurred in a small hotel. The causative agent of disease could not be detected. The cause and the source of the disease were established through epidemiological investigations and laboratory diagnosis. The causative agent of the disease was norovirus GI.3. Norovirus GI was detected in the water from the well and on surfaces at the hotel. Both epidemiological investigations and laboratory diagnostics are needed in resolving epidemics. Continuous development of laboratory methods is important.

  6. Suitability of locally manufactured galvanized iron (GI wire fiber as reinforcing fiber in brick chip concrete

    Directory of Open Access Journals (Sweden)

    Md. Abul Bashar Emon

    2017-12-01

    Full Text Available A case study has been conducted in order to improve concrete quality in Bangladesh, using fiber reinforcing techniques with locally available low-cost Galvanized Iron (GI wire fibers. GI wire is in fact mild steel wire with a thin coating of zinc. In order to assess the suitability of GI wire fibers as an alternative to steel fibers, various properties of GI wire fibers i.e. tensile strength, bending capacity etc. have been investigated and compared with the properties of steel fibers in light of relevant ACI and ASTM guidelines. Various tests were conducted on GI wire fibers as well as plain concrete reinforced with GI wire fibers. The experimental results show that GI wire fiber has compatible properties with steel fibers. Moreover, compressive strength, flexural strength, toughness indices and residual strength factors of GI wire fiber reinforced concrete (GFRC have shown significant improvement compared to normal concrete. A comparison with Steel Fiber Reinforced Concrete (SFRC revealed that performance of GFRC is quite similar to that of SFRC. It was observed that fiber content of 2.5-3.5% by weight produces relatively better results for the particular mix design used in the study. Furthermore, a cost analysis reveals that SFRC is about 19% more expensive than GFRC in Bangladesh; for 1 cubic meter of concrete work when fiber dosage is 2.5% by weight. Therefore, the study finds that GFRC has shown some promising results to be a low-cost alternative to steel fiber reinforced concrete from Bangladesh’s perspective.

  7. Anterior sacral meningocele presenting as intracystic bleeding.

    Science.gov (United States)

    Gilete-Tejero, Ignacio Javier; Ortega-Martínez, Marta; Mata-Gómez, Jacinto; Rico-Cotelo, María; Bernal-García, Luis Miguel; Yerga-Lorenzana, Beatriz; Casado-Naranjo, Ignacio

    2017-05-18

    To report a case of anterior sacral meningocele with intralesional bleeding secondary to sacrococcygeal trauma. Likewise, there is a discussion about the physiopathology and the surgical approach to these types of lesions. A 43-year-old man diagnosed with Marfan syndrome suffered sacrococcygeal trauma. He was admitted to the emergency room due to symptoms of headache, nausea, and lower limb subjective weakness. CT and MRI showed a large retroperitoneal mass with hemorrhagic content close to the sacrum. Likewise, the MRI showed an image compatible with subarachnoid hemorrhage in the thoracic spinal area, cerebral convexity, and the basal cisterns. The patient went into surgery for an anterior abdominal approach in the midline to reduce the content of the lesion, and subsequently, in the same act, a posterior approach was done with an S1-S2 laminectomy and obliteration of the pedicle. Postoperative MRI 5 months later showed resolution of the ASM. Anterior sacral meningocele is characterized by herniation of the dura mater and the arachnoid mater outside the spinal canal through a defect of the sacrum. We add the risk of bleeding after trauma-never seen in the literature-as one of the possible inherent complications of this lesion. This report highlights a complication never seen in the literature of a relatively rare condition. In our case, the combined approach was effective for both clinical control and lesion regression.

  8. The condensed MCMDM-1 VWD bleeding questionnaire as a predictor of bleeding disorders in women with unexplained menorrhagia.

    Science.gov (United States)

    Azzam, Hanan A G; Goneim, Hayam R; El-Saddik, Amr M; Azmy, Emad; Hassan, Mohammed; El-Sharawy, Solafa

    2012-06-01

    Menorrhagia is a common clinical problem and is unexplained in more than 50% of women. Many studies have suggested that underlying bleeding disorders are prevalent in menorrhagic women. However, the assessment and quantifying of hemorrhagic symptoms are still limited and not widely used. Thirty women aged 11-31 years with a clinical diagnosis of unexplained menorrhagia were investigated to assess the diagnostic utility of the condensed MCMDM-1VWD bleeding questionnaire as a predictive of bleeding disorders in these women. In addition to administration of the questionnaire, comprehensive hemostatic testing was performed to all women. The incidence of inherited bleeding disorders among this group was 66.6% (20/30). Eight patients had von Willebrand disease (VWD) and seven had possible Glanzmann's thrombasthenia. Rare bleeding disorders including hemophilia A carrier, Afibrinogenemia, Factor V deficiency and combined factor V and factor VIII deficiency were also identified. The receiver operator characteristic analysis of the condensed MCMDM-1 VWD bleeding questionnaire in menorrhagic women showed that the cutoff, sensitivity, specificity, positive and negative predictive values were 3.5, 85, 90, 89 and 86%, respectively. Bleeding score was strongly correlated to bleeding time in women with possible Glanzmann's thrombasthenia. In VWD, a significant inverse correlation between the bleeding score and the VW factor levels was detected with a significant increase of bleeding score in type III VWD compared with type I. Bleeding disorders are common in women with unexplained menorrhagia and the condensed MCMDM-1VWD bleeding questionnaire can distinguish between menorrhagic women with and without bleeding disorders and help assess their severity.

  9. A biphasic model for bleeding in soft tissue

    Science.gov (United States)

    Chang, Yi-Jui; Chong, Kwitae; Eldredge, Jeff D.; Teran, Joseph; Benharash, Peyman; Dutson, Erik

    2017-11-01

    The modeling of blood passing through soft tissues in the body is important for medical applications. The current study aims to capture the effect of tissue swelling and the transport of blood under bleeding or hemorrhaging conditions. The soft tissue is considered as a non-static poro-hyperelastic material with liquid-filled voids. A biphasic formulation effectively, a generalization of Darcy's law-is utilized, treating the phases as occupying fractions of the same volume. The interaction between phases is captured through a Stokes-like friction force on their relative velocities and a pressure that penalizes deviations from volume fractions summing to unity. The soft tissue is modeled as a hyperelastic material with a typical J-shaped stress-strain curve, while blood is considered as a Newtonian fluid. The method of Smoothed Particle Hydrodynamics is used to discretize the conservation equations based on the ease of treating free surfaces in the liquid. Simulations of swelling under acute hemorrhage and of draining under gravity and compression will be demonstrated. Ongoing progress in modeling of organ tissues under injuries and surgical conditions will be discussed.

  10. Abnormal Uterine Bleeding: American College of Nurse-Midwives.

    Science.gov (United States)

    2016-07-01

    Variations in uterine bleeding, termed abnormal uterine bleeding, occur commonly among women and often are physiologic in nature with no significant consequences. However, abnormal uterine bleeding can cause significant distress to women or may signify an underlying pathologic condition. Most women experience variations in menstrual and perimenstrual bleeding in their lifetimes; therefore, the ability of the midwife to differentiate between normal and abnormal bleeding is a key diagnostic skill. A comprehensive history and use of the PALM-COEIN classification system will provide clear guidelines for clinical management, evidence-based treatment, and an individualized plan of care. The purpose of this Clinical Bulletin is to define and describe classifications of abnormal uterine bleeding, review updated terminology, and identify methods of assessment and treatment using a woman-centered approach. © 2016 by the American College of Nurse-Midwives.

  11. Erich Teigamägi jagab aega spordi ja äri vahel / Erich Teigamägi ; interv. Indrek Kald

    Index Scriptorium Estoniae

    Teigamägi, Erich

    2005-01-01

    AS-i Linnasoojus nõukogu esimees ja kergejõustikuliidu mitmevõistluse alarühma juht oma karjäärist, töötajate motiveerimisest ja ühiskondlikust ametist spordivaldkonnas. Lisa: Erich Teigamägi. Kommenteerib Erki Nool.

  12. Pentadecapeptide BPC 157 reduces bleeding time and thrombocytopenia after amputation in rats treated with heparin, warfarin or aspirin.

    Science.gov (United States)

    Stupnisek, Mirjana; Franjic, Sandra; Drmic, Domagoj; Hrelec, Masa; Kolenc, Danijela; Radic, Bozo; Bojic, Davor; Vcev, Aleksandar; Seiwerth, Sven; Sikiric, Predrag

    2012-05-01

    Recently, in rat abdominal aorta terminoterminal-anastomosis the stable gastric pentadecapeptide BPC 157 prevents obstructive thrombus formation and rapidly destroys already formed obstructive thrombus. Also, BPC 157 wound healing may signify the clot as conductive matrix or "scaffold" to speed up wound healing process, and decrease bleeding. Here, in rats, BPC 157 (10 μg/kg, 10 ng/kg) improved always reduced bleeding time and amount of bleeding after (tail) amputation only, heparin (250 mg/kg, 25mg/kg, 10mg/kg i.v.), warfarin (1.5mg/kg i.g. once daily for 3 consecutive days), aspirin (0.1g/kg i.g. (once daily/3 consecutive days) or 1.0 g/kg i.p. once), and amputation associated with those agents application. BPC 157 counteracting regimens (i.v., i.p., i.g. (immediately after any challenge)) correspondingly follow the route of bleeding-agents application. All heparin-, warfarin-, and aspirin-rats and normal-rats that received BPC 157 exhibited lesser fall in platelets count. BPC 157 attenuated over-increased APTT-, TT-values in 10mg/kg heparin-rats, but did not influence heparin activity (anti-Xa test). Indicatively, unless counteracted in BPC 157 rats, excessive bleeding-acute thrombocytopenia (BPC 157 markedly prolongs the survival time (heparin-rats, 25mg/kg, right foot amputation). Copyright © 2011 Elsevier Ltd. All rights reserved.

  13. Massive gastrointestinal bleed due to multiple gastric neuroendocrine tumors

    Directory of Open Access Journals (Sweden)

    Vishal Sharma

    2015-01-01

    Full Text Available Gastric neuroendocrine tumors (G-NETs are uncommon lesions which are usually diagnosed on histological evaluation of gastric polyps. These may occur sporadically or due to hypergastrinemia in the setting of atrophic gastritis or Zollinger-Ellison Syndrome. Large lesions may ulcerate and result in gastrointestinal bleeding. However, massive gastrointestinal bleeding is rare in patients with NETs. We report a 60-year-old lady who presented with massive gastrointestinal bleeding due to multiple G-NETs.

  14. Quantifying avoidance-related behaviour and bleeding times of ...

    African Journals Online (AJOL)

    Animals slaughtered at the commercial abattoir were calmer and had shorter bleeding times (61 ± 1.16 s) than those slaughtered at the municipal abattoir which had a mean bleeding time of 74.2 ± 2.11 s. Older animals were calmer and had longer bleeding times (67.5 ± 1.82 s) than the younger animals which had a mean ...

  15. Use of recombinant factor VIIa in the treatment of massive retroperitoneal bleeding due to severe necrotizing pancreatitis

    Directory of Open Access Journals (Sweden)

    Stefanović Branislav

    2009-01-01

    Full Text Available Background. Recently, a growing number of case reports and case series have suggested that the use of recombinant activated factor VII (rFVIIa may be effective in treatment of patients with non-hemophilic acquired coagulopathy not responding to conventional treatment such as major surgery, major trauma, sepsis, necrotizing pancreatitis and bleeding due to cerebral arteriovenous malformations. Case report. We presented a septic patient with massive, lifethreatening bleeding caused by retroperitoneal necrosis, due to severe acute necrotizing pancreatitis. As conservative treatment (blood, plasma, cryoprecipitates and platelet transfusions failed to induce cessation of bleeding, the patient was urgently operated on. In spite of usual procedures of surgical hemostasis (ligation, suture, thermocauterisation, fibrin glue, temporary tamponade, hemorrhage could not be stopped. The patient manifested the signs of hypothermia and metabolic acidosis and, therefore, the decision was made to use recombinant activated factor VII (Novo Seven®. The application of rFVIIa resulted in significant discontinuation of hemorrhage, restoration to normal blood count as well as other relevant coagulation parameters. Conclusion. Although application of rFVIIa is still in the initial clinical phase, and the experience is based mainly on uncontrolled series as well as on individual observations, it seems that this drug can be promising, potent and attractive adjunctive prohemostatic agent. This drug may play a beneficial role in the treatment of serious and unresponsive, 'nonsurgical', life-threatening bleeding due to severe acute necrotizing pancreatitis.

  16. Recent Update of Embolization of Upper Gastrointestinal Tract Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    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.

  17. CERVICAL ECTOPIC PREGNANCY WITH MASSIVE BLEEDING: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Slavcho Tomov

    2015-05-01

    Full Text Available A 29-year-old patient with cervical ectopic pregnancy (CEP presented as "suspected" cervical mass, and irregular vaginal bleeding was directed to a gynecologic oncologist for consultation. During the examination a massive bleeding occurred. After an unsuccessful attempt to stop the bleeding with a balloon catheter and vaginal tamponade, a total abdominal hysterectomy was performed. The predisposing factors, the differential diagnostic possibilities and the clinical approaches in CEP are discussed. Total abdominal hysterectomy is the procedure of choice for treatment of cervical pregnancy under conditions of urgency and life-threatening bleeding.

  18. [Dutch College of General Practitioners' practice guideline on 'Vaginal bleeding'].

    Science.gov (United States)

    de Vries, Corlien J H; Meijer, Loes J; Janssen, C A H Ineke; Burgers, Jako S; Opstelten, Wim

    2015-01-01

    The revised Dutch College of General Practitioners' practice guideline on 'Vaginal bleeding' provides recommendations for abnormal bleeding in women in the reproduction phase of life and for post-menopausal bleeding. This guideline is closely attuned to the guideline on 'Heavy menstrual bleeding' of the Dutch Society of Obstetrics and Gynaecology. Transvaginal sonography is not reliable for excluding endometrial carcinoma in women with abnormal vaginal bleeding treated with tamoxifen. The choice of medical treatment is determined in consultation with the patient. The following factors are assessed: severity and bother, long-term need for contraception, preference for cycle control, desire to have a child, pain during menstruation, comorbidity and use of medication. Treatment options are nonhormonal (NSAIDs, or tranexamic acid) or hormonal (a levonorgestrel-releasing intrauterine system, or combined oral contraceptive). In women of reproductive age, referral is indicated if medical treatment is not effective. Other indications are intracavitary abnormalities diagnosed by transvaginal sonography, tamoxifen use, persistent contact bleeding, and suspicion of coagulation disorders. Indications for referral for post-menopausal bleeding include: sonographic endometrial thickness > 4 mm, abnormal cervical cytology, tamoxifen use, irregular bleeding during use of hormone therapy for vasomotor symptoms and persistent or recurrent bleeding, regardless of endometrial thickness.

  19. Abnormal Bleeding during Menopause Hormone Therapy: Insights for Clinical Management

    Directory of Open Access Journals (Sweden)

    Sebastião Freitas De Medeiros

    2013-01-01

    Full Text Available Objective Our objective was to review the involved mechanisms and propose actions for controlling/treating abnormal uterine bleeding during climacteric hormone therapy. Methods A systemic search of the databases SciELO, MEDLINE, and Pubmed was performed for identifying relevant publications on normal endometrial bleeding, abnormal uterine bleeding, and hormone therapy bleeding. Results Before starting hormone therapy, it is essential to exclude any abnormal organic condition, identify women at higher risk for bleeding, and adapt the regimen to suit eachwoman's characteristics. Abnormal bleeding with progesterone/progestogen only, combined sequential, or combined continuous regimens may be corrected by changing the progestogen, adjusting the progestogen or estrogen/progestogen doses, or even switching the initial regimen to other formulation. Conclusion To diminish the occurrence of abnormal bleeding during hormone therapy (HT, it is important to tailor the regimen to the needs of individual women and identify those with higher risk of bleeding. The use of new agents as adjuvant therapies for decreasing abnormal bleeding in women on HT awaits future studies.

  20. Systematic review: tranexamic acid for upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    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...... one trial included endoscopic treatments or proton pump inhibitors. Five per cent of patients on tranexamic acid and 8% of controls died (RR: 0.61, 95% CI: 0.42-0.89). No significant differences were found on bleeding, bleeding-related mortality, surgery or transfusion requirements. Adverse events...

  1. The Cochrane Library and safety of systemic corticosteroids for acute respiratory conditions in children: an overview of reviews.

    Science.gov (United States)

    Fernandes, Ricardo M; Oleszczuk, Marta; Woods, Charles R; Rowe, Brian H; Cates, Christopher J; Hartling, Lisa

    2014-09-01

    Acute respiratory conditions are a leading cause of childhood morbidity and mortality. Corticosteroids are effective and established treatments in some acute respiratory infections (e.g. croup) and asthma exacerbations; however, their role is controversial in other conditions owing to inconsistent effectiveness or safety concerns (e.g. bronchiolitis, acute wheeze). To examine clinically relevant short-term safety outcomes related to acute single or recurrent systemic short-term (corticosteroid use based on systematic reviews of acute respiratory conditions. We searched the Cochrane Database of Systematic Reviews in February 2013 for systematic reviews comparing systemic corticosteroids with placebo for children (aged 0-18 years) with acute asthma, preschool wheezing, bronchiolitis, croup, pharyngitis/tonsillitis or pneumonia. We selected the following outcomes a priori: gastrointestinal (GI) bleeding and abdominal pain; behavioural effects (tremor or hyperactivity, jitteriness, irritability or emotional distress); hypertension; serious adverse events, including death, length of stay in hospital; and relapse leading to hospitalization. One reviewer extracted data and another reviewer independently verified data. Results were combined using Peto odds ratios and risk differences (RD) for dichotomous outcomes and mean differences for continuous outcomes. Seven reviews containing 44 relevant randomized controlled trials were included. Three reviews were on asthma and one each on bronchiolitis, croup, wheeze and pharyngitis/tonsillitis. Six trials (2114 patients) assessed GI bleeding and/or abdominal pain and showed no significant differences between corticosteroids and placebo (1.5% vs. 1.8%, respectively). Various behavioural effects and hypertension/blood pressure were measured in four trials each (838 and 1617 patients, respectively), with no significant differences reported. None of the trials reported deaths in any of the treatment groups. Based on 17 trials (2056

  2. A randomised clinical study to evaluate the efficacy of alcohol-free or alcohol-containing mouthrinses with chlorhexidine on gingival bleeding

    Science.gov (United States)

    Jose, A.; Butler, A.; Payne, D.; Maclure, R.; Rimmer, P.; Bosma, M. L.

    2015-01-01

    Objectives Gingival bleeding following twice-daily use of 0.2% w/v chlorhexidine digluconate mouthrinse with and without alcohol (0.2% CHX-alcohol; 0.2% CHX-alcohol-free, respectively) and brushing with a standard fluoride toothpaste was compared to brushing alone. Methods Three hundred and nineteen subjects with mild-to-moderate gingivitis (with ≥16 gradable permanent teeth including four molars, bleeding after brushing and ≥20 bleeding sites) completed this randomised, examiner-blinded, parallel-group study. A prophylaxis was performed at baseline. Gingival Severity Index (GSI; primary objective), Gingival Index (GI) and Plaque Index (PI) were assessed at baseline and after 6 weeks of treatment. Adverse events (AEs) were recorded throughout the study. Results Between treatment differences at week 6 demonstrated significantly lower GSI for the 0.2% CHX-alcohol and 0.2% CHX-alcohol-free groups compared to brushing alone (primary endpoint; treatment difference −0.061 [95% CI −0.081, −0.041] and −0.070 [95% CI −0.090, −0.050], respectively; both p Chlorhexidine mouthrinse with or without alcohol as an adjunct to brushing with regular fluoride toothpaste significantly reduces bleeding scores, plaque and gingival inflammation compared to brushing alone. TRAEs are characteristic of those associated with the use of chlorhexidine and are similar for both mouthrinses. PMID:26271869

  3. No increased bleeding risk for oral surgery in patients with severe congenital bleeding disorders due to intense perioperative management.

    Science.gov (United States)

    Goldmann, G; Berens, C; Marquardt, N; Reich, R; Oldenburg, J; Wenghoefer, M

    2015-06-01

    In order to evaluate complication rates of dentoalveolar surgery in patients with congenital bleeding disorders, a retrospective case-control study was performed. A collective of patients with congenital bleeding disorders (n = 69), who received common oral surgery procedures in combination with intense perioperative monitoring and coagulation factor substitution at the University Hospital of Bonn between 1992 and 2011, was matched with patients without bleeding disorders by age, sex, and type of surgery. In addition to the rates of perioperative bleeding and other complications, the duration of surgery and the use of local hemostatic agents were compared between both cohorts. There were no significant differences between the two groups regarding the rate of postoperative bleeding (2.9 vs. 1.4%, patients with congenital bleeding disorders vs controls) and the rate of other complications (7.2 vs. 21.7%). Furthermore, no significant difference in operation time (54 min in patients with congenital bleeding disorders vs 45 min in controls) was observed. However, there was a significant difference (p complication rate following oral surgery in patients with hereditary bleeding disorders can be reduced to that of patients without bleeding disorders. However, these results are reached at significant costs due to coagulation factor replacement and inpatient treatment.

  4. Thrombosis and bleeding disorders outside Western countries.

    Science.gov (United States)

    Mannucci, P M

    2007-07-01

    The rapidly developing countries of Asia are witnessing substantial progress in the awareness of bleeding and thrombotic disorders as important health care problems. It has been thought for a long time that venous thromboembolism is very rare in Asia. Recent large studies that involved the majority of Asian countries demonstrated that this is not true, so that the practice of not using thromboprophylaxis in high-risk medical and surgical cases should be abandoned. The management of hemophilia and allied coagulation disorders has also dramatically improved in several Asian countries, due to the increased availability of blood products for replacement therapy coupled with the leadership role exerted by a few charismatic physicians, particularly in India and Thailand. As to the future, countries such as China and India have the capacity and expertise in biotechnology to consider the production of recombinant factors and gene transfer as the best strategies to tackle the management of persons with hemophilia in these densely populated and huge countries.

  5. ENDOSCOPIC DIAGNOSIS AND TREATMENT OF UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    Daniela Benedeto-Stojanov

    2015-06-01

    Full Text Available Upper gastrointestinal bleeding (UGB is a common medical emergency problem with significant morbidity and mortality. The aim of this paper is to establish the incidence of upper gastrointestinal bleeding in relation to sex and age, determine the prevalence of bleeding lesions and perform analysis of bleeding peptic ulcer in relation to the location, age, gender, Forrest classification and the need for endoscopic hemostasis. Thе prospective study included 70 patients with UGB, 42 men and 28 women, mean age 68.64±13.66 years. The diagnosis of bleeding lesions was made exclusively by means of esophagogastroduodenoscopy. Forrest classification was used in the evaluation of the activity of bleeding ulcers of the stomach and duodenum. The largest number of bleeding patients was of male sex (60%. Bleeding most commonly occurred in patients older than 60 years (84.29%. Statistically, female patients were significantly older than patients of male gender (p=0.001. The most common cause of bleeding was peptic ulcer (65.71%. The average age of patients with gastric ulcer was 70.57±15.68 years, with a duodenal ulcer 63.78±16.70 years. In the duodenum, Forrest Ib, IIa and IIb ulcers were usually confirmed, whereas Forrest IIc ulcers were identified in the stomach. Endoscopic hemostasis was required in 55.56% of patients with duodenal and in 23.81% of patients with gastric ulcer. The incidence of UGB is higher in men and it increases with age. The most common cause of bleeding is ulcer disease. Patients with gastric ulcer are older than patients with duodenal ulcer, while both gastric and duodenal ulcers are found in the oldest patients. Duodenal ulcers cause serious bleeding and more often require endoscopic hemostasis.

  6. Barriers to effective diagnosis and management of a bleeding patient with undiagnosed bleeding disorder across multiple specialties: results of a quantitative case-based survey

    Directory of Open Access Journals (Sweden)

    Reding MT

    2012-10-01

    Full Text Available Mark T Reding,1 David L Cooper21Center for Bleeding and Clotting Disorders, University of Minnesota Medical Center, Minneapolis, MN, 2Medical Affairs, Novo Nordisk Inc, Princeton, NJ, USABackground: Bleeding symptoms commonly seen by multiple physician specialties may belie undiagnosed congenital or acquired bleeding disorders. Acquired hemophilia is a potentially life-threatening cause of unexplained acute bleeding manifested by an abnormal activated partial thromboplastin time (aPTT that does not correct with 1:1 mixing with normal plasma.Methods: Practicing physicians (hematology/oncology, emergency medicine, geriatrics, internal medicine, rheumatology, obstetrics and gynecology, critical care medicine, and general surgery completed an online survey based on a hypothetical case scenario.Results: Excluding surgeons and obstetrician/gynecologist respondents, 302 physicians (about 50 per specialty were presented with an older adult woman complaining of recurrent epistaxis. Nearly 90% ordered a complete blood count and coagulation studies (aPTT, prothrombin time [PT]/international normalized ratio [INR]. Despite a prolonged aPTT of 42 seconds, <50% of nonhematologists would repeat the aPTT, and <45% would consult a hematologist; emergency medicine physicians were least likely (10% and rheumatologists were most likely (43% to consult. After presentation weeks later with bruising and abdominal/back pain, ≥90% of physicians within each specialty ordered a complete blood count or PT/INR/aPTT. Despite an aPTT of 63 seconds, the majority did not repeat the aPTT. At this point, approximately 75% of internal medicine and geriatric physicians indicated they would consult a hematologist, versus 47% in emergency medicine and 50% in critical care. All participants preferred abdominal computed tomography (80%–84%. After 12 hours of additional observation, 73% to 94% of respondents consulted a hematologist. Complete blood count revealed anemia and an a

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Anemia, bleeding, and blood transfusion in the intensive care unit: causes, risks, costs, and new strategies.

    Science.gov (United States)

    McEvoy, Michael T; Shander, Aryeh

    2013-11-01

    The definition of anemia is controversial and varies with the sex, age, and ethnicity of the patient. Anemia afflicts half of hospitalized patients and most elderly hospitalized patients. Acute anemia in the operating room or intensive care unit is associated with increased morbidity as well as other adverse outcomes, including death. The risks of anemia are compounded by the added risks associated with transfusion of red blood cells, the most common treatment for severe anemia. The causes of anemia in hospitalized patients include iron deficiency, suppression of erythropoietin and iron transport, trauma, phlebotomy, coagulopathies, adverse effects of and reactions to medications, and stress-induced gastrointestinal bleeding. The types and causes of anemia and the increased health care utilization and costs associated with anemia and undetected internal bleeding are described. The potential benefits and risks associated with transfusion of red blood cells also are explored. Last, the strategies and new tools to help prevent anemia, allow earlier detection of internal bleeding, and avoid unnecessary blood transfusions are discussed.

  10. Predictors of post operative bleeding and blood transfusion in ...

    African Journals Online (AJOL)

    Introduction: In spite of the recent advances in heart surgery, patients undergoing cardiac surgery with cardiopulmonary bypass are at risk of developing significant post-operative bleeding and substantial blood requirements. Objective: To evaluate the impact of some perioperative predictors of post-operative bleeding, and ...

  11. Lower Gastrointestinal Bleeding Due to Multiple Polyps in Ileum

    OpenAIRE

    Sah Bandar, Ivo Novita; Syam, Ari Fahrial; Manan, Chudahman; Simadibrata, Marcellus; Abdullah, Murdani

    2002-01-01

    The causes of lower gastrointestinal bleeding (hematochezia) are amyloidosis, anal fissure, angiodysplastic lesions, coagulation disorder, colitis, colon cancer, colorectal polyps, Crohn's disease, diverticulitis, haemorrhoids, etc. This was a case of lower gastrointestinal bleeding due to colonic inflammatoric polyp. This inflammatoric polyps were caused by infection/inflammation and improved after antibiotic and NSAID therapy.

  12. Impact of inherited bleeding disorders on pregnancy and postpartum hemorrhage.

    Science.gov (United States)

    Shahbazi, Shirin; Moghaddam-Banaem, Lida; Ekhtesari, Fatemeh; Ala, Fereydoun A

    2012-10-01

    Inherited bleeding disorders are caused by various genetic defects in the proteins involved in haemostasis. Female patients or carriers are faced with the risk of haemorrhage throughout life. During pregnancy and postpartum, this complication affects the health of either the mother or the baby, or both. This retrospective cohort study was designed to assess the occurrence of obstetric bleeding in the three trimesters of pregnancy, along with primary and secondary postpartum haemorrhage among 100 women with inherited bleeding disorders. A questionnaire was designed in order to collect historical data. The patients were evaluated in three groups: haemophilia carriers, von Willebrand disease (VWD) and rare bleeding disorders. In comparison with normal women, significantly severe bleeding was observed among patients in all of the five stages. VWD patients showed a higher frequency of bleeding in first trimester but the rate of miscarriage was lower. Haemophilia carriers were threatened with bleeding complications during the prenatal period, but they also had the highest frequency of postpartum haemorrhage. Based on our results, vaginal bleeding is a serious threat in all three patient groups, especially during the first trimester of pregnancy and in the postpartum period.

  13. Increased accuracy in heparin and protamine administration decreases bleeding

    DEFF Research Database (Denmark)

    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 ...

  14. NCIDENCE OF BLEEDING MANIFESTATIONS IN FEVER WITH THROMBOCYTOPENIA CASES

    Directory of Open Access Journals (Sweden)

    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%.

  15. Endoscopic injection sclerotherapy for bleeding varices in children ...

    African Journals Online (AJOL)

    Endoscopic injection sclerotherapy for bleeding varices in children with intrahepatic and extrahepatic portal venous obstruction: Benefit of injection tract embolisation. ... In a previous study at our institution, sclerotherapy was associated with a high re-bleeding rate and oesophageal ulceration. Embolisation of the injection ...

  16. Bleeding gastrointestinal stromal tumour of the stomach complicated ...

    African Journals Online (AJOL)

    Cancer is a major risk factor for venous thromboembolism (VTE). Its treatment is an added risk factor for VTE. Malignancy results in a hypercoagulable state and hence DVT requiring anticoagulation. Cancer patients are at high risk of anticoagulant associated bleeding. Bleeding complications occur more with unfractionated ...

  17. Histopathological findings of Post-Menopausal bleeding in ...

    African Journals Online (AJOL)

    Background: Postmenopausal bleeding is an alarming sign that may be associated with uterine malignancy. In recent years about 60% of women with post menopausal bleeding are said to have no organic cause in developed countries. There is no data concerning about this issue in Ethiopia. Objective: To determine ...

  18. Prediction models in women with postmenopausal bleeding: a systematic review

    NARCIS (Netherlands)

    van Hanegem, Nehalennia; Breijer, Maria C.; Opmeer, Brent C.; Mol, Ben W. J.; Timmermans, Anne

    2012-01-01

    Postmenopausal bleeding is associated with an elevated risk of having endometrial cancer. The aim of this review is to give an overview of existing prediction models on endometrial cancer in women with postmenopausal bleeding. In a systematic search of the literature, we identified nine prognostic

  19. First-trimester vaginal bleeding and complications later in pregnancy

    DEFF Research Database (Denmark)

    Lykke, Jacob Alexander; Dideriksen, Katrine Lehrmann; Lidegaard, Øjvind

    2010-01-01

    To evaluate the association of first-trimester bleeding without miscarriage and complications later in the first pregnancy as well as in the next pregnancy.......To evaluate the association of first-trimester bleeding without miscarriage and complications later in the first pregnancy as well as in the next pregnancy....

  20. [Prophylaxis for stress ulcer bleeding in the intensive care unit].

    Science.gov (United States)

    Avendaño-Reyes, J M; Jaramillo-Ramírez, H

    2014-01-01

    The critically ill patient can develop gastric erosions and, on occasion, stress ulcers with severe gastrointestinal bleeding that can be fatal. The purpose of this review was to provide current information on the pathophysiology, risk factors, and prophylaxis of digestive tract bleeding from stress ulcers in the intensive care unit. We identified articles through a PubMed search, covering the years 1970 to 2013. The most relevant articles were selected using the search phrases "stress ulcer", "stress ulcer bleeding prophylaxis", and "stress-related mucosal bleeding" in combination with "intensive care unit". The incidence of clinically significant bleeding has decreased dramatically since 1980. The most important risk factors are respiratory failure and coagulopathy. Proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs) are used in stress ulcer bleeding prophylaxis. Both drugs have been shown to be superior to placebo in reducing the risk for gastrointestinal bleeding and PPIs are at least as effective as H2RAs. Early enteral feeding has been shown to reduce the risk for stress ulcer bleeding, albeit in retrospective studies. Admittance to the intensive care unit in itself does not justify prophylaxis. PPIs are at least as effective as H2RAs. We should individualize the treatment of each patient in the intensive care unit, determining risk and evaluating the need to begin prophylaxis. Copyright © 2014 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

  1. Primary prevention and management of variceal bleeding: Review ...

    African Journals Online (AJOL)

    Primary prevention and management of variceal bleeding: Review of Historical Evidence. MOM Suliman. Abstract. Background: Prevention and control of active bleeding caused by portal hypertension is still a challenge. Surgery used to be the only option in the earlier days, but now many options exist. Choice of the correct ...

  2. Pattern recognition in menstrual bleeding diaries by statistical cluster analysis

    Directory of Open Access Journals (Sweden)

    Wessel Jens

    2009-07-01

    Full Text Available Abstract Background The aim of this paper is to empirically identify a treatment-independent statistical method to describe clinically relevant bleeding patterns by using bleeding diaries of clinical studies on various sex hormone containing drugs. Methods We used the four cluster analysis methods single, average and complete linkage as well as the method of Ward for the pattern recognition in menstrual bleeding diaries. The optimal number of clusters was determined using the semi-partial R2, the cubic cluster criterion, the pseudo-F- and the pseudo-t2-statistic. Finally, the interpretability of the results from a gynecological point of view was assessed. Results The method of Ward yielded distinct clusters of the bleeding diaries. The other methods successively chained the observations into one cluster. The optimal number of distinctive bleeding patterns was six. We found two desirable and four undesirable bleeding patterns. Cyclic and non cyclic bleeding patterns were well separated. Conclusion Using this cluster analysis with the method of Ward medications and devices having an impact on bleeding can be easily compared and categorized.

  3. Gastrointestinal bleeding in patients with hereditary hemorrhagic telangiectasia

    DEFF Research Database (Denmark)

    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....

  4. GeoNetwork powered GI-cat: a geoportal hybrid solution

    Science.gov (United States)

    Baldini, Alessio; Boldrini, Enrico; Santoro, Mattia; Mazzetti, Paolo

    2010-05-01

    To the aim of setting up a Spatial Data Infrastructures (SDI) the creation of a system for the metadata management and discovery plays a fundamental role. An effective solution is the use of a geoportal (e.g. FAO/ESA geoportal), that has the important benefit of being accessible from a web browser. With this work we present a solution based integrating two of the available frameworks: GeoNetwork and GI-cat. GeoNetwork is an opensource software designed to improve accessibility of a wide variety of data together with the associated ancillary information (metadata), at different scale and from multidisciplinary sources; data are organized and documented in a standard and consistent way. GeoNetwork implements both the Portal and Catalog components of a Spatial Data Infrastructure (SDI) defined in the OGC Reference Architecture. It provides tools for managing and publishing metadata on spatial data and related services. GeoNetwork allows harvesting of various types of web data sources e.g. OGC Web Services (e.g. CSW, WCS, WMS). GI-cat is a distributed catalog based on a service-oriented framework of modular components and can be customized and tailored to support different deployment scenarios. It can federate a multiplicity of catalogs services, as well as inventory and access services in order to discover and access heterogeneous ESS resources. The federated resources are exposed by GI-cat through several standard catalog interfaces (e.g. OGC CSW AP ISO, OpenSearch, etc.) and by the GI-cat extended interface. Specific components implement mediation services for interfacing heterogeneous service providers, each of which exposes a specific standard specification; such components are called Accessors. These mediating components solve providers data modelmultiplicity by mapping them onto the GI-cat internal data model which implements the ISO 19115 Core profile. Accessors also implement the query protocol mapping; first they translate the query requests expressed

  5. Intravenous esomeprazole: a pharmacoeconomic profile of its use in the prevention of recurrent peptic ulcer bleeding.

    Science.gov (United States)

    Keating, Gillian M

    2011-06-01

    Intravenous esomeprazole (Nexium®) is approved in Europe for the prevention of rebleeding following therapeutic endoscopy for acute bleeding gastric or duodenal ulcers. In a pivotal clinical trial, patients with peptic ulcer bleeding and high-risk stigmata who received intravenous esomeprazole for 72 hours following endoscopic haemostatic therapy were significantly less likely than those receiving intravenous placebo to experience recurrent peptic ulcer bleeding at days 3, 7 and 30. In addition, the need for repeat endoscopic haemostatic therapy, the total amount of blood transfused and the number of additional hospital days required because of rebleeding were significantly lower in intravenous esomeprazole recipients than in intravenous placebo recipients. All patients received oral esomeprazole for 27 days following intravenous study drug administration. Intravenous esomeprazole was generally well tolerated in the pivotal trial, with infusion-site reactions being among the most commonly reported adverse events. Two pharmacoeconomic analyses conducted from a healthcare payer perspective used decision-tree models with 30-day time horizons to examine the cost effectiveness and cost utility of intravenous esomeprazole in patients with bleeding peptic ulcers who had undergone endoscopic haemostatic therapy. With regard to the incremental cost per bleed averted, intravenous esomeprazole was predicted to be dominant in Spain and cost effective in Sweden and the US compared with no intravenous esomeprazole. Efficacy results and resource utilization data from the pivotal clinical trial were inputted into this model, and the results of the analysis were generally robust to plausible variations in key variables. In the cost-utility analysis, which was conducted in the UK and is available as an abstract and poster, esomeprazole was considered to be the most cost-effective treatment alternative, compared with omeprazole or pantoprazole. For this analysis, clinical outcomes

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Can social policy influence socioeconomic disparities? Korean War GI Bill eligibility and markers of depression.

    Science.gov (United States)

    Vable, Anusha M; Canning, David; Glymour, M Maria; Kawachi, Ichiro; Jimenez, Marcia P; Subramanian, Subu V

    2016-02-01

    The Korean War GI Bill provided socioeconomic benefits to veterans; however, its association with health is unclear; we hypothesize GI Bill eligibility is associated with fewer depressive symptoms and smaller disparities. Data from 246 Korean War GI Bill eligible veterans and 240 nonveterans from the Health and Retirement Study were matched on birth year, southern birth, race, height, and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78 years) was assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale, dichotomized to reflect elevated depressive symptoms. Regression analyses were stratified into low (at least one parent Korean War GI Bill eligibility predicted fewer depressive symptoms among individuals from low cSES backgrounds [β = -0.64, 95% confidence interval (CI) = (-1.18, -0.09), P = .022]. Socioeconomic disparities were smaller among veterans than nonveterans for number of depressive symptoms [β = -0.76, 95% CI = (-1.33, -0.18), P = .010] and elevated depressive symptoms [β = -11.7, 95% CI = (-8.2, -22.6), P = .035]. Korean War GI Bill eligibility predicted smaller socioeconomic disparities in depression markers. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Epidemiological Trends of GI Cancers in Patients Visiting a Tertiary Care Hospital in Chandigarh, North India.

    Science.gov (United States)

    Sharma, Munesh K; Singh, Tarundeep; Pandey, Avdesh K; Kankaria, Ankita

    2015-01-01

    Cancer has become an epidemic disease. Nearly ten million new cancer cases are diagnosed annually in the world and out of these about half are from the developing world. To appropriately plan for treatment, management and prevention of the disease, it becomes necessary to study the trends about morbidity caused by cancers. Data for patients diagnosed with any form of gastrointestinal (GI) cancers was extracted from records maintained in the outpatient department registers of the Oncology Department of Government Medical College and Hospital in Chandigarh from 1999 to 2012. Trends were analysed for different categories of GI cancers for the period of 12 years. In present study GI cancers accounted for 23 % of all registered cases (n-9603) of carcinomas. Males predominated for all GI cancers except in the gall bladder. Gastrointestinal cancers as a proportion of total cancers increased from 21% in 1999 to 25.9% in 2012 with a significant increasing trend in our series (χ2 for linear trend=9.36, pCancers of the tonsil, oral cavity and pharynx taken together showed an increasing trend over the years (χ2 for trend=55.2, pcancers of the lower GI (χ2=19.6, pcancers form a significant proportion of all cancers reporting to our data. In depth studies to ascertain the reasons for the changing trends are required to design intervention programs. Further information is necessary from cancer registries and from the hospital records of oncology departments.

  9. A comprehensive review of spatial allocation of LID-BMP-GI practices: Strategies and optimization tools.

    Science.gov (United States)

    Zhang, Kun; Chui, Ting Fong May

    2017-12-06

    Low-impact development (LID), best management practice (BMP), and green infrastructure (GI) are semi-engineered stormwater management practices that have been widely studied and implemented worldwide. Implemented in the complex environment of urban areas, LID-BMP-GI practices often intertwine with a very large number of hydro-environmental and socio-economic considerations and constraints. Therefore, they need to be carefully selected, designed, and allocated within an urban area. Both planning and optimization can lead to more systematic and strategic approaches to address this multi-scale, multi-parameter problem of practice allocation. In this review, we first identify the main components of the strategic planning cycle, their scope and inter-relationships, and their corresponding mathematical representations. We then present a comprehensive review of the existing literature on spatial allocation optimization tools (SAOTs) for LID-BMP-GI practices and summarize the generic structure and the systematic typology of the existing SAOTs. We conclude with a discussion of several current research gaps in the spatial allocation of LID-BMP-GI practices. In this review, we aim to summarize the strategies and optimization tools for the spatial allocation of LID-BMP-GI practices that are beneficial to practitioners. The other aim is to provide recommendations for future research on the development of more advanced and comprehensive SAOTs. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Recent advances in the management of peptic ulcer bleeding [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Ian Beales

    2017-09-01

    Full Text Available Acute upper gastrointestinal haemorrhage due to peptic ulcer bleeding remains an important cause of emergency presentation and hospital admission. Despite advances in many aspects of management, peptic ulcer bleeding is still associated with significant morbidity, mortality, and healthcare costs. Comprehensive international guidelines have been published, but advances as well as controversies continue to evolve. Important recent advances include the evidence supporting a more restrictive transfusion strategy aiming for a target haemoglobin of 70–90 g/l. Comparative studies have confirmed that the Glasgow–Blatchford score remains the most useful score for predicting the need for intervention as well as for identifying the lowest-risk patients suitable for outpatient management. New scores, including the AIMS65 and Progetto Nazionale Emorragia Digestiva score, may be more accurate in predicting mortality. Pre-endoscopy erythromycin appears to improve outcomes and is probably underused. High-dose oral proton pump inhibition (PPI for 11 days after PPI infusion is advantageous in those with a Rockall score of 6 or more. Oral is as effective as parenteral iron at restoring haemoglobin levels after a peptic ulcer bleed and both are superior to placebo in this respect. Within endoscopic techniques, haemostatic powders and over-the-scope clips can be used when other methods have failed. A disposable Doppler probe appears to provide more accurate determination of both rebleeding risk and the success of endoscopic therapy than purely visual guidance. Non-Helicobacter pylori, non-aspirin/non-steroidal anti-inflammatory drug ulcers contribute an increasing percentage of bleeding peptic ulcers and are associated with a poor prognosis and high rebleeding rate. The optimal management of these ulcers remains to be determined.

  11. No increased systemic fibrinolysis in women with heavy menstrual bleeding.

    Science.gov (United States)

    Wiewel-Verschueren, S; Knol, H M; Lisman, T; Bogchelman, D H; Kluin-Nelemans, J C; van der Zee, A G J; Mulder, A B; Meijer, K

    2014-09-01

    Bleeding disorders have been recognized as important etiologic or contributory factors in women with heavy menstrual bleeding. Fibrinolysis in the endometrium plays a role in heavy menstrual bleeding. It is unknown whether increased systemic fibrinolysis might also increase the risk of heavy menstrual bleeding. To investigate fibrinolytic parameters, including clot lysis time, in women with heavy menstrual bleeding. We included 102 patients referred for heavy menstrual bleeding (Pictorial Bleeding Assessment Chart score of > 100) in our cohort. Patients and controls (28 healthy volunteers without heavy menstrual bleeding) underwent hemostatic testing in the first week after menstruation. For 79 patients and all controls, fibrinolytic parameters (thrombin-activatable fibrinolysis inhibitor activity, and plasminogen activator inhibitor-1, tissue-type plasminogen activator and plasmin inhibitor levels) and clot lysis time were available. Fibrinolytic parameters were similar between patients and controls, except for thrombin-activatable fibrinolysis inhibitor (89.4% vs. 82.5%) and plasmin inhibitor (106% vs. 96%), the levels of which which were significantly higher in patients. In women with menorrhagia without gynecologic abnormalities, we found lower thrombin-activatable fibrinolysis inhibitor and plasminogen activator inhibitor-1 levels than in women with gynecologic abnormalities (thrombin-activatable fibrinolysis inhibitor, 85.4% vs. 94.8%; plasminogen activator inhibitor-1, 16.0 μg L(-1) vs. 24.5 μg L(-1) ). Systemic fibrinolytic capacity is not increased in women with heavy menstrual bleeding. Overall, levels of the fibrinolytic inhibitors thrombin-activatable fibrinolysis inhibitor and plasmin inhibitor were even higher in patients than in controls. However, in a subgroup of women without gynecologic abnormalities, relatively lower levels of inhibitors may contribute to the heavy menstrual bleeding. © 2014 International Society on Thrombosis and Haemostasis.

  12. Bleeding disorders in the tribe: result of consanguineous in breeding

    Directory of Open Access Journals (Sweden)

    Borhany Munira

    2010-09-01

    Full Text Available Abstract Objective To determine the frequency and clinical features of bleeding disorders in the tribe as a result of consanguineous marriages. Design Cross Sectional Study Introduction Countries in which consanguinity is a normal practice, these rare autosomal recessive disorders run in close families and tribes. Here we describe a family, living in village Ali Murad Chandio, District Badin, labeled as haemophilia. Patients & Methods Our team visited the village & developed the pedigree of the whole extended family, up to seven generations. Performa was filled by incorporating patients, family history of bleeding, signs & symptoms, and bleeding from any site. From them 144 individuals were screened with CBC, bleeding time, platelet aggregation studies & RiCoF. While for PT, APTT, VWF assay and Factor VIII assay, samples were kept frozen at -70 degrees C until tested. Results The family tree of the seven generations comprises of 533 individuals, 63 subjects died over a period of 20 years and 470 were alive. Out of all those 144 subjects were selected on the basis of the bleeding history. Among them 98(68.1% were diagnosed to have a bleeding disorder; 44.9% patients were male and 55.1% patients were female. Median age of all the patients was 20.81, range (4 months- 80 yrs. The results of bleeding have shown that majority had gum bleeding, epistaxis and menorrhagia. Most common bleeding disorder was Von Willebrand disease and Platelet functional disorders. Conclusion Consanguineous marriages keep all the beneficial and adversely affecting recessive genes within the family; in homozygous states. These genes express themselves and result in life threatening diseases. Awareness, education & genetic counseling will be needed to prevent the spread of such common occurrence of these bleeding disorders in the community.

  13. Post-ritual Circumcision Bleeding-Characteristics and Treatment Outcome.

    Science.gov (United States)

    Mano, Roy; Nevo, Amihay; Sivan, Bezalel; Morag, Roy; Ben-Meir, David

    2017-07-01

    To report the characteristics, treatment, and short-term outcome of neonatal post-circumcision bleeding, and to identify predictors of surgical treatment. The medical records of 90 consecutive neonates who presented to the emergency room with post-circumcision bleeding between 2009 and 2014 were reviewed. Circumcisions were performed using the traditional Mogen shield device. The study end point was surgical intervention for hemostasis. Predictors of surgical treatment were evaluated. An estimated total of 28,383 circumcisions were performed during the study period; thus, the post-circumcision bleeding rate was 0.32%. Initial treatment included compressive dressing in 15 infants (17%) and hemostatic dressing in 47 infants (52%); 28 infants (31%) did not require treatment upon arrival to the emergency room. Two infants (2%) received blood transfusion. Surgical treatment was required in 11 infants (12%); 10 of 43 infants (23%) with active bleeding on arrival to the emergency room required surgery compared to 1 of 47 infants (2%) without active bleeding (P = .003). Similarly, 3 of 7 infants (43%) referred from other hospitals required surgery compared to 8 of 83 infants (10%) referred from the community (P = .037). Abnormal blood tests at presentation were not associated with surgical treatment. At 1 month of follow-up, 2 infants were admitted for recurrent bleeding. Coagulation abnormalities were found in 4 infants. Surgical treatment was required in 12% of infants presenting to the emergency room with post-circumcision bleeding. The rate of surgical intervention was significantly higher in infants with active bleeding at presentation and in those referred from other hospitals. Physicians should consider admitting infants presenting with active post-circumcision bleeding, whereas infants without active bleeding may be observed and discharged. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. The prevalence of underlying bleeding disorders in patients with heavy menstrual bleeding with and without gynecologic abnormalities

    NARCIS (Netherlands)

    Knol, H. Marieke; Mulder, Andre; Bogchelman, Dick H.; Kluin-Nelemans, Hanneke C.; van der Zee, Ate G. J.; Meijer, Karina

    OBJECTIVE: The purpose of this study was to assess the prevalence of underlying bleeding disorders in women with heavy menstrual bleeding (HMB) with and without gynecologic abnormalities. STUDY DESIGN: We performed a single-center prospective cohort study of 112 consecutive patients who were

  15. GI Symptoms in Infants Are a Potential Target for Fermented Infant Milk Formulae: A Review

    Directory of Open Access Journals (Sweden)

    Bert J. M. van de Heijning

    2014-09-01

    Full Text Available Besides pre- and pro-biotic-containing infant formulae, fermented infant formulae are commonly used to relieve or prevent symptoms of gastrointestinal (GI discomfort in young infants. During the fermentation process in cow’s milk-based formulae, the beneficial bacteria modulate the product by forming several beneficial compounds, which contribute to the alleviation of the symptoms observed. This review summarizes the clinical evidence on the impact of fermented infant formulae on common pediatric GI-symptoms. The potential mechanisms involved are discussed: i.e., the lactose and protein (in- digestibility, effects on gastric emptying and gut transit and modulation of the colonic microbiota. Although initial evidence indicates a beneficial effect of fermented formulae on GI discomfort in newborns, validation and confirmation of the clinical proof obtained so far is warranted, as well as further research to (more fully understand the mode of action.

  16. The Glycemic Index of Rice and Rice Products: A Review, and Table of GI Values.

    Science.gov (United States)

    Kaur, Bhupinder; Ranawana, Viren; Henry, Jeyakumar

    2016-01-01

    Rice is the principle staple and energy source for nearly half the world's population and therefore has significant nutrition and health implications. Rice is generally considered a high glycemic index (GI) food, however, this depends on varietal, compositional, processing, and accompaniment factors. Being a major contributor to the glycemic load in rice eating populations, there is increasing concern that the rising prevalence of insulin resistance is as a result of the consumption of large amounts of rice. Devising ways and means of reducing the glycemic impact of rice is therefore imperative. This review gathers studies examining the GI of rice and rice products and provides a critical overview of the current state of the art. A table collating published GI values for rice and rice products is also included.

  17. Species- and dose-specific pancreatic responses and progression in single- and repeat-dose studies with GI181771X: a novel cholecystokinin 1 receptor agonist in mice, rats, and monkeys.

    Science.gov (United States)

    Myer, James R; Romach, Elizabeth H; Elangbam, Chandikumar S

    2014-01-01

    Compound-induced pancreatic injury is a serious liability in preclinical toxicity studies. However, its relevance to humans should be cautiously evaluated because of interspecies variations. To highlight such variations, we evaluated the species- and dose-specific pancreatic responses and progression caused by GI181771X, a novel cholecystokinin 1 receptor agonist investigated by GlaxoSmithKline for the treatment of obesity. Acute (up to 2,000 mg/kg GI181771X, as single dose) and repeat-dose studies in mice and/or rats (0.25-250 mg/kg/day for 7 days to 26 weeks) showed wide-ranging morphological changes in the pancreas that were dose and duration dependent, including necrotizing pancreatitis, acinar cell hypertrophy/atrophy, zymogen degranulation, focal acinar cell hyperplasia, and interstitial inflammation. In contrast to rodents, pancreatic changes were not observed in cynomolgus monkeys given GI181771X (1-500 mg/kg/day with higher systemic exposure than rats) for up to 52 weeks. Similarly, no GI181771X treatment-associated abnormalities in pancreatic structure were noted in a 24-week clinical trial with obese patients (body mass index >30 or >27 kg/m(2)) as assessed by abdominal ultrasound or by magnetic resonance imaging. Mechanisms for interspecies variations in the pancreatic response to CCK among rodents, monkeys, and humans and their relevance to human risk are discussed.

  18. Löögiüksuse "Admiral Pitka" formeerimine ja tegevus / Toomas Hiio

    Index Scriptorium Estoniae

    Hiio, Toomas, 1965-

    2008-01-01

    Johan Pitka tegevusest 1940-1944. Tema lähematest kaastöölistest Paul Laamannist ja Evald Karotoomest. Löögiüksuse formeerimisest Saksa ametkondade asjaajamises ning Evald Karotoomi ja Paul Laamanni tunnistuste järgi. Kes kuulusid Pitka löögirühma. Saadik Aleksander Warma suhtumisest Pitka löögiüksuse moodustamisse. Vastuolust Soomes viibinud mõõdukate eestlaste ja Harald Vellneri ning Karl Talpaku vahel. Löögirühma tegevusest Tallinnas sakslaste taandumise ajal.

  19. Stroke and recurrent haemorrhage associated with antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Staerk, Laila; Lip, Gregory Y H; Olesen, Jonas B

    2015-01-01

    STUDY QUESTION: What are the risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding associated with restarting antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation? METHODS: This Danish cohort study (1996-201...

  20. Agonist-induced platelet reactivity correlates with bleeding in haemato-oncological patients

    NARCIS (Netherlands)

    Batman, B.; van Bladel, E. R.; van Hamersveld, M.; Pasker-De Jong, Pieternel C M; Korporaal, S. J.A.|info:eu-repo/dai/nl/275174395; Urbanus, R. T.|info:eu-repo/dai/nl/304818402; Roest, M.; Boven, Leonie A; Fijnheer, R.|info:eu-repo/dai/nl/085299731

    2017-01-01

    Background and objective: Prophylactic platelet transfusions are administered to prevent bleeding in haemato-oncological patients. However, bleeding still occurs, despite these transfusions. This practice is costly and not without risk. Better predictors of bleeding are needed, and flow cytometric

  1. Capsule Endoscopy in the Assessment of Obscure Gastrointestinal Bleeding: An Evidence-Based Analysis

    Science.gov (United States)

    2015-01-01

    Background Obscure gastrointestinal bleeding (OGIB) is defined as persistent or recurrent bleeding associated with negative findings on upper and lower gastrointestinal (GI) endoscopic evaluations. The diagnosis and management of patients with OGIB is particularly challenging because of the length and complex loops of the small intestine. Capsule endoscopy (CE) is 1 diagnostic modality that is used to determine the etiology of bleeding. Objectives The objective of this analysis was to review the diagnostic accuracy, safety, and impact on health outcomes of CE in patients with OGIB in comparison with other diagnostic modalities. Data Sources A literature search was performed using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database, for studies published between 2007 and 2013. Review Methods Data on diagnostic accuracy, safety, and impact on health outcomes were abstracted from included studies. Quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results The search yielded 1,189 citations, and 24 studies were included. Eight studies reported diagnostic accuracy comparing CE with other diagnostic modalities. Capsule endoscopy has a higher sensitivity and lower specificity than magnetic resonance enteroclysis, computed tomography, and push enteroscopy. Capsule endoscopy has a good safety profile with few adverse events, although comparative safety data with other diagnostic modalities are limited. Capsule endoscopy is associated with no difference in patient health-related outcomes such as rebleeding or follow-up treatment compared with push enteroscopy, small-bowel follow-through, and angiography. Limitations There was significant heterogeneity in estimates of diagnostic accuracy, which prohibited a statistical summary of findings. The analysis was also limited by the fact that there is no

  2. Simulation of bleeding in endoscopic procedures using virtual reality.

    Science.gov (United States)

    Sweet, Robert; Porter, James; Oppenheimer, Peter; Hendrickson, Duff; Gupta, Arnab; Weghorst, Suzanne

    2002-09-01

    An image-based approach has been developed to represent bleeding in a simulator for transurethral resection of the prostate (TURP). Whereas previous groups attempted to simulate bleeding mathematically over tissue surfaces or in blood vessels, our approach focused on macroscopic visualization of bleeding in a fluid environment. The TURP is an ideal procedure for simulator-based training because of its importance as a skill to acquire as well as its long learning curve. The most challenging step in creating a realistic TURP simulator is simulated bleeding. We took an image-based approach in which we generated blood flow movies of bleeding vessels having different severity and position under variable fluid flow conditions and processed them to separate the blood flow from the background anatomy. We then organized the movies into a parametric database. During the running of the simulation, resection systematically triggers the playback of a blood flow movie (bleeding event). The movie is texture mapped onto a virtual surface that is positioned, oriented, morphed, composited, and looped into the virtual scene. The technique produced an accurate depiction of bleeding vessels one would encounter during a TURP. The image changes readily according to the fluid flow state.

  3. Risk Factors Associated with Reoperation for Bleeding following Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Maxwell A. Thompson

    2014-01-01

    Full Text Available Introduction. This study’s objective was to identify risk factors associated with reoperation for bleeding following liver transplantation (LTx. Methods. A retrospective study was performed at a single institution between 2001 and 2012. Operative reports were used to identify patients who underwent reoperation for bleeding within 2 weeks following LTx (operations for nonbleeding etiologies were excluded. Results. Reoperation for bleeding was observed in 101/928 (10.8% of LTx patients. The following characteristics were associated with reoperation on multivariable analysis: recipient MELD score (OR 1.06/MELD unit, 95% CI 1.03, 1.09, number of platelets transfused (OR 0.73/platelet unit, 95% CI 0.58, 0.91, and aminocaproic acid utilization (OR 0.46, 95% CI 0.27, 0.80. LTx patients who underwent reoperation for bleeding had a longer ICU stay (5 days ± 7 versus 2 days ± 3, P<0.001 and hospitalization (18 days ± 9 versus 10 days ± 18, P<0.001. The risk of death increased in patients who underwent reoperation for bleeding (HR 1.89, 95% CI 1.26, 2.85. Conclusion. Reoperation for bleeding following LTx was associated with increased resource utilization and recipient mortality. A lower threshold for intraoperative platelet transfusion and antifibrinolytics, especially in patients with high lab-MELD score, may decrease the incidence of reoperation for bleeding following LTx.

  4. Plasma copeptin levels in the patients with gastrointestinal bleeding.

    Science.gov (United States)

    Salt, Ömer; Durukan, Polat; Ozkan, S; Saraymen, R; Sen, A; Yurci, M A

    2017-10-01

    Gastrointestinal bleeding is a significant cause of morbidity and mortality worldwide. In addition, it constitutes an important part of health expenditures. In this study, we aimed to determine whether there is a relationship between plasma copeptin levels and the etiology, location and severity of gastrointestinal bleeding. This study was performed prospectively in 104 consecutive patients who were admitted to an emergency department with complaints of bloody vomiting or bloody or black stool. To evaluate the level of biochemical parameters such as Full Blood Count (FBC), serum biochemistry, bleeding parameters and copeptin, blood samples were obtained at admission. For the copeptin levels, 2 more blood samples were obtained at the 12th and 24th hours after admission. The values obtained were compared using statistical methods. In terms of the etiology of bleeding, the copeptin levels in the patients with peptic ulcer were higher than the levels in patients with other gastrointestinal bleeding. However, the difference was not statistically significant. There were no significant differences among all groups' 0th, 12th and 24th hour levels of copeptin. We conclude that copeptin cannot be effectively used as a biochemical parameter in an emergency department to determine the etiology and location of gastrointestinal bleeding. It can, however, be used to make decisions on endoscopy and the hospitalization of patients with suspected gastrointestinal bleeding. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Overview of bleeding disorders in adolescent females with menorrhagia.

    Science.gov (United States)

    Ahuja, Sanjay P; Hertweck, S Paige

    2010-12-01

    Women bleed with menses, during childbirth, and after childbirth. Women are more likely to manifest a bleeding disorder as they have more opportunities to experience bleeding challenges in their lifetime. Bleeding disorders such as hemophilia and von Willebrand disease affect 2.5-3 million American women. The most common inherited bleeding disorder in the population is von Willebrand disease with an estimated prevalence of 1-2%. von Willebrand factor (vWF) is required to adhere platelets to exposed subendothelium and protects factor VIII from proteolysis in the circulation. The prevalence of vWF rises in studies involving women with menorrhagia, with estimates ranging as high as 10-20% in white women, and 1-2% among African American women. Other bleeding disorders seen in adolescents with menorrhagia are disorders of inherited platelet dysfunction, clotting factor deficiencies, thrombocytopenia, and disorders of the fibrinolytic pathway. Not only are women more likely to present early in their life with a bleeding disorder, they are also more likely to have other gynecologic manifestations as a result of these disorders. This article presents an overview of the problem and touches upon the different management strategies available. Copyright © 2010 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  6. Impaired renal function and bleeding in elderly treated with dabigatran.

    Science.gov (United States)

    Berthelot, Emmanuelle; Lavenu-Bombled, Cecile; Orostegui-Giron, Lupe; Desconclois, Céline; Assayag, Patrick

    2014-09-01

    Advantages of dabigatran, a thrombin inhibitor, for stroke prevention in patients with atrial fibrillation are numerous. Elderly patients with impaired renal function are at high risk of bleeding. Recommendations about the renal monitoring in elderly patients are not precise enough. The hemoclot direct thrombin inhibitor (HTI) assay measures accurately the dabigatran activity. Both could help managing serious bleeding events in selected populations. Four elderly patients recently treated with appropriate doses of dabigatran were hospitalized for major bleeding. Three patients were very elderly (> 80 years) and three had impaired renal function (clearance < 50 ml/min) before treatment initiation. Serious bleeding events occurred shortly after dabigatran initiation (< 2 months). In all cases, there was a documented dabigatran plasma overdose associated with a renal function impairment concomitant with the bleeding. Why should physicians be aware of this finding?: A close follow-up of the renal function in clinically fragile elderly patient, before and during the weeks following dabigatran initiation, could help to detect the risk of major bleeding event. The HTI dosage could help managing the treatment in case of severe bleeding event.

  7. Acute Ischaemic Colitis- A Case Report

    Directory of Open Access Journals (Sweden)

    M Basra

    2012-03-01

    Full Text Available Acute ischaemic colitis (AIC is being increasingly recognised as an uncommon cause of abdominal pain associated with fresh bleeding per rectum. It is paramount to maintain a high index of suspicion and adopt appropriate management strategies to avoid complications and inappropriate interventions. In this paper, we describe a case of AIC and review literature pertinent to the management of this condition. Keywords: Ischaemic colitis, acute abdomen, management.

  8. [Gastrointestinal bleeding following ingestion of low-dose ibuprofen].

    Science.gov (United States)

    Vaquero Sosa, E; Bodas Pinedo, A; Maluenda Carrillo, C

    2013-01-01

    Ibuprofen is a non-steroidal anti-inflammatory drug frequently used in children for fever and pain. It is usually considered to be safe and of low risk at low doses and short-term use. The aim of our study was to review the cases of gastrointestinal bleeding and assessment of gastrointestinal bleeding after recommended doses of ibuprofen. We describe 9 previously healthy patients with upper gastrointestinal bleeding after receiving weight-related doses of ibuprofen for fever. Copyright © 2011 Asociación Española de Pediatría. Published by Elsevier España. All rights reserved.

  9. Acquired hemophilia A: an underdiagnosed, severe bleeding disorder.

    Science.gov (United States)

    Zdziarska, Joanna; Musiał, Jacek

    2014-01-01

    Acquired hemophilia is a rare bleeding disorder caused by autoantibodies that inhibit coagulation factor VIII. In most cases, it manifests with severe, often life‑threatening bleeds. Acquired hemophilia may be idiopathic or secondary to another condition, most commonly other autoimmune disease or cancer. Treatment is directed to stop bleeding and eradicate inhibitory autoantibodies. Like in most life‑threatening conditions, early diagnosis and treatment are essential for good prognosis. Prompt diagnosis and treatment of acquired hemophilia are constantly improving owing to the increasing availability of laboratory diagnostic tests and growing awareness of physicians of various specialties.

  10. How do you treat bleeding disorders with desmopressin?

    Science.gov (United States)

    Özgönenel, Bülent; Rajpurkar, Madhvi; Lusher, Jeanne M

    2007-01-01

    Desmopressin is an analog of vasopressin that exerts a substantial haemostatic effect by inducing the release of von Willebrand factor from its storage sites in endothelial cells. It has proved useful in treating or preventing bleeding episodes in patients with von Willebrand disease, haemophilia A and platelet function defects. Its efficacy in achieving a satisfactory level of haemostasis has reduced the use of blood products to treat bleeding episodes. Clinicians need to become familiar with the use of this drug that has become a home medication for many patients with inherited bleeding disorders. PMID:17344569

  11. Gastrointestinal Bleeding Scintigraphy in the Early 21st Century.

    Science.gov (United States)

    Grady, Erin

    2016-02-01

    Gastrointestinal bleeding scintigraphy performed with (99m)Tc-labeled autologous erythrocytes or historically with (99m)Tc-sulfur colloid has been a clinically useful tool since the 1970s. This article reviews the history of the techniques, the different methods of radiolabeling erythrocytes, the procedure, useful indications, diagnostic accuracy, the use of SPECT/CT and CT angiography to evaluate gastrointestinal bleeding, and Meckel diverticulum imaging. The causes of pediatric bleeding are discussed by age. © 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

  12. Therapeutic approach to "downhill" esophageal varices bleeding due to superior vena cava syndrome in Behcet's disease: a case report

    Directory of Open Access Journals (Sweden)

    Haghighi Mahshid

    2006-12-01

    Full Text Available Abstract Background One of the rare presentations of superior vena cava syndrome is bleeding of "downhill" esophageal varices (DEV and different approaches have been used to control it. This is a case report whose DEV was eradicated by band ligation for the first time. Case presentation We report a 42-year-old man who is a known case of Behcet's disease. The patient's first presentation was superior vena cava syndrome due to thrombosis followed by bipolar ulcers and arthralgia. He received warfarin, prednisolone and azathioprine. The clinical course of the patient was complicated by one episode of hematemesis without abdominal pain when the patient's PT was in therapeutic range. After resuscitation and correction of PT with fresh frozen plasma transfusion, upper gastrointestinal endoscopy was done. Prominent varices were seen in the upper third of the esophagus, tapering to the middle part without acute bleeding. Stomach and duodenum were normal. Color ultrasonography evaluation of the portal, hepatic and splenic veins was negative for thrombosis. Band ligation was done and the patient's bleeding did not recur. Conclusion Band ligation is a safe and effective method for controlling DEV bleeding in patients with uncorrectable underlying disorders.

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

    Directory of Open Access Journals (Sweden)

    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. Nebulized anticoagulants for acute lung injury - a systematic review of preclinical and clinical investigations

    NARCIS (Netherlands)

    Tuinman, Pieter R.; Dixon, Barry; Levi, Marcel; Juffermans, Nicole P.; Schultz, Marcus J.

    2012-01-01

    Data from interventional trials of systemic anticoagulation for sepsis inconsistently suggest beneficial effects in case of acute lung injury (ALI). Severe systemic bleeding due to anticoagulation may have offset the possible positive effects. Nebulization of anticoagulants may allow for improved

  15. redMaGiC: selecting luminous red galaxies from the DES Science Verification data

    Energy Technology Data Exchange (ETDEWEB)

    Rozo, E. [Univ. of Arizona, Tucson, AZ (United States). et al.

    2016-05-30

    We introduce redMaGiC, an automated algorithm for selecting Luminous Red Galaxies (LRGs). The algorithm was developed to minimize photometric redshift uncertainties in photometric large-scale structure studies. redMaGiC achieves this by self-training the color-cuts necessary to produce a luminosity-thresholded LRG sam- ple of constant comoving density. Additionally, we demonstrate that redMaGiC photo-zs are very nearly as accurate as the best machine-learning based methods, yet they require minimal spectroscopic training, do not suffer from extrapolation biases, and are very nearly Gaussian. We apply our algorithm to Dark Energy Survey (DES) Science Verification (SV) data to produce a redMaGiC catalog sampling the redshift range z ϵ [0.2,0.8]. Our fiducial sample has a comoving space density of 10-3 (h-1Mpc)-3, and a median photo-z bias (zspec zphoto) and scatter (σz=(1 + z)) of 0.005 and 0.017 respectively.The corresponding 5σ outlier fraction is 1.4%. We also test our algorithm with Sloan Digital Sky Survey (SDSS) Data Release 8 (DR8) and Stripe 82 data, and discuss how spectroscopic training can be used to control photo-z biases at the 0.1% level.

  16. Effects of Dietary Yogurt on the Healthy Human Gastrointestinal (GI Microbiome

    Directory of Open Access Journals (Sweden)

    Daniel J. Lisko

    2017-02-01

    Full Text Available The gastrointestinal (GI tract performs key functions that regulate the relationship between the host and the microbiota. Research has shown numerous benefits of probiotic intake in the modulation of immune responses and human metabolic processes. However, unfavorable attention has been paid to temporal changes of the microbial composition and diversity of the GI tract. This study aimed to investigate the effects of yogurt consumption on the GI microbiome bacteria community composition, structure and diversity during and after a short-term period (42 days. We used a multi-approach combining classical fingerprinting techniques (T-RFLPs, Sanger analyses and Illumina MiSeq 16S rRNA gene amplicon sequencing to elucidate bacterial communities and Lactobacilli and Bifidobacteria populations within healthy adults that consume high doses of yogurt daily. Results indicated that overall GI microbial community and diversity was method-dependent, yet we found individual specific changes in bacterial composition and structure in healthy subjects that consumed high doses of yogurt throughout the study.

  17. The geographical identification (GI under geographic perspective for coalho cheese in agreste region of Pernambuco state

    Directory of Open Access Journals (Sweden)

    Janieire Dorlamis Cordeiro Bezerra

    2017-02-01

    Full Text Available This theme, geographic identification, although it has an intrinsic relationship with space and the organization of it, is little studied in Geography. For GI becomes tool to promote territorial development this should be linked to a policy not only economic but social and environmental, seeking to reach the marginalized producers in order to avoid social exclusion. GI coalho cheese Agreste of Pernambuco is indication of origin (IO which will help in spatial changes. To obtain a certification studies will required to contribute to the achievement of the GI, and futher after certification further research will be extremely necessary in order to manage the certification process and inclusion of family farming. Therefore, it will possible to conclude that the coalho cheese GI Agreste Pernambuco in fact included the family farmer, enhancing production, improving their income and enabling the rise. Therefore, the certification will bring beyond recognition in the region, a socio-spatial change, which in the future will involve studies of socio-economic indicators, with the interaction of man with the territory, how to adopt it and use it, contextualizing the space changes.

  18. Eesti Miss teeb videofilmi / Evelyn Mikomägi ; interv. Valdo Jahilo

    Index Scriptorium Estoniae

    Mikomägi, Evelyn

    2001-01-01

    Eesti Miss Estonia 2000 Evelyn Mikomägi tegi koos sõbra, Sven-Olof Svenne Englundiga dokfilmi Küprosel peetud maailma suurimast iludusvõistlusest Miss Universe 2000. Neile kuulub ühisfirma "Living Frames" Rootsis, mille peategevus on suunatud 16mm ja 35mm filmide tootmisele

  19. Elektrooniline laulu- ja tantsupidu / Jamie Lidell ; interv. Tristan Priimägi

    Index Scriptorium Estoniae

    Lidell, Jamie

    2006-01-01

    Tristan Priimägi külastas 25. mail Inglismaal Brighton festivalil üritust "Warp Moves", kus intervjueeris Eesti Kunstimuuseumis 2. juuni öösel üritusel "KUMU Öö" esinevaid artiste Jamie Lidelli ja Plaidi

  20. Public administration GI-based web-sites for spatial planning

    DEFF Research Database (Denmark)

    Campagna, Michele; Arleth, Mette

    2005-01-01

    This paper presents the results of an ongoing comparative study on the accessibility of Geographic Information at public authorities’ websites in Denmark and Italy. Qualitative and quantitative mappings of the level of accessibility to GI in the two countries are made and the results are compared...