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Sample records for bleeding disorders converting

  1. Acquired bleeding disorders

    African Journals Online (AJOL)

    B one marrow aplasia ... Laboratory approach to a suspected acquired bleeding disorder. (LER = leuko- .... lymphocytic leukaemia, and lymphoma). ... cells), a bone marrow aspirate and trephine biopsy (BMAT) is not ..... transplantation.

  2. Bleeding Disorders in Women

    Science.gov (United States)

    ... might be heavy, print and use a menstrual chart to track your bleeding and talk to your ... you’re “low in iron.” Heavy bleeding after dental surgery, other surgery, or childbirth. Prolonged bleeding episodes ...

  3. Intracranial hemorrhage in congenital bleeding disorders.

    Science.gov (United States)

    Tabibian, Shadi; Motlagh, Hoda; Naderi, Majid; Dorgalaleh, Akbar

    2018-01-01

    : Intracranial hemorrhage (ICH), as a life-threatening bleeding among all kinds of congenital bleeding disorders (CBDs), is a rare manifestation except in factor XIII (FXIII) deficiency, which is accompanied by ICH, early in life, in about one-third of patients. Most inherited platelet function disorders (IPFDs) are mild to moderate bleeding disorders that can never experience a severe bleeding as in ICH; however, Glanzmann's thrombasthenia, a common and severe inherited platelet function disorder, can lead to ICH and occasional death. This bleeding feature can also be observed in grey platelet syndrome, though less frequently than in Glanzmann's thrombasthenia. In hemophilia, intracerebral hemorrhage is affected by various risk factors one of which is the severity of the disease. The precise prevalence of ICH in these patients is not clear but an estimated incidence of 3.5-4% among newborns with hemophilia is largely ascertained. Although ICH is a rare phenomenon in CBDs, it can be experienced by every patient with severe hemophilia A and B, FXIII deficiency (FXIIID), FVIID, FXD, FVD, FIID, and afibrinogenemia. Upon observing the general signs and symptoms of ICH such as vomiting, seizure, unconsciousness, and headache, appropriate replacement therapies and cranial ultrasound scans must be done to decrease ICH-related morbidity and mortality.

  4. Menstrual Patterns and Treatment of Heavy Menstrual Bleeding in Adolescents with Bleeding Disorders.

    Science.gov (United States)

    Dowlut-McElroy, Tazim; Williams, Karen B; Carpenter, Shannon L; Strickland, Julie L

    2015-12-01

    To characterize menstrual bleeding patterns and treatment of heavy menstrual bleeding in adolescents with bleeding disorders. We conducted a retrospective review of female patients aged nine to 21 years with known bleeding disorders who attended a pediatric gynecology, hematology, and comprehensive hematology/gynecology clinic at a children's hospital in a metropolitan area. Prevalence of heavy menstrual bleeding at menarche, prolonged menses, and irregular menses among girls with bleeding disorders and patterns of initial and subsequent treatment for heavy menstrual bleeding in girls with bleeding disorders. Of 115 participants aged nine to 21 years with known bleeding disorders, 102 were included in the final analysis. Of the 69 postmenarcheal girls, almost half (32/69, 46.4%) noted heavy menstrual bleeding at menarche. Girls with von Willebrand disease were more likely to have menses lasting longer than seven days. Only 28% of girls had discussed a treatment plan for heavy menstrual bleeding before menarche. Hormonal therapy was most commonly used as initial treatment of heavy menstrual bleeding. Half (53%) of the girls failed initial treatment. Combination (hormonal and non-hormonal therapy) was more frequently used for subsequent treatment. Adolescents with bleeding disorders are at risk of heavy bleeding at and after menarche. Consultation with a pediatric gynecologist and/or hematologist prior to menarche may be helpful to outline abnormal patterns of menstrual bleeding and to discuss options of treatment in the event of heavy menstrual bleeding. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  5. Bleeding from gastrointestinal angioectasias is not related to bleeding disorders - a case control study

    Directory of Open Access Journals (Sweden)

    Lärfars Gerd

    2010-09-01

    Full Text Available Abstract Background Angioectasias in the gastrointestinal tract can be found in up to 3% of the population. They are typically asymptomatic but may sometimes result in severe bleeding. The reasons for why some patients bleed from their angioectasias are not fully understood but it has been reported that it may be explained by an acquired von Willebrand syndrome (AVWS. This condition has similar laboratory findings to congenital von Willebrand disease with selective loss of large von Willebrand multimers. The aim of this study was to find out if AVWS or any other bleeding disorder was more common in patients with bleeding from angioectasias than in a control group. Methods We compared bleeding tests and coagulation parameters, including von Willebrand multimers, from a group of 23 patients with anemia caused by bleeding from angioectasias, with the results from a control group lacking angioectasias. Results No significant differences between the two groups were found in coagulation parameters, bleeding time or von Willebrand multimer levels. Conclusion These results do not support a need for routine bleeding tests in cases of bleeding from angioectasias and do not show an overall increased risk of AVWS among these patients.

  6. A rare case of bleeding disorder: Glanzmann's thrombasthenia.

    Science.gov (United States)

    Swathi, Jami; Gowrishankar, A; Jayakumar, S A; Jain, Karun

    2017-01-01

    Glanzmann's thrombasthenia (GT) is a rare bleeding disorder, which is characterized by a lack of platelet aggregation. It is characterized by qualitative or quantitative abnormalities of the platelet membrane glycoprotein IIb/IIIa. Physiologically, this platelet receptor normally binds several adhesive plasma proteins, and this facilitates attachment and aggregation of platelets to ensure thrombus formation at sites of vascular injury. The lack of resultant platelet aggregation in GT leads to mucocutaneous bleeding whose manifestation may be clinically variable, ranging from easy bruising to severe and potentially life-threatening hemorrhages. To highlight this rare but potentially life-threating disorder, GT. We report a case of GT that was first detected because of the multiple episodes of gum bleeding. The patient was an 18-year-old girl who presented with a history of repeated episodes of gum bleeding since childhood. Till the first visit to our hospital, she had not been diagnosed with GT despite a history of bleeding tendency, notably purpura in areas of easy bruising, gum bleeding, and prolonged bleeding time after abrasions and insect stings. GT was diagnosed on the basis of prolonged bleeding time, lack of platelet aggregation with adenosine di phosphate, epinephrine and collagen. GT should always be considered as differential diagnosis while evaluating any case of bleeding disorder.

  7. Bleeding disorders in dental practice: A diagnostic overview

    Directory of Open Access Journals (Sweden)

    Abhirup Goswami

    2014-01-01

    Full Text Available Dental health care workers are increasingly called upon to provide quality dental care to individuals whose bleeding and clotting mechanisms have been altered by inherited or acquired diseases. This provides an opportunity for the dentist who is trained in the recognition of oral and systemic signs of altered hemostasis to assist in the diagnosis of the underlying condition. A number of dental procedures result in the risk of bleeding that can have serious consequences, such as severe hemorrhage or possibly death, for the patient with a bleeding disorder. Oral care providers must be aware of the impact of bleeding disorders on the management of their patients. These disorders must be recognized from history, clinical examinations, and laboratory investigations, if indicated, prior to surgical procedures including those in dental surgery to prevent bleeding related complications. Safe dental care may require consultation with the patient′s physician, systemic management, and dental treatment modifications. The purpose of this article is how to identify these patients with bleeding disorders.

  8. Gynaecological and obstetric management of women with inherited bleeding disorders.

    Science.gov (United States)

    Demers, Christine; Derzko, Christine; David, Michèle; Douglas, Joanne

    2006-10-01

    The prevalence of bleeding disorders, notably von Willebrand disease (vWD), among adult women with objectively documented menorrhagia is consistently reported to be 10% to 20% and is even higher in adolescents presenting with menorrhagia. This consensus document has been developed by a multidisciplinary committee consisting of an anesthesiologist, 2 hematologists, and an obstetrician/gynaecologist and has been endorsed by their relevant specialty bodies. It has been prepared with the express purpose of providing guidelines for both women with inherited bleeding disorders and for their caregivers regarding the gynaecological and obstetric management of these women, including appropriate anesthesia support where indicated. Diagnostic tools and specific medical and, where appropriate, surgical alternatives to management are reviewed and evidence-based recommendations presented. A MEDLINE search of the English literature between January 1975 and November 2003 was performed using the following key words: menorrhagia, uterine bleeding, pregnancy, von Willebrand, congenital bleeding disorder, desmopressin/DDAVP, tranexamic acid, oral contraceptives, medroxyprogesterone, therapy, hysterectomy, anesthesia, epidural, spinal. Recommendations from other society guidelines were reviewed. 1. Inherited bleeding disorders should be considered in the differential diagnosis of all patients presenting with menorrhagia (II-2B). The graphical scoring system presented is a validated tool which offers a simple yet practical method that can be used by patients to quantify their blood loss (II-2B). 2. Because underlying bleeding disorders are frequent in women with menorrhagia, physicians should consider performing a hemoglobin/hematocrit, platelet count, ferritin, PT (INR) and APTT in women with menorrhagia. In women who have a personal history of other bleeding or a family history of bleeding, further investigation should be considered, including a vWD workup (factor VIII, vWF antigen

  9. Common management issues in pediatric patients with mild bleeding disorders.

    Science.gov (United States)

    O'Brien, Sarah H

    2012-10-01

    Type 1 von Willebrand disease and mild platelet function defects are among the most common disorders seen by pediatric hematologists. The management and prevention of bleeding in these patients can be challenging, as there are limited published data to guide clinical practice, and a complete lack of randomized clinical trials. Desmopressin (DDAVP) and antifibrinolytics are the mainstays of treatment in these patients, yet the optimal dosing and timing of these agents to prevent or resolve bleeding, while minimizing adverse side effects, is sometimes unclear. DDAVP-induced hyponatremia is a particularly under-recognized complication in children with bleeding disorders who undergo surgery. Clinicians need to be aware of local measures that are equally important in treating problems such as epistaxis and surgical bleeding. This review will discuss the published literature and provide practical suggestions regarding four common management issues in the care of children and adolescents with mild bleeding disorders: epistaxis, heavy menstrual bleeding, dental extractions, and tonsillectomy. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  10. Severity and Features of Epistaxis in Children with a Mucocutaneous Bleeding Disorder

    NARCIS (Netherlands)

    Stokhuijzen, Eva; Segbefia, Catherine I.; Biss, Tina T.; Clark, Dewi S.; James, Paula D.; Riddel, Jim; Blanchette, Victor S.; Rand, Margaret L.

    2018-01-01

    Objective To use standardized bleeding questionnaires to compare the severity and patterns of epistaxis in children with a mucocutaneous bleeding disorder and control children. Study design The epistaxis sections of the Pediatric Bleeding Questionnaire (PBQ) administered to pediatric patients with

  11. Abnormal Uterine Bleeding including coagulopathies and other menstrual disorders.

    Science.gov (United States)

    Deligeoroglou, Efthimios; Karountzos, Vasileios

    2018-04-01

    Abnormal Uterine Bleeding (AUB) is a frequent cause of visits to the emergency department and a major reason for concern among adolescents and their families. The most common cause of AUB, in otherwise healthy adolescents, is ovulatory dysfunction, although 5-36% of adolescents who present with heavy menstrual bleeding, have an underlying bleeding disorder (BD). The most common form of BDs is von Willebrand Disease, reflecting 13% of adolescents with AUB. Management of AUB depends on the underlying etiology, the bleeding severity, as well as the need for hospitalization. Treatment of adolescents with an underlying coagulopathy depends on the severity of the BD, while therapeutic interventions are summarized in supportive measures, hormonal treatments (e.g. Combined Oral Contraceptives), non-hormonal treatments (e.g. tranexamic acid and desmopressin), surgical options (e.g. dilatation & curettage) and treatment options in specific conditions. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Treatment for preventing bleeding in people with haemophilia or other congenital bleeding disorders undergoing surgery.

    Science.gov (United States)

    Coppola, Antonio; Windyga, Jerzy; Tufano, Antonella; Yeung, Cindy; Di Minno, Matteo Nicola Dario

    2015-02-09

    In people with haemophilia or other congenital bleeding disorders undergoing surgical interventions, haemostatic treatment is needed in order to correct the underlying coagulation abnormalities and minimise the bleeding risk. This treatment varies according to the specific haemostatic defect, its severity and the type of surgical procedure. The aim of treatment is to ensure adequate haemostatic coverage for as long as the bleeding risk persists and until wound healing is complete. To assess the effectiveness and safety of different haemostatic regimens (type, dose and duration, modality of administration and target haemostatic levels) administered in people with haemophilia or other congenital bleeding disorders for preventing bleeding complications during and after surgical procedures. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of the last search: 20 November 2014. Randomised and quasi-randomised controlled trials comparing any hemostatic treatment regimen to no treatment or to another active regimen in children and adults with haemophilia or other congenital bleeding disorders undergoing any surgical intervention. Two authors independently assessed trials (eligibility and risks of bias) and extracted data. Meta-analyses were performed on available and relevant data. Of the 16 identified trials, four (112 participants) were eligible for inclusion.Two trials evaluated 59 people with haemophilia A and B undergoing 63 dental extractions. Trials compared the use of a different type (tranexamic acid or epsilon-aminocaproic acid) and regimen of antifibrinolytic agents as haemostatic support to the initial replacement treatment. Neither trial specifically addressed mortality (one of this review's primary outcomes); however, in the frame

  13. Animal Models of Hemophilia and Related Bleeding Disorders

    Science.gov (United States)

    Lozier, Jay N.; Nichols, Timothy C.

    2013-01-01

    Animal models of hemophilia and related diseases are important for development of novel treatments and to understand the pathophysiology of bleeding disorders in humans. Testing in animals with the equivalent human disorder provides informed estimates of doses and measures of efficacy, which aids in design of human trials. Many models of hemophilia A, hemophilia B, and von Willebrand disease have been developed from animals with spontaneous mutations (hemophilia A dogs, rats, sheep; hemophilia B dogs; and von Willebrand disease pigs and dogs), or by targeted gene disruption in mice to create hemophilia A, B, or VWD models. Animal models have been used to generate new insights into the pathophysiology of each bleeding disorder and also to perform pre-clinical assessments of standard protein replacement therapies as well as novel gene transfer technology. Both the differences between species and differences in underlying causative mutations must be considered in choosing the best animal for a specific scientific study PMID:23956467

  14. Post-partum hemorrhage in women with rare bleeding disorders.

    Science.gov (United States)

    Peyvandi, Flora; Menegatti, Marzia; Siboni, Simona Maria

    2011-02-01

    Post-partum hemorrhage (PPH) accounts for a substantial fraction of maternal deaths in the general population. Among all women, however, those affected with rare bleeding disorders (RBDs) represent a particular group since to usual bleeding symptoms, they are likely to experience bleedings associated to obstetrical and gynaecological problems. Pregnancy and childbirth, two important stages in the life of a woman, pose a special clinical challenge in women with RBDs, since information about these issues are really scarce and limited to few case reports. These data show that all women with RBDs, except for FXI deficiency, have to be considered potentially at risk for developing PPH, therefore they should be monitored carefully during and immediately after pregnancy. The implication is that women with bleeding disorders may require prophylaxis and/or close observation for several weeks and should be followed by a multidisciplinary team including expertises such as laboratory haematologist, obstetrician-gynaecologist, anaesthesiologist, family physician, and laboratory technician. © 2011 Elsevier Ltd. All rights reserved.

  15. 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

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

    Directory of Open Access Journals (Sweden)

    Sajid Raihan

    2010-01-01

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

  17. Von Willebrand disease and other bleeding disorders in women: consensus on diagnosis and management from an international expert panel

    NARCIS (Netherlands)

    James, Andra H.; Kouides, Peter A.; Abdul-Kadir, Rezan; Edlund, Mans; Federici, Augusto B.; Halimeh, Susan; Kamphuisen, Pieter W.; Konkle, Barbara A.; Martínez-Perez, Oscar; McLintock, Claire; Peyvandi, Flora; Winikoff, Rochelle

    2009-01-01

    Reproductive tract bleeding in women is a naturally occurring event during menstruation and childbirth. In women with menorrhagia, however, congenital bleeding disorders historically have been underdiagnosed. This consensus is intended to allow physicians to better recognize bleeding disorders as a

  18. Synergistic shortening of the bleeding time by desmopressin and ethamsylate in patients with various constitutional bleeding disorders.

    Science.gov (United States)

    Kobrinsky, N L; Israels, E D; Bickis, M G

    1991-01-01

    Desmopressin and ethamsylate were evaluated for possible synergistic effects on the bleeding time. The drugs were administered individually and together to 12 patients with markedly prolonged bleeding times known to be relatively or absolutely unresponsive to desmopressin alone. The bleeding disorders studied included Glanzmann's thrombasthenia (one), other disorders of platelet function (four), pseudo-von Willebrand disease (one), and von Willebrand disease type I (three), type II (two), and type III (one). Desmopressin alone shortened the bleeding time from 23.9 +/- 1.5 to 19.5 +/- 2.3 min (p = 0.03). Ethamsylate alone was without effect. Desmopressin and ethamsylate together shortened the bleeding time to 11.2 +/- 1.4 min (p less than 0.01 compared to baseline, p = 0.02 compared to desmopressin alone). The combination was ineffective in three patients, with Glanzmann's thrombasthenia (one), and von Willebrand disease type I (one) and type III (one). Toxic effects of the drugs were not observed. Five patients received desmopressin and ethamsylate prior to dental work with mandibular block (one), heart surgery requiring cardiopulmonary bypass (two), and adenotonsillectomy surgery (two). Normal hemostasis was achieved in each case. A synergistic shortening of the bleeding time was observed with the combination of desmopressin and ethamsylate in a wide range of bleeding disorders.

  19. Ten-year study of postoperative complications following dental extractions in patients with inherited bleeding disorders.

    Science.gov (United States)

    Hsieh, J-T; Klein, K; Batstone, M

    2017-09-01

    Dental extractions challenge the body's haemostatic mechanism. Postoperative bleeding from dental extraction can be prolonged, or even life threatening in patients with inherited bleeding disorders. Pre- and postoperative clotting factor replacements or systemic desmopressin (ddAVP) have been advocated at our institution to prevent bleeding complications in these patients. This study aimed to assess the postoperative bleeding rate in patients with inherited bleeding disorders that underwent dental extractions at our institution between 2003 and 2012. Patients with inherited bleeding disorders such as haemophilia A, haemophilia B, and von Willebrand's disease were included. Retrospective chart review was conducted. The result showed 53 extraction events occurred in 45 patients over the 10-year period. Ten out of 53 extraction events (18.9%) had postoperative bleeding requiring further factor replacement or ddAVP. Postoperative bleeding in one patient with mild haemophilia A was complicated by the development of inhibitors. Type and severity of bleeding disorder, bone removal, and use of a local haemostatic agent did not have any significant effect on postoperative bleeding. Despite the use of perioperative factors and desmopressin, the postoperative bleeding rates remain high for patients with inherited bleeding disorders. More studies are required to assess the safety and effectiveness of using local haemostatic control to achieve haemostasis following extractions. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  20. Intracranial hemorrhage after blunt head trauma in children with bleeding disorders.

    Science.gov (United States)

    Lee, Lois K; Dayan, Peter S; Gerardi, Michael J; Borgialli, Dominic A; Badawy, Mohamed K; Callahan, James M; Lillis, Kathleen A; Stanley, Rachel M; Gorelick, Marc H; Dong, Li; Zuspan, Sally Jo; Holmes, James F; Kuppermann, Nathan

    2011-06-01

    To determine computerized tomography (CT) use and prevalence of traumatic intracranial hemorrhage (ICH) in children with and without congenital and acquired bleeding disorders. We compared CT use and ICH prevalence in children with and without bleeding disorders in a multicenter cohort study of 43 904 children bleeding disorders; all had Glasgow Coma Scale (GCS) scores of 14 to 15. These children had higher CT rates than children without bleeding disorders and GCS scores of 14 to 15 (risk ratio, 2.29; 95% CI, 2.15 to 2.44). Of the children who underwent imaging with CT, 2 of 186 children with bleeding disorders had ICH (1.1%; 95% CI, 0.1 to 3.8) , compared with 655 of 14 969 children without bleeding disorders (4.4%; 95% CI, 4.1-4.7; rate ratio, 0.25; 95% CI, 0.06 to 0.98). Both children with bleeding disorders and ICHs had symptoms; none of the children required neurosurgery. In children with head trauma, CTs are obtained twice as often in children with bleeding disorders, although ICHs occurred in only 1.1%, and these patients had symptoms. Routine CT imaging after head trauma may not be required in children without symptoms who have congenital and acquired bleeding disorders. Copyright © 2011 Mosby, Inc. All rights reserved.

  1. Hepatitis A and B immunization for individuals with inherited bleeding disorders.

    Science.gov (United States)

    Steele, M; Cochrane, A; Wakefield, C; Stain, A-M; Ling, S; Blanchette, V; Gold, R; Ford-Jones, L

    2009-03-01

    Hepatitis A and B vaccines are highly effective tools that can greatly reduce infection risk in the bleeding disorder population. Although hepatitis A and B immunization for individuals with bleeding disorders is universally recommended, various advisory bodies often differ with respect to many practical aspects of vaccination. To review the published literature and guidelines and form a practical, comprehensive and consistent approach to hepatitis A and B immunization for individuals with bleeding disorders. We reviewed published immunization guidelines from North American immunization advisory bodies and published statements from North American and international haemophilia advisory bodies. A search of the MEDLINE database was performed to find original published literature pertaining to hepatitis A or B immunization of patients with haemophilia or bleeding disorder patients that provided supporting or refuting evidence for advisory body guidelines. Various advisory bodies' immunization guidelines regarding individuals with bleeding disorders have contradictory statements and often did not clarify issues (e.g. post vaccination surveillance). Published literature addressing immunization in bleeding disorder patients is sparse and mostly examines route of vaccine administration, complications and corresponding antibody response. Although the risk of hepatitis A and B infection is low, the use of simple measures such as vaccination is reasonable and advocated by haemophilia advisory bodies. Following our review of the available literature and North American guidelines, we have developed comprehensive and practical recommendations addressing hepatitis A and B immunization for the bleeding disorder population that may be applicable in Bleeding Disorder clinics.

  2. Post-tonsillectomy hemorrhagic outcomes in children with bleeding disorders at a single institution.

    Science.gov (United States)

    Patel, Priyesh N; Arambula, Alexandra M; Wheeler, Allison P; Penn, Edward B

    2017-09-01

    To report on the post-tonsillectomy bleeding outcomes and factors associated with hemorrhage among children with pre- or post-operatively diagnosed bleeding disorders treated with an institutional protocol. Retrospective cohort study of patients with hematologic disorders who underwent tonsillectomy between 2003 and 2016 and were treated with perioperative desmopressin or factor replacement and/or aminocaproic acid. Postoperative outcomes were compared to controls matched for age, sex, and indication for surgery. Analysis of factors associated with hemorrhage was performed in patients with bleeding disorders using Mann-Whitney U or chi-squared tests. 45 patients with hematologic disorders met inclusion criteria. Platelet dysfunction, including von Willebrand Disease (vWD), was the most common diagnosis (77.8%). Most patients had a preoperative diagnosis of a bleeding disorder and received perioperative hematologic medications (86.7%). Compared to matched controls, patients with hematologic disorders experienced more postoperative bleeding (15.5%; 12 bleeds, 7 patients vs. 1.7%; 1 bleed, 1 patient, p = 0.05) and had longer postoperative stays (1.3 days vs. 0.4 days, p bleed were significantly more likely to have a factor deficiency (e.g. Hemophilia over vWD) and have a postoperative diagnosis (compared to preoperative diagnosis) for which they did not receive perioperative hematologic medication. Of patients with a postoperative bleed, all those diagnosed postoperatively required at least one surgical intervention to control bleeding compared to 33% of patients with a preoperative diagnosis. A history of post-surgical bleeding, male sex, age at surgery, and pharyngitis as surgical indication were not associated with higher hemorrhage rates in this group. This study suggests a clinically important magnitude of increased bleeding risk in patients with hematologic disease. This risk appears to decrease with the use of an institutional protocol consisting of

  3. Rare acquired hemostatic disorders as a cause of prolonged bleeding – presentation of two case reports

    Directory of Open Access Journals (Sweden)

    Polona Novak

    2011-10-01

    Full Text Available BACKGROUNDPatient’s anamnesis is of primary importance in determining hemostatic disorders. Based on anamnestic data, a clinician may decide for further laboratory tests. We must consider an acquired bleeding disorder in a patient with unusual, unexpected and prolonged bleeding episodes. In this article we will describe two rare acquired hemostatic disordes.TWO CASE REPORTSOur first patient had prolonged bleeding after a pacemaker implantation. We diagnosed him with acquired von Willebrand syndrome. Further on, the patient required a planned surgical procedure. In our second case we describe a patient with unusual and excessive skin bruising and prolonged bleeding after teeth extractions. He was diagnosed with acquired hemophilia.CONCLUSIONIn the assessment of a patient with a potential acquired bleeding disorder we must first rule out the most common causes, such as iatrogenic ones. But, because of high morbidity and mortality rates, we must also be aware of some rare acquired bleeding disorders. In case of uncertainty, we should consult with a hematologist.

  4. Challenges in the management of bleeding disorders in Nigeria ...

    African Journals Online (AJOL)

    Only 39.1% centers had factor concentrates available. Conclusion: Facilities required for diagnosing and treating BD are significantly deficient in most centers in Nigeria. Funding to provide facility and training is required to improve on this inadequacy. Keywords: Bleeding, hemophilia, thrombocytopenia, whole blood ...

  5. Pharmacologic Agents in the Management of Bleeding Disorders

    Science.gov (United States)

    1990-01-01

    Cronberg S. Glanz- patients. Scand J Hacmatol 1985;35:497-500. mann’s thrombasthenia: pregnancy and parturition (abstract). 82. Olson RE. Vitamin K. In...Uraemic bleeding: role of anaemia and beneficial effect 120. Czer LSC, Bateman TM, Gray RJ, ct al. Treatment of severe of red cell transfusions

  6. GFI1B mutation causes a bleeding disorder with abnormal platelet function.

    Science.gov (United States)

    Stevenson, W S; Morel-Kopp, M-C; Chen, Q; Liang, H P; Bromhead, C J; Wright, S; Turakulov, R; Ng, A P; Roberts, A W; Bahlo, M; Ward, C M

    2013-11-01

    GFI1B is a transcription factor important for erythropoiesis and megakaryocyte development but previously unknown to be associated with human disease. A family with a novel bleeding disorder was identified and characterized. Genetic linkage analysis and massively parallel sequencing were used to localize the mutation causing the disease phenotype on chromosome 9. Functional studies were then performed in megakaryocytic cell lines to determine the biological effects of the mutant transcript. We have identified a family with an autosomal dominant bleeding disorder associated with macrothrombocytopenia, red cell anisopoikilocytosis, and platelet dysfunction. The severity of bleeding is variable with some affected individuals experiencing spontaneous bleeding while other family members exhibit only abnormal bleeding with surgery. A single nucleotide insertion was identified in GFI1B that predicts a frameshift mutation in the fifth zinc finger DNA-binding domain. This mutation alters the transcriptional activity of the protein, resulting in a reduction in platelet α-granule content and aberrant expression of key platelet proteins. GFI1B mutation represents a novel human bleeding disorder, and the described phenotype identifies GFI1B as a critical regulator of platelet shape, number, and function. © 2013 International Society on Thrombosis and Haemostasis.

  7. Application of Molecular Genetics to the Investigation of Inherited Bleeding Disorders

    DEFF Research Database (Denmark)

    Lethagen, Stefan Rune; Dunø, Morten; Nielsen, Lars Bo

    2013-01-01

    Hemophilia is an inherited bleeding disorder primarily caused by deficiency of coagulation factor (F)VIII (hemophilia A) or FIX (hemophilia B). Both conditions are X-linked. More than 2100 different F8 mutations have been described, the most common being a 500 kb inversion involving exon 1 to exo...... quality control systems in place, and participate in established external quality assessment programs....... the causative mutation is unknown. More rare bleeding disorders are generally recessively inherited, and are often caused by mutations that are specific for individual families, and mutations are scattered throughout the genes. Laboratories performing molecular genetic analyses must have validated internal...

  8. Hepatitis C infection in patients with hereditary bleeding disorders: epidemiology, natural history, and management.

    Science.gov (United States)

    Papadopoulos, Nikolaos; Argiana, Vasiliki; Deutsch, Melanie

    2018-01-01

    Hereditary bleeding disorders include a group of diseases with abnormalities of coagulation. Prior to 1990, infection with hepatitis C virus (HCV) was mainly transmitted via pooled plasma products as a treatment for hereditary bleeding disorders. Anti-HCV positivity in these patients may be as high as >70% in some areas, while some of them have also been coinfected with human immunodeficiency virus. Since about 20% of HCV-infected patients clear the infection naturally, chronic HCV infection represents a significant health problem in this group of patients. Mortality due to chronic HCV infection is estimated to be >10 times higher in patients with hemophilia than in the general population, and is mainly due to liver cirrhosis and hepatocellular carcinoma. The antiviral treatment of HCV in patients with hereditary bleeding disorders is not different from that of any other infected patients. Nevertheless, many patients with hereditary bleeding disorders have declined (Peg)interferon-based treatment because of side effects. In recent years, multiple orally administrated direct-acting antivirals (DAAs) have been approved for HCV treatment. Unfortunately, there is not much experience from treating these patients with DAA regimens, as major studies and real-life data did not include adequate numbers of patients with inherited hemorrhagic disorders. However, the available data indicate that DAAs have an excellent safety profile with a sustained virological response rate of >90%.

  9. Health-related quality of life, developmental milestones, and self-esteem in young adults with bleeding disorders

    NARCIS (Netherlands)

    Limperg, P. F.; Haverman, L.; Maurice-Stam, H.; Coppens, M.; Valk, C.; Kruip, M. J. H. A.; Eikenboom, J.; Peters, M.; Grootenhuis, M. A.

    2018-01-01

    The treatment of bleeding disorders improved in the last decades. However, the effect of growing up with bleeding disorders on developmental, emotional, and social aspects is understudied. Therefore, this study assesses HRQOL, developmental milestones, and self-esteem in Dutch young adults (YA) with

  10. Health-related quality of life, developmental milestones, and self-esteem in young adults with bleeding disorders

    NARCIS (Netherlands)

    Limperg, P.F. (P. F.); L. Haverman (Lotte); H. Maurice-Stam (Heleen); M. Coppens; Valk, C. (C.); M.J.H.A. Kruip (Marieke); J.C.J. Eikenboom (Jeroen); M. Peters; M.A. Grootenhuis (Martha)

    2017-01-01

    textabstractBackground: The treatment of bleeding disorders improved in the last decades. However, the effect of growing up with bleeding disorders on developmental, emotional, and social aspects is understudied. Therefore, this study assesses HRQOL, developmental milestones, and self-esteem in

  11. Challenges in the Evaluation for Possible Abuse: Presentations of Congenital Bleeding Disorders in Childhood

    Science.gov (United States)

    Jackson, Jami; Carpenter, Shannon; Anderst, Jim

    2012-01-01

    Objectives: To describe children with congenital bleeding disorders that present in a manner that may be concerning for non-accidental trauma (NAT), and to evaluate associations with disease and demographic characteristics. Methods: Ten year retrospective charts of subjects were reviewed at a Hemophilia Treatment Center. Demographic, historical,…

  12. Health-related quality of life, developmental milestones, and self-esteem in young adults with bleeding disorders.

    Science.gov (United States)

    Limperg, P F; Haverman, L; Maurice-Stam, H; Coppens, M; Valk, C; Kruip, M J H A; Eikenboom, J; Peters, M; Grootenhuis, M A

    2018-01-01

    The treatment of bleeding disorders improved in the last decades. However, the effect of growing up with bleeding disorders on developmental, emotional, and social aspects is understudied. Therefore, this study assesses HRQOL, developmental milestones, and self-esteem in Dutch young adults (YA) with bleeding disorders compared to peers. Ninety-five YA (18-30 years) with bleeding disorders (78 men; mean 24.7 years, SD 3.5) and 17 women (mean 25.1 years, SD 3.8) participated and completed the Pediatric Quality of Life Inventory Young Adult version, the Course of Life Questionnaire, and the Rosenberg Self-Esteem Scale. Differences between patients with bleeding disorders and their peers, and between hemophilia severity groups, were tested using Mann-Whitney U tests. YA men with bleeding disorders report a slightly lower HRQOL on the total scale, physical functioning, and school/work functioning in comparison to healthy peers (small effect sizes). YA men with severe hemophilia report more problems on the physical functioning scale than non-severe hemophilia. YA men with bleeding disorders achieved more psychosexual developmental milestones than peers, but show a delay in 'paid jobs, during middle and/or high school.' A somewhat lower self-esteem was found in YA men with bleeding disorders in comparison to peers (small effect size). For YA women with bleeding disorders, no differences were found on any of the outcomes in comparison to peers. This study demonstrates some impairments in HRQOL and self-esteem in YA men with bleeding disorders. By monitoring HRQOL, problems can be identified early, especially with regard to their physical and professional/school functioning.

  13. Detection of bleeding disorders in Lebanon: outcomes of a pilot programme.

    Science.gov (United States)

    Djambas Khayat, C; Samaha, H; Noun, P; Bakhos Asmar, J D; Taher, A; Adib, S; Inati, A; Sakr, S

    2014-03-01

    To promote management and awareness of bleeding disorders in Lebanon, a pilot programme was launched in 2009 by the Lebanese Hemophilia Association assisted by World Federation of Hemophilia. The aim of this study was to diagnose patients with bleeding disorders and to assess the potential challenges in implementing a screening programme. The pilot project was launched in 26 social health centres in the Bekaa valley. The study tools included the evaluation of the Tossetto Bleeding Score and the Pictorial Bleeding Assessment Chart (PBAC) for menstruation. Persons with a bleeding score higher than 2 and PBAC higher than 185 were eligible for further blood tests including the prothrombin time, partial thromboplastin time, complete blood count, bleeding time and von Willebrand ristocetin cofactor activity. 643 patients were enrolled, of whom 60.6% were women. Overall, 91 persons had an abnormal score. 50 eligible patients were tested: 32 had normal tests, nine new patients with severe Von Willebrand were discovered, 4 had VW:RiCo of 40, 3 prolonged APTT and 2 thrombocytopaenia. There was a clear correlation between the severity of the score and the willingness to perform the tests (P = 0.02). Women were reluctant to participate fully when investigators were men. The probability of adherence to the screening protocol is significantly increased when directed by women health care professional. For patients with milder forms, global screening programmes were neither feasible nor acceptable but those more severely affected have to be identified. Providers are crucial in preselecting patients with blood problems who are not coping well. © 2013 John Wiley & Sons Ltd.

  14. Autologous plasma rich in growth factors in the prevention of severe bleeding after teeth extractions in patients with bleeding disorders: a controlled comparison with fibrin glue

    Science.gov (United States)

    Cocero, Nadia; Pucci, Fabrizio; Messina, Maria; Pollio, Berardino; Mozzati, Marco; Bergamasco, Laura

    2015-01-01

    Background Dental extractions in haemophiliacs may cause secondary bleeding, requiring repeated surgical and haematological interventions. As a local haemostatic, fibrin glue has recognised efficacy but, as a plasma-derived product, it carries the risk of viral infections. We, therefore, compared fibrin glue with an autologous haemostatic, plasma rich in growth factors (PRGF), in a controlled trial. Material and methods One hundred and twenty patients with different blood disorders were randomised into two cohorts to undergo dental extraction procedures without hospitalisation. Prior to the extractions, patients underwent systemic haematological treatment. Complications were defined as secondary bleeding after the 7-day follow-up period or protracting after the repair procedure. Results There were 106 extractions (7 retained 3rd molars) in the group managed with fibrin glue: secondary bleeding affected 3/60 patients (5%) on the third day after extraction and necessitated additional surgery and systemic treatment (in one case the procedure had to be repeated on the 7th day). In the PRGF arm there were 98 extractions (23 retained 3rd molars): secondary bleeding affected two patients (3.3%) on the first day after extraction and was arrested with surgery without systemic treatment. Four out of the five secondary bleeds occurred in patients with haemophilia A. Concomitant diabetes or liver disease significantly increased the bleeding risk. Discussion The bleeding rates in the study and control arm prove that PRGF works as well as fibrin glue as a local haemostatic. Further assets are that PRGF has autologous origin, does not require additional systemic treatment in post-extraction repair surgery, is associated with an earlier onset of neo-angiogenesis and, overall, can reduce patients’ distress and costs to the health system. PMID:25369587

  15. Bleeding Disorders

    Science.gov (United States)

    ... federal government website managed by the Office on Women's Health in the Office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services . 200 Independence Avenue, S.W., Washington, DC 20201 1-800-994- ...

  16. Dental health and oral health-related quality of life in children with congenital bleeding disorders.

    Science.gov (United States)

    Salem, K; Eshghi, P

    2013-01-01

    The purpose of this study was to investigate the dental and some other aspects of oral health status of young patients with congenital bleeding disorders (CBD) and the impact of these on their quality of life (OHR-QoL) compared with controls. DMFS-dmfs (Decayed, Missed, Filled Tooth surfaces in permanent and primary teeth) scores, Simplified oral hygiene index, occurance of hypoplasia of first permanent molars, Temporomandibular joint dysfunction and occlusion of 46 CBD patients at the age range of 2-15 years and 46 of other children as control were compared, and the impact of their oral health situation on quality of life was also investigated. Data were analysed by chi-square, t-test and Pearson correlation. Patients were significantly more caries-free with less decayed teeth in primary-permanent dentition (P = 0.03, t = -2.17).The mean scores of OHR-QoL of CBD patients and controls were not significantly different. Oral Bleeding was the significant variable in relation to 'oral health-related quality of life' in CBD groups (Pearson correlation, r = -0.56, P = 0.000). OHR-QoL in the control group was related to dmfs score (r = -0.392, P = 0.011) and male gender (r = -0.329, P = 0.026). Congenital bleeding disorder CBD patients were found to have a better dental health situation in primary dentition compared with controls; however, their 'oral health-related quality of life' was similar. Oral bleeding was the only significant factor related to OHR-QoL in CBD. It shows an overall importance of development of comprehensive care centres for CBD as the main cause of this achievement. © 2012 Blackwell Publishing Ltd.

  17. Clinical and laboratory characteristics of adolescents with platelet function disorders and heavy menstrual bleeding

    Directory of Open Access Journals (Sweden)

    Amesse Lawrence S

    2013-01-01

    Full Text Available Abstract Background Platelet function disorders (PFDs have emerged as an important etiology of heavy menstrual bleeding (HMB in adolescents. However, neither clinical nor laboratory data have been methodically analyzed in this population subset. The objective of this study was to evaluate these parameters in order to distinguish characteristics of the disorder that in turn will lead to earlier diagnosis and therapy initiation. Methods Retrospective review of medical records from postmenarcheal adolescents with documented PFDs referred to a hemophilia treatment center and university faculty practices for bleeding diatheses with their clinical and laboratory data evaluated. Results Of 63 teens with documented PFDs, HMB was the most common clinical manifestation of PFD (43; 68.3%. Of these, 37 (86% were diagnosed with PFD either at or after menarche with the diagnosis based on HMB symptoms alone. Only 6 (14% were diagnosed with a PFD prior to menarche, based on associated bleeding, i.e., epistaxis, ecchymosis, and all developed HMB after menstruation onset. Interestingly, 20 girls were diagnosed with a PFD prior to menarche and of these, only 6 (30% went on to develop HMB after pubertal transition, while the majority (14; 70% did not. The average age-at-PFD diagnosis was 14.5yrs, significantly differing from the 10.9yrs average age-at-PFD diagnosis in their counterparts that, after menarche, did not develop HMB (PP P Conclusions Adolescents with PFDs and HMB appear to be clinically distinct from their non-HMB counterparts. This group of girls is characterized by HMB the major bleeding symptom, significantly high incidences of blood group O and the δ-SPD with a PFD diagnosed well after menarche. High false negative standard platelet function study results indicate additional diagnostic strategies, particularly for δ-SPD, should be considered.

  18. Bleeding Episodes Among Patients with Congenital Fibrinogen Disorders, a Study On 12 New Iranian Patients

    Directory of Open Access Journals (Sweden)

    Majid Naderi

    2018-01-01

    Full Text Available Background: Congenital fibrinogen disorders (CFDs comprise about 10% of rare bleeding disorders (RBDs. CFDs are divided into two groups of quantitative (afibrinogenemia and hypofibrinogenemia with autosomal recessive inheritance pattern, and qualitative (dysfibrinogenemia, hypodysfibrogenemia disorders, mainly with autosomal dominant inheritance pattern. Sistan and Baluchestan Province in Iran, with its high rate of consanguineous marriages, has a high incidence of RBDs including CFD. In the current study, we report clinical manifestations of patients with CFDs.Methods: Twelve new Iranian patients from Sistan and Baluchestan Province with different types of CFDs were selected for this study. Diagnosis of CFDs was based on clinical features and familial history followed by laboratory assessment by routine and specific coagulation tests including prothrombin time (PT and activated partial time tests (APTT, as well as FI activity assay by Clauss method.Results: Out of 12 patients, 3(25% had afibrinogenemia, 7(58.3% had hypofibrinogenemia while 2(16/7% were suspected of having dysfibrinogenemia. Although umbilical cord bleeding (UCB 9(75% was the most common clinical presentation among the study population, this feature was not observed among patients with dysfibrinogenemia. Hematoma (100% was the most common presentation of patients with dysfibrinogenemia.  Conclusion: Results of this study revealed that some clinical presentations are the diagnostic features of CFDs and can be used for precise and in-time diagnosis CFDs in conjunction with family history and laboratory findings.Keywords: Fibrinogen Deficiency; Congenital Afibrinogenemia; Blood Coagulation Disorder; Afibrinogenemia

  19. Effects of a 6-week, individualized, supervised exercise program for people with bleeding disorders and hemophilic arthritis.

    Science.gov (United States)

    Mulvany, Ruth; Zucker-Levin, Audrey R; Jeng, Michael; Joyce, Catherine; Tuller, Janet; Rose, Jonathan M; Dugdale, Marion

    2010-04-01

    People with bleeding disorders may develop severe arthritis due to joint hemorrhages. Exercise is recommended for people with bleeding disorders, but guidelines are vague and few studies document efficacy. In this study, 65% of people with bleeding disorders surveyed reported participating in minimal exercise, and 50% indicated a fear of exercise-induced bleeding, pain, or physical impairment. The purpose of this study was to examine the feasibility, safety, and efficacy of a professionally designed, individualized, supervised exercise program for people with bleeding disorders. A single-group, pretest-posttest clinical design was used. Thirty-three patients (3 female, 30 male; 7-57 years of age) with mild to severe bleeding disorders were enrolled in the study. Twelve patients had co-existing illnesses, including HIV/AIDS, hepatitis, diabetes, fibromyalgia, neurofibromatosis, osteopenia, osteogenesis imperfecta, or cancer. Pre- and post-program measures included upper- and lower-extremity strength (force-generating capacity), joint range of motion, joint and extremity circumference, and distance walked in 6 minutes. Each patient was prescribed a 6-week, twice-weekly, individualized, supervised exercise program. Twenty participants (61%) completed the program. Pre- and post-program data were analyzed by paired t tests for all participants who completed the program. No exercise-induced injuries, pain, edema, or bleeding episodes were reported. Significant improvements occurred in joint motion, strength, and distance walked in 6 minutes, with no change in joint circumference. The greatest gains were among the individuals with the most severe joint damage and coexisting illness. Limitations included a small sample size with concomitant disease, which is common to the population, and a nonblinded examiner. A professionally designed and supervised, individualized exercise program is feasible, safe, and beneficial for people with bleeding disorders, even in the presence

  20. The experience of girls and young women with inherited bleeding disorders.

    Science.gov (United States)

    Khair, K; Holland, M; Pollard, D

    2013-09-01

    Haemophilia carriers and women with inherited bleeding disorders (IBD) experience menorrhagia, bleed following dentistry, surgery, injury or childbirth. Symptoms are easily treated leading to full and active lives. Nevertheless, some girls and women suffer with abnormal bleeding for many years before diagnosis. We explored the experiences of girls and young women (aged 9-34 years) with IBD by means of focus groups which consisted of moderated discussion addressing specific aspects of bleeding, management and coping strategies. Subsequently, these issues were explored further though a paper-based questionnaire distributed via five specialist haemophilia centres in the UK. The study suggested that young women with IBD who are managed at haemophilia centres receive appropriate care and feel well supported. Although the clinic-based literature available to these women is "fit for purpose", it does not fully address the perceived needs specifically regarding sex, menorrhagia, conception and childbirth, the Pill, tattoos/piercings and so on, leading many to turn to other information sources. Most of those who responded to our survey are confident in their lives, able to manage their IBD and take pragmatic views towards the inherited nature of their condition. But there is a substantial subgroup of women who experience stigmatization, isolation and bullying and express concerns relating to fertility and conception. Overall, this cohort would benefit from opportunities for mutual support. This could be via Internet-based social networking and may be of particular value to those who are unable to seek help from traditional medical services due to religious or other cultural barriers. © 2013 John Wiley & Sons Ltd.

  1. Evidence supporting the use of recombinant activated factor VII in congenital bleeding disorders

    Directory of Open Access Journals (Sweden)

    Pär I Johansson

    2010-06-01

    Full Text Available Pär I Johansson, Sisse R OstrowskiCapital Region Blood Bank, Section for Transfusion Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, DenmarkBackground: Recombinant activated factor VII (rFVIIa, NovoSeven® was introduced in 1996 for the treatment of hemophilic patients with antibodies against coagulation factor VIII or IX.Objective: To review the evidence supporting the use of rFVIIa for the treatment of patients with congenital bleeding disorders.Patients and methods: English-language databases were searched in September 2009 for reports of randomized controlled trials (RCTs evaluating the ability of rFVIIa to restore hemostasis in patients with congenital bleeding disorders.Results: Eight RCTs involving 256 hemophilic patients with antibodies against coagulation factors, also known as inhibitors, were identified. The evidence supporting the use of rFVIIa in these patients was weak with regard to dose, clinical setting, mode of administration, efficacy, and adverse events, given the limited sample size of each RCT and the heterogeneity of the studies.Conclusion: The authors suggest that rFVIIa therapy in hemophilic patients with inhibitors should be based on the individual’s ability to generate thrombin and form a clot, and not on the patient’s weight alone. Therefore, assays for thrombin generation, such as whole-blood thromboelastography, have the potential to significantly improve the treatment of these patients.Keywords: hemophilia, inhibitors, coagulation factor VIII, coagulation factor IX, rFVIIa, NovoSeven, FEIBA, hemostasis, RCT

  2. Clopidogrel bioactivation and risk of bleeding in patients cotreated with angiotensin-converting enzyme inhibitors after myocardial infarction

    DEFF Research Database (Denmark)

    Kristensen, K E; Zhu, H-J; Wang, X

    2014-01-01

    in vitro and linked the results with a pharmacoepidemiological study. In vitro, ACEIs inhibited CES1-mediated hydrolysis of a model substrate, and trandolapril and enalapril increased formation of clopidogrel active metabolite. In 70,934 patients with myocardial infarction, hazard ratios for clinically...... significant bleeding in ACEI-treated patients cotreated with or without clopidogrel were 1.10 (95% confidence interval (CI): 0.97-1.25, P = 0.124) and 0.90 (95% CI: 0.81-0.99, P = 0.025), respectively, as compared with patients who did not receive ACEIs. This difference was statistically significant (P = 0...

  3. The impact of bleeding disorders on the socioeconomic status of adult patients. Results of a comparative single centre cohort study.

    Science.gov (United States)

    Holstein, Katharina; von Mackensen, Sylvia; Bokemeyer, Carsten; Langer, Florian

    2017-07-10

    The impact of inherited bleeding disorders on the socioeconomic status (SES) of affected individuals is not clear. The SES of adult patients with congenital bleeding disorders (PWBD) from a centre in Germany (age 42.3 ± 15.0 years) was compared to that of a gender- and age-matched control group of patients with thrombophilia or a thrombotic event (PWT). Patients completed a questionnaire including aspects of SES, impact of the disease on their lives, and health-related quality of life (HRQoL). Forty-five patients were enrolled in each group; 71 % of PBWD had a severe form of the bleeding disorder (FVIII/IX activity impact of the disease on their lives than PWT (33.3 %, p impact of the disease on their lives compared to PWT, but not a significantly different SES in general.

  4. Evaluation of Fibrin Sealants and Tissue Adhesives in Oral Surgery for Patients with Bleeding Disorders

    Directory of Open Access Journals (Sweden)

    Gülsüm Ak

    2012-03-01

    Full Text Available OBJECTIVE: The aim of this study was to evaluate the efficiency of two local haemostatic agents administered together with preoperative dose of replacement therapy for oral surgical procedures in patients with bleeding disorders METHODS: Twenty-one patients were divided into three groups randomly. Patients in Group 1 (n=7 received preoperative replacement therapy with postoperative fibrin sealant application in the surgical site. Patients in Group 2 (n=7 received preoperative replacement therapy with postoperative tissue adhesive application in the surgical site. Patients in Group 3 (n=7 were given total dose of replacement therapy pre- and postoperatively. RESULTS: No postoperative bleeding was observed in 17 patients including five patients in Group 1 (71.42%, six patients in Group 2 (85.71% and six patients in Group 3 (85.71%. Haemorrhagic complication was observed in only four patients among all groups. CONCLUSION: We conclude that utilization of fibrin sealants and tissue adhesives in oral surgery is beneficial due to the lessened amount of factor concentrates used for replacement therapy and the rapid haemostasis at the operation side to perform serial surgical procedures in the same session.

  5. Heavy Menstrual Bleeding (Menorrhagia)

    Science.gov (United States)

    ... Us Information For… Media Policy Makers Blood Disorders Heavy Menstrual Bleeding Recommend on Facebook Tweet Share Compartir ... It can also be bleeding that is very heavy. How do you know if you have heavy ...

  6. Is dilatation and curettage obsolete for diagnosing intrauterine disorders in premenopausal patients with persistent abnormal uterine bleeding?

    NARCIS (Netherlands)

    Emanuel, M. H.; Wamsteker, K.; Lammes, F. B.

    1997-01-01

    To determine the predictive value of dilatation and curettage (D&C) for diagnosing intrauterine disorders in patients with persistent abnormal uterine bleeding. An observational descriptive study was performed in a large university-affiliated teaching hospital. The suspicion of intrauterine

  7. A prospective cohort study of light transmission platelet aggregometry for bleeding disorders: is testing native platelet-rich plasma non-inferior to testing platelet count adjusted samples?

    Science.gov (United States)

    Castilloux, Jean Francois; Moffat, Karen A; Liu, Yang; Seecharan, Jodi; Pai, Menaka; Hayward, Catherine P M

    2011-10-01

    Light transmission platelet aggregometry (LTA) is important to diagnose bleeding disorders. Experts recommend testing LTA with native (N) rather than platelet count adjusted (A) platelet-rich plasma (PRP), although it is unclear if this provides non-inferior, or superior, detection of bleeding disorders. Our goal was to determine if LTA with NPRP is non-inferior to LTA with APRP for bleeding disorder assessments. A prospective cohort of patients, referred for bleeding disorder testing, and healthy controls, were evaluated by LTA using common agonists, NPRP and APRP (adjusted to 250 x 10⁹ platelets/l). Recruitment continued until 40 controls and 40 patients with definite bleeding disorders were tested. Maximal aggregation (MA) data were assessed for the detection of abnormalities from bleeding disorders (all causes combined to limit bias), using sample-type specific reference intervals. Areas under receiver-operator curves (AUROC) were evaluated using pre-defined criteria (area differences: 0 for superiority). Forty-four controls and 209 patients were evaluated. Chart reviews for 169 patients indicated 67 had bleeding disorders, 28 from inherited platelet secretion defects. Mean MA differences between NPRP and APRP were small for most agonists (ranges, controls: -3.3 to 5.8; patients: -3.0 to 13.7). With both samples, reduced MA with two or more agonists was associated with a bleeding disorder. AUROC differences between NPRP and APRP were small and indicated that NPRP were non-inferior to APRP for detecting bleeding disorders by LTA, whereas APRP met superiority criteria. Our study validates using either NPRP or APRP for LTA assessments of bleeding disorders.

  8. Atrial fibrillation in patients with severe mental disorders and the risk of stroke, fatal thromboembolic events and bleeding

    DEFF Research Database (Denmark)

    Søgaard, Mette; Skjøth, Flemming; Kjældgaard, Jette Nordstrøm

    2017-01-01

    : Denmark (population 5.6 million), 2000-2015. PARTICIPANTS: Patients with AF with schizophrenia (n=534), severe depression (n=400) or bipolar disease (n=569) matched 1:5 on age, sex and calendar time to patients with AF without mental disorders. EXPOSURE: Inpatient or hospital-based outpatient diagnosis...... of schizophrenia, severe depression or bipolar disease. PRIMARY AND SECONDARY OUTCOME MEASURES: HRs for stroke, fatal thromboembolic events and major bleeding comparing patients with and without mental disorders estimated by Cox regression with sequential adjustment for risk factors for stroke and bleeding......, comorbidity and initiation of oral anticoagulant therapy (OAT). RESULTS: Compared with matched comparisons, crude 5-year HRs of ischaemic stroke were 1.37 (95% CI 0.88 to 2.14) for schizophrenia, 1.36 (95% CI 0.89 to 2.08) for depression and 1.04 (95% CI 0.69 to 1.56) for bipolar disease. After adjusting...

  9. Direct-to-consumer advertising for bleeding disorders: a content analysis and expert evaluation of advertising claims

    Science.gov (United States)

    Abel, G. A.; Neufeld, E. J.; Sorel, M; Weeks, J. C.

    2009-01-01

    OBJECTIVE In the United States, the Food and Drug Administration (FDA) requires that all direct-to-consumer advertising (DTCA) contain both an accurate statement of a medication’s effects (“truth”) and an even-handed discussion of its benefits and risks/adverse effects (“fair balance”). DTCA for medications to treat rare diseases such as bleeding disorders is unlikely to be given high priority for FDA review. METHODS We reviewed all DTCA for bleeding disorder products appearing in the patient-directed magazine HemeAware from January, 2004 to June, 2006. We categorized the information presented in each advertisement as benefit, risk/adverse effect, or neither, and assessed the amount of text and type size devoted to each. We also assessed the readability of each type of text using the Flesch Reading Ease Score (FRES, where a score of ≥ 65 is considered of average readability), and assessed the accuracy of the advertising claims utilizing a panel of five bleeding disorder experts. RESULTS A total of 39 unique advertisements for 12 products were found. On average, approximately twice the amount of text was devoted to benefits as compared to risks/adverse effects, and the later was more difficult to read (FRES of 20.45 for risks/adverse effects versus 32.08 for benefits; difference of 11.56 [95% CI: 4.52, 18.60]). Only about two-thirds of the advertising claims were considered by a majority of the experts to be based on at least low-quality evidence. CONCLUSION As measured by our methods, print DTCA for bleeding disorders may not reach the FDA’s standards of truth and fair balance. PMID:18647231

  10. Direct-to-consumer advertising for bleeding disorders: a content analysis and expert evaluation of advertising claims.

    Science.gov (United States)

    Abel, G A; Neufeld, E J; Sorel, M; Weeks, J C

    2008-10-01

    In the United States, the Food and Drug Administration (FDA) requires that all direct-to-consumer advertising (DTCA) contain both an accurate statement of a medication's effects ('truth') and an even-handed discussion of its benefits and risks/adverse effects ('fair balance'). DTCA for medications to treat rare diseases such as bleeding disorders is unlikely to be given high priority for FDA review. We reviewed all DTCA for bleeding disorder products appearing in the patient-directed magazine HemeAware from January 2004 to June 2006. We categorized the information presented in each advertisement as benefit, risk/adverse effect, or neither, and assessed the amount of text and type size devoted to each. We also assessed the readability of each type of text using the Flesch Reading Ease Score (FRES, where a score of >or=65 is considered of average readability), and assessed the accuracy of the advertising claims utilizing a panel of five bleeding disorder experts. A total of 39 unique advertisements for 12 products were found. On average, approximately twice the amount of text was devoted to benefits as compared with risks/adverse effects, and the latter was more difficult to read [FRES of 32.0 for benefits vs. 20.5 for risks/adverse effects, a difference of 11.5 (95% CI: 4.5-18.5)]. Only about two-thirds of the advertising claims were considered by a majority of the experts to be based on at least low-quality evidence. As measured by our methods, print DTCA for bleeding disorders may not reach the FDA's standards of truth and fair balance.

  11. Gastrointestinal bleeding

    Science.gov (United States)

    ... Sigmoidoscopy Alternative Names Lower GI bleeding; GI bleeding; Upper GI bleeding; Hematochezia Images GI bleeding - series Fecal occult blood test References Kovacs TO, Jensen DM. Gastrointestinal hemorrhage. In: Goldman L, Schafer AI, eds. Goldman- ...

  12. Tumor necrosis factor alpha converting enzyme: an encouraging target for various inflammatory disorders.

    Science.gov (United States)

    Bahia, Malkeet S; Silakari, Om

    2010-05-01

    Tumor necrosis factor alpha is one of the most common pro-inflammatory cytokines responsible for various inflammatory disorders. It plays an important role in the origin and progression of rheumatoid arthritis and also in other autoimmune disease conditions. Some anti-tumor necrosis factor alpha antibodies like Enbrel, Humira and Remicade have been successfully used in these disease conditions as antagonists of tumor necrosis factor alpha. Inhibition of generation of active form of tumor necrosis factor alpha is a promising therapy for various inflammatory disorders. Therefore, the inhibition of an enzyme (tumor necrosis factor alpha converting enzyme), which is responsible for processing inactive form of tumor necrosis factor alpha into its active soluble form, is an encouraging target. Many tumor necrosis factor alpha converting enzyme inhibitors have been the candidates of clinical trials but none of them have reached in to the market because of their broad spectrum inhibitory activity for other matrix metalloproteases. Selectivity of tumor necrosis factor alpha converting enzyme inhibition over matrix metalloproteases is of utmost importance. If selectivity is achieved successfully, side-effects can be over-ruled and this approach may become a novel therapy for treatment of rheumatoid arthritis and other inflammatory disorders. This cytokine not only plays a pivotal role in inflammatory conditions but also in some cancerous conditions. Thus, successful targeting of tumor necrosis factor alpha converting enzyme may result in multifunctional therapy.

  13. Evaluation of Aryoseven Safety (Recombinant Activated Factor VII) in Patients with Bleeding Disorders (An Observational Post-Marketing Surveillance Study).

    Science.gov (United States)

    Toogeh, Gholamreza; Abolghasemi, Hassan; Eshghi, Peyman; Managhchi, Mohammadreza; Shaverdi-Niasari, Mohammadreza; Karimi, Katayoon; Roostaei, Samin; Emran, Neda; Abdollahi, Alireza

    2016-01-01

    Recombinant activated factor VII induces hemostasis in patients with coagulopathy disorders. AryoSeven™ as a safe Iranian Recombinant activated factor VII has been available on our market. This study was performed to establish the safety of AryoSeven on patients with coagulopathy disorder. This single-center, descriptive, cross sectional study was carried out in Thrombus and Homeostasis Research Center ValiAsr Hospital during 2013-2014. Fifty one patients with bleeding disorders who received at least one dose of Aryoseven were enrolled. Patients' demographic data and adverse effect of drug and reaction related to Aryoseven or previous usage of Recombinant activated FVII were recorded in questionnaires. Finally data were analyzed to compare side effects of Aryoseven and other Recombinant activated FVII brands. Aryoseven was prescribed for 51 Patients. Of all participants with mean age 57.18+21.38 yr, 31 cases were male and 26 subjects had past history of recombinant activated FVII usage. Glanzman was the most frequent disorder followed by congenital FVII deficiency, hemophilia with inhibitors, factor 5 deficiency, acquired hemophilia, hemophilia A with inhibitor, and hemophilia A or B with inhibitor. The majority of bleeding episodes had occurred in joints. Three patients (5.9%) complained about adverse effects of Aryoseven vs. 11.5 % about adverse effects of other brands. However this difference was not significant, statistically. Based on monitor patients closely for any adverse events, we concluded that Aryoseven administration under careful weighing of benefit versus potential harm may comparable with other counterpart drugs.

  14. Canine models of inherited bleeding disorders in the development of coagulation assays, novel protein replacement and gene therapies.

    Science.gov (United States)

    Nichols, T C; Hough, C; Agersø, H; Ezban, M; Lillicrap, D

    2016-05-01

    Animal models of inherited bleeding disorders are important for understanding disease pathophysiology and are required for preclinical assessment of safety prior to testing of novel therapeutics in human and veterinary medicine. Experiments in these animals represent important translational research aimed at developing safer and better treatments, such as plasma-derived and recombinant protein replacement therapies, gene therapies and immune tolerance protocols for antidrug inhibitory antibodies. Ideally, testing is done in animals with the analogous human disease to provide essential safety information, estimates of the correct starting dose and dose response (pharmacokinetics) and measures of efficacy (pharmacodynamics) that guide the design of human trials. For nearly seven decades, canine models of hemophilia, von Willebrand disease and other inherited bleeding disorders have not only informed our understanding of the natural history and pathophysiology of these disorders but also guided the development of novel therapeutics for use in humans and dogs. This has been especially important for the development of gene therapy, in which unique toxicities such as insertional mutagenesis, germ line gene transfer and viral toxicities must be assessed. There are several issues regarding comparative medicine in these species that have a bearing on these studies, including immune reactions to xenoproteins, varied metabolism or clearance of wild-type and modified proteins, and unique tissue tropism of viral vectors. This review focuses on the results of studies that have been performed in dogs with inherited bleeding disorders that closely mirror the human condition to develop safe and effective protein and gene-based therapies that benefit both species. © 2016 International Society on Thrombosis and Haemostasis.

  15. 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 ...

  16. Prevalence of and risk for gastrointestinal bleeding and peptic ulcerative disorders in a cohort of HIV patients from a U.S. healthcare claims database.

    Directory of Open Access Journals (Sweden)

    Emily Bratton

    Full Text Available The primary study objectives were to estimate the frequencies and rates of gastrointestinal bleeding and peptic ulcerative disorder in HIV-positive patients compared with age- and sex-matched HIV-negative subjects. Data from a US insurance claims database was used for this analysis. Among 89,207 patients with HIV, 9.0% had a GI bleed, 1.0% had an upper gastrointestinal bleed, 5.6% had a lower gastrointestinal bleed, 1.9% had a peptic ulcerative disorder diagnosis, and 0.6% had both gastrointestinal/peptic ulcerative disorder. Among 267,615 HIV-negative subjects, the respective frequencies were 6.9%, 0.6%, 4.3%, 1.4%, and 0.4% (p<0.0001 for each diagnosis subcategory. After combining effect measure modifiers into comedication and comorbidity strata, gastrointestinal bleeding hazard ratios (HRs were higher for HIV-positive patients without comedication/comorbidity, and those with comedication alone (HR, 2.73; 95% confidence interval [CI], 2.62-2.84; HR, 1.59; 95% CI, 1.47-1.71. The rate of peptic ulcerative disorder among those without a history of ulcers and no comorbidity/comedication was also elevated (HR, 2.72; 95% CI, 2.48-2.99. Hazard ratios of gastrointestinal bleeding, and peptic ulcerative disorder without a history of ulcers were lower among patients infected with HIV with comedication/comorbidity (HR, 0.64; 95% CI, 0.56-0.73; HR, 0.46; 95% CI, 0.33-0.65. Rates of gastrointestinal bleeding plus peptic ulcerative disorder followed a similar pattern. In summary, the rates of gastrointestinal/peptic ulcerative disorder events comparing HIV-infected subjects to non-HIV-infected subjects were differential based on comorbidity and comedication status.

  17. Vaginal Bleeding

    Science.gov (United States)

    ... or period, is a woman's monthly bleeding.Abnormal vaginal bleeding is different from normal menstrual periods. It ... therapy) Cancer of the cervix, ovaries, uterus or vagina Thyroid problems Bleeding during pregnancy can have several ...

  18. Definition of an organisational model for the prevention and reduction of health and social impacts of inherited bleeding disorders.

    Science.gov (United States)

    Calizzani, Gabriele; Menichini, Ivana; Candura, Fabio; Lanzoni, Monica; Profili, Samantha; Tamburrini, Maria Rita; Fortino, Antonio; Vaglio, Stefania; Marano, Giuseppe; Facco, Giuseppina; Oliovecchio, Emily; Franchini, Massimo; Coppola, Antonio; Arcieri, Romano; Bon, Cinzia; Saia, Mario; Nuti, Sabina; Morfini, Massimo; Liumbruno, Giancarlo M; Di Minno, Giovanni; Grazzini, Giuliano

    2014-04-01

    Due to the increase in life expectancy, patients with haemophilia and other inherited bleeding disorders are experiencing age-related comorbidities that present new challenges. In order to meet current and emerging needs, a model for healthcare pathways was developed through a project funded by the Italian Ministry of Health. The project aimed to prevent or reduce the social-health burden of the disease and its complications. The National Blood Centre appointed a panel of experts comprising clinicians, patients, National and Regional Health Authority representatives. Following an analysis of the scientific and regulatory references, the panel drafted a technical proposal containing recommendations for Regional Health Authorities, which has been formally submitted to the Ministry of Health. Finally, a set of indicators to monitor haemophilia care provision has been defined. In the technical document, the panel of experts proposed the adoption of health policy recommendations summarised in areas, such as: multidisciplinary integrated approach for optimal healthcare provision; networking and protocols for emergency care; home therapy; registries/databases; replacement therapy supply and distribution; recruitment and training of experts in bleeding disorders. The recommendations became the content of proposal of agreement between the Government and the Regions. Monitoring and evaluation of haemophilia care through the set of established indicators was partially performed due to limited available data. The project provided recommendations for the clinical and organisational management of patient with haemophilia. A particular concern was given to those areas that play a critical role in the comorbidities and complications prevention. Recommendations are expected to harmonise healthcare care delivery across regional networks and building the foundation for the national haemophilia network.

  19. Intracranial Hemorrhage: A Devastating Outcome of Congenital Bleeding Disorders-Prevalence, Diagnosis, and Management, with a Special Focus on Congenital Factor XIII Deficiency.

    Science.gov (United States)

    Alavi, Seyed Ezatolla Rafiee; Jalalvand, Masumeh; Assadollahi, Vahideh; Tabibian, Shadi; Dorgalaleh, Akbar

    2018-04-01

    Intracranial hemorrhage (ICH) is a medical emergency. In congenital bleeding disorders, ICH is a devastating presentation accompanied with a high rate of morbidity and mortality. The prevalence of ICH is highly variable among congenital bleeding disorders, with the highest incidence observed in factor (F) XIII deficiency (FXIIID) (∼30%). This life-threatening presentation is less common in afibrinogenemia, FVIII, FIX, FVII, and FX deficiencies, and is rare in severe FV and FII deficiencies, type 3 von Willebrand disease and inherited platelet function disorders (IPFDs). In FXIIID, this diathesis most often occurs after trauma in children, whereas spontaneous ICH is more frequent in adults. About 15% of patients with FXIIID and ICH die; the bleeding causes 80% of deaths in this coagulopathy. Although in FXIIID, the bleed most commonly is intraparenchymal (> 90%), epidural, subdural, and subarachnoid hemorrhages also have been reported, albeit rarely. As this life-threatening bleeding causes neurological complications, early diagnosis can prevent further expansion of the hematoma and secondary damage. Neuroimaging plays a crucial role in the diagnosis of ICH, but signs and symptoms in patients with severe FXIIID should trigger replacement therapy even before establishment of the diagnosis. Although a high dose of FXIII concentrate can reduce the rate of morbidity and mortality of ICH in FXIIID, it may occasionally trigger inhibitor development, thus complicating ICH management and future prophylaxis. Nevertheless, replacement therapy is the mainstay of treatment for ICH in FXIIID. Neurosurgery is performed in patients with FXIIID and epidural hematoma and a hemorrhage diameter exceeding 2 cm or a volume of ICH is more than 30 cm 3 . Contact sports are not recommended in people with FXIIID as they can elicit ICH. However, a considerable number of safe sports and activities have been suggested to have more benefits than dangers for patients with congenital bleeding

  20. Internal Bleeding

    Science.gov (United States)

    ... Fractures (Part II) Additional Content Medical News Internal Bleeding By Amy H. Kaji, MD, PhD, Associate Professor, ... Emergency First Aid Priorities Cardiac Arrest Choking Internal Bleeding Severed or Constricted Limbs or Digits Soft-Tissue ...

  1. Bleeding and Blood Disorders in Clients of Voluntary Medical Male Circumcision for HIV Prevention - Eastern and Southern Africa, 2015-2016.

    Science.gov (United States)

    Hinkle, Lawrence E; Toledo, Carlos; Grund, Jonathan M; Byams, Vanessa R; Bock, Naomi; Ridzon, Renee; Cooney, Caroline; Njeuhmeli, Emmanuel; Thomas, Anne G; Odhiambo, Jacob; Odoyo-June, Elijah; Talam, Norah; Matchere, Faustin; Msungama, Wezi; Nyirenda, Rose; Odek, James; Come, Jotamo; Canda, Marcos; Wei, Stanley; Bere, Alfred; Bonnecwe, Collen; Choge, Isaac Ang'Ang'A; Martin, Enilda; Loykissoonlal, Dayanund; Lija, Gissenge J I; Mlanga, Erick; Simbeye, Daimon; Alamo, Stella; Kabuye, Geoffrey; Lubwama, Joseph; Wamai, Nafuna; Chituwo, Omega; Sinyangwe, George; Zulu, James Exnobert; Ajayi, Charles A; Balachandra, Shirish; Mandisarisa, John; Xaba, Sinokuthemba; Davis, Stephanie M

    2018-03-23

    Male circumcision reduces the risk for female-to-male human immunodeficiency virus (HIV) transmission by approximately 60% (1) and has become a key component of global HIV prevention programs in countries in Eastern and Southern Africa where HIV prevalence is high and circumcision coverage is low. Through September 2017, the President's Emergency Plan for AIDS Relief (PEPFAR) had supported 15.2 million voluntary medical male circumcisions (VMMCs) in 14 priority countries in Eastern and Southern Africa (2). Like any surgical intervention, VMMC carries a risk for complications or adverse events. Adverse events during circumcision of males aged ≥10 years occur in 0.5% to 8% of procedures, though the majority of adverse events are mild (3,4). To monitor safety and service quality, PEPFAR tracks and reports qualifying notifiable adverse events. Data reported from eight country VMMC programs during 2015-2016 revealed that bleeding resulting in hospitalization for ≥3 days was the most commonly reported qualifying adverse event. In several cases, the bleeding adverse event revealed a previously undiagnosed or undisclosed bleeding disorder. Bleeding adverse events in men with potential bleeding disorders are serious and can be fatal. Strategies to improve precircumcision screening and performance of circumcisions on clients at risk in settings where blood products are available are recommended to reduce the occurrence of these adverse events or mitigate their effects (5).

  2. Perimenopausal Bleeding and Bleeding After Menopause

    Science.gov (United States)

    ... Patients About ACOG Perimenopausal Bleeding and Bleeding After Menopause Home For Patients Search FAQs Perimenopausal Bleeding and ... 2011 PDF Format Perimenopausal Bleeding and Bleeding After Menopause Gynecologic Problems What are menopause and perimenopause? What ...

  3. Recognition and management of platelet-refractory bleeding in patients with Glanzmann’s thrombasthenia and other severe platelet function disorders

    Directory of Open Access Journals (Sweden)

    Chitlur M

    2017-04-01

    Full Text Available Meera Chitlur,1 Madhvi Rajpurkar,1 Michael Recht,2 Michael D Tarantino,3 Donald L Yee,4 David L Cooper,5 Sriya Gunawardena5 1Carman and Ann Adams Department of Pediatrics, Wayne State University and Children’s Hospital of Michigan, Detroit, MI, USA; 2Oregon Health and Science University, Portland, OR, USA; 3Bleeding and Clotting Disorders Institute, Peoria, IL, USA; 4Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; 5Clinical Development, Medical and Regulatory Affairs, Novo Nordisk Inc., Plainsboro, NJ, USA Abstract: Patients with rare qualitative platelet disorders or platelet function disorders (PFDs may present to the hospital physician with severe bleeding episodes or excessive surgical bleeding. Although standard treatment consists of platelet transfusions, repeated transfusions may result in the development of antiplatelet antibodies (APA or clinical refractoriness, rendering further platelet therapy ineffective. In such settings, an approved treatment option for patients with Glanzmann’s thrombasthenia (GT, one of the well-known rare PFDs, is recombinant activated coagulation factor VII (rFVIIa. Data regarding the efficacy of rFVIIa in patients with GT and platelet refractoriness are available from a large patient registry, an international survey, and multiple case reports and demonstrate efficacy in patients with and without refractoriness or APA. This article reviews the rFVIIa clinical data in patients with GT and platelet refractoriness and discusses clinical implications relevant to the hospital-based physician. Because uncontrolled bleeding can be life-threatening, hospital physicians should be alert to the signs of platelet refractoriness, be able to recognize continued internal or external bleeding, and know how to adapt treatment regimens for the effective management of bleeding. The management of patients who receive rFVIIa should occur in consultation with a hematologist with experience in PFDs, and

  4. Ehlers-danlos syndrome with platelet aggregation defect-presenting as mysterious bleeding disorder

    Directory of Open Access Journals (Sweden)

    Sawhney M

    2003-03-01

    Full Text Available A 7-year-old girl presented with recurrent episodes of petechiae, purpura and ecchymoses since six months of age and recurrent episodes of mild to severe epistaxis since two years of age requiring repeated blood transfusions. In April '99 while being investigated for a massive epistaxis, she was found to have platelet function defect with abnormal aggregation of platelets to ADP, epinephrine, collagen as well as to ristocetin. Further investigations ruled out the possibility of Glanzmann's disorder and von-Willebrand's disease as to its cause. In May 2001 she was referred to the dermatologist for evaluation of subcutaneous tumours, which had developed since the last six months. On clinical evaluation, she was found to be having mild hyperextensibility of the skin, joint hypermobility, atrophic scars over knee, spontaneous bruises over right forearm and left thigh and nontender firm to hard subcutaneous nodules over both wrists, both shoulders, right index finger and dorsum of right foot consistent with a clinical picture of a mild form of Ehlers-Danlos syndrome (EDS. Histopathology of the nodule from left wrist was consistent with molluscoid tumour of EDS and skin histopathology and ultrastructure studies showed thick irregular collagen fibrils. Only other sibling, a five-year-old male also had history of repeated mild to moderate epistaxis and on examination was found to have a milder variant of EDS. Born out of I degree consanguineous marriage of normal parents with mildly affected other sibling, she was diagnosed to be suffering from EDS with autosomal recessive inheritance, most probably EDS type X due to the associated platelet aggregation defect. Only one such family with EDS type X has been reported so far.

  5. Ehlers-danlos syndrome with platelet aggregation defect-presenting as mysterious bleeding disorder

    Directory of Open Access Journals (Sweden)

    Sawhney M

    2003-01-01

    Full Text Available A 7-year-old girl presented with recurrent episodes of petechiae, purpura and ecchymoses since six months of age and recurrent episodes of mild to severe epistaxis since two years of age requiring repeated blood transfusions. In April '99 while being investigated for a massive epistaxis, she was found to have platelet function defect with abnormal aggregation of platelets to ADP, epinephrine, collagen as well as to ristocetin. Further investigations ruled out the possibility of Glanzmann's disorder and von-Willebrand's disease as to its cause. In May 2001 she was referred to the dermatologist for evaluation of subcutaneous tumours, which had developed since the last six months. On clinical evaluation, she was found to be having mild hyperextensibility of the skin, joint hypermobility, atrophic scars over knee, spontaneous bruises over right forearm and left thigh and nontender firm to hard subcutaneous nodules over both wrists, both shoulders, right index finger and dorsum of right foot consistent with a clinical picture of a mild form of Ehlers-Danlos syndrome (EDS. Histopathology of the nodule from left wrist was consistent with molluscoid tumour of EDS and skin histopathology and ultrastructure studies showed thick irregular collagen fibrils. Only other sibling, a five-year-old male also had history of repeated mild to moderate epistaxis and on examination was found to have a milder variant of EDS. Born out of I degree consanguineous marriage of normal parents with mildly affected other sibling, she was diagnosed to be suffering from EDS with autosomal recessive inheritance, most probably EDS type X due to the associated platelet aggregation defect. Only one such family with EDS type X has been reported so far.

  6. Bleeding Disorders Treatment Options

    Science.gov (United States)

    ... Deficiency Factor V Deficiency Combined FV & FVIII Deficiencies Factor VII Deficiency Factor X Deficiency Factor XI Deficiency Factor ... Deficiency Factor V Deficiency Combined FV & FVIII Deficiencies Factor VII Deficiency Factor X Deficiency Factor XI Deficiency Factor ...

  7. A therapeutic-only versus prophylactic platelet transfusion strategy for preventing bleeding in patients with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation

    Science.gov (United States)

    Crighton, Gemma L; Estcourt, Lise J; Wood, Erica M; Trivella, Marialena; Doree, Carolyn; Stanworth, Simon

    2015-01-01

    Background Platelet transfusions are used in modern clinical practice to prevent and treat bleeding in thrombocytopenic patients with bone marrow failure. Although considerable advances have been made in platelet transfusion therapy in the last 40 years, some areas continue to provoke debate, especially concerning the use of prophylactic platelet transfusions for the prevention of thrombocytopenic bleeding. This is an update of a Cochrane review first published in 2004 and updated in 2012 that addressed four separate questions: therapeutic-only versus prophylactic platelet transfusion policy; prophylactic platelet transfusion threshold; prophylactic platelet transfusion dose; and platelet transfusions compared to alternative treatments. We have now split this review into four smaller reviews looking at these questions individually; this review is the first part of the original review. Objectives To determine whether a therapeutic-only platelet transfusion policy (platelet transfusions given when patient bleeds) is as effective and safe as a prophylactic platelet transfusion policy (platelet transfusions given to prevent bleeding, usually when the platelet count falls below a given trigger level) in patients with haematological disorders undergoing myelosuppressive chemotherapy or stem cell transplantation. Search methods We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (Cochrane Library 2015, Issue 6), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the Transfusion Evidence Library (from 1950) and ongoing trial databases to 23 July 2015. Selection criteria RCTs involving transfusions of platelet concentrates prepared either from individual units of whole blood or by apheresis, and given to prevent or treat bleeding in patients with malignant haematological disorders receiving myelosuppressive chemotherapy or undergoing HSCT. Data collection and analysis We used standard methodological procedures

  8. Different doses of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation

    Science.gov (United States)

    Estcourt, Lise J; Stanworth, Simon; Doree, Carolyn; Trivella, Marialena; Hopewell, Sally; Blanco, Patricia; Murphy, Michael F

    2015-01-01

    Background Platelet transfusions are used in modern clinical practice to prevent and treat bleeding in people who are thrombocytopenic due to bone marrow failure. Although considerable advances have been made in platelet transfusion therapy in the last 40 years, some areas continue to provoke debate, especially concerning the use of prophylactic platelet transfusions for the prevention of thrombocytopenic bleeding. This is an update of a Cochrane review first published in 2004, and updated in 2012 that addressed four separate questions: prophylactic versus therapeutic-only platelet transfusion policy; prophylactic platelet transfusion threshold; prophylactic platelet transfusion dose; and platelet transfusions compared to alternative treatments. This review has now been split into four smaller reviews; this review compares different platelet transfusion doses. Objectives To determine whether different doses of prophylactic platelet transfusions (platelet transfusions given to prevent bleeding) affect their efficacy and safety in preventing bleeding in people with haematological disorders undergoing myelosuppressive chemotherapy with or without haematopoietic stem cell transplantation (HSCT). Search methods We searched for randomised controlled trials in the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2015, Issue 6), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the Transfusion Evidence Library (from 1950), and ongoing trial databases to 23 July 2015. Selection criteria Randomised controlled trials involving transfusions of platelet concentrates, prepared either from individual units of whole blood or by apheresis, and given to prevent bleeding in people with malignant haematological disorders or undergoing HSCT that compared different platelet component doses (low dose 1.1 × 1011/m2 ± 25%, standard dose 2.2 × 1011/m2 ± 25%, high dose 4.4 × 1011/m2 ± 25%). Data collection and analysis We used the standard

  9. Comparison of different platelet count thresholds to guide administration of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation.

    Science.gov (United States)

    Estcourt, Lise J; Stanworth, Simon J; Doree, Carolyn; Hopewell, Sally; Trivella, Marialena; Murphy, Michael F

    2015-11-18

    Platelet transfusions are used in modern clinical practice to prevent and treat bleeding in people who are thrombocytopenic due to bone marrow failure. Although considerable advances have been made in platelet transfusion therapy in the last 40 years, some areas continue to provoke debate, especially concerning the use of prophylactic platelet transfusions for the prevention of thrombocytopenic bleeding.This is an update of a Cochrane review first published in 2004, and previously updated in 2012 that addressed four separate questions: prophylactic versus therapeutic-only platelet transfusion policy; prophylactic platelet transfusion threshold; prophylactic platelet transfusion dose; and platelet transfusions compared to alternative treatments. This review has now been split into four smaller reviews looking at these questions individually; this review compares prophylactic platelet transfusion thresholds. To determine whether different platelet transfusion thresholds for administration of prophylactic platelet transfusions (platelet transfusions given to prevent bleeding) affect the efficacy and safety of prophylactic platelet transfusions in preventing bleeding in people with haematological disorders undergoing myelosuppressive chemotherapy or haematopoietic stem cell transplantation (HSCT). We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2015, Issue 6, 23 July 2015), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the Transfusion Evidence Library (from 1950), and ongoing trial databases to 23 July 2015. We included RCTs involving transfusions of platelet concentrates, prepared either from individual units of whole blood or by apheresis, and given to prevent bleeding in people with haematological disorders (receiving myelosuppressive chemotherapy or undergoing HSCT) that compared different thresholds for administration of prophylactic platelet transfusions (low

  10. Comparison of different platelet count thresholds to guide administration of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation

    Science.gov (United States)

    Estcourt, Lise J; Stanworth, Simon J; Doree, Carolyn; Hopewell, Sally; Trivella, Marialena; Murphy, Michael F

    2015-01-01

    Background Platelet transfusions are used in modern clinical practice to prevent and treat bleeding in people who are thrombocytopenic due to bone marrow failure. Although considerable advances have been made in platelet transfusion therapy in the last 40 years, some areas continue to provoke debate, especially concerning the use of prophylactic platelet transfusions for the prevention of thrombocytopenic bleeding. This is an update of a Cochrane review first published in 2004, and previously updated in 2012 that addressed four separate questions: prophylactic versus therapeutic-only platelet transfusion policy; prophylactic platelet transfusion threshold; prophylactic platelet transfusion dose; and platelet transfusions compared to alternative treatments. This review has now been split into four smaller reviews looking at these questions individually; this review compares prophylactic platelet transfusion thresholds. Objectives To determine whether different platelet transfusion thresholds for administration of prophylactic platelet transfusions (platelet transfusions given to prevent bleeding) affect the efficacy and safety of prophylactic platelet transfusions in preventing bleeding in people with haematological disorders undergoing myelosuppressive chemotherapy or haematopoietic stem cell transplantation (HSCT). Search methods We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2015, Issue 6, 23 July 2015), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the Transfusion Evidence Library (from 1950), and ongoing trial databases to 23 July 2015. Selection criteria We included RCTs involving transfusions of platelet concentrates, prepared either from individual units of whole blood or by apheresis, and given to prevent bleeding in people with haematological disorders (receiving myelosuppressive chemotherapy or undergoing HSCT) that compared different thresholds for

  11. Abnormal uterine bleeding

    Science.gov (United States)

    Anovulatory bleeding; Abnormal uterine bleeding - hormonal; Polymenorrhea - dysfunctional uterine bleeding ... ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Reaffirmed 2015. www. ...

  12. Male gender, school attendance and sports participation are positively associated with health-related quality of life in children and adolescents with congenital bleeding disorders.

    Science.gov (United States)

    Limperg, P F; Joosten, M M H; Fijnvandraat, K; Peters, M; Grootenhuis, M A; Haverman, L

    2018-02-08

    This study assesses health-related quality of life (HRQOL), and variables associated with HRQOL, in children and adolescents with haemophilia and congenital bleeding disorders (CBD) in the Netherlands. Patients Differences and effect sizes in HRQOL compared to healthy peers, and between hemophilia severity groups, were tested using Mann Whitney U-tests. Multivariate regression analyses were performed to assess variables associated with HRQOL. Data of 145 patients (81%) were analyzed (N = 32 with severe haemophilia). Children (0-12 years) show no significant impairments in HRQOL compared to healthy peers. Adolescent boys (13-18 years) with CBD report a slightly higher HRQOL on the total and emotional functioning scales than healthy peers (small-moderate effect sizes). In contrast, adolescent girls experience lower HRQOL on total, social functioning and psychosocial health scales compared to healthy peers (moderate effect sizes). No differences between severity groups were found in HRQOL, but more problem behaviour was found in young boys (0-5 years) with severe haemophilia. Male gender, participation in sports and school attendance are positively associated with HRQOL. Parental country of birth, type of treatment and number of bleeds are not associated with HRQOL. Continuing monitoring HRQOL in daily clinical practice for children with CBD is important, since possible influencing psychosocial factors can change over time, with special focus on adolescent girls, sports participation and school absence. © 2018 John Wiley & Sons Ltd.

  13. Management of tooth extraction in a patient with a rare bleeding disorder associated with Hermansky-Pudlak syndrome: a case report.

    Science.gov (United States)

    Minkin, Patton; Bertetti, Richard; Lindsey, Sean; Bovino, Brian

    2015-02-01

    This report describes the case of a 27-year-old man who had been diagnosed with Hermansky-Pudlak syndrome shortly after birth. Because the patient had a major bleeding disorder associated with his syndrome, local and systemic hemostatic protection recommendations had to be considered before tooth extraction. Synthetic vasopressin (1-deamino-8-d-arginine vasopressin [DDAVP]) was transfused intravenously before surgery. During surgery the patient was transfused with 1 U of human leukocyte antigen (HLA)-matched apheresis platelets. A hemostatic packing of Avitene and Gelfoam was adapted to the extraction site. Treatment with DDAVP, HLA-matched platelets, and local application of a packing with Avitene and Gelfoam resulted in sustained hemostasis and an excellent healing response. Surgical and routine extractions appear to be safe procedures in patients with Hermansky-Pudlak syndrome when appropriate local and systemic hemostatic measures are used. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Treatment Modalities in Adolescents Who present With Heavy Menstrual Bleeding.

    Science.gov (United States)

    Alaqzam, Tasneem S; Stanley, Angela C; Simpson, Pippa M; Flood, Veronica H; Menon, Seema

    2018-03-07

    This study sought to determine the relationship of bleeding disorders to iron deficiency anemia. Additionally, this study was undertaken to examine all current treatment modalities used in a menorrhagia clinic with respect to heavy menstrual bleeding management to identify the most effective options for menstrual management in the setting of an underlying bleeding disorder. DESIGN, SETTING, PARTICIPANT, INTERVENTION, AND MAIN OUTCOME MEASURES: Retrospective chart review of adolescent <21 years with heavy menstrual bleeding attending a multidisciplinary hematology-adolescent gynecology clinic. Information included demographics, bleeding diathesis, hematologic parameters, treatment, and the diagnosis was extracted from each chart. Subjects were grouped into two categories based on the diagnosis of a bleeding disorder. Hemoglobin level, iron deficiency anemia, and need for transfusion were compared between a bleeding disorder and no bleeding disorder group. Subjects were grouped into categories depending on hormonal modality and treatment success of the groups were compared. 73 subjects tested for a bleeding disorder. Of the subjects completing testing, 34 (46%) were diagnosed with a bleeding disorders. 39 (54%) subjects had heavy menstrual bleeding due to other causes. There was no significant difference in hemoglobin between those with and without a bleeding disorder. Iron deficiency anemia was significantly higher in subjects without bleeding disorder. When comparing hormone therapy success, the levonorgestrel IUD (LNG-IUD) (89%) had the highest rate of menstrual suppression followed by norethindrone acetate 5-10mg/day (83%), and the transdermal patch (80%). All subjects using both tranexamic acid and hormonal therapy had 100% achievement of menstrual suppression. A high frequency of bleeding disorder was found in those tested. Subjects with a bleeding disorder were less likely to present with severe anemia requiring blood transfusion and less likely to have iron

  15. Serum angiotensin--converting enzyme (SACE) in sarcoidosis and other granulomatous disorders.

    Science.gov (United States)

    Studdy, P; Bird; James, D G; Sherlock, S

    Serum angiotensin-converting enzyme (SACE) activity was significantly higher in 90 patients with sarcoidosis (55 +/- [S.D.] 23 nmol min-1 ml-1) than in 80 healthy controls (34 +/- 9 nmol min-1 ml-1). Steroid therapy modified SACE activity; 60 sarcoidosis patients who were not being treated with steroids had significantly higher enzyme activities (58 +/- 24 nmol min-1 ml-1) than 30 steroid-treated sarcoidosis patients (40 +/- 19 nmol min-1 ml-1). In 50% of the non-steroid treated sarcoidosis patients SACE activity was more than than 2 S.D. above the mean value for the controls. SACE activity was measured in 22 tuberculous patients (38 +/- 14 nmol min-1 ml-1), 20 leprosy patients (34 +/- 9 nmol min-1 ml-1), 31 with primary biliary cirrhosis (44 +/- 20 nmol min-1 ml-1), 26 with inflammatory bowel disease (31 +/- 9 nmol min-1 ml-1), eight with hepatic granulomatous disease, five with Hodgkin's disease, and two with schistosomiasis. The combined false-positive rate for these non-sarcoidosis patients was 10%. Serial SACE assays provide useful information on the course of sarcoidosis and response to steroid treatment.

  16. Serum angiotensin-converting enzyme (SACE) in sarcoidosis and other granulomatous disorders.

    Science.gov (United States)

    Studdy, P; Bird, R; James, D G

    Serum angiotensin-converting enzyme (SACE) activity was significantly higher in 90 patients with sarcoidosis (55 +/- [S.D.] 23 nmol min-1 ml-1) than in 80 healthy controls (34 +/- 9 nmol min-1 ml-1). Steroid therapy modified SACE activity; 60 sarcoidosis patients who were not being treated with steroids had significantly higher enzyme activities (58 +/- 24 nmol min-1 ml-1) than 30 steroid-treated sarcoidosis patients (40 +/- 19 nmol min-1 ml-1). In 50% of the non-steroid treated sarcoidosis patients SACE activity was more than 2 S.D. above the mean value for the controls. SACE activity was measured in 22 tuberculous patients (38 +/- 14 nmol min-1 ml-1), 20 leprosy patients (34 +/- 9 nmol min-1 ml-1), 31 with primary biliary cirrhosis (44 +/- 20 nmol min-1 ml-1), 26 with inflammatory bowel disease (31 +/- 9 nmol min-1 ml-1), 8 with hepatic granulomatous disease, 5 with Hodgkin's disease, and 2 with schistosomiasis. The combined false-positive rate for these non-sarcoidosis patients was 10%. Serial SACE assays provide useful information on the course of sarcoidosis and response to steroid treatment.

  17. Vaginal bleeding in pregnancy

    Science.gov (United States)

    Pregnancy - vaginal bleeding; Maternal blood loss - vaginal ... Up to 1 in 4 women have vaginal bleeding at some time during their pregnancy. Bleeding is more common in the first 3 months (first trimester), especially with twins.

  18. Recombinant Activated Factor VII (Eptacog Alfa Activated, NovoSeven®) in Patients with Rare Congenital Bleeding Disorders. A Systematic Review on its Use in Surgical Procedures.

    Science.gov (United States)

    Di Minno, Matteo Nicola Dario; Ambrosino, Pasquale; Myasoedova, Veronika; Amato, Manuela; Ventre, Itala; Tremoli, Elena; Minno, Alessandro Di

    2017-01-01

    In the absence of definite guidelines in the area, we have carried a systemic review to provide a thorough overview concerning the efficacy and safety of recombinant activated factor VII (rFVIIa, NovoSeven®, Novo Nordisk A/S, Bagsværd, Denmark) in patients with Glanzmann's thrombasthenia (GT) and FVII deficiency, undergoing surgical procedures. PubMed, Web of Science, Scopus and EMBASE databases was employed for the search. Three multicenter registries were identified: the Glanzmann's Thrombasthenia Registry (GTR), the Seven Treatment Evaluation Registry (STER), and a German post-marketing surveillance registry (the WIRK study). In addition, data from 10 case-series and/or single-center experiences have been summarized. We have found that the following; perioperatively, the hemostatic effectiveness of rFVIIa was high in GT patients and in those with FVII deficiency undergoing both minor and major surgical procedures. Moreover, in all studies, rFVIIa was well tolerated. Thus, the current evidence shows an optimal perioperative safety/efficacy profile of rFVIIa in the setting of these rare bleeding disorders, and provides the rationale for further studies aimed at evaluating the optimal perioperative anti-hemorrhagic prophylaxis with rFVIIa in GT and in FVII deficient patients. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  19. 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

  20. Evaluation of a web-based registry of inherited bleeding disorders: a descriptive study of the Brazilian experience with HEMOVIDAweb Coagulopatias.

    Science.gov (United States)

    Rezende, Suely Meireles; Rodrigues, Silvia Helena Lacerda; Brito, Kelly Neves Pinheiro; da Silva, Diego Lima Quintino; Santo, Marcos Lázaro; Simões, Bárbara de Jesus; Genovez, Guilherme; Melo, Helder Teixeira; Araújo, João Paulo Baccara; Barca, Danila Augusta Accioly Varella

    2017-02-10

    Inherited bleeding disorders (IBD) consist of a group of rare heterogeneous diseases, which require treatment for life. Management of these disorders is complex and costly. Therefore, good quality data of the affected population is crucial to guide policy planning. The aim of this manuscript is to describe the impact of a national, web-based registry - the Hemovidaweb Coagulopatias (HWC) - in the management of the IBD in Brazil. The system was developed in PHP 5.0 language and is available on the internet at http://coagulopatiasweb.datasus.gov.br . The system was validated in September 2008 and launched nationally with input from January 1, 2009. HWC collects variables related to socio-demographic, clinical, laboratory and treatment data of patients with IBD. Within 7 years, there was an increment of 90.8% on the diagnosis of IBD altogether, which increased from 11,040 in December 2007 to 21,066 in December 2014. This is now the fourth and third largest world population of patients with haemophilia and von Willebrand's disease (vWD), respectively, according to the most recent (2015) Annual Global Survey of the World Federation of Hemophilia. The data collected provided the basis for planning and implementing home therapy, prophylaxis and immune tolerance induction (ITI), recently initiated in Brazil. HWC was an effective tool in the increment of registration of patients with IBD in Brazil. Furthermore, it was essential to support policy planning, monitoring, evaluation and treatment. Future development should focus on surveillance, health outcomes and research. Every country should implement a national registry on IBD.

  1. RECOMBINANT FACTOR VIIa – NEW TREATMENT OPTION FOR CONTROL OF INTRACTABLE BLEEDING IN SURGICAL AND TRAUMA PATIENTS AND IN OTHER HAEMOSTASIS DISORDERS

    Directory of Open Access Journals (Sweden)

    Samo Zver

    2004-12-01

    Full Text Available Background. Recombinant factor VIIa (rFVIIa, which is currently registered only for the treatment of haemophilia A and B patients with inhibitors, is seen increasingly as a possible universal haemostatic agent in untractable bleedings. One possible mechanism for the efficacy rFVIIa may be a consequence of it’s from the tissue factor (TF and from the level of disfunction in haemostatic system independant activity, which generates »thrombin burst« formation. It seems that rFVIIa remains active only at the site of tissue injury/bleeding.Conclusions. There are two components of bleeding in surgery and trauma patients. One is bleeding from large calibre arteries and veins which requires surgical intervention. The other, which goes along with the first one, is coagulopathic bleeding. The latter is a consequence of consumptional and dilutional coagulopathy, hypothermia, multitransfusion syndrom and metabolic disbalances in patients. rFVIIa effects coagulopathic component of the bleeding. For effective treatment with rFVIIa in such patients, replacement therapy with erythrocytes, platelets and fresh frozen plasma is mandatory and requires a haematologist assistance in the treatment strategy.Most reported cases of effective rFVIIa usage are from the field of traumatology. Until now, there have been no universal recommendations when to start treatment with rFVIIa in a bleeding trauma patient. Most experience with rFVIIa are from Israel and their recommendations are perhaps the most valuable ones. rFVIIa was used several times during intra-operative and post-operative bleeding episodes. There are reports of clinical studies and usage in patients with/ after prostate surgery, cardiovascular operations and liver transplants.There are data about effective rFVIIa usage in neurology and neurosurgery patients (intracranial haemorrhages, obstetrics and gynecology field. Possible future indications are thrombocytopenias, thrombocytopathias (Glanzmann

  2. Vaginal or uterine bleeding - overview

    Science.gov (United States)

    ... and other menstrual conditions; Abnormal menstrual periods; Abnormal vaginal bleeding ... There are many causes of abnormal vaginal bleeding. HORMONES ... Doctors call the problem abnormal uterine bleeding (AUB) . AUB ...

  3. Bleeding esophageal varices

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000268.htm Bleeding esophageal varices To use the sharing features on ... veins in the esophagus to balloon outward. Heavy bleeding can occur if the veins break open. Any ...

  4. GI bleeding - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100162.htm GI bleeding - series—Normal anatomy To use the sharing features ... M. Editorial team. Related MedlinePlus Health Topics Gastrointestinal Bleeding A.D.A.M., Inc. is accredited by ...

  5. Bleeding into the skin

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003235.htm Bleeding into the skin To use the sharing features on this page, please enable JavaScript. Bleeding into the skin can occur from broken blood ...

  6. Vaginal bleeding between periods

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003156.htm Vaginal bleeding between periods To use the sharing features ... this page, please enable JavaScript. This article discusses vaginal bleeding that occurs between a woman's monthly menstrual ...

  7. Bleeding during Pregnancy

    Science.gov (United States)

    ... in pregnancy? • What problems with the placenta can cause bleeding during pregnancy? • Can bleeding be a sign of preterm labor? • ... the hospital. What problems with the placenta can cause bleeding during pregnancy? Several problems with the placenta later in pregnancy ...

  8. Abnormal uterine bleeding in perimenopause.

    Science.gov (United States)

    Goldstein, S R; Lumsden, M A

    2017-10-01

    Abnormal uterine bleeding is one of the commonest presenting complaints encountered in a gynecologist's office or primary-care setting. The wider availability of diagnostic tools has allowed prompt diagnosis and treatment of an increasing number of menstrual disorders in an office setting. This White Paper reviews the advantages and disadvantages of transvaginal ultrasound, blind endometrial sampling and diagnostic hysteroscopy. Once a proper diagnosis has been established, appropriate therapy may be embarked upon. Fortunately, only a minority of such patients will have premalignant or malignant disease. When bleeding is sufficient to cause severe anemia or even hypovolemia, prompt intervention is called for. In most of the cases, however, the abnormal uterine bleeding will be disquieting to the patient and significantly affect her 'quality of life'. Sometimes, reassurance and expectant management will be sufficient in such patients. Overall, however, in cases of benign disease, some intervention will be required. The use of oral contraceptive pills especially those with a short hormone-free interval, the insertion of the levonorgestrel intrauterine system, the incorporation of newer medical therapies including antifibrinolytic drugs and selective progesterone receptor modulators and minimally invasive treatments have made outpatient therapy increasingly effective. For others, operative hysteroscopy and endometrial ablation are proven therapeutic tools to provide both long- and short-term relief of abnormal uterine bleeding, thus avoiding, or deferring, hysterectomy.

  9. Dysfunctional uterine bleedings of a climacteric period

    International Nuclear Information System (INIS)

    Prilepskaya, V.N.

    1993-01-01

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

  10. Nonvariceal upper gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Burke, Stephen J.; Weldon, Derik; Sun, Shiliang; Golzarian, Jafar

    2007-01-01

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

  11. Nonvariceal upper gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-07-15

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

  12. Upper gastrointestinal bleeding.

    Science.gov (United States)

    Feinman, Marcie; Haut, Elliott R

    2014-02-01

    Upper gastrointestinal (GI) bleeding remains a commonly encountered diagnosis for acute care surgeons. Initial stabilization and resuscitation of patients is imperative. Stable patients can have initiation of medical therapy and localization of the bleeding, whereas persistently unstable patients require emergent endoscopic or operative intervention. Minimally invasive techniques have surpassed surgery as the treatment of choice for most upper GI bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. What Should You Know about Blood Disorders in Women?

    Science.gov (United States)

    ... Cancel Submit Search the CDC Bleeding Disorders in Women Note: Javascript is disabled or is not supported ... this page: About CDC.gov . Bleeding Disorders in Women Survey Findings on Young Women and Bleeding Disorders ...

  14. Angiotensin-converting enzyme insertion/deletion polymorphism association with obesity and some related disorders in Egyptian females: a case-control observational study

    OpenAIRE

    Motawi, Tarek K.; Shaker, Olfat G.; Shahin, Nancy N.; Ahmed, Nancy M.

    2016-01-01

    Background According to the WHO report in 2015, obesity is the fifth leading cause of death worldwide, and the prevalence of Egyptian female obesity is 37.5?%. Since obesity is highly influenced by genetics, and adipose tissue renin-angiotensin system is over-activated in obesity, the effect of angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism on obesity and related disorders was studied in several populations, because of its effect on ACE activity. Our objective was t...

  15. Pelvic artery embolization in gynecological bleeding

    International Nuclear Information System (INIS)

    Hausegger, K.A.; Schreyer, H.; Bodhal, H.

    2002-01-01

    The most common reasons for gynecological bleeding are pregnancy-related disorders, fibroids of the uterus, and gynecological malignances. Transarterial embolization is an effective treatment modality for gynecological bleeding regardless of its etiology. Depending on the underlying disease, a different technique of embolization is applied. In postpartal bleeding a temporary effect of embolization is desired, therefore gelatine sponge is used as embolizing agent. In fibroids and malignant tumors the effect should permanent, therefore PVA particles are used. Regardless the etiology, the technical and clinical success of transarterial embolization is at least 90%. In nearly every patient a post-embolization syndrome can be observed, represented by local pain and fever. This post-embolization syndrome usually does not last longer than 3 days. If embolization is performed with meticulous attention to angiographic technique and handling of embolic material, ischemic damage of adjacent organs is rarely observed. Transarterial embolization should be an integrative modality in the treatment of gynecological bleeding. (orig.) [de

  16. Severe Bleeding: First Aid

    Science.gov (United States)

    ... 12, 2017. Jevon P, et al. Part 5 — First-aid treatment for severe bleeding. Nursing Times. 2008;104:26. Oct. 19, 2017 Original article: http://www.mayoclinic.org/first-aid/first-aid-severe-bleeding/basics/ART-20056661 . Mayo ...

  17. Abnormal Uterine Bleeding FAQ

    Science.gov (United States)

    ... acid —This medication treats heavy menstrual bleeding. • Nonsteroidal anti-inflammatory drugs—These drugs, which include ibuprofen, may help control heavy bleeding and relieve menstrual cramps. • Antibiotics—If you have an infection, you may be ...

  18. Upper GI Bleeding in Children

    Science.gov (United States)

    Upper GI Bleeding in Children What is upper GI Bleeding? Irritation and ulcers of the lining of the esophagus, stomach or duodenum can result in upper GI bleeding. When this occurs the child may vomit blood ...

  19. 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

  20. Small Bowel Bleeding

    Science.gov (United States)

    ... pouchings in the wall of the colon), or cancer. Upper GI (esophagus, stomach, or duodenum) bleeding is most often due ... begins transmitting images of the inside of the esophagus, stomach, and small bowel to a ... Bowel Disease Irritable Bowel Syndrome ...

  1. Abnormal Uterine Bleeding

    Science.gov (United States)

    ... especially the progestin-only pill (also called the “mini-pill”) can actually cause abnormal bleeding for some ... Basics Sports Safety Injury Rehabilitation Emotional Well-Being Mental Health Sex and Birth Control Sex and Sexuality ...

  2. Invisible Bleeding: The Command Team’s Role in the Identification, Understanding, and Treatment of Traumatic Brain Injury and Post Traumatic Stress Disorder

    Science.gov (United States)

    2013-04-11

    Traumatic Brain Injury, Post Traumatic Stress Disorder , TBI, PTSD , Wounded...Brain Injury (TBI) and Post Traumatic Stress Disorder ( PTSD ). Command teams must leverage the existing programs and infrastructure while demonstrating a...subsequent struggle with Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder ( PTSD ) have given me the unique insight to tackle

  3. The International Bleeding Risk Score

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Laine, L.; Dalton, H.

    2017-01-01

    The International Bleeding Risk Score: A New Risk Score that can Accurately Predict Mortality in Patients with Upper GI-Bleeding.......The International Bleeding Risk Score: A New Risk Score that can Accurately Predict Mortality in Patients with Upper GI-Bleeding....

  4. Hydrogen converters

    International Nuclear Information System (INIS)

    Mondino, Angel V.

    2003-01-01

    The National Atomic Energy Commission of Argentina developed a process of 99 Mo production from fission, based on irradiation of uranium aluminide targets with thermal neutrons in the RA-3 reactor of the Ezeiza Atomic Centre. These targets are afterwards dissolved in an alkaline solution, with the consequent liberation of hydrogen as the main gaseous residue. This work deals with the use of a first model of metallic converter and a later prototype of glass converter at laboratory scale, adjusted to the requirements and conditions of the specific redox process. Oxidized copper wires were used, which were reduced to elementary copper at 400 C degrees and then regenerated by oxidation with hot air. Details of the bed structure and the operation conditions are also provided. The equipment required for the assembling in cells is minimal and, taking into account the operation final temperature and the purge with nitrogen, the procedure is totally safe. Finally, the results are extrapolated for the design of a converter to be used in a hot cell. (author)

  5. Vaginal bleeding in late pregnancy

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000627.htm Vaginal bleeding in late pregnancy To use the sharing ... JavaScript. One out of 10 women will have vaginal bleeding during their 3rd trimester. At times, it ...

  6. Management of severe perioperative bleeding

    DEFF Research Database (Denmark)

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

    2017-01-01

    : 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...... and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide...

  7. Ray converter

    International Nuclear Information System (INIS)

    Reiss, K.H.

    1976-01-01

    In a radiographic system a converter is used for changing image forming intensity distribution in a bundle of penetrating rays into a flow of electrically charged particles by electrodes located in a gas space and partly latticed (grids) which lie at potentials stepped from cathode to anode. The invention is particularly characterized by the provision of at least two grids extending between and parallel to the cathode and the anode. The electrical field which lies between two electrodes lies at least between the grids located closest to the cathode being to the extent of between 1 and 10 percent, in the average preferably 3 percent below the electrical break down field in the gas in a homogeneous electrical field

  8. Pinworms and postmenopausal bleeding.

    OpenAIRE

    al-Rufaie, H K; Rix, G H; Pérez Clemente, M P; al-Shawaf, T

    1998-01-01

    The human pinworm Enterobius vermicularis is normally found within the human gastrointestinal tract. Pregnant females migrate out of their host's anus at night to lay their eggs perianally. As a consequence of this nocturnal migration some worms find their way into adjacent orifices, most commonly the female genitourinary tract, producing irritative symptoms such as vulvovaginitis. A case of pinworm infestation of the uterus presented as postmenopausal bleeding.

  9. Scintigraphic evaluation of gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Park, Yong Tai; Lee, Choon Keun; Lee, Sun Wha; Choi, Woo Suk; Yoon, Yup; Lim, Jae Hoon

    1988-01-01

    Gastrointestinal bleeding remains a major diagnostic problem. Although advances have been made in the medical and surgical methods of managing gastrointestinal bleeding, the commonly employed techniques of barium radiography, endoscopy, and angiography may not successfully localize the site and define the cause of gastrointestinal bleeding. Two widely available technetium-99m-labeled radiopharmaceuticals, sulfur colloid and red blood cells are currently used in the evaluation of patients who are bleeding from the gastrointestinal tract. Surgically confirmed 19 patients with use of 99m Tc-sulfur colloid (7 cases) and 99m Tc-RBC (12 cases) were retrospectively evaluated. The overall sensitivity of scintigraphy in detection of bleeding and localization of bleeding site was 68% and 84%, respectively. The authors conclude that bleeding scintigraphy is a safe, sensitive, and non-invasive method as an effective screening test before performing angiography or surgery.

  10. Angiotensin-converting enzyme insertion/deletion polymorphism association with obesity and some related disorders in Egyptian females: a case-control observational study.

    Science.gov (United States)

    Motawi, Tarek K; Shaker, Olfat G; Shahin, Nancy N; Ahmed, Nancy M

    2016-01-01

    According to the WHO report in 2015, obesity is the fifth leading cause of death worldwide, and the prevalence of Egyptian female obesity is 37.5 %. Since obesity is highly influenced by genetics, and adipose tissue renin-angiotensin system is over-activated in obesity, the effect of angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism on obesity and related disorders was studied in several populations, because of its effect on ACE activity. Our objective was to study the association of ACE I/D polymorphism with obesity and certain related disorders, namely hypertension, insulin resistance and metabolic syndrome, in Egyptian females. Eighty female volunteers were recruited, blood pressure and body measurements were recorded and a fasting blood sample was obtained for the quantitation of glucose, lipid profile, insulin, leptin and identification of ACE I/D polymorphs. Subjects were grouped based on hypertension and obesity states. Comparisons of continuous parameters were made with independent sample t -test between two groups. The frequencies of ACE genotypes and alleles, and the association between gene polymorphism and metabolic parameters were assessed using chi-square or Fisher's exact test. Genotype frequencies were in Hardy-Weinberg equilibrium for all groups. Genotype distribution did not differ significantly between controls and cases of all the studied disorders. Although DD carriers had apparently higher parameters of blood pressure, lipid profile and insulin resistance, only diastolic blood pressure was almost significant ( p  = 0.057). I-carriers were significantly less susceptible to hypertension than DD carriers having normal waist/hip ratio ( p  = 0.007, OR = 17.29, CI = 1.81-164.96) and normal conicity index ( p  = 0.024, OR = 7.00, CI = 1.36-35.93). In DD genotype carriers, a significant association was found between insulin resistance and high body mass index ( p  = 0.004, OR = 8.89, CI

  11. Evaluation and Management of Adolescents with Abnormal Uterine Bleeding.

    Science.gov (United States)

    Mullins, Tanya L Kowalczyk; Miller, Rachel J; Mullins, Eric S

    2015-09-01

    The International Federation of Gynecology and Obstetrics and the American Congress of Obstetricians and Gynecologists support the use of new terminology for abnormal uterine bleeding (AUB) to consistently categorize AUB by etiology. The term AUB can be further classified as AUB/heavy menstrual bleeding (HMB) (replacing the term "menorrhagia") or AUB/intermenstrual bleeding (replacing the term "metrorrhagia"). Although many cases of AUB in adolescent women are attributable to immaturity of the hypothalamic-pituitary-ovarian axis, underlying bleeding disorders should be considered in women with AUB/HMB. This article reviews the new terminology for AUB, discusses important relevant features of history and examination, presents the laboratory evaluation of HMB, and describes hormonal (oral contraceptive pills, progestin-only methods, long-acting reversible contraceptives including intrauterine systems), hematologic (tranexamic acid and desmopressin), and surgical management options for AUB/HMB. Copyright 2015, SLACK Incorporated.

  12. Pseudoxanthoma elasticum: A rare cause of gastrointestinal bleed

    Directory of Open Access Journals (Sweden)

    Ishrat H Dar

    2015-01-01

    Full Text Available Causes of obscure gastrointestinal (GI bleed are diverse and rare. The most common cause for GI bleeding of small bowel origin is angiodysplasia, followed by tumors of the small intestine, and various other causes, including small bowel ulcers and aortienteric fistulas. Pseudoxanthoma elasticum (PXE is a rare cause of GI bleed. It is an inherited elastic tissue disorder with degeneration of elastic fibers involving mainly skin, eyes and the cardiovascular system. Upper GI hemorrhage occurs in 13% of cases and is often resistant to nonsurgical methods of treatment. Presented herein is a case of GI bleed in a 65-year-old woman who had PXE and hyperplastic polyps in the stomach.

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

    DEFF Research Database (Denmark)

    Ngu, JH; 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....

  14. An unexpected cause of vaginal bleeding: the role of pelvic radiography.

    Science.gov (United States)

    Kyrgios, Ioannis; Emmanouilidou, Eleftheria; Theodoridis, Theodoros; Galli-Tsinopoulou, Assimina

    2014-02-14

    Vaginal bleeding and/or discharge in young girls may result from infection, urological problems, endocrine causes, bleeding disorders, dermatological conditions, trauma, sexual abuse, masses or foreign bodies. We report a case of excessive vaginal bleeding caused by a foreign body in a prepubertal girl with emphasis on the diagnostic challenges and pitfalls regarding imaging techniques. In our patient, although invasive and expensive investigations had been initially made, the foreign body was last detected only when a plain pelvic radiography was performed.

  15. Heavy menstrual bleeding: An update on management.

    Science.gov (United States)

    Davies, Joanna; Kadir, Rezan A

    2017-03-01

    Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss (MBL) >80 mL per cycle, that interferes with a woman's physical, emotional, social wellbeing and quality of life. Aetiology is due to underlying uterine pathologies, coagulopathy, ovulation dysfunction, or iatrogenic. Up to 20% of women with HMB will have an underlying inherited bleeding disorder (IBD). Assessment of HMB should entail a menstrual and gynaecological history and a bleeding score to distinguish those women who require additional haematological investigations. A pelvic examination and ultrasound scan help to rule out presence of any underlying pathology. Management depends on the underlying cause and the woman's preference and her fertility wishes. Medical therapies include hormonal treatments; levonorgestrel-releasing intrauterine system (LNG-IUS) and combined hormonal contraceptives are most commonly used. Ulipristal acetate is an approved preoperative treatment for uterine fibroids, and has demonstrated efficacy in reducing MBL. Haemostatic therapies include tranexamic acid and DDAVP (1-deamino-8-D-arginine). DDAVP is used for HMB associated with certain IBDs. These therapies can be used in isolation or in combination with hormonal treatments. HMB associated with certain severe IBDs may require factor concentrate administration during menses to alleviate symptoms. Endometrial ablation is a minor surgical procedure that is associated with low operative morbidity and can be performed as an outpatient. Hysterectomy remains the definitive treatment of choice when medical therapies have failed and endometrial ablation is not suitable. Crown Copyright © 2017 Published by Elsevier Ltd. All rights reserved.

  16. Bruising and Bleeding

    Science.gov (United States)

    ... Drug Interactions Pill Identifier Commonly searched drugs Aspirin Metformin Warfarin Tramadol Lactulose Ranitidine News & Commentary Recent News ... hemophilia , liver disorders, vitamin K deficiency , or the use of certain drugs) Defects in blood vessels Platelet ...

  17. Recurrent Bleeding After Perimesencephalic Hemorrhage.

    Science.gov (United States)

    Kauw, Frans; Velthuis, Birgitta K; Kizilates, Ufuk; van der Schaaf, Irene C; Rinkel, Gabriel J E; Vergouwen, Mervyn D I

    2017-12-01

    Perimesencephalic hemorrhage (PMH) is a type of subarachnoid hemorrhage with excellent long-term outcomes. Only 1 well-documented case of in-hospital rebleeding after PMH is described in the literature, which occurred after initiating antithrombotic treatment because of myocardial ischemia. We describe a patient with PMH without antithrombotic treatment who had 2 episodes of recurrent bleeding on the day of ictus. To validate the radiologic findings, we conducted a case-control study. Six neuroradiologists and 2 neuroradiology fellows performed a blinded assessment of serial unenhanced head computed tomography (CT) scans of 8 patients with a perimesencephalic bleeding pattern (1 index patient, 6 patients with PMH, 1 patient with perimesencephalic bleeding pattern and basilar artery aneurysm) to investigate a potential increase in amount of subarachnoid blood. A 56-year-old woman with a perimesencephalic bleeding pattern and negative CT angiography had 2 episodes after the onset headache with a sudden increase of the headache. Blinded assessment of serial head CT scans of 8 patients with a perimesencephalic bleeding pattern identified the patient who was clinically suspected to have 2 episodes of recurrent bleeding to have an increased amount of subarachnoid blood on 2 subsequent CT scans. Recurrent bleeding after PMH may also occur in patients not treated with antithrombotics. Even after early rebleeding, the prognosis of PMH is excellent. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. 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...

  19. 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...... to failure to control initial bleeding or early re-bleeding occurring in up to 30-40% of patients. Initial procedures are to secure and protect the airway, and administer volume replacement to stabilize the patient. Treatment with vasoactive drugs should be started as soon as possible, since a reduction...... in portal pressure is associated with a better control of bleeding and may facilitate later endoscopic procedures. Vasopressin and its analogues Terlipressin and somatostatin and analogues are the two types of medicine, which has been evaluated. In meta-analysis, only Terlipressin have demonstrated effects...

  20. 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.

  1. Approach to upper gastrointestinal bleeding

    African Journals Online (AJOL)

    Benign ulcer. Mallory-Weiss tear .... pressure and direct thermal coagulation. Alternatively, use ... Forrest classification of peptic ulcer bleeding related to risks of rebleeding. (NBVV - non- .... esomeprazole for prevention of recurrent peptic ulcer ...

  2. The bleeding time may be longer in children than in adults.

    Science.gov (United States)

    Sanders, J M; Holtkamp, C A; Buchanan, G R

    1990-01-01

    The bleeding time, the most frequently performed test reflecting in vivo platelet function, is the duration of blood flow from a standardized incision on the volar surface of the forearm. Normal values have been determined in adult subjects, but with the exception of neonates, data on the range of bleeding time values in pediatric patients are unavailable. Standard hematology textbooks imply that bleeding time values in children are similar to those of adults. We have reviewed our 9 years of experience with 137 children (mean age 6.5 years) who were referred for diagnostic evaluation of a bleeding disorder but whose history and physical examination were felt by us to be inconsistent with an abnormality of hemostasis. Bleeding time values in these individuals (mean 6.0 min, 95th percentile 9.0 min) were compared with those of 85 normal adult volunteers (mean 4.4 min, 95th percentile 6.5 min). The Simplate-I disposable device and vertical (perpendicular to elbow crease) incision direction were used in both groups. This difference between the pediatric and adult bleeding time values is statistically significant (p less than 0.0001). Neither age nor sex had a significant effect on the pediatric bleeding time measurements. We conclude that the bleeding time, when performed as described, is longer in children than in adults and that pediatric standards for bleeding time should be used in order to avoid a spurious diagnosis of a primary hemostatic disorder in some normal children.

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

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Abnormal Uterine Bleeding (AUB) KidsHealth / For Teens / Abnormal Uterine Bleeding (AUB) ... Print en español Sangrado uterino anormal What Is Abnormal Uterine Bleeding? Abnormal uterine bleeding (AUB) is the name doctors ...

  4. The medical management of abnormal uterine bleeding in reproductive-aged women.

    Science.gov (United States)

    Bradley, Linda D; Gueye, Ndeye-Aicha

    2016-01-01

    In the treatment of women with abnormal uterine bleeding, once a thorough history, physical examination, and indicated imaging studies are performed and all significant structural causes are excluded, medical management is the first-line approach. Determining the acuity of the bleeding, the patient's medical history, assessing risk factors, and establishing a diagnosis will individualize their medical regimen. In acute abnormal uterine bleeding with a normal uterus, parenteral estrogen, a multidose combined oral contraceptive regimen, a multidose progestin-only regimen, and tranexamic acid are all viable options, given the appropriate clinical scenario. Heavy menstrual bleeding can be treated with a levonorgestrel-releasing intrauterine system, combined oral contraceptives, continuous oral progestins, and tranexamic acid with high efficacy. Nonsteroidal antiinflammatory drugs may be utilized with hormonal methods and tranexamic acid to decrease menstrual bleeding. Gonadotropin-releasing hormone agonists are indicated in patients with leiomyoma and abnormal uterine bleeding in preparation for surgical interventions. In women with inherited bleeding disorders all hormonal methods as well as tranexamic acid can be used to treat abnormal uterine bleeding. Women on anticoagulation therapy should consider using progestin-only methods as well as a gonadotropin-releasing hormone agonist to treat their heavy menstrual bleeding. Given these myriad options for medical treatment of abnormal uterine bleeding, many patients may avoid surgical intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Fibrinogen-coated albumin microcapsules reduce bleeding in severely thrombocytopenic rabbits

    NARCIS (Netherlands)

    Levi, M. [=Marcel M.; Friederich, P. W.; Middleton, S.; de Groot, P. G.; Wu, Y. P.; Harris, R.; Biemond, B. J.; Heijnen, H. F.; Levin, J.; ten Cate, J. W.

    1999-01-01

    Severe thrombocytopenia frequently occurs in patients receiving chemotherapy and in patients with autoimmune disorders. Thrombocytopenia is associated with bleeding, which may be serious and life threatening. Current treatment strategies for thrombocytopenia may require transfusion of allogeneic

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

    Directory of Open Access Journals (Sweden)

    Atakan Savrun

    2015-12-01

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

  7. PALM-COEIN Nomenclature for Abnormal Uterine Bleeding.

    Science.gov (United States)

    Deneris, Angela

    2016-05-01

    Approximately 30% of women will experience abnormal uterine bleeding (AUB) during their life time. Previous terms defining AUB have been confusing and imprecisely applied. As a consequence, both clinical management and research on this common problem have been negatively impacted. In 2011, the International Federation of Gynecology and Obstetrics (FIGO) Menstrual Disorders Group (FMDG) published PALM-COEIN, a new classification system for abnormal bleeding in the reproductive years. Terms such as menorrhagia, menometrorrhagia, metrorrhagia, dysfunctional uterine bleeding, polymenorrhea, oligomenorrhea, and uterine hemorrhage are no longer recommended. The PALM-COEIN system was developed to standardize nomenclature to describe the etiology and severity of AUB. A brief description of the PALM-COEIN nomenclature is presented as well as treatment options for each etiology. Clinicians will frequently encounter women with AUB and should report findings utilizing the PALM-COEIN system. © 2016 by the American College of Nurse-Midwives.

  8. Do children without a known bleeding tendency undergoing PICC placement require coagulation laboratory testing?

    Science.gov (United States)

    Woodley-Cook, Joel; Amaral, Joao; Connolly, Bairbre; Brandão, Leonardo R

    2015-04-01

    Obtaining basic hemostatic laboratory investigations prior to peripherally inserted central catheter (PICC) insertion remains controversial, even if the procedure is converted to a tunneled central venous line (CVL) placement. To determine the value of pre-procedural blood screening (hemoglobin level, platelet count, aPTT/INR) in hospitalized children without a known bleeding diathesis. This retrospective review included pediatric patients undergoing PICC insertion who had both laboratory screening and post-PICC hemoglobin level. Two cohorts (A: 0-3 months; B: >3 months-18 years) were analyzed for procedural major/minor bleeding. Of 1,441 consecutive children identified during a 3-year period, 832 patients (226 in cohort A, 606 in cohort B) fulfilled the inclusion criteria. Overall, 36% (300/832) of the patients had at least one abnormal laboratory result. Only 0.2% (3/1,441) of patients required conversion to a central venous line. In cohort A no major bleeding occurred; the minor bleeding frequency was 30% (68/226). Neither abnormal laboratory results nor correction of abnormal laboratory results was associated with minor bleeding complications. The positive and negative predictive values (PPV/NPV) of having abnormal laboratory screening were 0.22 and 0.68, respectively. In cohort B the major bleeding frequency was 1% (6/606) but no patient required any blood transfusion; minor bleeding occurred in 29% (174/606). Neither abnormal laboratory results nor correction of abnormal laboratory results was associated with minor bleeding complications. The PPV and NPV of abnormal laboratory screening results were 0.24 and 0.72, respectively. Pre-procedural blood screening did not predict bleeding in hospitalized children without a known bleeding diathesis undergoing PICC insertion. The rarity of major bleeding complications and need for conversion to a central venous line did not support a need for laboratory screening.

  9. Technologies for converter topologies

    Science.gov (United States)

    Zhou, Yan; Zhang, Haiyu

    2017-02-28

    In some embodiments of the disclosed inverter topologies, an inverter may include a full bridge LLC resonant converter, a first boost converter, and a second boost converter. In such embodiments, the first and second boost converters operate in an interleaved manner. In other disclosed embodiments, the inverter may include a half-bridge inverter circuit, a resonant circuit, a capacitor divider circuit, and a transformer.

  10. Wavelength converter technology

    DEFF Research Database (Denmark)

    Kloch, Allan; Hansen, Peter Bukhave; Poulsen, Henrik Nørskov

    1999-01-01

    Wavelength conversion is important since it ensures full flexibility of the WDM network layer. Progress in optical wavelength converter technology is reviewed with emphasis on all-optical wavelength converter types based on semiconductor optical amplifiers.......Wavelength conversion is important since it ensures full flexibility of the WDM network layer. Progress in optical wavelength converter technology is reviewed with emphasis on all-optical wavelength converter types based on semiconductor optical amplifiers....

  11. Ibrutinib-associated bleeding: pathogenesis, management and risk reduction strategies.

    Science.gov (United States)

    Shatzel, J J; Olson, S R; Tao, D L; McCarty, O J T; Danilov, A V; DeLoughery, T G

    2017-05-01

    Ibrutinib is an irreversible inhibitor of Bruton's tyrosine kinase (Btk) that has proven to be an effective therapeutic agent for multiple B-cell-mediated lymphoproliferative disorders. Ibrutinib, however, carries an increased bleeding risk compared with standard chemotherapy. Bleeding events range from minor mucocutaneous bleeding to life-threatening hemorrhage, due in large part to the effects of ibrutinib on several distinct platelet signaling pathways. There is currently a minimal amount of data to guide clinicians regarding the use of ibrutinib in patients at high risk of bleeding or on anticoagulant or antiplatelet therapy. In addition, the potential cardiovascular protective effects of ibrutinib monotherapy in patients at risk of vascular disease are unknown. Patients should be cautioned against using non-steroidal anti-inflammatory drugs, fish oils, vitamin E and aspirin-containing products, and consider replacing ibrutinib with a different agent if dual antiplatelet therapy is indicated. Patients should not take vitamin K antagonists concurrently with ibrutinib; direct oral anticoagulants should be used if extended anticoagulation is strongly indicated. In this review, we describe the pathophysiology of ibrutinib-mediated bleeding and suggest risk reduction strategies for common clinical scenarios associated with ibrutinib. © 2017 International Society on Thrombosis and Haemostasis.

  12. Management of abnormal uterine bleeding – focus on ambulatory hysteroscopy

    Directory of Open Access Journals (Sweden)

    Kolhe S

    2018-03-01

    Full Text Available Shilpa Kolhe Ambulatory Gynaecology Unit, Royal Derby Hospital, Derby, UK Abstract: The rapid evolution in ambulatory hysteroscopy (AH has transformed the approach to diagnose and manage abnormal uterine bleeding (AUB. The medical management in primary care remains the mainstay for initial treatment of this common presentation; however, many women are referred to secondary care for further evaluation. To confirm the diagnosis of suspected intrauterine pathology, the traditional diagnostic tool of day case hysteroscopy and dilatation and curettage in a hospital setting under general anesthesia is now no longer required. The combination of ultrasound diagnostics and modern AH now allows thorough evaluation of uterine cavity in an outpatient setting. Advent of miniature hysteroscopic operative systems has revolutionized the ways in which clinicians can not only diagnose but also treat menstrual disorders such as heavy menstrual bleeding, intermenstrual bleeding and postmenopausal bleeding in most women predominantly in a one-stop clinic. This review discussed the approach to manage women presenting with AUB with a focus on the role of AH in the diagnosis and treatment of this common condition in an outpatient setting. Keywords: abnormal uterine bleeding, ambulatory hysteroscopy, endometrial polyps, one-stop clinic, vaginoscopic approach

  13. Histopathological pattern of abnormal uterine bleeding in endometrial biopsies.

    Science.gov (United States)

    Vaidya, S; Lakhey, M; Vaidya, S; Sharma, P K; Hirachand, S; Lama, S; KC, S

    2013-03-01

    Abnormal uterine bleeding is a common presenting complaint in gyanecology out patient department. Histopathological evaluation of the endometrial samples plays a significant role in the diagnosis of abnormal uterine bleeding. This study was carried out to determine the histopathological pattern of the endometrium in women of various age groups presenting with abnormal uterine bleeding. Endometrial biopsies and curettings of patients presenting with abnormal uterine bleeding was retrospectively studied. A total of 403 endometrial biopsies and curettings were analyzed. The age of the patients ranged from 18 to 70 years. Normal cyclical endometrium was seen in 165 (40.94%) cases, followed by 54 (13.40%) cases of disordered proliferative endometrium and 44 (10.92%) cases of hyperplasia. Malignancy was seen in 10 (2.48%) cases. Hyperplasia and malignancy were more common in the perimenopausal and postmenopausal age groups. Histopathological examination of endometrial biopsies and curettings in patients presenting with abnormal uterine bleeding showed a wide spectrum of changes ranging from normal endometrium to malignancy. Endometrial evaluation is specially recommended in women of perimenopausal and postmenopausal age groups presenting with AUB, to rule out a possibility of any preneoplastic condition or malignancy.

  14. Bleeding diathesis in Noonan syndrome

    NARCIS (Netherlands)

    Staudt, Joost M.; van der Horst, Chantal M. A. M.; Peters, Marjolijn; Melis, Paris

    2005-01-01

    An 18-year-old girl with Noonan syndrome was operated on for prominent ears. Subcutaneous haematomas developed on both sides, and coagulation tests reported a bleeding diathesis. This is seldom mentioned in descriptions of the syndrome, but it has been shown that one-third of all patients with the

  15. Radiological diagnosis of gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Neufang, K.F.R.; Gross-Fengels, W.; Lorenz, R.

    1990-01-01

    In the diagnosis of acute gastrointestinal bleeding, endoscopy holds the first place today. Radiological investigations are indispensable whenever endoscopy cannot precisely localise the bleeding site, whenever a tumour is present or suspected, in all cases of lower gastrointestinal bleeding, and in haemobilia. A tailored radiological approach is recommended. The radiological basis programme should be at least a complete abdominal ultrasound study and plain abdominal radiograms. CT and ERCP scans may become necessary in selected cases. As a rule, angiographical localisation of the bleeding site will be successful only in the acute stage; selective visceral arteriograms have to be obtained, which may be executed in the digital subtraction technique in patients who are cooperating and clinically stable. Angiodysplasias and aneurysms, however, may be demonstrated angiographically in the interval as well. Upper and/or lower G.I. tract studies with barium or water-soluble contrast media may be indicated in the interval in order to demonstrate tumours, metastatic lesions, diverticula and gut malformations. (orig.) [de

  16. Managing Chemotherapy Side Effects: Bleeding Problems

    Science.gov (United States)

    ... C ancer I nstitute Managing Chemotherapy Side Effects Bleeding Problems “My nurse said that chemotherapy could make ... with a clean cloth. Keep pressing until the bleeding stops. If you bruise: Put ice on the ...

  17. Postpolypectomy lower GI bleeding: descriptive analysis

    NARCIS (Netherlands)

    Sorbi, D.; Norton, I.; Conio, M.; Balm, R.; Zinsmeister, A.; Gostout, C. J.

    2000-01-01

    BACKGROUND: Postpolypectomy hemorrhage may warrant intensive care monitoring, transfusions, and surgery. We sought factors predicting significant bleeding requiring blood transfusion and the benefits of critical care monitoring. METHODS: Patients with postpolypectomy bleeding between April 1989 and

  18. ITER convertible blanket evaluation

    International Nuclear Information System (INIS)

    Wong, C.P.C.; Cheng, E.

    1995-01-01

    Proposed International Thermonuclear Experimental Reactor (ITER) convertible blankets were reviewed. Key design difficulties were identified. A new particle filter concept is introduced and key performance parameters estimated. Results show that this particle filter concept can satisfy all of the convertible blanket design requirements except the generic issue of Be blanket lifetime. If the convertible blanket is an acceptable approach for ITER operation, this particle filter option should be a strong candidate

  19. Power converters definitions, classification and converter topologies

    CERN Document Server

    Bordry, Frederick

    2006-01-01

    This paper introduces power conversion principles and defines the terminology. The concepts of sources and switches are defined and classified. From the basic laws of source interconnections, a generic method of power converter synthesis is presented. Some examples illustrate this systematic method. Finally, the notions of commutation cell and soft commutation are introduced and discussed.

  20. 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......) again as soon as cardiovascular risks outweigh gastrointestinal risks. Patients in need of continued treatment with ASA or a nonsteroidal anti-inflammatory drug should be put on prophylactic treatment with PPI at standard dosage. The combination of 75mg ASA and PPI should be preferred to monotherapy...

  1. Gastrointestinal Bleeding Secondary to Calciphylaxis

    Science.gov (United States)

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

    2015-01-01

    Patient: Female, 66 Final Diagnosis: Calciphylaxis Symptoms: Gastrointesinal haemorrhage Medication: None Clinical Procedure: Hemodialysis • blood transfusions Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of calciphylaxis leading to lower gastrointestinal (GI) bleeding and rectal ulceration of the GI mucosa. Case Report: A 66-year-old woman with past medical history of diabetes mellitus, hypertension, end-stage renal disease (ESRD), recently diagnosed ovarian cancer, and on hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive vascular calcifications. Recurrent episodes of profuse GI bleeding were managed conservatively with blood transfusion as needed. Following her diagnosis of calciphylaxis, supplementation with vitamin D and calcium containing phosphate binders was stopped. She was started on daily hemodialysis with low calcium dialysate bath as well as intravenous sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure. Conclusions: Calciphylaxis leading to intestinal ischemia/perforation should be considered in the differential diagnosis in ESRD on HD presenting with abdominal pain or GI bleeding. PMID:26572938

  2. Management of bleeding in acquired hemophilia A: results from the European Acquired Haemophilia (EACH2) Registry.

    Science.gov (United States)

    Baudo, Francesco; Collins, Peter; Huth-Kühne, Angela; Lévesque, Hervé; Marco, Pascual; Nemes, László; Pellegrini, Fabio; Tengborn, Lilian; Knoebl, Paul

    2012-07-05

    Acquired hemophilia A is a rare bleeding disorder caused by autoantibodies to coagulation FVIII. Bleeding episodes at presentation are spontaneous and severe in most cases. Optimal hemostatic therapy is controversial, and available data are from observational and retrospective studies only. The EACH2 registry, a multicenter, pan-European, Web-based database, reports current patient management. The aim was to assess the control of first bleeding episodes treated with a bypassing agent (rFVIIa or aPCC), FVIII, or DDAVP among 501 registered patients. Of 482 patients with one or more bleeding episodes, 144 (30%) received no treatment for bleeding; 31 were treated with symptomatic therapy only. Among 307 patients treated with a first-line hemostatic agent, 174 (56.7%) received rFVIIa, 63 (20.5%) aPCC, 56 (18.2%) FVIII, and 14 (4.6%) DDAVP. Bleeding was controlled in 269 of 338 (79.6%) patients treated with a first-line hemostatic agent or ancillary therapy alone. Propensity score matching was applied to allow unbiased comparison between treatment groups. Bleeding control was significantly higher in patients treated with bypassing agents versus FVIII/DDAVP (93.3% vs 68.3%; P = .003). Bleeding control was similar between rFVIIa and aPCC (93.0%; P = 1). Thrombotic events were reported in 3.6% of treated patients with a similar incidence between rFVIIa (2.9%) and aPCC (4.8%).

  3. Automated registration of tail bleeding in rats.

    Science.gov (United States)

    Johansen, Peter B; Henriksen, Lars; Andresen, Per R; Lauritzen, Brian; Jensen, Kåre L; Juhl, Trine N; Tranholm, Mikael

    2008-05-01

    An automated system for registration of tail bleeding in rats using a camera and a user-designed PC-based software program has been developed. The live and processed images are displayed on the screen and are exported together with a text file for later statistical processing of the data allowing calculation of e.g. number of bleeding episodes, bleeding times and bleeding areas. Proof-of-principle was achieved when the camera captured the blood stream after infusion of rat whole blood into saline. Suitability was assessed by recording of bleeding profiles in heparin-treated rats, demonstrating that the system was able to capture on/off bleedings and that the data transfer and analysis were conducted successfully. Then, bleeding profiles were visually recorded by two independent observers simultaneously with the automated recordings after tail transection in untreated rats. Linear relationships were found in the number of bleedings, demonstrating, however, a statistically significant difference in the recording of bleeding episodes between observers. Also, the bleeding time was longer for visual compared to automated recording. No correlation was found between blood loss and bleeding time in untreated rats, but in heparinized rats a correlation was suggested. Finally, the blood loss correlated with the automated recording of bleeding area. In conclusion, the automated system has proven suitable for replacing visual recordings of tail bleedings in rats. Inter-observer differences can be eliminated, monotonous repetitive work avoided, and a higher through-put of animals in less time achieved. The automated system will lead to an increased understanding of the nature of bleeding following tail transection in different rodent models.

  4. [Antithrombotic therapy and nonvariceal upper gastrointestinal bleeding].

    Science.gov (United States)

    Belanová, Veronika; Gřiva, Martin

    2015-12-01

    The incidence of acute upper gastrointestinal bleeding is about 85-108/100,000 inhabitants per year, nonvariceal bleeding accounts for 80-90%. Antiplatelet and anticoagulation treatment are the significant risk factors for upper gastrointestinal bleeding. To evaluate the occurrence of upper gastrointestinal bleeding in the general community of patients in a county hospital. And to compare the role played by antiplatelet and anticoagulation drugs and other risk medication. Retrospective analysis of patients over 18 years of age who underwent endoscopy for acute upper gastrointestinal bleeding or anaemia (haemoglobinupper gastrointestinal tract during a hospital stay in 2013 (from January to June). We included 111 patients of average age 69±15 years, men 60%. Nonvariceal bleeding accounted for 90% of the cases. None of the patients with variceal bleeding (10% of patients) took antiplatelet or anticoagulation therapy. There were 100 patients with nonvariceal bleeding of average age 70±15, 61% men. With the symptoms of acute bleeding (hematemesis, melena) presented in 73% of patients. The most frequent cause of bleeding was gastric and duodenal ulcer (54%). 32% of patients with nonvariceal bleeding had antiplatelets, 19% anticoagulants and 10% used nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors or corticosteroids. 30-days mortality of patients with nonvariceal bleeding was 11%, annual mortality was 23%. There was no significant difference in mortality, blood transfusion requirements or surgical intervention between the patients with antithrombotic agents and without them. 25% of patients (8 patients) using acetylsalicylic acid did not fulfil the indication for this treatment. Among the patients examined by endoscopy for symptomatic nonvariceal bleeding and/or anaemia (haemoglobingastrointestinal bleeding. With regard to that, it is alarming, that there still exists a nonnegligible percentage of patients taking acetylsalicylic acid even

  5. Cascaded resonant bridge converters

    Science.gov (United States)

    Stuart, Thomas A. (Inventor)

    1989-01-01

    A converter for converting a low voltage direct current power source to a higher voltage, high frequency alternating current output for use in an electrical system where it is desired to use low weight cables and other circuit elements. The converter has a first stage series resonant (Schwarz) converter which converts the direct current power source to an alternating current by means of switching elements that are operated by a variable frequency voltage regulator, a transformer to step up the voltage of the alternating current, and a rectifier bridge to convert the alternating current to a direct current first stage output. The converter further has a second stage series resonant (Schwarz) converter which is connected in series to the first stage converter to receive its direct current output and convert it to a second stage high frequency alternating current output by means of switching elements that are operated by a fixed frequency oscillator. The voltage of the second stage output is controlled at a relatively constant value by controlling the first stage output voltage, which is accomplished by controlling the frequency of the first stage variable frequency voltage controller in response to second stage voltage. Fault tolerance in the event of a load short circuit is provided by making the operation of the first stage variable frequency voltage controller responsive to first and second stage current limiting devices. The second stage output is connected to a rectifier bridge whose output is connected to the input of the second stage to provide good regulation of output voltage wave form at low system loads.

  6. Endocrine carcinoma of the pancreatic tail exhibiting gastric variceal bleeding

    Directory of Open Access Journals (Sweden)

    Si-Yuan Wu

    2014-01-01

    Full Text Available Nonfunctional endocrine carcinoma of the pancreas is uncommon. Without excess hormone secretion, it is clinically silent until the enlarging or metastatic tumor causes compressive symptoms. Epigastric pain, dyspepsia, jaundice, and abdominal mass are the usual symptoms, whereas upper gastrointestinal (GI bleeding is rare. Here, we describe the case of a 24-year-old man with the chief complaint of hematemesis. Upper GI panendoscopy revealed isolated gastric varices at the fundus and upper body. Ultrasonography and computed tomography showed a tumor mass at the pancreatic tail causing a splenic vein obstruction, engorged vessels near the fundus of the stomach, and splenomegaly. After distal pancreatectomy and splenectomy, the bleeding did not recur. The final pathologic diagnosis was endocrine carcinoma of the pancreas. Gastric variceal bleeding is a possible manifestation of nonfunctional endocrine carcinoma of the pancreas if the splenic vein is affected by a tumor. In non-cirrhotic patients with isolated gastric variceal bleeding, the differential diagnosis should include pancreatic disorders.

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

    International Nuclear Information System (INIS)

    Dawood, N.S.; Peter, K.; Ibrar, F.; Dawood, A.

    2010-01-01

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

  8. Clinical utility of neuronal cells directly converted from fibroblasts of patients for neuropsychiatric disorders: studies of lysosomal storage diseases and channelopathy

    Science.gov (United States)

    Kano, Shin-ichi; Yuan, Ming; Cardarelli, Ross A.; Maegawa, Gustavo; Higurashi, Norimichi; Gaval-Cruz, Meriem; Wilson, Ashley M.; Tristan, Carlos; Kondo, Mari A.; Chen, Yian; Koga, Minori; Obie, Cassandra; Ishizuka, Koko; Seshadri, Saurav; Srivastava, Rupali; Kato, Takahiro A.; Horiuchi, Yasue; Sedlak, Thomas W.; Lee, Yohan; Rapoport, Judith L.; Hirose, Shinichi; Okano, Hideyuki; Valle, David; O'Donnell, Patricio; Sawa, Akira; Kai, Mihoko

    2015-01-01

    Methodologies for generating functional neuronal cells directly from human fibroblasts [induced neuronal (iN) cells] have been recently developed, but the research so far has only focused on technical refinements or recapitulation of known pathological phenotypes. A critical question is whether this novel technology will contribute to elucidation of novel disease mechanisms or evaluation of therapeutic strategies. Here we have addressed this question by studying Tay-Sachs disease, a representative lysosomal storage disease, and Dravet syndrome, a form of severe myoclonic epilepsy in infancy, using human iN cells with feature of immature postmitotic glutamatergic neuronal cells. In Tay-Sachs disease, we have successfully characterized canonical neuronal pathology, massive accumulation of GM2 ganglioside, and demonstrated the suitability of this novel cell culture for future drug screening. In Dravet syndrome, we have identified a novel functional phenotype that was not suggested by studies of classical mouse models and human autopsied brains. Taken together, the present study demonstrates that human iN cells are useful for translational neuroscience research to explore novel disease mechanisms and evaluate therapeutic compounds. In the future, research using human iN cells with well-characterized genomic landscape can be integrated into multidisciplinary patient-oriented research on neuropsychiatric disorders to address novel disease mechanisms and evaluate therapeutic strategies. PMID:25732146

  9. 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. ...

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

    Directory of Open Access Journals (Sweden)

    Jason Siegel

    2016-06-01

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

  11. [Menstrual disorders in adolescents: commonplace or worrisome?].

    Science.gov (United States)

    Jacot-Guillarmod, M; Renteria, S C

    2010-06-16

    The first menstrual cycles following menarche are often caracterized by irregular and/or heavy bleeding. The adolescent patient may be worried by these episodes of bleeding. In 50-80% of cases these are anovulatory bleeding due to the immaturity of the gonadotrophic axis. Nevertheless pathologies such as von Willebrand disease, genital infection, polycystic ovary syndrom, eating disorders, a tumor or a pregnancy may be diagnosed by bleeding abnormalities. The challenge for the physician is to distinguish between bleeding abnormalities secondary to anovulation and pathologies where investigations and specific follow-up is mandatory. Adolescents who experience abnormal bleeding must be counceled according to their perceptions and expectations.

  12. SSG Wave Energy Converter

    DEFF Research Database (Denmark)

    Margheritini, Lucia; Vicinanza, Diego; Frigaard, Peter

    2008-01-01

    The SSG (Sea Slot-cone Generator) is a wave energy converter of the overtopping type. The structure consists of a number of reservoirs one on the top of each others above the mean water level, in which the water of incoming waves is stored temporary. In each reservoir, expressively designed low...... head hydroturbines are converting the potential energy of the stored water into power. A key to success for the SSG will be the low cost of the structure and its robustness. The construction of the pilot plant is scheduled and this paper aims to describe the concept of the SSG wave energy converter...

  13. Electric current - frequency converter

    International Nuclear Information System (INIS)

    Kumahara, Tadashi; Kinbana, Setsuro.

    1967-01-01

    Herein disclosed is an improved simple electric current-frequency converter, the input current and output frequency linearity of which is widened to a range of four to five figures while compensating, for temperature. The converter may be used for computor processing and for telemetering the output signals from a nuclear reactor. The converter is an astable multivibrator which includes charging circuits comprising emitter-voltage compensated NPN transistors, a charged voltage detecting circuit of temperature compensated field effect transistors, and a transistor switching circuit for generating switching pulses independent of temperature. The converter exhibited a 0.7% frequency change within a range of 5 - 45 0 C and less than a 0.1% frequency drift after six hours of operation when the input current was maintained constant. (Yamaguchi, T.)

  14. Improving Power Converter Reliability

    DEFF Research Database (Denmark)

    Ghimire, Pramod; de Vega, Angel Ruiz; Beczkowski, Szymon

    2014-01-01

    of a high-power IGBT module during converter operation, which may play a vital role in improving the reliability of the power converters. The measured voltage is used to estimate the module average junction temperature of the high and low-voltage side of a half-bridge IGBT separately in every fundamental......The real-time junction temperature monitoring of a high-power insulated-gate bipolar transistor (IGBT) module is important to increase the overall reliability of power converters for industrial applications. This article proposes a new method to measure the on-state collector?emitter voltage...... is measured in a wind power converter at a low fundamental frequency. To illustrate more, the test method as well as the performance of the measurement circuit are also presented. This measurement is also useful to indicate failure mechanisms such as bond wire lift-off and solder layer degradation...

  15. Thermionic photovoltaic energy converter

    Science.gov (United States)

    Chubb, D. L. (Inventor)

    1985-01-01

    A thermionic photovoltaic energy conversion device comprises a thermionic diode mounted within a hollow tubular photovoltaic converter. The thermionic diode maintains a cesium discharge for producing excited atoms that emit line radiation in the wavelength region of 850 nm to 890 nm. The photovoltaic converter is a silicon or gallium arsenide photovoltaic cell having bandgap energies in this same wavelength region for optimum cell efficiency.

  16. 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.

  17. Gastric ulcer bleeding: diagnosis by computed tomography

    International Nuclear Information System (INIS)

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

    1999-01-01

    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

  18. Upper gastrointestinal bleeding in patients with CKD.

    Science.gov (United States)

    Liang, Chih-Chia; Wang, Su-Ming; Kuo, Huey-Liang; Chang, Chiz-Tzung; Liu, Jiung-Hsiun; Lin, Hsin-Hung; Wang, I-Kuan; Yang, Ya-Fei; Lu, Yueh-Ju; Chou, Che-Yi; Huang, Chiu-Ching

    2014-08-07

    Patients with CKD receiving maintenance dialysis are at risk for upper gastrointestinal bleeding. However, the risk of upper gastrointestinal bleeding in patients with early CKD who are not receiving dialysis is unknown. The hypothesis was that their risk of upper gastrointestinal bleeding is negatively linked to renal function. To test this hypothesis, the association between eGFR and risk of upper gastrointestinal bleeding in patients with stages 3-5 CKD who were not receiving dialysis was analyzed. Patients with stages 3-5 CKD in the CKD program from 2003 to 2009 were enrolled and prospectively followed until December of 2012 to monitor the development of upper gastrointestinal bleeding. The risk of upper gastrointestinal bleeding was analyzed using competing-risks regression with time-varying covariates. In total, 2968 patients with stages 3-5 CKD who were not receiving dialysis were followed for a median of 1.9 years. The incidence of upper gastrointestinal bleeding per 100 patient-years was 3.7 (95% confidence interval, 3.5 to 3.9) in patients with stage 3 CKD, 5.0 (95% confidence interval, 4.8 to 5.3) in patients with stage 4 CKD, and 13.9 (95% confidence interval, 13.1 to 14.8) in patients with stage 5 CKD. Higher eGFR was associated with a lower risk of upper gastrointestinal bleeding (P=0.03), with a subdistribution hazard ratio of 0.93 (95% confidence interval, 0.87 to 0.99) for every 5 ml/min per 1.73 m(2) higher eGFR. A history of upper gastrointestinal bleeding (Pupper gastrointestinal bleeding risk. In patients with CKD who are not receiving dialysis, lower renal function is associated with higher risk for upper gastrointestinal bleeding. The risk is higher in patients with previous upper gastrointestinal bleeding history and low serum albumin. Copyright © 2014 by the American Society of Nephrology.

  19. Management of acute gastric varices bleeding

    Directory of Open Access Journals (Sweden)

    Chen-Jung Chang

    2013-10-01

    Full Text Available Gastroesophageal varices bleeding is a major complication in patients with cirrhosis. Gastric varices (GVs occur in approximately 20% of patients with portal hypertension. However, GV bleeding develops in only 25% of patients with GV and requires more transfusion and has higher mortality than esophageal variceal (EV bleeding. The best strategy for managing acute GV bleeding is similar to that of acute EV bleeding, which involves airway protection, hemodynamic stabilization, and intensive care. Blood transfusion should be cautiously administered in order to avoid rebleeding. Vasoactive agents such as terlipressin or somatostatin should be used when GV bleeding is suspected. Routine use of prophylactic antibiotics reduces bacterial infection and lowers rebleeding rates. By administering endoscopic cyanoacrylate injection, the initial hemostasis rate achieved is at least 90% in most cases; the average mortality rate of GV bleeding is approximately 10–30% and the rebleeding rate is between 22% and 37%. Although endoscopic injection of cyanoacrylate is superior to sclerotherapy and band ligation, and has remained the treatment of choice for treating acute GV bleeding, the outcome of this treatment is still unsatisfactory. New treatment options, such as thrombin injection, transjugular intrahepatic portosystemic shunts, or balloon-occluded retrograde transvenous obliteration, have shown promising results for acute GV bleeding. However, randomized controlled trials are needed to compare the efficacy of these therapies with cyanoacrylate.

  20. Serendipity in scintigraphic gastrointestinal bleeding studies

    International Nuclear Information System (INIS)

    Goergen, T.G.

    1983-01-01

    A retrospective review of 80 scintigraphic bleeding studies performed with Tc-99m sulfur colloid or Tc-99m labeled red blood cells showed five cases where there were abnormal findings not related to bleeding. In some cases, the abnormalities were initially confused with bleeding or could obscure an area of bleeding, while in other cases, the abnormalities represented additional clinical information. These included bone marrow replacement related to tumor and radiation therapy, hyperemia related to a uterine leiomyoma and a diverticular abscess, and a dilated abdominal aorta (aneurysm). Recognition of such abnormalities should prevent an erroneous diagnosis and the additional information may be of clinical value

  1. The angiotensin converting enzyme inhibitor, captopril, prevents the hyperactivity and impulsivity of neurokinin-1 receptor gene 'knockout' mice: sex differences and implications for the treatment of attention deficit hyperactivity disorder.

    Science.gov (United States)

    Porter, Ashley J; Pillidge, Katharine; Grabowska, Ewelina M; Stanford, S Clare

    2015-04-01

    Mice lacking functional neurokinin-1 receptors (NK1R-/-) display behavioural abnormalities resembling attention deficit hyperactivity disorder (ADHD): locomotor hyperactivity, impulsivity and inattentiveness. The preferred ligand for NK1R, substance P, is metabolised by angiotensin converting enzyme (ACE), which forms part of the brain renin angiotensin system (BRAS). In view of evidence that the BRAS modulates locomotor activity and cognitive performance, we tested the effects of drugs that target the BRAS on these behaviours in NK1R-/- and wildtype mice. We first tested the effects of the ACE inhibitor, captopril, on locomotor activity. Because there are well-established sex differences in both ADHD and ACE activity, we compared the effects of captopril in both male and female mice. Locomotor hyperactivity was evident in male NK1R-/- mice, only, and this was abolished by treatment with captopril. By contrast, male wildtypes and females of both genotypes were unaffected by ACE inhibition. We then investigated the effects of angiotensin AT1 (losartan) and AT2 (PD 123319) receptor antagonists on the locomotor activity of male NK1R-/- and wildtype mice. Both antagonists increased the locomotor activity of NK1R-/- mice, but neither affected the wildtypes. Finally, we tested the effects of captopril on the performance of male NK1R-/- and wildtype mice in the 5-choice serial reaction-time task (5-CSRTT) and found that ACE inhibition prevented the impulsivity of NK1R-/- mice. These results indicate that certain behaviours, disrupted in ADHD, are influenced by an interaction between the BRAS and NK1R, and suggest that ACE inhibitors could provide a novel treatment for this disorder. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

  2. 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...

  3. Provocative Endoscopy to Identify Bleeding Site in Upper Gastrointestinal Bleeding: A Novel Approach in Transarterial Embolization.

    Science.gov (United States)

    Kamo, Minobu; Fuwa, Sokun; Fukuda, Katsuyuki; Fujita, Yoshiyuki; Kurihara, Yasuyuki

    2016-07-01

    This report describes a novel approach to endoscopically induce bleeding by removing a clot from the bleeding site during angiography for upper gastrointestinal (UGI) hemorrhage. This procedure enabled accurate identification of the bleeding site, allowing for successful targeted embolization despite a negative initial angiogram. Provocative endoscopy may be a feasible and useful option for angiography of obscure bleeding sites in patients with UGI arterial hemorrhage. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  4. Both Hemophilia Health Care Providers and Hemophilia A Carriers Report that Carriers have Excessive Bleeding

    Science.gov (United States)

    Paroskie, Allison; Oso, Olatunde; DeBaun, Michael R.; Sidonio, Robert F

    2014-01-01

    Introduction Hemophilia A, the result of reduced factor VIII (FVIII) activity, is an X-linked recessive bleeding disorder. Previous reports of Hemophilia A carriers suggest an increased bleeding tendency. Our objective was to determine the attitudes and understanding of the Hemophilia A carrier bleeding phenotype, and opinions regarding timing of carrier testing from the perspective of both medical providers and affected patients. Data from this survey was used as preliminary data for an ongoing prospective study. Material and Methods An electronic survey was distributed to physicians and nurses employed at Hemophilia Treatment Centers (HTC), and Hemophilia A carriers who were members of Hemophilia Federation of America. Questions focused on the clinical understanding of bleeding symptoms and management of Hemophilia A carriers, and the timing and intensity of carrier testing. Results Our survey indicates that 51% (36/51) of providers compared to 78% (36/46) of carriers believe that Hemophilia A carriers with normal FVIII activity have an increased bleeding tendency (pHemophilia A carriers report a high frequency of bleeding symptoms. Regarding carrier testing, 72% (50/69) of medical providers recommend testing after 14 years of age, conversely 65% (29/45) of Hemophilia A carriers prefer testing to be done prior to this age (pHemophilia A carriers self-report a higher frequency of bleeding than previously acknowledged, and have a preference for earlier testing to confirm carrier status. PMID:24309601

  5. Helical CT in acute lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Ernst, Olivier; Leroy, Christophe; Sergent, Geraldine; Bulois, Philippe; Saint-Drenant, Sophie; Paris, Jean-Claude

    2003-01-01

    The purpose of this study was to assess the usefulness of helical CT in depicting the location of acute lower gastrointestinal bleeding. A three-phase helical CT of the abdomen was performed in 24 patients referred for acute lower gastrointestinal bleeding. The diagnosis of the bleeding site was established by CT when there was at least one of the following criteria: spontaneous hyperdensity of the peribowel fat; contrast enhancement of the bowel wall; vascular extravasation of the contrast medium; thickening of the bowel wall; polyp or tumor; or vascular dilation. Diverticula alone were not enough to locate the bleeding site. The results of CT were compared with the diagnosis obtained by colonoscopy, enteroscopy, or surgery. A definite diagnosis was made in 19 patients. The bleeding site was located in the small bowel in 5 patients and the colon in 14 patients. The CT correctly located 4 small bowel hemorrhages and 11 colonic hemorrhages. Diagnosis of the primary lesion responsible for the bleeding was made in 10 patients. Our results suggest that helical CT could be a good diagnostic tool in acute lower gastrointestinal bleeding to help the physician to diagnose the bleeding site. (orig.)

  6. 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...... to and subsequent to first trimester bleeding without miscarriage....

  7. Rectal bleeding in children: endoscopic evaluation revisited

    NARCIS (Netherlands)

    de Ridder, Lissy; van Lingen, Anna V.; Taminiau, Jan A. J. M.; Benninga, Marc A.

    2007-01-01

    Objectives Rectal bleeding is an alarming event both for the child and parents. It is hypothesized that colonoscopy instead of sigmoidoscopy and adding esophago-gastro-duodenoscopy in case of accompanying complaints, improves the diagnostic accuracy in children with prolonged rectal bleeding. Study

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

    African Journals Online (AJOL)

    Portal hypertension due to intrahepatic disease or extrahepatic portal vein obstruction (EHPVO) is an important cause of upper gastro- intestinal bleeding in children. About 50% of children with EHPVO present with bleeding from oesophageal varices.1-3 Improvements in the management of children with intrahepatic ...

  9. 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.

  10. Perioperative bleeding and blood transfusion are major risk factors for venous thromboembolism following bariatric surgery.

    Science.gov (United States)

    Nielsen, Alexander W; Helm, Melissa C; Kindel, Tammy; Higgins, Rana; Lak, Kathleen; Helmen, Zachary M; Gould, Jon C

    2018-05-01

    Morbidly obese patients are at increased risk for venous thromboembolism (VTE) after bariatric surgery. Perioperative chemoprophylaxis is used routinely with bariatric surgery to decrease the risk of VTE. When bleeding occurs, routine chemoprophylaxis is often withheld due to concerns about inciting another bleeding event. We sought to evaluate the relationship between perioperative bleeding and postoperative VTE in bariatric surgery. The American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) dataset between 2012 and 2014 was queried to identify patients who underwent bariatric surgery. Gastric bypass (n = 28,145), sleeve gastrectomy (n = 30,080), bariatric revision (n = 324), and biliopancreatic diversion procedures (n = 492) were included. Univariate and multivariate regressions were used to determine perioperative factors predictive of postoperative VTE within 30 days in patients who experience a bleeding complication necessitating transfusion. The rate of bleeding necessitating transfusion was 1.3%. Bleeding was significantly more likely to occur in gastric bypass compared to sleeve gastrectomy (1.6 vs. 1.0%) (p surgeries, increased age, length of stay, operative time, and comorbidities including hypertension, dyspnea with moderate exertion, partially dependent functional status, bleeding disorder, transfusion prior to surgery, ASA class III/IV, and metabolic syndrome increased the perioperative bleeding risk (p Bariatric surgery patients who receive postoperative blood transfusion are at a significantly increased risk for VTE. The etiology of VTE in those who are transfused is likely multifactorial and possibly related to withholding chemoprophylaxis and the potential of a hypercoagulable state induced by the transfusion. In those who bleed, consideration should be given to reinitiating chemoprophylaxis when safe, extending treatment after discharge, and screening ultrasound.

  11. Effect of Gastric Acid Suppressant Prophylaxis on Incidence of Gastrointestinal Bleeding in Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Tahoora Abdollahi

    2016-11-01

    Full Text Available Background: Critically ill children admitted to pediatric intensive care unit (PICU are at increased risk of gastrointestinal bleeding due to stress related mucosal injury. Reducing gastric acid by acid suppressant medication is the accepted prophylaxis treatment, but there is not any definitive guideline for using prophylaxis in PICU patients. The present study aimed to assess the effect of Proton Pump Inhibitor (PPI and H2 Blocker (H2B prophylaxis on gastrointestinal bleeding in admitted patients of PICU, Mashhad- Iran.Materials and Methods: In this study, 100 patients admitted in PICU divided into two equal groups on the first day of admission. They received ranitidine or pantoprazole as prophylaxis of stress ulcer. Those patients who had history of gastrointestinal bleeding or coagulation disorder were excluded. 100 PICU patients who had not received prophylaxis during last 6 months retrospectively evaluated as control of the study. Data were collected as demographic characteristics, admission reason, definitive diagnosis, receiving corticosteroid and mechanical ventilation in each patient. Gastrointestinal bleeding (hematemesis, coffee ground aspirate, and melena and clinically significant gastrointestinal bleeding were daily monitored. Data analyzed through descriptive statistical tests, Chi-square, logistic regression, t-test and using SPSS-16 software.Results: Among 204 patients (control group=105 and case group=99, incidence of gastrointestinal bleeding (GB was 13.2% in which 6.9% of cases presented with clinically significant gastrointestinal bleeding (CSGB. Loss of consciousness and respiratory distress were the main reason of admission. There was no significant differences between the incidence of (GB and (CSGB in experimental and control groups (P>0.05 as well as ranitidine and pantoprazole prophylaxis (P>0.05. Significant risk factors of (GB were mechanical ventilation and loss of consciousness and corticosteroid therapy

  12. An Electromagnetic Beam Converter

    DEFF Research Database (Denmark)

    2009-01-01

    The present invention relates to an electromagnetic beam converter and a method for conversion of an input beam of electromagnetic radiation having a bell shaped intensity profile a(x,y) into an output beam having a prescribed target intensity profile l(x',y') based on a further development...

  13. Converting the reset

    NARCIS (Netherlands)

    J.K. Hoogland (Jiri); C.D.D. Neumann; D. Bloch

    2001-01-01

    textabstractWe give a simple algorithm to incorporate the effects of resets in convertible bond prices, without having to add an extra factor to take into account the value of the reset. Furthermore we show that the effect of a notice period, and additional make-whole features, can be treated in a

  14. Definition of Power Converters

    CERN Document Server

    Bordry, F

    2015-01-01

    The paper is intended to introduce power conversion principles and to define common terms in the domain. The concept s of sources and switches are defined and classified. From the basic laws of source interconnections, a generic method of power converter synthesis is presented. Some examples illustrate this systematic method. Finally, the commutation cell and soft commuta tion are introduced and discussedd.

  15. Thermoelectrode for thermoelectric converter

    International Nuclear Information System (INIS)

    Bodiul, Pavel; Bondarciuc, Nicolae; Ghitu, Dumitru; Nikolaeva, Albina; Konopko, Leonid; Turcan, Ana

    2008-01-01

    The invention relates to the electronic engneering and can be used for manufacturing of thermoelectrodes for thermoelectric converters. The thermoelectrode is made of semiconductor anisotropic material in the form of thread in glass insulation. At the same timer, the thread is made of stannum-doped tellurium in the ratio of 0.1...3 at.%.

  16. The Convertible Arbitrage Strategy Analyzed

    NARCIS (Netherlands)

    Loncarski, I.; Ter Horst, J.R.; Veld, C.H.

    2006-01-01

    This paper analyzes convertible bond arbitrage on the Canadian market for the period 1998 to 2004.Convertible bond arbitrage is the combination of a long position in convertible bonds and a short position in the underlying stocks. Convertible arbitrage has been one of the most successful strategies

  17. 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

  18. Recent pharmacological management of oral bleeding in hemophilic patient

    Directory of Open Access Journals (Sweden)

    Monica Widyawati Setiawan

    2011-09-01

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

  19. Break-through bleeding in relation to predicted factor VIII levels in patients receiving prophylactic treatment for severe hemophilia A

    NARCIS (Netherlands)

    Collins, P. W.; Blanchette, V. S.; Fischer, K.; Bjorkman, S.; Oh, M.; Fritsch, S.; Schroth, P.; Spotts, G.; Astermark, J.; Ewenstein, B.

    Background: The role of prophylactic factor VIII (FVIII) to decrease hemophilic bleeding and arthropathy is well established. The rationale for this strategy is to convert patients with severe hemophilia A to a moderate clinical phenotype by reducing time spent with a FVIII level <1 IU dL(-1).

  20. ABNORMAL UTERINE BLEEDING IN ADOLESCENTS — ENDOCRINE PROFILE CONDITION

    Directory of Open Access Journals (Sweden)

    E. V. Sibirskaya

    2014-01-01

    Full Text Available Aim: The purpose of the study was to evaluate the endocrine profile condition in adolescent girls with abnormal uterine bleeding. Patients and methods: The participants of the study were 110 adolescent girls in the age between 11 and 15 years taken to hospital by emergency indication in the period between 2010–2013 years with dysfunctional uterine bleeding for the term from 3 to 48 days. In the first day of hospitalization before starting the hormonal therapy all patients underwent the physical examination, ultrasonic examination of pelvic organs and endocrine profile assessment. Concentration of follicle-stimulating hormone (FSH and luteinizing hormone (LH and the levels of mammotropic hormone, thyrotropic hormone, estradiol, progesterone and testosterone in their blood were determined. Besides that physicians assessed the complete blood count indices: hemoglobin concentration, erythrocyte number and hematocrits. Results: It was determined that the predisposing causes of abnormal uterine bleeding development in adolescents: high somatic pathology frequency, abnormalities of neuroendocrinal system and menstrual cycle. Gynecological pathology in adolescents is represented by significant disorders of menstrual function establishment expressed in the later beginning of menstruation, its intensity and duration. The authors also note the higher frequency of inflammatory diseases such as adnexitis, edeitis, vulvovaginitis and coleitis in comparison with the control group (37.3 and 30%, respectively. Another tendency was observed while studying the endocrine profile: in patients with hyperestrogenism the normal or increased content of FSH at the normal or lowered LH concentration is observed. At the same time, in patients with hypestrogenism FSH concentration at the lower limits of the age group is lowered, while LH concentration is lowered or normal. Conclusion: Abnormal uterine bleeding in adolescents in the most cases is developing in the setting

  1. Postpartum bleeding: efficacy of endovascular management

    International Nuclear Information System (INIS)

    Lee, Sun Young; Ko, Gi Young; Song, Ho Young; Gwon, Dong Il; Sung, Kyu Bo; Yoon, Hyun Ki

    2003-01-01

    To assess the effectiveness and safety of transcatheter arterial embolization for the treatment of massive postpartum bleeding. Transcatheter arterial embolization was attempted in 25 patients with massive postpartum bleeding. After identification at bilateral internal iliac arteriography, the bleeding artery was embolized using gelfoam, polyvinyl alcohol particles or microcoils, and to prevent rebleeding through collateral pathways, the contralateral uterine artery or anterior division of the internal iliac artery was also embolized. Clinical success and complications were retrospectively assessed and documented. Active bleeding foci were detected in 13 patients (52%), and involved the unilateral (n=10) or bilateral (n=2) uterine artery and unilateral vaginal artery (n=1). Twelve (92%) of the 13 patients recovered completely following embolization, but one underwent hysterectomy due to persistent bleeding. The focus of bleeding was not detected in 12 patients (48%), but 11 (92%) of these also recovered following embolization of the bilateral uterine or internal iliac arteries. One patient, however, died due to sepsis. Two of the 12 patients underwent hysterectomy due ro rebleeding on the 12 th and 13 th day, respectively, after embolization. Transcatheter arterial embolization is relatively safe and effective for the treatment massive postpartum bleeding

  2. Postpartum bleeding: efficacy of endovascular management

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sun Young; Ko, Gi Young; Song, Ho Young; Gwon, Dong Il; Sung, Kyu Bo; Yoon, Hyun Ki [Asan Medical Center, Seoul (Korea, Republic of)

    2003-06-01

    To assess the effectiveness and safety of transcatheter arterial embolization for the treatment of massive postpartum bleeding. Transcatheter arterial embolization was attempted in 25 patients with massive postpartum bleeding. After identification at bilateral internal iliac arteriography, the bleeding artery was embolized using gelfoam, polyvinyl alcohol particles or microcoils, and to prevent rebleeding through collateral pathways, the contralateral uterine artery or anterior division of the internal iliac artery was also embolized. Clinical success and complications were retrospectively assessed and documented. Active bleeding foci were detected in 13 patients (52%), and involved the unilateral (n=10) or bilateral (n=2) uterine artery and unilateral vaginal artery (n=1). Twelve (92%) of the 13 patients recovered completely following embolization, but one underwent hysterectomy due to persistent bleeding. The focus of bleeding was not detected in 12 patients (48%), but 11 (92%) of these also recovered following embolization of the bilateral uterine or internal iliac arteries. One patient, however, died due to sepsis. Two of the 12 patients underwent hysterectomy due ro rebleeding on the 12{sup th} and 13{sup th} day, respectively, after embolization. Transcatheter arterial embolization is relatively safe and effective for the treatment massive postpartum bleeding.

  3. Endoscopic management of bleeding peptic ulcers

    International Nuclear Information System (INIS)

    Farooqi, J.I.; Farooqi, R.J.

    2001-01-01

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

  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. Causes of lower gastrointestinal bleeding on colonoscopy

    International Nuclear Information System (INIS)

    Rehman, A.U.; Gul, R.; Khursheed, L.; Hadayat, R.

    2017-01-01

    Background: Bleeding from anus is usually referred as rectal bleeding but actually rectal bleeding is defined as bleeding from lower colon or rectum, which means bleeding from a place distal to ligament of Treitz. This study was conducted to determine the frequency of different causes of rectal bleeding in patients at Ayub Teaching Hospital, Abbottabad. Methods: One hundred and seventy-five patients with evidence of rectal bleed, without gender discrimination were selected by non-probability convenient sampling from the out-patient department and general medical wards. Patients with suspected upper GI source of bleeding; acute infectious bloody diarrhoea and any coagulopathy were excluded from the study. All patients were subjected to fibre optic colonoscopy after preparation of the gut and findings were recorded. Where necessary, biopsy samples were also taken. Diagnosis was based on colonoscopic findings. Results: A total of 175 patients (92 males and 83 females) with mean age 35.81±9.18 years were part of the study. Colonoscopy showed abnormal findings in 150 (85.7%) patients. The commonest diagnosis was haemorrhoids, which was found in 39 (22.3%) patients. It was followed by inflammatory bowel disease (IBD) in 30 (17.1%) patients, solitary rectal ulcer in 13 (7.4%) patients and polyps in 25 (14.3%) patients. Other less frequent findings were non-specific inflammation and fungating growths in rectum. Conclusion: Haemorrhoids was the leading cause of bleeding per rectum in this study, followed by evidence of IBD while infrequent findings of polyps and diverticuli indicate that these are uncommon in this region. (author)

  6. [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.

  7. Upper gastrointestinal bleeding - state of the art.

    Science.gov (United States)

    Szura, Mirosław; Pasternak, Artur

    2014-01-01

    Upper gastrointestinal (GI) bleeding is a condition requiring immediate medical intervention, with high associated mortality exceeding 10%. The most common cause of upper GI bleeding is peptic ulcer disease, which largely corresponds to the intake of NSAIDs and Helicobacter pylori infection. Endoscopy is the essential tool for the diagnosis and treatment of active upper GI hemorrhage. Endoscopic therapy together with proton pump inhibitors and eradication of Helicobacter pylori significantly reduces rebleeding rates, mortality and number of emergency surgical interventions. This paper presents contemporary data on the diagnosis and treatment of upper gastrointestinal bleeding.

  8. Scintigraphic demonstration of acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Alavi, A.

    1980-01-01

    Acute gastrointestinal bleeding may be localized using noninvasive radionuclide methods. We have favored the use of technetium-99m sulfur colloid with sequential imaging because of the rapid clearance of background activity. Definition of the site of upper gastrointestinal bleeding, however, may be obscured by intense uptake of radioactivity by liver and spleen. The sensitivity of the method is such that the bleeding rates of 0.05-0.1 ml/min can be detected compared to a sensitivity of 0.5 ml/min for angiography.

  9. Treating gynaecological disorders with traditional Chinese medicine ...

    African Journals Online (AJOL)

    Traditional Chinese Medicine (TCM) has significant advantages in treating gynaecological disorders. The paper has provided a brief introduction on the current progress of treating some gynaecological disorders including endometriosis, infertility, dysmenorrhea, abnormal uterine bleeding, premenstrual syndrome, ...

  10. Platelet Disorders: MedlinePlus Health Topic

    Science.gov (United States)

    ... Thromobocytopenia - drug-induced (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Platelet Disorders updates ... Willebrand disease Show More Show Less Related Health Topics Bleeding Disorders Blood Clots Blood Count Tests Blood ...

  11. Converter topologies and control

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez, Fernando; Qin, Hengsi; Chapman, Patrick

    2018-05-01

    An inverter includes a transformer that includes a first winding, a second winding, and a third winding, a DC-AC inverter electrically coupled to the first winding of the transformer, a cycloconverter electrically coupled to the second winding of the transformer, an active filter electrically coupled to the third winding of the transformer. The DC-AC inverter is adapted to convert the input DC waveform to an AC waveform delivered to the transformer at the first winding. The cycloconverter is adapted to convert an AC waveform received at the second winding of the transformer to the output AC waveform having a grid frequency of the AC grid. The active filter is adapted to sink and source power with one or more energy storage devices based on a mismatch in power between the DC source and the AC grid.

  12. Converting high boiling hydrocarbons

    Energy Technology Data Exchange (ETDEWEB)

    Terrisse, H; DuFour, L

    1929-02-12

    A process is given for converting high boiling hydrocarbons into low boiling hydrocarbons, characterized in that the high boiling hydrocarbons are heated to 200 to 500/sup 0/C in the presence of ferrous chloride and of such gases as hydrogen, water gas, and the like gases under a pressure of from 5 to 40 kilograms per square centimeter. The desulfurization of the hydrocarbons occurs simultaneously.

  13. 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

  14. Advanced converters and reactors

    International Nuclear Information System (INIS)

    Haefele, W.; Kessler, G.

    1984-01-01

    As Western Europe and most countries of the Asia-Pacific region (except Australia) have only small natural uranium resources, they must import nuclear fuel from the major uranium supplier countries. The introduction of advanced converter and breeder reactor technology allows a fuel utilization of a factor of 4 to 100 higher than with present low converters (LWRs) and will make uranium-importing countries less vulnerable to price jumps and supply stops in the uranium market. In addition, breeder-reactor technology will open up a potential that can cover world energy requirements for several thousand years. The enormous development costs of advanced converter and breeder technologies can probably be raised only by highly industrialized countries. Those highly industrialized countries that have little or no uranium resources (Western Europe, Japan) will probably be the first to introduce this advanced reactor technology on a commercial scale. A number of small countries and islands will need only small power reactors with inherent safety capabilities, especially in the beginning of their nuclear energy programs. For economic reasons, the fuel cycle services should come from large reprocessing centers of countries having sufficiently large nuclear power programs or from international fuel cycle centers. (author)

  15. Talk with Expectant Parents about Late Vitamin K Deficient Bleeding Among Infants

    Centers for Disease Control (CDC) Podcasts

    In this podcast, Dr. Lauren Marcewicz, a pediatrician with CDC’s Division of Blood Disorders, speaks about vitamin K deficiency bleeding in infants, the importance of vitamin K prophylaxis at birth, and how healthcare providers can provide the best information to their expectant parents.

  16. Bleeding and starving: fasting and delayed refeeding after upper gastrointestinal bleeding.

    Science.gov (United States)

    Fonseca, Jorge; Meira, Tânia; Nunes, Ana; Santos, Carla Adriana

    2014-01-01

    Early refeeding after nonvariceal upper gastrointestinal bleeding is safe and reduces hospital stay/costs. The aim of this study was obtaining objective data on refeeding after nonvariceal upper gastrointestinal bleeding. From 1 year span records of nonvariceal upper gastrointestinal bleeding patients that underwent urgent endoscopy: clinical features; rockall score; endoscopic data, including severity of lesions and therapy; feeding related records of seven days: liquid diet prescription, first liquid intake, soft/solid diet prescription, first soft/solid intake. From 133 patients (84 men) Rockall classification was possible in 126: 76 score ≥5, 50 score bleeding, eight rebled, two underwent surgery, 13 died. Ulcer was the major bleeding cause, 63 patients underwent endoscopic therapy. There was 142/532 possible refeeding records, no record 37% patients. Only 16% were fed during the first day and half were only fed on third day or later. Rockall upper gastrointestinal bleeding patients must be refed earlier, according to guidelines.

  17. AL Amyloidosis Complicated by Persistent Oral Bleeding

    Directory of Open Access Journals (Sweden)

    Luiz Antonio Liarte Marconcini

    2015-01-01

    Full Text Available A case of amyloid light chain (AL amyloidosis is presented here with uncontrolled bleeding after a nonsurgical dental procedure, most likely multifactorial in nature, and consequently treated with a multidisciplinary approach.

  18. Gastrointestinal Bleeding: MedlinePlus Health Topic

    Science.gov (United States)

    ... are many possible causes of GI bleeding, including hemorrhoids , peptic ulcers , tears or inflammation in the esophagus, ... blood Show More Show Less Related Health Topics Hemorrhoids Peptic Ulcer National Institutes of Health The primary ...

  19. Percutaneous nephrolithotomy; alarming variables for postoperative bleeding

    Directory of Open Access Journals (Sweden)

    Shakhawan H.A. Said

    2017-03-01

    Conclusion: According to our present results stone complexity (GSS grade 3 and 4, history of ipsilateral renal stone surgery, and occurrence of intraoperative pelvicalyceal perforation are alarming variables for post-PCNL bleeding.

  20. Intrathoracic Gastric Volvulus presenting with GIT Bleed

    OpenAIRE

    Rahul Kadam; VSV Prasad

    2017-01-01

    Intrathoracic gastric volvulus in neonatal period is a life-threatening surgical emergency. We report a case of neonate with respiratory distress and GI bleeding who was diagnosed to have congenital diaphragmatic eventration with Intrathoracic gastric volvulus.

  1. Transfusion strategy for acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Handel, James; Lang, Eddy

    2015-09-01

    Clinical question Does a hemoglobin transfusion threshold of 70 g/L yield better patient outcomes than a threshold of 90 g/L in patients with acute upper gastrointestinal bleeding? Article chosen Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013;368(1):11-21. Study objectives The authors of this study measured mortality, from any cause, within the first 45 days, in patients with acute upper gastrointestinal bleeding, who were managed with a hemoglobin threshold for red cell transfusion of either 70 g/L or 90 g/L. The secondary outcome measures included rate of further bleeding and rate of adverse events.

  2. Upper gastrointestinal bleeding in irbid, jordan

    International Nuclear Information System (INIS)

    Banisalamah, A.A.; Mraiat, Z.M.

    2007-01-01

    To define the various causes of nonvariceal upper gastrointestinal bleeding, to outline management modalities and to determine the final outcome of patients. A retrospective analysis of patients presenting with upper gastrointestinal (UGI) bleeding from January 2003 to December 2006 (4 years) was conducted. Patients with endoscopically proven variceal bleeding were excluded. Out of the 120 patients, most of the patients belonged to an age group of more than 50 years (mean 48.5 years). Haematemesis was the most common presentation and Acute Gastric Mucosal Lesion (AGML) was the most frequently encountered lesion. The cause of bleeding was not identified in 10 patients (undetermined group). Twenty-two (18.3%) underwent surgery and we had an overall mortality of 15.8%. AGML being the leading cause can be managed conservatively most of the time. There is a male preponderance and the incidence and mortality increases with advancing age. The undetermined group remains a diagnostic problem. (author)

  3. Convertible bond valuation focusing on Chinese convertible bond market

    OpenAIRE

    Yang, Ke

    2010-01-01

    This paper mainly discusses the methods of valuation of convertible bonds in Chinese market. Different from common convertible bonds in European market, considering the complicate features of Chinese convertible bond, this paper represents specific pricing approaches for pricing convertible bonds with different provisions along with the increment of complexity of these provisions. More specifically, this paper represents the decomposing method and binomial tree method for pricing both of Non-...

  4. 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...

  5. Management of patients with ulcer bleeding.

    Science.gov (United States)

    Laine, Loren; Jensen, Dennis M

    2012-03-01

    This guideline presents recommendations for the step-wise management of patients with overt upper gastrointestinal bleeding. Hemodynamic status is first assessed, and resuscitation initiated as needed. Patients are risk-stratified based on features such as hemodynamic status, comorbidities, age, and laboratory tests. Pre-endoscopic erythromycin is considered to increase diagnostic yield at first endoscopy. Pre-endoscopic proton pump inhibitor (PPI) may be considered to decrease the need for endoscopic therapy but does not improve clinical outcomes. Upper endoscopy is generally performed within 24h. The endoscopic features of ulcers direct further management. Patients with active bleeding or non-bleeding visible vessels receive endoscopic therapy (e.g., bipolar electrocoagulation, heater probe, sclerosant, clips) and those with an adherent clot may receive endoscopic therapy; these patients then receive intravenous PPI with a bolus followed by continuous infusion. Patients with flat spots or clean-based ulcers do not require endoscopic therapy or intensive PPI therapy. Recurrent bleeding after endoscopic therapy is treated with a second endoscopic treatment; if bleeding persists or recurs, treatment with surgery or interventional radiology is undertaken. Prevention of recurrent bleeding is based on the etiology of the bleeding ulcer. H. pylori is eradicated and after cure is documented anti-ulcer therapy is generally not given. Nonsteroidal anti-inflammatory drugs (NSAIDs) are stopped; if they must be resumed low-dose COX-2-selective NSAID plus PPI is used. Patients with established cardiovascular disease who require aspirin should start PPI and generally re-institute aspirin soon after bleeding ceases (within 7 days and ideally 1-3 days). Patients with idiopathic ulcers receive long-term anti-ulcer therapy.

  6. Angiographic diagnosis and treatment of gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Park, Jae Hyung; Sung, Kyu Bo; Koo, Kyung Hoi; Bae, Tae Young; Chung, Eun Chul; Han, Man Chung

    1986-01-01

    Diagnostic angiographic evaluations were done in 33 patients with gastrointestinal bleeding for recent 5 years at Department of Radiology, Seoul National University Hospital. On 11 patients of them, therapeutic interventional procedures were made and the results were analysed. 1. In a total of 33 cases, there were 18 cases of upper GI bleeding and 15 cases of lower GI bleeding. The most frequent causes were peptic ulcer in the former and intestinal typhoid fever in the latter. 2. Bleeding sites were localized angiographically in 28 cases, so the detection rate was 85%. Four of the five angiographically negative cases were lower GI bleeding cases. 3. The most frequent bleeding site was left gastric artery (7/33). The next was ileocecal branch of superior mesenteric artery (6/33). 4. Among the 11 interventional procedures, Gelfoam embolization was done in 7 cases and Vasopressin infusion was tried in 4 cases. They were successful in 4 and 3 cases, suggesting 57% and 47% success rates respectively.

  7. Angiographic diagnosis and treatment of gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Sung, Kyu Bo; Koo, Kyung Hoi; Bae, Tae Young; Chung, Eun Chul; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1986-02-15

    Diagnostic angiographic evaluations were done in 33 patients with gastrointestinal bleeding for recent 5 years at Department of Radiology, Seoul National University Hospital. On 11 patients of them, therapeutic interventional procedures were made and the results were analysed. 1. In a total of 33 cases, there were 18 cases of upper GI bleeding and 15 cases of lower GI bleeding. The most frequent causes were peptic ulcer in the former and intestinal typhoid fever in the latter. 2. Bleeding sites were localized angiographically in 28 cases, so the detection rate was 85%. Four of the five angiographically negative cases were lower GI bleeding cases. 3. The most frequent bleeding site was left gastric artery (7/33). The next was ileocecal branch of superior mesenteric artery (6/33). 4. Among the 11 interventional procedures, Gelfoam embolization was done in 7 cases and Vasopressin infusion was tried in 4 cases. They were successful in 4 and 3 cases, suggesting 57% and 47% success rates respectively.

  8. Transcatheter arterial embolization for traumatic bleeding control

    International Nuclear Information System (INIS)

    Ryu, Choon Wook; Lee, Sang Kwon; Suh, Kyung Jin; Kim, Tae Heon; Kim, Yong Joo; Kang, Duck Sik

    1989-01-01

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

  9. [Hysteroscopic polypectomy, treatment of abnormal uterine bleeding].

    Science.gov (United States)

    de Los Rios, P José F; López, R Claudia; Cifuentes, P Carolina; Angulo, C Mónica; Palacios-Barahona, Arlex U

    2015-07-01

    To evaluate the effectiveness of the hysteroscopic polypectomy in terms of the decrease of the abnormal uterine bleeding. A cross-sectional and analytical study was done with patients to whom a hysteroscopic polypectomy was done for treating the abnormal uterine bleeding, between January 2009 and December 2013. The response to the treatment was evaluated via a survey given to the patients about the behavior of the abnormal uterine bleeding after the procedure and about overall satisfaction. The results were obtained after a hysteroscopic polypectomy done to 128 patients and were as follows. The average time from the polypectomy applied until the survey was 30.5 months, with a standard deviation of 18 months. 67.2% of the patients reported decreased abnormal uterine bleeding and the 32.8% reported a persistence of symptoms. On average 82.8% of the. patients were satisfied with the treatment. Bivariate and multivariate analysis showed no association between the variables studied and no improvement of abnormal uterine bleeding after surgery (polypectomy). There were no complications. Hysteroscopic polypectomy is a safe surgical treatment, which decreases on two of three patients the abnormal uterine bleeding in the presence of endometrial polyps, with an acceptable level of satisfaction.

  10. Transcatheter emboilization therapy of massive colonic bleeding

    International Nuclear Information System (INIS)

    Shin, G. H.; Oh, J. H.; Yoon, Y.

    1996-01-01

    To evaulate the efficacy and safety of emergent superselective transcatheter embolization for controlling massive colonic bleeding. Six of the seven patients who had symptom of massive gastrointestinal bleeding underwent emergent transcatheter embolization for control of the bleeding. Gastrointestinal bleeding in these patients was originated from various colonic diseases: rectal cancer(n=1), proctitis(n=1), benign ulcer(n=1), mucosal injury by ventriculoperitoneal shunt(n=1), and unknown(n=2). All patients except one with rectal cancer were critically ill. Superselective embolization were done by using Gelfoam particles and/or coils. The vessels embolized were ileocolic artery(n=1). superior rectal artery(n=2), inferior rectal artery (n=1), and middle and inferior rectal arteries(n=1). Hemostasis was successful immediately in all patients. Two underwnet surgery due to recurrent bleeding developed 3 days after the procedure(n=1) or in associalion with underlying rectal cancer(n=1). On surgical specimen of two cases, there was no mucosal ischemic change. Transcatheter embolization is a safe and effective treatment of method for the control of massive colonic bleeding

  11. X-Y Converter Family

    DEFF Research Database (Denmark)

    Bhaskar, Mahajan Sagar; Sanjeevikumar, Padmanaban; Wheeler, Patrick

    2016-01-01

    A New breed of a buck boost converter, named as the XY converter family is proposed in this article. In the XY family, 16 topologies are presented which are highly suitable for renewable energy applications which require a high ratio of DC-DC converter; such as a photovoltaic multilevel inverter...... system, high voltage automotive applications and industrial drives. Compared to the traditional boost converter and existing recent converters, the proposed XY converter family has the ability to provide a higher output voltage by using less number of power devices and reactive components. Other distinct...... features of the XY converter family are i) Single control switch ii) Provide negative output voltage iii) Non-isolated topologies iv) High conversion ratio without making the use of high duty cycle and v) modular structure. XY family is compared with the recent high step-up converters and the detailed...

  12. Resonant power converters

    CERN Document Server

    Kazimierczuk, Marian K

    2012-01-01

    This book is devoted to resonant energy conversion in power electronics. It is a practical, systematic guide to the analysis and design of various dc-dc resonant inverters, high-frequency rectifiers, and dc-dc resonant converters that are building blocks of many of today's high-frequency energy processors. Designed to function as both a superior senior-to-graduate level textbook for electrical engineering courses and a valuable professional reference for practicing engineers, it provides students and engineers with a solid grasp of existing high-frequency technology, while acquainting them wit

  13. Cycloidal Wave Energy Converter

    Energy Technology Data Exchange (ETDEWEB)

    Stefan G. Siegel, Ph.D.

    2012-11-30

    This program allowed further advancing the development of a novel type of wave energy converter, a Cycloidal Wave Energy Converter or CycWEC. A CycWEC consists of one or more hydrofoils rotating around a central shaft, and operates fully submerged beneath the water surface. It operates under feedback control sensing the incoming waves, and converts wave power to shaft power directly without any intermediate power take off system. Previous research consisting of numerical simulations and two dimensional small 1:300 scale wave flume experiments had indicated wave cancellation efficiencies beyond 95%. The present work was centered on construction and testing of a 1:10 scale model and conducting two testing campaigns in a three dimensional wave basin. These experiments allowed for the first time for direct measurement of electrical power generated as well as the interaction of the CycWEC in a three dimensional environment. The Atargis team successfully conducted two testing campaigns at the Texas A&M Offshore Technology Research Center and was able to demonstrate electricity generation. In addition, three dimensional wave diffraction results show the ability to achieve wave focusing, thus increasing the amount of wave power that can be extracted beyond what was expected from earlier two dimensional investigations. Numerical results showed wave cancellation efficiencies for irregular waves to be on par with results for regular waves over a wide range of wave lengths. Using the results from previous simulations and experiments a full scale prototype was designed and its performance in a North Atlantic wave climate of average 30kW/m of wave crest was estimated. A full scale WEC with a blade span of 150m will deliver a design power of 5MW at an estimated levelized cost of energy (LCOE) in the range of 10-17 US cents per kWh. Based on the new results achieved in the 1:10 scale experiments these estimates appear conservative and the likely performance at full scale will

  14. Antifibrinolytics for heavy menstrual bleeding.

    Science.gov (United States)

    Bryant-Smith, Alison C; Lethaby, Anne; Farquhar, Cindy; Hickey, Martha

    2018-04-15

    Heavy menstrual bleeding (HMB) is an important physical and social problem for women. Oral treatment for HMB includes antifibrinolytic drugs, which are designed to reduce bleeding by inhibiting clot-dissolving enzymes in the endometrium.Historically, there has been some concern that using the antifibrinolytic tranexamic acid (TXA) for HMB may increase the risk of venous thromboembolic disease. This is an umbrella term for deep venous thrombosis (blood clots in the blood vessels in the legs) and pulmonary emboli (blood clots in the blood vessels in the lungs). To determine the effectiveness and safety of antifibrinolytic medications as a treatment for heavy menstrual bleeding. We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO and two trials registers in November 2017, together with reference checking and contact with study authors and experts in the field. We included randomized controlled trials (RCTs) comparing antifibrinolytic agents versus placebo, no treatment or other medical treatment in women of reproductive age with HMB. Twelve studies utilised TXA and one utilised a prodrug of TXA (Kabi). We used standard methodological procedures expected by Cochrane. The primary review outcomes were menstrual blood loss (MBL), improvement in HMB, and thromboembolic events. We included 13 RCTs (1312 participants analysed). The evidence was very low to moderate quality: the main limitations were risk of bias (associated with lack of blinding, and poor reporting of study methods), imprecision and inconsistency.Antifibrinolytics (TXA or Kabi) versus no treatment or placeboWhen compared with a placebo, antifibrinolytics were associated with reduced mean blood loss (MD -53.20 mL per cycle, 95% CI -62.70 to -43.70; I² = 8%; 4 RCTs, participants = 565; moderate-quality evidence) and higher rates of improvement (RR 3.34, 95% CI 1.84 to 6.09; 3 RCTS, participants = 271; moderate-quality evidence). This suggests that

  15. 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.

  16. Is Previous Tubal Ligation a Risk Factor for Hysterectomy because of Abnormal Uterine Bleeding?

    Directory of Open Access Journals (Sweden)

    Sanam Moradan

    2012-07-01

    Full Text Available Objectives: Post tubal ligation syndrome (PTLS is a term used to describe a variety of post tubal ligation side effects or symptoms. These include increased menstrual bleeding and hysterectomy. Whether or not post tubal syndrome is a real entity, it has been a subject of controversy in the medical literature for decades. Numerous studies have reported conflicting conclusions about these symptoms. In this study the incidence of hysterectomy for bleeding disorders among sterilized women was compared with the incidence of hysterectomy for bleeding disorders among non-sterilized female population of the same age.Methods: This study was carried out on 160 women, 38-52 years, who underwent hysterectomy in Amir University Hospital, Semnan, Iran, from September 2008 to September 2011. After gathering of data from medical records, in this study, the incidence of hysterectomy for bleeding disorders among sterilized women was compared with the incidence of hysterectomy for bleeding disorders among nonsterilized female population for the same age.Results: The mean age of the study group was 44/4±5/7 and the mean age of the control group was 45/2±5/3, (p=0.424.The mean parity of the study group was 3/8±1/8 and the mean parity of the control group was 3/5±1/4, (p=0.220. So, in regard to age and parity, two groups were matched. Hysterectomies were performed for 160 cases and abnormal uterine bleeding was the cause of hysterectomy in 67 cases. Among 67 cases, 19 cases (37.3% had previous tubal sterilization + hysterectomy (study group and 48 cases (44% were not undergoing tubal sterilization but had hysterectomy for abnormal bleeding causes (control group. Statistical analyses showed that there were not significant differences between two groups, (RR=0.85; 95% CI: 0.56-1.28; p=0.418.Conclusion: The result of this study showed that previous tubal sterilization is not a risk factor for undergoing hysterectomy because of abnormal uterine bleeding.

  17. Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis

    NARCIS (Netherlands)

    Cooper, Natalie A. M.; Barton, Pelham M.; Breijer, Maria; Caffrey, Orla; Opmeer, Brent C.; Timmermans, Anne; Mol, Ben W. J.; Khan, Khalid S.; Clark, T. Justin

    2014-01-01

    Heavy menstrual bleeding (HMB) and post-menopausal bleeding (PMB) together constitute the commonest gynaecological presentation in secondary care and impose substantial demands on health service resources. Accurate diagnosis is of key importance to realising effective treatment, reducing morbidity

  18. Reliability measures in managing GI bleeding.

    Science.gov (United States)

    Sonnenberg, Amnon

    2012-06-01

    Multiple procedures and devices are used in a complex interplay to diagnose and treat GI bleeding. To model how a large variety of diagnostic and therapeutic components interact in the successful management of GI bleeding. The analysis uses the concept of reliability block diagrams from probability theory to model management outcome. Separate components of the management process are arranged in a serial or parallel fashion. If the outcome depends on the function of each component individually, such components are modeled to be arranged in series. If components complement each other and can mutually compensate for each of their failures, such components are arranged in a parallel fashion. General endoscopy practice. Patients with GI bleeding of unknown etiology. All available endoscopic and radiographic means to diagnose and treat GI bleeding. Process reliability in achieving hemostasis. Serial arrangements tend to reduce process reliability, whereas parallel arrangements increase it. Whenever possible, serial components should be bridged and complemented by additional alternative (parallel) routes of operation. Parallel components with low individual reliability can still contribute to overall process reliability as long as they function independently of other pre-existing alternatives. Probability of success associated with individual components is partly unknown. Modeling management of GI bleeding by a reliability block diagram provides a useful tool in assessing the impact of individual endoscopic techniques and administrative structures on the overall outcome. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  19. Gas converter. Gaswandler

    Energy Technology Data Exchange (ETDEWEB)

    Eisenmann, A

    1984-09-27

    A gas converter is proposed for carbonisation gas containing hydrocarbons, consisting of a bricked shaft, which has a free combustion chamber and a solid bed of bulk grainy material with partly burnt hot carbonisation gases flowing through it as the lower boundary of this combustion chamber, in the upper part of which a hot reaction zone at about 1000 to 1200/sup 0/C is formed and which has a cracked gas extraction below the solid bed and an ash outlet. The solid bed is arranged at an angle to the vertical. The shaft has a solid material outlet for the bed material no longer capable of taking part in the reaction on the wall going obliquely downwards and a solid material inlet for new bulk bed material on the opposite wall going obliquely upwards.

  20. Electromagnetic wave energy converter

    Science.gov (United States)

    Bailey, R. L. (Inventor)

    1973-01-01

    Electromagnetic wave energy is converted into electric power with an array of mutually insulated electromagnetic wave absorber elements each responsive to an electric field component of the wave as it impinges thereon. Each element includes a portion tapered in the direction of wave propagation to provide a relatively wideband response spectrum. Each element includes an output for deriving a voltage replica of the electric field variations intercepted by it. Adjacent elements are positioned relative to each other so that an electric field subsists between adjacent elements in response to the impinging wave. The electric field results in a voltage difference between adjacent elements that is fed to a rectifier to derive dc output power.

  1. Power converters for ITER

    CERN Document Server

    Benfatto, I

    2006-01-01

    The International Thermonuclear Experimental Reactor (ITER) is a thermonuclear fusion experiment designed to provide long deuterium– tritium burning plasma operation. After a short description of ITER objectives, the main design parameters and the construction schedule, the paper describes the electrical characteristics of the French 400 kV grid at Cadarache: the European site proposed for ITER. Moreover, the paper describes the main requirements and features of the power converters designed for the ITER coil and additional heating power supplies, characterized by a total installed power of about 1.8 GVA, modular design with basic units up to 90 MVA continuous duty, dc currents up to 68 kA, and voltages from 1 kV to 1 MV dc.

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

    International Nuclear Information System (INIS)

    Asgher, S.; Saleem, M.K.

    2015-01-01

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

  3. Nano- and micro-materials in the treatment of internal bleeding and uncontrolled hemorrhage.

    Science.gov (United States)

    Gaston, Elizabeth; Fraser, John F; Xu, Zhi Ping; Ta, Hang T

    2018-02-01

    Internal bleeding is defined as the loss of blood that occurs inside of a body cavity. After a traumatic injury, hemorrhage accounts for over 35% of pre-hospital deaths and 40% of deaths within the first 24 hours. Coagulopathy, a disorder in which the blood is not able to properly form clots, typically develops after traumatic injury and results in a higher rate of mortality. The current methods to treat internal bleeding and coagulopathy are inadequate due to the requirement of extensive medical equipment that is typically not available at the site of injury. To discover a potential route for future research, several current and novel treatment methods have been reviewed and analyzed. The aim of investigating different potential treatment options is to expand available knowledge, while also call attention to the importance of research in the field of treatment for internal bleeding and hemorrhage due to trauma. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Abnormal uterine bleeding unrelated to structural uterine abnormalities: management in the perimenopausal period.

    Science.gov (United States)

    Sabbioni, Lorenzo; Zanetti, Isabella; Orlandini, Cinzia; Petraglia, Felice; Luisi, Stefano

    2017-02-01

    Abnormal uterine bleeding (AUB) is one of the commonest health problems encountered by women and a frequent phenomenon during menopausal transition. The clinical management of AUB must follow a standardized classification system to obtain the better diagnostic pathway and the optimal therapy. The PALM-COEIN classification system has been approved by the International Federation of Gynecology and Obstetrics (FIGO); it recognizes structural causes of AUB, which can be measured visually with imaging techniques or histopathology, and non-structural entities such as coagulopathies, ovulatory dysfunctions, endometrial and iatrogenic causes and disorders not yet classified. In this review we aim to evaluate the management of nonstructural causes of AUB during the menopausal transition, when commonly women experience changes in menstrual bleeding patterns and unexpected bleedings which affect their quality of life.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Hemospray application in nonvariceal upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

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

    2013-01-01

    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...... 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...... 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...

  7. Fibrinogen concentrate for bleeding - a systematic review

    DEFF Research Database (Denmark)

    Lunde, J; Stensballe, J; Wikkelsø, A

    2014-01-01

    Fibrinogen concentrate as part of treatment protocols increasingly draws attention. Fibrinogen substitution in cases of hypofibrinogenaemia has the potential to reduce bleeding, transfusion requirement and subsequently reduce morbidity and mortality. A systematic search for randomised controlled...... trials (RCTs) and non-randomised studies investigating fibrinogen concentrate in bleeding patients was conducted up to November 2013. We included 30 studies of 3480 identified (7 RCTs and 23 non-randomised). Seven RCTs included a total of 268 patients (165 adults and 103 paediatric), and all were...... determined to be of high risk of bias and none reported a significant effect on mortality. Two RCTs found a significant reduction in bleeding and five RCTs found a significant reduction in transfusion requirements. The 23 non-randomised studies included a total of 2825 patients, but only 11 of 23 studies...

  8. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

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

    2008-01-01

    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....... 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...... arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered. Patients with cancer may only need treatment for the acute bleeding episode, and an endovascular approach has the advantage...

  9. Bleeding stomal varices in portal hypertension

    Directory of Open Access Journals (Sweden)

    Karen Tran-Harding, MD

    2018-04-01

    Full Text Available We report a case of a 50-year-old man with a history of liver cirrhosis and colon cancer post end colostomy presenting to the emergency department with stomal bleeding and passage of clots into the colostomy bag. The patient was treated with transjugular intrahepatic portosystemic shunt (TIPS and concomitant embolization of the stomal varices via the TIPS shunt using N-butyl cyanoacrylate mixed with ethiodol. Although stomal variceal bleeding is uncommon, this entity can have up to 40% mortality upon initial presentation, given the challenges in diagnosis and management. Currently, there are no established standard treatments for stomal variceal bleeding. In addition, to the best of our knowledge, there are no cases in the current literature in which treatment of this entity is performed with a combination of TIPS shunt placement and N-butyl cyanoacrylate variceal embolization. Keywords: Stomal varices, TIPS, Cirrhosis, Colon cancer, Embolization, NBCA

  10. Bayesian network modelling of upper gastrointestinal bleeding

    Science.gov (United States)

    Aisha, Nazziwa; Shohaimi, Shamarina; Adam, Mohd Bakri

    2013-09-01

    Bayesian networks are graphical probabilistic models that represent causal and other relationships between domain variables. In the context of medical decision making, these models have been explored to help in medical diagnosis and prognosis. In this paper, we discuss the Bayesian network formalism in building medical support systems and we learn a tree augmented naive Bayes Network (TAN) from gastrointestinal bleeding data. The accuracy of the TAN in classifying the source of gastrointestinal bleeding into upper or lower source is obtained. The TAN achieves a high classification accuracy of 86% and an area under curve of 92%. A sensitivity analysis of the model shows relatively high levels of entropy reduction for color of the stool, history of gastrointestinal bleeding, consistency and the ratio of blood urea nitrogen to creatinine. The TAN facilitates the identification of the source of GIB and requires further validation.

  11. Integrated power electronic converters and digital control

    CERN Document Server

    Emadi, Ali; Nie, Zhong

    2009-01-01

    Non-isolated DC-DC ConvertersBuck ConverterBoost ConverterBuck-Boost ConverterIsolated DC-DC ConvertersFlyback ConverterForward ConverterPush-Pull ConverterFull-Bridge ConverterHalf-Bridge ConverterPower Factor CorrectionConcept of PFCGeneral Classification of PFC CircuitsHigh Switching Frequency Topologies for PFCApplication of PFC in Advanced Motor DrivesIntegrated Switched-Mode Power ConvertersSwitched-Mode Power SuppliesThe Concept of Integrated ConverterDefinition of Integrated Switched-Mode Power Supplies (ISMPS)Boost-Type Integrated TopologiesGeneral Structure of Boost-Type Integrated T

  12. 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.

  13. 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.

  14. [Epidemiology of upper gastrointestinal bleeding in Gabon].

    Science.gov (United States)

    Gaudong Mbethe, G L; Mounguengui, D; Ondounda, M; Magne, C; Bignoumbra, R; Ntsoumou, S; Moussavou Kombila, J-B; Nzenze, J R

    2014-01-01

    The department of internal medicine of the military hospital of Gabon managed 92 cases of upper gastrointestinal bleeding from April 2009 to November 2011. The frequency of these hemorrhages in the department was 8.2%; they occurred most often in adults aged 30-40 years and 50-60 years, and mainly men (74%). Erosive-ulcerative lesions (65.2%) were the leading causes of hemorrhage, followed by esophageal varices (15.2%). These results underline the importance of preventive measures for the control of this bleeding.

  15. Prospective analysis of delayed colorectal post-polypectomy bleeding.

    Science.gov (United States)

    Park, Soo-Kyung; Seo, Jeong Yeon; Lee, Min-Gu; Yang, Hyo-Joon; Jung, Yoon Suk; Choi, Kyu Yong; Kim, Hungdai; Kim, Hyung Ook; Jung, Kyung Uk; Chun, Ho-Kyung; Park, Dong Il

    2018-01-17

    Although post-polypectomy bleeding is the most frequent complication after colonoscopic polypectomy, only few studies have investigated the incidence of bleeding prospectively. The aim of this study was to investigate the incidence of delayed post-polypectomy bleeding and its associated risk factors prospectively. Patients who underwent colonoscopic polypectomy at Kangbuk Samsung Hospital from January 2013 to December 2014 were prospectively enrolled in this study. Trained nurses contacted patients via telephone 7 and 30 days after polypectomy and completed a standardized questionnaire regarding the development of bleeding. Delayed post-polypectomy bleeding was categorized as minor or major and early or late bleeding. Major delayed bleeding was defined as a > 2-g/dL drop in the hemoglobin level, requiring hospitalization for control of bleeding or blood transfusion; late delayed bleeding was defined as bleeding occurring later than 24 h after polypectomy. A total of 8175 colonoscopic polypectomies were performed in 3887 patients. Overall, 133 (3.4%) patients developed delayed post-polypectomy bleeding. Among them, 90 (2.3%) and 43 (1.1%) patients developed minor and major delayed bleeding, respectively, and 39 (1.0%) patients developed late delayed bleeding. In the polyp-based multivariate analysis, young age ( 10 mm (OR 2.45; 95% CI 1.38-4.36) were significant risk factors for major delayed bleeding, while young age (< 50 years; OR 2.6; 95% CI 1.35-5.12) and immediate bleeding (OR 3.3; 95% CI 1.49-7.30) were significant risk factors for late delayed bleeding. Young age, aspirin use, polyp size, and immediate bleeding were found to be independent risk factors for delayed post-polypectomy bleeding.

  16. Progranulin inhibits platelet aggregation and prolongs bleeding time in rats.

    Science.gov (United States)

    Al-Yahya, A M; Al-Masri, A A; El Eter, E A; Hersi, A; Lateef, R; Mawlana, O

    2018-05-01

    Several adipokines secreted by adipose tissue have an anti-thrombotic and anti-atherosclerotic function. Recently identified adipokine progranulin was found to play a protective role in atherosclerosis. Bearing in mind the central role of platelets in inflammation and atherosclerosis, we aimed, in this study, to examine the effect of progranulin on platelet function and coagulation profile in rats. Healthy male albino Wistar rats weighing (250-300 g) were divided into 4 groups. Three groups were given increasing doses of progranulin (0.001 µg, 0.01 µg, and 0.1 µg) intraperitoneally, while the control group received phosphate-buffered saline (PBS). Bleeding time, prothrombin time, activated partial thromboplastin time and platelet aggregation responses to adenosine diphosphate and arachidonic acid were assessed. Administration of progranulin resulted in a significant inhibition of platelet aggregation in response to both adenosine diphosphate, and arachidonic acid. Bleeding time, prothrombin time and activated partial thromboplastin time were significantly prolonged in all groups that received progranulin, in particular, the 0.1 µg dose, in comparison to the control group. This preliminary data is first suggesting that the antiplatelet and anticoagulant action of progranulin could have a physiological protective function against thrombotic disorders associated with obesity and atherosclerosis. However, these results merit further exploration.

  17. Biomaterials and Advanced Technologies for Hemostatic Management of Bleeding.

    Science.gov (United States)

    Hickman, DaShawn A; Pawlowski, Christa L; Sekhon, Ujjal D S; Marks, Joyann; Gupta, Anirban Sen

    2018-01-01

    Bleeding complications arising from trauma, surgery, and as congenital, disease-associated, or drug-induced blood disorders can cause significant morbidities and mortalities in civilian and military populations. Therefore, stoppage of bleeding (hemostasis) is of paramount clinical significance in prophylactic, surgical, and emergency scenarios. For externally accessible injuries, a variety of natural and synthetic biomaterials have undergone robust research, leading to hemostatic technologies including glues, bandages, tamponades, tourniquets, dressings, and procoagulant powders. In contrast, treatment of internal noncompressible hemorrhage still heavily depends on transfusion of whole blood or blood's hemostatic components (platelets, fibrinogen, and coagulation factors). Transfusion of platelets poses significant challenges of limited availability, high cost, contamination risks, short shelf-life, low portability, performance variability, and immunological side effects, while use of fibrinogen or coagulation factors provides only partial mechanisms for hemostasis. With such considerations, significant interdisciplinary research endeavors have been focused on developing materials and technologies that can be manufactured conveniently, sterilized to minimize contamination and enhance shelf-life, and administered intravenously to mimic, leverage, and amplify physiological hemostatic mechanisms. Here, a comprehensive review regarding the various topical, intracavitary, and intravenous hemostatic technologies in terms of materials, mechanisms, and state-of-art is provided, and challenges and opportunities to help advancement of the field are discussed. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  18. Impedance Source Power Electronic Converters

    DEFF Research Database (Denmark)

    Liu, Yushan; Abu-Rub, Haitham; Ge, Baoming

    Impedance Source Power Electronic Converters brings together state of the art knowledge and cutting edge techniques in various stages of research related to the ever more popular impedance source converters/inverters. Significant research efforts are underway to develop commercially viable...... and technically feasible, efficient and reliable power converters for renewable energy, electric transportation and for various industrial applications. This book provides a detailed understanding of the concepts, designs, controls, and application demonstrations of the impedance source converters/inverters. Key...... features: Comprehensive analysis of the impedance source converter/inverter topologies, including typical topologies and derived topologies. Fully explains the design and control techniques of impedance source converters/inverters, including hardware design and control parameter design for corresponding...

  19. Impedance source power electronic converters

    CERN Document Server

    Liu, Yushan; Ge, Baoming; Blaabjerg, Frede; Ellabban, Omar; Loh, Poh Chiang

    2016-01-01

    Impedance Source Power Electronic Converters brings together state of the art knowledge and cutting edge techniques in various stages of research related to the ever more popular impedance source converters/inverters. Significant research efforts are underway to develop commercially viable and technically feasible, efficient and reliable power converters for renewable energy, electric transportation and for various industrial applications. This book provides a detailed understanding of the concepts, designs, controls, and application demonstrations of the impedance source converters/inverters. Key features: Comprehensive analysis of the impedance source converter/inverter topologies, including typical topologies and derived topologies. Fully explains the design and control techniques of impedance source converters/inverters, including hardware design and control parameter design for corresponding control methods. Presents the latest power conversion solutions that aim to advance the role of pow...

  20. Scintigraphic pattern of small bowel bleeding

    International Nuclear Information System (INIS)

    Anshu Rajnish Sharma; Charan, S.; Silva, I.

    2004-01-01

    Introduction: Small intestine is the longest part of gastrointestinal tract. Intra-luminal haemorrhage occurring anywhere in its long and tortuous course is difficult to trace. It is relatively inaccessible to endoscopic evaluation. Upper GI endoscopy can see only up to distal duodenum, whereas colonoscope can view maximum of 30 centimeters of terminal ileum after negotiating the scope through ileo-caecal valve. Hence, localization of bleeding source from small bowel remains a difficult clinical problem. This group of patients can be evaluated with scintigraphy for localizing the site of bleeding before undergoing either angiography or surgery. To our best of knowledge, there is no study, which has utilized scintigraphy for evaluation of small bowel bleed exclusively. The present study has been designed to know the efficacy of 99mTc-RBC scintigraphy in detecting small bowel bleed and to know whether it can differentiate between jejunal and ileal bleeding ? Materials and methods: Thirteen patients presenting with lower gastrointestinal bleeding (malena) were enrolled for the study. In all cases, upper GI endoscopy (UGIE) was unremarkable. Colonoscopic examination was either negative or suspected bleeding occurring proximal to ileo-caecal valve. Thus, in these patients, it is presumed clinically that bleeding is originating from small bowel. Barium meal follow through (BMFT) studies, however, could not delineate any etiological lesion in these patients. There were 8 men and 5 women (mean age 48 years). All patients were anemic (Hb- 6 gm%) and mean 3 units of blood were transfused.These patients were subjected to Tc-99m labeled red blood cells scintigraphy (15 mci, in-vivo method) for localization of source of bleeding. The scintiscan was acquired in two phases. A first pass phase acquired at a rate of 2 seconds per frame for 60 seconds followed by acquisition of static abdominal images (500 K, 256 x 256 matrix) at 5 minutes intervals up to 90 minutes on LFOV gamma

  1. 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.

  2. Renal Bleeding Due to Extramedullary Hematopoiesis in a Patient With Chronic Myelogenous Leukemia

    Directory of Open Access Journals (Sweden)

    Stephanie Zettner

    2014-11-01

    Full Text Available Chronic myelogenous leukemia (CML is a myeloproliferative disorder that normally presents in middle-aged adults. Renal infiltration and extramedullary hematopoiesis in renal tissue has been rarely reported. This case report presents a patient with CML and renal insufficiency who developed gross hematuria. Efforts at controlling the hematuria led to a cascade of events propelled by the underlying disorder that ultimately led to a radical nephrectomy, multiorgan failure, and prolonged hospitalization. We suggest that management of gross hematuria in clinically stable patients with CML, suspected of having extramedullary hematopoiesis, should prioritize treatment of the myeloproliferative disorder over efforts to control bleeding.

  3. Renal Bleeding Due to Extramedullary Hematopoiesis in a Patient With Chronic Myelogenous Leukemia.

    Science.gov (United States)

    Zettner, Stephanie; Mistry, Sandeep G

    2014-11-01

    Chronic myelogenous leukemia (CML) is a myeloproliferative disorder that normally presents in middle-aged adults. Renal infiltration and extramedullary hematopoiesis in renal tissue has been rarely reported. This case report presents a patient with CML and renal insufficiency who developed gross hematuria. Efforts at controlling the hematuria led to a cascade of events propelled by the underlying disorder that ultimately led to a radical nephrectomy, multiorgan failure, and prolonged hospitalization. We suggest that management of gross hematuria in clinically stable patients with CML, suspected of having extramedullary hematopoiesis, should prioritize treatment of the myeloproliferative disorder over efforts to control bleeding.

  4. Granulocytes and vascularization regulate uterine bleeding and tissue remodeling in a mouse menstruation model.

    Directory of Open Access Journals (Sweden)

    Astrid Menning

    Full Text Available Menstruation-associated disorders negatively interfere with the quality of life of many women. However, mechanisms underlying pathogenesis of menstrual disorders remain poorly investigated up to date. Among others, this is based on a lack of appropriate pre-clinical animal models. We here employ a mouse menstruation model induced by priming mice with gonadal hormones and application of a physical stimulus into the uterus followed by progesterone removal. As in women, these events are accompanied by menstrual-like bleeding and tissue remodeling processes, i.e. disintegration of decidualized endometrium, as well as subsequent repair. We demonstrate that the onset of bleeding coincides with strong upregulation of inflammatory mediators and massive granulocyte influx into the uterus. Uterine granulocytes play a central role in regulating local tissue remodeling since depletion of these cells results in dysregulated expression of matrix modifying enzymes. As described here for the first time, uterine blood loss can be quantified by help of tampon-like cotton pads. Using this novel technique, we reveal that blood loss is strongly reduced upon inhibition of endometrial vascularization and thus, is a key regulator of menstrual bleeding. Taken together, we here identify angiogenesis and infiltrating granulocytes as critical determinants of uterine bleeding and tissue remodeling in a mouse menstruation model. Importantly, our study provides a technical and scientific basis allowing quantification of uterine blood loss in mice and thus, assessment of therapeutic intervention, proving great potential for future use in basic research and drug discovery.

  5. 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...

  6. Continued bleeding following acute intracerebral hemorrhage

    NARCIS (Netherlands)

    Brouwers, H.B.

    2014-01-01

    In this Ph.D. thesis, ‘Continued bleeding following acute intracerebral hemorrhage’, we have discussed the background literature, risk factors, and underlying biology of hematoma expansion, as well as the clinical applicability of the CT angiography (CTA) 'spot sign' as an imaging marker of this

  7. Massive rectal bleeding from colonic diverticulosis

    African Journals Online (AJOL)

    ABEOLUGBENGAS

    barium enema studies have indicated increasing world prevalence ... Other diagnostic modalities include barium enema, computerised ... This is in contrast to the findings in our patient when colonoscopy was carried out, in which the diverticula were more at the descending colon-left sided, and were found to be bleeding.

  8. Acute radiologic intervention in gastrointestinal bleeding

    International Nuclear Information System (INIS)

    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. (orig.) [de

  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. Management of Acute Bleeding Per Rectum

    Directory of Open Access Journals (Sweden)

    Benita K.T. Tan

    2004-01-01

    Conclusion: Perianal conditions contributed to the majority of acute patient admissions. Colonic causes of bleeding were less common and were most stable. There were differences in the frequencies of aetiologies in our population compared to Western populations. Understanding the common pathologies and outcomes guides the management of our patients.

  11. 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.

  12. Endometrial biopsy findings in postmenopausal bleeding

    International Nuclear Information System (INIS)

    Sarfraz, T.; Tariq, H.

    2007-01-01

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

  13. 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...

  14. Gastrointestinal bleeding following NSAID ingestion in children

    African Journals Online (AJOL)

    Both presented with a history of fever and passage of bloody stools. There was a positive history of NSAID ingestion in both patients that was prescribed in the referring hospitals. ..... Bostwick HE, Halata MS, Feerick J, Newman LJ, Medow MS. Gastrointestinal bleeding in children following ingestion of low-dose. Ibuprofen.

  15. Clinical utility of new bleeding criteria: a prospective study of evaluation for the Bleeding Academic Research Consortium definition of bleeding in patients undergoing percutaneous coronary intervention.

    Science.gov (United States)

    Choi, Jae-Hyuk; Seo, Jeong-Min; Lee, Dong Hyun; Park, Kyungil; Kim, Young-Dae

    2015-04-01

    The aim of this study was to evaluate the clinical utility of the new bleeding criteria, proposed by the Bleeding Academic Research Consortium (BARC), compared with the old criteria for determining the action of physicians in contact with bleeding events, after percutaneous coronary intervention (PCI). The BARC criteria were independently associated with an increased risk of 1-year mortality after PCI, and provided a predictive value, in regard to 1-year mortality. The standardized bleeding definitions will be expected to help the physician to correctly analyze the bleeding events, to select an optimal treatment, and to objectively compare the results of multiple trials and registries. All the patients undergoing PCI from June to September 2012 were prospectively enrolled. Patients who experienced a bleeding event were further classified, based on three different bleeding severity criteria: BARC, Thrombolysis In Myocardial Infarction (TIMI), and Global Use of Strategies To Open coronary arteries (GUSTO). The primary outcome was the occurrence of bleeding events requiring interruption of antiplatelet therapy (IAT) by physicians. A total of 376 consecutive patients were included in this study. Total bleeding events occurred in 46 patients (12.2%). BARC type ≥2 bleeding occurred in 30 patients (8.0%); however, TIMI major or minor bleeding, and GUSTO moderate or severe bleeding occurred in 6 (1.6%) and 11 patients (2.9%), respectively. Of the 46 patients, 28 (60.9% of patients) required IAT. On receiver-operating characteristic curve analysis, bleeding defined BARC type ≥2 effectively predicted IAT, with a sensitivity of 89.3%, and a specificity of 98.5% (pdefinition may be a more useful tool for the detection of bleeding with clinical relevance, for patients undergoing PCI. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  16. Microcoil Embolization for Acute Lower Gastrointestinal Bleeding

    International Nuclear Information System (INIS)

    D'Othee, Bertrand Janne; Surapaneni, Padmaja; Rabkin, Dmitry; Nasser, Imad; Clouse, Melvin

    2006-01-01

    Purpose. To assess outcomes after microcoil embolization for active lower gastrointestinal (GI) bleeding. Methods. We retrospectively studied all consecutive patients in whom microcoil embolization was attempted to treat acute lower GI bleeding over 88 months. Baseline, procedural, and outcome parameters were recorded following current Society of Interventional Radiology guidelines. Outcomes included technical success, clinical success (rebleeding within 30 days), delayed rebleeding (>30 days), and major and minor complication rates. Follow-up consisted of clinical, endoscopic, and pathologic data. Results. Nineteen patients (13 men, 6 women; mean age ± 95% confidence interval = 70 ± 6 years) requiring blood transfusion (10 ± 3 units) had angiography-proven bleeding distal to the marginal artery. Main comorbidities were malignancy (42%), coagulopathy (28%), and renal failure (26%). Bleeding was located in the small bowel (n = 5), colon (n 13) or rectum (n = 1). Technical success was obtained in 17 patients (89%); 2 patients could not be embolized due to vessel tortuosity and stenoses. Clinical follow-up length was 145 ± 75 days. Clinical success was complete in 13 (68%), partial in 3 (16%), and failed in 2 patients (11%). Delayed rebleeding (3 patients, 27%) was always due to a different lesion in another bowel segment (0 late rebleeding in embolized area). Two patients experienced colonic ischemia (11%) and underwent uneventful colectomy. Two minor complications were noted. Conclusion. Microcoil embolization for active lower GI bleeding is safe and effective in most patients, with high technical and clinical success rates, no procedure-related mortality, and a low risk of bowel ischemia and late rebleeding

  17. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    International Nuclear Information System (INIS)

    Leonhardt, Henrik; Mellander, Stefan; Snygg, Johan; Loenn, Lars

    2008-01-01

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

  18. Determinants and modifiers of bleeding phenotypes in haemophilia-A: General and tropical perspectives

    Directory of Open Access Journals (Sweden)

    Umma A. Ibrahim

    2018-07-01

    Full Text Available Haemophilia-A is an X-linked recessive bleeding disorder characterized by deficiency of FVIII. Although severity of haemophilia is largely determined by the extent to which different mutations abolish FVIII production, the overall phenotypic variations among haemophiliacs is determined by a combination of several other factors, which range from general to tropical factors on the one hand, and from genetic to immunologic and infective factors on the other hand. Determinants and modifiers of haemophilic bleeding phenotypes are important predictors of prognosis. However, tropical determinants of haemophilic bleeding phenotypes are virtually ignored because majority of haemophilia research originated from developed non-tropical countries. The aim of this paper is to present a balanced review of the haemophilic bleeding phenotypes from general and tropical perspectives. Hence, we present a concisely updated comprehensive review of the pathophysiologic and clinical significance of general vis-à-vis tropical determinants and modifiers of haemophilic bleeding phenotypes from genetic, immunologic and infective perspectives. Understanding of general phenotypic determinants such as FVIII gene mutations, immunological (inhibitors and infective (e.g. hepatitis and HIV complications, classical thrombophilias (e.g. FV-Leiden and non-classical thrombophilias (e.g. non-O blood groups will throw more light into the mechanisms by which some tropical prothrombotic gene mutations (such as sickle β-globin gene and certain chronic tropical pro-haemorrhagic parasitic infections (such as urinary and gastrointestinal helminthiasis may modify frequency, intensity and pattern of bleeding among haemophiliacs in the tropics. The clinical significance of iron deficiency within the context of helminthiasis and haemophilia is also reviewed. More research is needed to determine the precise effect of non-classical thrombophilias such as sickling disorders and ABO blood groups

  19. Proposed electromagnetic wave energy converter

    Science.gov (United States)

    Bailey, R. L.

    1973-01-01

    Device converts wave energy into electric power through array of insulated absorber elements responsive to field of impinging electromagnetic radiation. Device could also serve as solar energy converter that is potentially less expensive and fragile than solar cells, yet substantially more efficient.

  20. Catalytic converters in the fireplace

    International Nuclear Information System (INIS)

    Kouki, J.

    1995-01-01

    In addition to selecting the appropriate means of heating and using dry fuel, the amount of harmful emissions contained by flue gases produced by fireplaces can be reduced by technical means. One such option is to use an oxidising catalytic converter. Tests at TTS Institute's Heating Studies Experimental Station have focused on two such converters (dense and coarse) mounted in light-weight iron heating stoves. The ability of the dense catalytic converter to oxidise carbon monoxide gases proved to be good. The concentration of carbon monoxide in the flue gases was reduced by as much as 90 %. Measurements conducted by VTT (Technical Research Centre of Finland) showed that the conversion of other gases, e.g. of methane, was good. The exhaust resistance caused by the dense converter was so great as to necessitate the mounting of a fluegas evacuation fan in the chimney for the purpose of creating sufficient draught. When relying on natural draught, the dense converter requires a chimney of at least 7 metres and a by-pass connection while the fire is being lit. In addition, the converter will have to be constructed to be less dense and this will mean that it's capability to oxidise non-combusted gases will be reduced. The coarse converter did not impair the draught but it's oxidising property was insufficient. With the tests over, the converter was not observed to have become blocked up by impurities

  1. Multilevel push pull power converter

    DEFF Research Database (Denmark)

    2007-01-01

    A power converter for converting an input voltage (Vin) into an output voltage (Vout), comprising a first supply potential and a second supply potential established by the input voltage, and at least one primary winding having two terminals, a center tap arranged between the two terminals and con...

  2. Bleeding in cancer patients and its treatment: a review.

    Science.gov (United States)

    Johnstone, Candice; Rich, Shayna E

    2017-12-18

    Bleeding is a common problem in cancer patients, related to local tumor invasion, tumor angiogenesis, systemic effects of the cancer, or anti-cancer treatments. Existing bleeds can also be exacerbated by medications such as bevacizumab, nonsteroidal anti-inflammatory drugs (NSAIDs), and anticoagulants. Patients may develop acute catastrophic bleeding, episodic major bleeding, or low-volume oozing. Bleeding may present as bruising, petechiae, epistaxis, hemoptysis, hematemesis, hematochezia, melena, hematuria, or vaginal bleeding. Therapeutic intervention for bleeding should start by establishing goals of care, and treatment choice should be guided by life expectancy and quality of life. Careful thought should be given to discontinuation of medications and reversal of anticoagulation. Interventions to stop or slow bleeding may include systemic agents or transfusion of blood products. Noninvasive local treatment options include applied pressure, dressings, packing, and radiation therapy. Invasive local treatments include percutaneous embolization, endoscopic procedures, and surgical treatment.

  3. To Bleed or Not to Bleed: That is the Question. The Side Effects of Apixaban.

    Science.gov (United States)

    Ciccone, Marco Matteo; Zito, Annapaola; Devito, Fiorella; Maiello, Maria; Palmiero, Pasquale

    2018-01-01

    Apixaban is a new oral anticoagulant (NOACs: Novel Oral Anticoagulant), like dabigatran, rivaroxaban, and edoxaban. All of them are prescribed to patients with non valvular atrial fibrillation or venous thromboembolism, to replace warfarin, because of the lower probability of bleeding, however they can cause bleeding by themselves. Bleeding is an adverse event in patients taking anticoagulants. It is associated with a significant increase of morbidity and risk of death. However, these drugs should be used only for the time when anticoagulation is strictly required, especially when used for preventing deep vein thrombosis. Prolonged use increases the risk of bleeding. In the ARISTOTLE Trial Apixaban, compared with warfarin, was associated with a lower rate of intracranial hemorrhages and less adverse consequences following extracranial hemorrhage. Many physicians still have limited experience with new oral anticoagulants and about bleeding risk managment. We reviewed the available literature on extracranial and intracranial bleeding concerning apixaban. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  4. Challenges in the Management of Bleeding Disorders in Nigeria

    African Journals Online (AJOL)

    2018-04-04

    Apr 4, 2018 ... (which could be immune mediated, drug induced, or due to hematological ... or VWD to hemarthroses, hematuria, intramuscular, intracerebral, and ... adequate and skilled workforce, and service delivery in general.[10] Reding ...

  5. Scintigraphic detection and localization of gastrointestinal bleeding sites

    International Nuclear Information System (INIS)

    Alavi, A.

    1988-01-01

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

  6. Comparing Bleeding Risk Assessment Focused on Modifiable Risk Factors Only Versus Validated Bleeding Risk Scores in Atrial Fibrillation

    DEFF Research Database (Denmark)

    Guo, Yutao; Zhu, Hang; Chen, Yundai

    2018-01-01

    BACKGROUNDThere is uncertainty whether a focus on modifiable bleeding risk factors offers better prediction of major bleeding than other existing bleeding risk scores.METHODSThis study compared a score based on numbers of the modifiable bleeding risk factors recommended in the 2016 European...... guidelines ("European risk score") versus other published bleeding risk scores that have been derived and validated in atrial fibrillation subjects (HEMORR2HAGES, HAS-BLED, ATRIA, and ORBIT) in a large hospital-based cohort of Chinese inpatients with atrial fibrillation.RESULTSThe European score had modest...... predictive ability for major bleeding (c-index 0.63, 95% confidence interval 0.56-0.69) and intracranial hemorrhage (0.72, 0.65-0.79) but nonsignificantly (and poorly) predicted extracranial bleeding (0.55, 0.54-0.56; P = .361). The HAS-BLED score was superior to predict bleeding events compared...

  7. Abnormal Uterine Bleeding- evaluation by Endometrial Aspiration.

    Science.gov (United States)

    Singh, Pratibha

    2018-01-01

    Endometrial evaluation is generally indicated in cases presenting with abnormal uterine bleeding (AUB), especially in women more than 35 years of age. AUB encompasses a variety of presentation, for example, heavy menstrual bleeding, frequent bleeding, irregular vaginal bleeding, postcoital and postmenopausal bleeding to name a few. Many methods are used for the evaluation of such cases, with most common being sonography and endometrial biopsy with very few cases requiring more invasive approach like hysteroscopy. Endometrial aspiration is a simple and safe office procedure used for this purpose. We retrospectively analyzed cases of AUB where endometrial aspiration with Pipette (Medgyn) was done in outpatient department between January 2015 and April 2016. Case records (both paper and electronic) were used to retrieve data. One hundred and fifteen cases were included in the study after applying inclusion and exclusion criteria. Most cases were between 46 and 50 years of age followed by 41-45 years. No cases were below 25 or more than 65 years of age. Heavy menstrual bleeding was the most common presentation of AUB. Adequate samples were obtained in 86% of cases while 13.9% of cases' sample was inadequate for opinion, many of which were later underwent hysteroscopy and/or dilatation and curettage (D and C) in operation theater; atrophic endometrium was the most common cause for inadequate sample. Uterine malignancy was diagnosed in three cases. Endometrial aspiration has been compared with traditional D and C as well as postoperative histopathology in various studies with good results. Many such studies are done in India as well as in western countries confirming good correlation with histopathology and adequate tissue sample for the pathologist to give a confident diagnosis. No complication or side effect was noted with the use of this device. Endometrial aspiration is a simple, safe, and effective method to sample endometrium in cases of AUB avoiding risk of

  8. Abnormal Uterine Bleeding- evaluation by Endometrial Aspiration

    Directory of Open Access Journals (Sweden)

    Pratibha Singh

    2018-01-01

    Full Text Available Endometrial evaluation is generally indicated in cases presenting with abnormal uterine bleeding (AUB, especially in women more than 35 years of age. AUB encompasses a variety of presentation, for example, heavy menstrual bleeding, frequent bleeding, irregular vaginal bleeding, postcoital and postmenopausal bleeding to name a few. Many methods are used for the evaluation of such cases, with most common being sonography and endometrial biopsy with very few cases requiring more invasive approach like hysteroscopy. Endometrial aspiration is a simple and safe office procedure used for this purpose. Materials and Methods: We retrospectively analyzed cases of AUB where endometrial aspiration with Pipette (Medgyn was done in outpatient department between January 2015 and April 2016. Case records (both paper and electronic were used to retrieve data. Results: One hundred and fifteen cases were included in the study after applying inclusion and exclusion criteria. Most cases were between 46 and 50 years of age followed by 41–45 years. No cases were below 25 or more than 65 years of age. Heavy menstrual bleeding was the most common presentation of AUB. Adequate samples were obtained in 86% of cases while 13.9% of cases' sample was inadequate for opinion, many of which were later underwent hysteroscopy and/or dilatation and curettage (D and C in operation theater; atrophic endometrium was the most common cause for inadequate sample. Uterine malignancy was diagnosed in three cases. Discussion: Endometrial aspiration has been compared with traditional D and C as well as postoperative histopathology in various studies with good results. Many such studies are done in India as well as in western countries confirming good correlation with histopathology and adequate tissue sample for the pathologist to give a confident diagnosis. No complication or side effect was noted with the use of this device. Conclusion: Endometrial aspiration is a simple, safe, and

  9. Break-through bleeding in relation to predicted factor VIII levels in patients receiving prophylactic treatment for severe hemophilia A.

    Science.gov (United States)

    Collins, P W; Blanchette, V S; Fischer, K; Björkman, S; Oh, M; Fritsch, S; Schroth, P; Spotts, G; Astermark, J; Ewenstein, B

    2009-03-01

    The role of prophylactic factor VIII (FVIII) to decrease hemophilic bleeding and arthropathy is well established. The rationale for this strategy is to convert patients with severe hemophilia A to a moderate clinical phenotype by reducing time spent with a FVIII level break-through bleeding in patients with severe hemophilia A on prophylaxis. This study analysed data from 44 patients aged 1-6 and 99 patients aged 10-65 years with severe hemophilia A (FVIII safety and efficacy of a recombinant FVIII (Advate). Each patient had pharmacokinetic measurements and FVIII infusions recorded, and these were used to calculate time spent with a FVIII below 1, 2 and 5 IU dL(-1). The data demonstrate that increasing time with a FVIII below 1 IU dL(-1) is associated with increased total bleeds and hemarthroses. Lack of adherence to the intended frequency of FVIII infusion was the most important determinant of low FVIII and increased bleeding. In children aged 1-6 years, the rate of bleeding was also influenced by FVIII half-life and clearance. These data have important implications for the management of patients with severe hemophilia.

  10. Radiation tolerant power converter controls

    CERN Document Server

    Todd, B; King, Q; Uznanski, S

    2012-01-01

    The Large Hadron Collider (LHC) at the European Organisation for Nuclear Research (CERN) is the world's most powerful particle collider. The LHC has several thousand magnets, both warm and super-conducting, which are supplied with current by power converters. Each converter is controlled by a purpose-built electronic module called a Function Generator Controller (FGC). The FGC allows remote control of the power converter and forms the central part of a closed-loop control system where the power converter voltage is set, based on the converter output current and magnet-circuit characteristics. Some power converters and FGCs are located in areas which are exposed to beam-induced radiation. There are numerous radiation induced effects, some of which lead to a loss of control of the power converter, having a direct impact upon the accelerator's availability. Following the first long shut down (LS1), the LHC will be able to run with higher intensity beams and higher beam energy. This is expected to lead to signifi...

  11. Talk with Expectant Parents about Late Vitamin K Deficient Bleeding Among Infants

    Centers for Disease Control (CDC) Podcasts

    2013-12-19

    In this podcast, Dr. Lauren Marcewicz, a pediatrician with CDC’s Division of Blood Disorders, speaks about vitamin K deficiency bleeding in infants, the importance of vitamin K prophylaxis at birth, and how healthcare providers can provide the best information to their expectant parents.  Created: 12/19/2013 by National Center on Birth Defects and Developmental Disabilities (NCBDDD).   Date Released: 12/31/2013.

  12. The role of endoscopy in pediatric gastrointestinal bleeding

    Science.gov (United States)

    Franke, Markus; Geiß, Andrea; Greiner, Peter; Wellner, Ulrich; Richter-Schrag, Hans-Jürgen; Bausch, Dirk; Fischer, Andreas

    2016-01-01

    Background and study aims: Gastrointestinal bleeding in children and adolescents accounts for up to 20 % of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents. Patients and methods: Pediatric patients with gastrointestinal bleeding admitted to our endoscopy unit from 2001 to 2009 (n = 154) were identified. Retrospective statistical and neural network analysis was used to assess outcome and to determine an investigative management algorithm. Results: The source of bleeding could be identified in 81 % (n = 124/154). Gastrointestinal bleeding was predominantly lower gastrointestinal bleeding (66 %, n = 101); upper gastrointestinal bleeding was much less common (14 %, n = 21). Hematochezia was observed in 94 % of the patients with lower gastrointestinal bleeding (n = 95 of 101). Hematemesis (67 %, n = 14 of 21) and melena (48 %, n = 10 of 21) were associated with upper gastrointestinal bleeding. The sensitivity and specificity of a neural network to predict lower gastrointestinal bleeding were 98 % and 63.6 %, respectively and to predict upper gastrointestinal bleeding were 75 % and 96 % respectively. The sensitivity and specifity of hematochezia alone to predict lower gastrointestinal bleeding were 94.2 % and 85.7 %, respectively. The sensitivity and specificity for hematemesis and melena to predict upper gastrointestinal bleeding were 82.6 % and 94 %, respectively. We then developed an investigative management algorithm based on the presence of hematochezia and hematemesis or melena. Conclusions: Hematochezia should prompt colonoscopy and hematemesis or melena should prompt esophagogastroduodenoscopy. If no

  13. Advanced DC/DC converters

    CERN Document Server

    Luo, Fang Lin

    2003-01-01

    DC/DC conversion techniques have undergone rapid development in recent decades. With the pioneering work of these authors, DC/DC converters have now moved into their sixth generation. This book offers a concise, practical presentation of DC/DC converters, summarizing the spectrum of conversion tecnologies and presentingmany new ideas and more than 100 new topologies. Nowhere else in the literature are DC/DC converters so logically sorted and systematically introduced, and nowhere else can readers find detailed information on prototype topologies that represent a major contribution to modern power engineering. More than 320 figures, 60 tables, and 500 formulae facilitate understand and provide precise data.

  14. 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...

  15. Bleeding during gonioscopy after deep sclerectomy.

    Science.gov (United States)

    Moreno-Montañés, Javier; Rodríguez-Conde, Rosa

    2003-10-01

    To show a new complication after deep sclerectomy (DS). We described two eyes of two patients with open-angle glaucoma and cataract who were operated on of an uneventful phacoemulsification and DS with SK-gel implantation. Bleeding during gonioscopic examination occurred in both eyes 7 and 8 months after combined surgery. The blood originated from the vessels around the Descemet window, and was probably due to manipulation or rocking of the goniolens. Pressure was immediately applied to the gonioscopic lens and the hyphema was interrupted. These cases show the presence of new vessels around the Descemet window after DS with SK-gel. Bleeding from the Descemet window vessels can occur during gonioscopy even months after DS. We recommend conducting a careful gonioscopic examination in patients who have undergone DS to avoid this complication.

  16. Risk Factors for Post-TAVI Bleeding According to the VARC-2 Bleeding Definition and Effect of the Bleeding on Short-Term Mortality: A Meta-analysis.

    Science.gov (United States)

    Wang, Jiayang; Yu, Wenyuan; Jin, Qi; Li, Yaqiong; Liu, Nan; Hou, Xiaotong; Yu, Yang

    2017-04-01

    In this study we investigated the effect of post-transcatheter aortic valve implantation (TAVI) bleeding (per Valve Academic Research Consortium-2 [VARC-2] bleeding criteria) on 30-day postoperative mortality and examined the correlation between pre- or intraoperative variables and bleeding. Multiple electronic literature databases were searched using predefined criteria, with bleeding defined per Valve Academic Research Consortium-2 criteria. A total of 10 eligible articles with 3602 patients were included in the meta-analysis. The meta-analysis revealed that post-TAVI bleeding was associated with a 323% increase in 30-day postoperative mortality (odds risk [OR]; 4.23, 95% confidence interval [CI], 2.80-6.40; P logistic regression analysis revealed that atrial fibrillation (AF) was independently correlated with TAVI-associated bleeding (OR, 2.63; 95% CI, 1.33-5.21; P = 0.005). Meta-regression showed that potential modifiers like the Society of Thoracic Surgeons (STS) score, mortality, the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE), aortic valve area, mean pressure gradient, left ventricular ejection fraction, preoperative hemoglobin and platelet levels, and study design had no significant effects on the results of the meta-analysis. Post-TAVI bleeding, in particular, major bleeding/life-threatening bleeding, increased 30-day postoperative mortality. Transapical access was a significant bleeding risk factor. Preexisting AF independently correlated with TAVI-associated bleeding, likely because of AF-related anticoagulation. Recognition of the importance and determinants of post-TAVI bleeding should lead to strategies to improve outcomes. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  17. Treatment and prognosis in peptic ulcer bleeding.

    Science.gov (United States)

    Laursen, Stig Borbjerg

    2014-01-01

    Peptic ulcer bleeding is a frequent cause of admission. Despite several advances in treatment the 30-day mortality seems unchanged at a level around 11%. Use of risk scoring systems is shown to be advantageous in the primary assessment of patients presenting with symptoms of peptic ulcer bleeding. Studies performed outside Denmark have demonstrated that use of risk scoring systems facilitates identification of low-risk patients suitable for outpatient management. Nevertheless, these systems have not been implemented for routine use in Denmark. This is mainly explained by concerns about the external validity due to considerable inter-country variation in patients' characteristics. In recent years, transcatheter arterial embolization (TAE) has become increasingly used for achievement of hemostasis in patients with peptic ulcer bleeding not responding to endoscopic therapy. As rebleeding is associated with poor outcome TAE could, in theory, also be beneficial as a supplementary treatment in patients with ulcer bleeding responding to endoscopic therapy. This has not been examined previously. Several studies have concluded that peptic ulcer bleeding is associated with excess long-term mortality. These findings are, however, questioned as the studies were based on life-table analysis, unmatched control groups, or did not perform adequate adjustment for comorbidity. Treatment with blood transfusion is, among patients undergoing cardiac bypass surgery, shown to increase the long-term mortality. Despite frequent use of blood transfusion in treatment of peptic ulcer bleeding a possible adverse effect of on long-term survival has not been examined in these patients. The aims of the present thesis were: 1. To examine which risk scoring system is best at predicting need of hospital-based intervention, rebleeding, and mortality in patients presenting with upper gastrointestinal bleeding (Study I) 2. To evaluate if supplementary transcatheter arterial embolization (STAE) after

  18. The usefulness of MDCT in acute intestinal bleeding

    International Nuclear Information System (INIS)

    Kim, Kum Rae; Park, Won Kyu; Kim, Jae Woon; Chang, Jay Chun; Jang, Han Won

    2006-01-01

    We wanted to evaluate the usefulness of MDCT for localizing a bleeding site and for helping make a decision on further management for acute intestinal bleeding. We conducted a retrospective review of 17 consecutive patients who presented with acute intestinal bleeding and who also underwent MDCT before angiography or surgery. The sensitivity of MDCT for detecting acute intestinal bleeding was assessed and compared with that of conventional angiography. The sensitivity of MDCT for the detection of acute intestinal bleeding was 77% (13 or 17), whereas that of angiography was 46% (6 or 13). All the bleeding points that were subsequently detected on angiography were visualized on MDCT. In three cases, the bleeding focus was detected on MDCT and not on angiography. In four cases, both MDCT and angiography did not detect the bleeding focus; for one of these cases, CT during SMA angiography was performed and this detected the active bleeding site. In patients with acute intestinal bleeding, MDCT is a useful image modality to detect the bleeding site and to help decide on further management before performing angiography or surgery. When tumorous lesions are detected, invasive angiography can be omitted

  19. Time-to-digital converters

    CERN Document Server

    Henzler, Stephan

    2010-01-01

    This text covers the fundamentals of time-to-digital converters on analog and digital conversion principles. It includes a theoretical investigation into quantization, linearity, noise and variability, and it details a range of advanced TDC architectures.

  20. Transformerless dc-Isolated Converter

    Science.gov (United States)

    Rippel, Wally E.

    1987-01-01

    Efficient voltage converter employs capacitive instead of transformer coupling to provide dc isolation. Offers buck/boost operation, minimal filtering, and low parts count, with possible application in photovoltaic power inverters, power supplies and battery charges. In photovoltaic inverter circuit with transformerless converter, Q2, Q3, Q4, and Q5 form line-commutated inverter. Switching losses and stresses nil because switching performed when current is zero.

  1. Picosecond image-converter diagnostics

    International Nuclear Information System (INIS)

    Schelev, M.Ya.

    1975-01-01

    A brief review is presented of the improvements in picosecond image-converter diagnostics carried out since the previous Congress in 1972. The account is given under the following headings: picosecond image converter cameras for visible and x-ray radiation diagnostics; Nd:glass and ruby mode-locked laser measurements; x-ray plasma emission diagnostics; computer treatment of pictures produced by picosecond cameras. (U.K.)

  2. Recurrent Bleeding Within 24 Hours After Uterine Artery Embolization for Severe Postpartum Hemorrhage: Are There Predictive Factors?

    International Nuclear Information System (INIS)

    Bros, Sébastien; Chabrot, Pascal; Kastler, Adrian; Ouchchane, Lemlih; Cassagnes, Lucie; Gallot, Denis; Boyer, Louis

    2012-01-01

    Purpose: To retrospectively identify predictive factors of recurrent bleeding within 24 h after uterine artery embolization (UAE) for postpartum hemorrhage (PPH). Materials and Methods: A total of 194 patients underwent UAE for PPH between August 1999 and April 2009 at our institution. Twelve patients experienced recurrent bleeding within the next 24 h; a second attempt at UAE was thus necessary, which was successful in 10 cases. In two cases, hemostatic hysterectomy was performed. Epidemiological, gynecological-obstetrical, anatomic, and biological data were analyzed. Results: Complete data were available for 148 of the 194 (76%) included patients. Sixty-four (43%) were primiparous, 18 (12.2%) had a placenta accreta, 21 (14%) had a coagulopathy, and 28 (18.9%) had an anatomic variant of the uterine arterial vasculature. Mean age and pregnancy term were similar in both recurring and nonrecurrent bleeding groups. After multivariate analysis, three criteria emerged as risk factors of recurrent bleeding: primiparity (10 patients, 83%; odds ratio [OR] = 18.84; P = 0.014), coagulation disorders (6 patients, 50%; OR = 12.08; P = 0.006), and anatomic variant of the uterine arterial vasculature (28 patients; OR = 9.83; P = 0.003). Conclusions: earch for uterine collaterals must be performed before UAE for PPH. Primiparity and coagulation disorders increase the risk of recurrent bleeding after UAE for PPH.

  3. Painless Urethral Bleeding During Penile Erection in an Adult Man With Klippel-Trenaunay Syndrome: A Case Report

    Directory of Open Access Journals (Sweden)

    Hongen Lei, MD, PhD

    2018-06-01

    Full Text Available Introduction: Klippel-Trenaunay syndrome (KTS is a rare congenital vascular disorder characterized by a triad of cutaneous port wine capillary malformations, varicose veins, and hemihypertrophy of bone and soft tissues. Aims: To report on a rare case of KTS in an adult man manifested by painless urethral bleeding during penile erection briefly review the clinical presentation and management of the genitourinary forms of this syndrome. Methods: On presentation, the clinical features of this patient, including medical history, signs and symptoms, and imaging examinations, were recorded. After diagnosis and initial treatment, a literature review of the urethral features of KTS was performed and is discussed in this report. Results: A 35-year-old man with KTS presented with painless urethral bleeding during penile erection that was associated with posterior urethral vascular malformations. The coagulation method was used to treat the malformation, and no urethral bleeding or gross hematuria occurred during a postoperative follow-up period of 6 months. Conclusion: This case demonstrates that coagulation therapy and careful follow-up can be adequate treatment approaches for urethral features of KTS. However, the long-term efficacy of coagulation for this disorder should be investigated further.Lei H, Guan X, Han H, et al. Painless Urethral Bleeding During Penile Erection in an Adult Man With Klippel-Trenaunay Syndrome: A Case Report. Sex Med 2018;6:180–183. Key Words: Urethral Bleeding, Klippel-Trenaunay Syndrome, Vascular Malformation, Posterior Urethra, Genitourinary Manifestation

  4. Juvenile polyposis syndrome: An unusual case report of anemia and gastrointestinal bleeding in young infant.

    Science.gov (United States)

    Hsiao, Yi-Han; Wei, Chin-Hung; Chang, Szu-Wen; Chang, Lung; Fu, Yu-Wei; Lee, Hung-Chang; Liu, Hsuan-Liang; Yeung, Chun-Yan

    2016-09-01

    Juvenile polyposis syndrome, a rare disorder in children, is characterized with multiple hamartomatous polyps in alimentary tract. A variety of manifestations include bleeding, intussusception, or polyp prolapse. In this study, we present an 8-month-old male infant of juvenile polyposis syndrome initially presenting with chronic anemia. To the best of our knowledge, this is the youngest case reported in the literature. We report a rare case of an 8-month-old male infant who presented with chronic anemia and gastrointestinal bleeding initially. Panendoscopy and abdominal computed tomography showed multiple polyposis throughout the entire alimentary tract leading to intussusception. Technetium-99m-labeled red blood cell (RBC) bleeding scan revealed the possibility of gastrointestinal tract bleeding in the jejunum. Histopathological examination on biopsy samples showed Peutz-Jeghers syndrome was excluded, whereas the diagnosis of juvenile polyposis syndrome was established. Enteroscopic polypectomy is the mainstay of the treatment. However, polyps recurred and occupied the majority of the gastrointestinal tract in 6 months. Supportive management was given. The patient expired for severe sepsis at the age of 18 months. Juvenile polyposis syndrome is an inherited disease, so it is not possible to prevent it. Concerning of its poor outcome and high mortality rate, it is important that we should increase awareness and education of the parents at its earliest stages.

  5. Bleeding prevalence and transfusion requirement in patients with thrombocytopenia in the emergency department.

    Science.gov (United States)

    Turvani, Fabrizio; Pigozzi, Luca; Barutta, Letizia; Pivetta, Emanuele; Pizzolato, Elisa; Morello, Fulvio; Battista, Stefania; Moiraghi, Corrado; Montrucchio, Giuseppe; Lupia, Enrico

    2014-10-01

    Thrombocytopenia is the most common coagulation disorder in critically ill patients. No studies have investigated the epidemiology and clinical impact of this condition in emergency department (ED) patients. We aimed to investigate epidemiological features, incidence of bleeding, and diagnostic and therapeutic requirements of patients with thrombocytopenia admitted to the ED. We performed a retrospective observational study enrolling all patients admitted to the medical-surgical ED of the "Città della Salute e della Scienza di Torino" Hospital with a platelet count <150×10(9) PLTs/L, during four non-consecutive months. There were no exclusion criteria. The study included 1218 patients. The percentage of patients with severe (<50×10(9) PLTs/L) or very severe (<20×10(9) PLTs/L) thrombocytopenia was about 12%. Thrombocytopenia associated with liver cirrhosis was the most represented etiology. On the contrary, the most frequent cause in patients with newly recognized low platelet count was disseminated intravascular coagulation/sepsis. The incidence of bleeding and hypovolemia, as well as the need of transfusional support and mechanical, surgical or endoscopic hemostasis progressively increased with the severity of thrombocytopenia. Our results suggest that the detection of a platelet count lower than 50×10(9) PLTs/L may help to identify patients with higher bleeding risk in the ED setting. Additional studies are required to evaluate whether, in this setting, thrombocytopenia may represent an independent risk factor for bleeding episodes and increased mortality.

  6. Minimizing the Risk of Perioperative Bleeding in a Child with Hemophilia A during Dental Rehabilitation under General Anesthesia: A Case Report

    OpenAIRE

    Yehia El Batawi, Hisham

    2013-01-01

    ABSTRACT Hemophilia, among other bleeding disorders, raises concerns for dental service providers who routinely use sharp hand and rotary instruments, address highly vascular soft tissue and provide dental extractions. In pediatric dentistry, dealing with fearful or irritable children increases the possibility of trauma and subsequent bleeding risks in hemophilic pediatric dental patients. In the current report, we discuss how anesthetic, pediatric and dental management may contribute to the ...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-06-01

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

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

    International Nuclear Information System (INIS)

    Owunwanne, A.; Sadek, S.; Yacoub, T.; Awdeh, M.; Abdel-Dayem, H.M.; Al-Wafai, I.; Vallgren, S.

    1989-01-01

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

  9. Two-inductor boost and buck converters

    Science.gov (United States)

    White, J. L.; Muldoon, W. J.

    The derivation, analysis and design of a coupled inductor boost converter is presented. Aspects of the qualitative ac behavior of coupled inductor converters are discussed. Considerations for the design of the magnetics for such converters are addressed.

  10. Management of Patients with Acute Lower Gastrointestinal Bleeding

    Science.gov (United States)

    Strate, Lisa L.; Gralnek, Ian M.

    2016-01-01

    This guideline provides recommendations for the management of patients with acute overt lower gastrointestinal hemorrhage. Hemodynamic status should be initially assessed with intravascular volume resuscitation started as needed. Risk stratification based upon clinical parameters should be performed to help distinguish patients at high and low-risk of adverse outcomes. Hematochezia associated with hemodynamic instability may be indicative of an upper GI bleeding source and thus warrants an upper endoscopy. In the majority of patients, colonoscopy should be the initial diagnostic procedure and should be performed within 24 hours of patient presentation after adequate colon preparation. Endoscopic hemostasis therapy should be provided to patients with high risk endoscopic stigmata of bleeding including active bleeding, non-bleeding visible vessel, or adherent clot. The endoscopic hemostasis modality used (mechanical, thermal, injection or combination) is most often guided by the etiology of bleeding, access to the bleeding site, and endoscopist experience with the various hemostasis modalities. Repeat colonoscopy, with endoscopic hemostasis performed if indicated, should be considered for patients with evidence of recurrent bleeding. Radiographic interventions (tagged red blood cell scintigraphy, CT angiography, angiography) should be considered in high-risk patients with ongoing bleeding who do not respond adequately to resuscitation, and who are unlikely to tolerate bowel preparation and colonoscopy. Strategies to prevent recurrent bleeding should be considered. NSAID use should be avoided in patients with a history of acute lower GI bleeding particularly if secondary to diverticulosis or angioectasia. In patients with established cardiovascular disease who require aspirin (secondary prophylaxis), aspirin should not be discontinued. The exact timing depends on the severity of bleeding, perceived adequacy of hemostasis and the risk of a thromboembolic event. Surgery

  11. ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding.

    Science.gov (United States)

    Gerson, Lauren B; Fidler, Jeff L; Cave, David R; Leighton, Jonathan A

    2015-09-01

    Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended

  12. Modeling of asymmetrical boost converters

    Directory of Open Access Journals (Sweden)

    Eliana Isabel Arango Zuluaga

    2014-01-01

    Full Text Available The asymmetrical interleaved dual boost (AIDB is a fifth-order DC/DC converter designed to interface photovoltaic (PV panels. The AIDB produces small current harmonics to the PV panels, reducing the power losses caused by the converter operation. Moreover, the AIDB provides a large voltage conversion ratio, which is required to step-up the PV voltage to the large dc-link voltage used in grid-connected inverters. To reject irradiance and load disturbances, the AIDB must be operated in a closed-loop and a dynamic model is required. Given that the AIDB converter operates in Discontinuous Conduction Mode (DCM, classical modeling approaches based on Continuous Conduction Mode (CCM are not valid. Moreover, classical DCM modeling techniques are not suitable for the AIDB converter. Therefore, this paper develops a novel mathematical model for the AIDB converter, which is suitable for control-pur-poses. The proposed model is based on the calculation of a diode current that is typically disregarded. Moreover, because the traditional correction to the second duty cycle reported in literature is not effective, a new equation is designed. The model accuracy is contrasted with circuital simulations in time and frequency domains, obtaining satisfactory results. Finally, the usefulness of the model in control applications is illustrated with an application example.

  13. High-Performance Data Converters

    DEFF Research Database (Denmark)

    Steensgaard-Madsen, Jesper

    -resolution internal D/A converters are required. Unit-element mismatch-shaping D/A converters are analyzed, and the concept of mismatch-shaping is generalized to include scaled-element D/A converters. Several types of scaled-element mismatch-shaping D/A converters are proposed. Simulations show that, when implemented...... in a standard CMOS technology, they can be designed to yield 100 dB performance at 10 times oversampling. The proposed scaled-element mismatch-shaping D/A converters are well suited for use as the feedback stage in oversampled delta-sigma quantizers. It is, however, not easy to make full use of their potential......-order difference of the output signal from the loop filter's first integrator stage. This technique avoids the need for accurate matching of analog and digital filters that characterizes the MASH topology, and it preserves the signal-band suppression of quantization errors. Simulations show that quantizers...

  14. Management of bleeding in vascular surgery.

    Science.gov (United States)

    Chee, Y E; Liu, S E; Irwin, M G

    2016-09-01

    Management of acute coagulopathy and blood loss during major vascular procedures poses a significant haemostatic challenge to anaesthetists. The acute coagulopathy is multifactorial in origin with tissue injury and hypotension as the precipitating factors, followed by dilution, hypothermia, acidemia, hyperfibrinolysis and systemic inflammatory response, all acting as a self-perpetuating spiral of events. The problem is confounded by the high prevalence of antithrombotic agent use in these patients and intraoperative heparin administration. Trials specifically examining bleeding management in vascular surgery are lacking, and much of the literature and guidelines are derived from studies on patients with trauma. In general, it is recommended to adopt permissive hypotension with a restrictive fluid strategy, using a combination of crystalloid and colloid solutions up to one litre during the initial resuscitation, after which blood products should be administered. A restrictive transfusion trigger for red cells remains the mainstay of treatment except for the high-risk patients, where the trigger should be individualized. Transfusion of blood components should be initiated by clinical evidence of coagulopathy such as diffuse microvascular bleeding, and then guided by either laboratory or point-of-care coagulation testing. Prophylactic antifibrinolytic use is recommended for all surgery where excessive bleeding is anticipated. Fibrinogen and prothrombin complex concentrates administration are recommended during massive transfusion, whereas rFVIIa should be reserved until all means have failed. While debates over the ideal resuscitative strategy continue, the approach to vascular haemostasis should be scientific, rational, and structured. As far as possible, therapy should be monitored and goal directed. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  15. Bleeding aneurysms of the celiac trunk

    International Nuclear Information System (INIS)

    Ziviello, M.; D'Isa, L.; Siani, A.; Maglione, F.; Cataldo, B.; Ziviello, R.; Capalbogiliberti, R.

    1988-01-01

    The authors report their experience in the study of bleeding aneurysms of the celiac arteries. Eleven patients were examined with US,CT, and angiography (8 hepatic artery aneurysms and 3 splenic artery aneurysms). Clinical findings included digestive bleeding, upper abdominal pain, palpable pulsating masses, and jaundice. Patient history included blunt abdominal trauma, penetrating trauma due to gunshot, acute pancreatitis, recent hepatic biospy. In all cases US showed an abdominal mass ranging in size from 2 to 10 cm. US findings included cyst-like lesions (8 cases), anobulated solid-like lesion, and complex lesion (2 cases). Continuity of the lesion with adjancent arterial vessels was noted in 5/11 cases, and pulsing activity in 3/11 cases. US patterns, although not specific, play an important role in the diagnosis when associated to other elements such as arterial continuity, mass pulsatility, patient history, and gastrointestinal bleeding. They suggest the need for more specific imaging exams, i.e. CT and angiography, and help avoid dangerous diagnostic biopsies. CT was performed to confirm US findings in 5 cases, and detected either hypodense cystic masses, or inhomogeneous masses with arterial enhancement after bolus injection of cm. CT was used to better demonstrate the lumen, patency of the vessel, the walls of the vessel, and the parietal thrombotic component. The typical arterial enhancement was the decisive finding for the diagnosis, even though a total continuity with arterial vessels was never observed. Angiography was the method of choice for the preoperative demonstration of hepatic artery aneurysms (10 cases) and for occlusive treatment with Gianturco coils (3 cases)

  16. An Unusual Case of Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Kristin N. Fiorino

    2011-01-01

    Full Text Available A 10-year-old boy presented with a 3-day history of worsening abdominal pain, fever, emesis and melena. Abdominal ultrasound revealed a right upper quadrant mass that was confirmed by computed tomography angiogram (CTA, which showed an 8 cm well-defined retroperitoneal vascular mass. 123Iodine metaiodobenzylguanidine (123MIBG scan indicated uptake only in the abdominal mass. Subsequent biopsy revealed a paraganglioma that was treated with chemotherapy. This case represents an unusual presentation of a paraganglioma associated with gastrointestinal (GI bleeding and highlights the utility of CTA and 123MIBG in evaluation and treatment.

  17. Somatostatin analogues for acute bleeding oesophageal varices

    DEFF Research Database (Denmark)

    Gøtzsche, Peter C.; Hrobjartsson, A.

    2008-01-01

    or recent bleeding from oesophageal varices. DATA COLLECTION AND ANALYSIS: The outcome measures extracted were: mortality, blood transfusions, use of balloon tamponade, initial haemostasis and rebleeding. Intention-to-treat analyses including all randomised patients were conducted if possible; a random...... it was substantially reduced in the other trials, relative risk 0.36 (0.19 to 0.68). Use of balloon tamponade was rarely reported. AUTHORS' CONCLUSIONS: The need for blood transfusions corresponded to one half unit of blood saved per patient. It is doubtful whether this effect is worthwhile. The findings do...

  18. Taeniasis: A possible cause of ileal bleeding.

    Science.gov (United States)

    Settesoldi, Alessia; Tozzi, Alessandro; Tarantino, Ottaviano

    2017-12-16

    Taenia spp. are flatworms of the class Cestoda, whose definitive hosts are humans and primates. Human infestation (taeniasis) results from the ingestion of raw meat contaminated with encysted larval tapeworms and is considered relatively harmless and mostly asymptomatic. Anemia is not recognized as a possible sign of taeniasis and taeniasis-induced hemorrhage is not described in medical books. Its therapy is based on anthelmintics such praziquantel, niclosamide or albendazole. Here we describe a case of acute ileal bleeding in an Italian man affected with both Taenia spp. infestation resistant to albendazole and Helicobacter pylori -associated duodenal ulcers.

  19. Iron Deficiency Anemia in Adolescents Who Present with Heavy Menstrual Bleeding.

    Science.gov (United States)

    Cooke, Amanda G; McCavit, Timothy L; Buchanan, George R; Powers, Jacquelyn M

    2017-04-01

    To assess the clinical severity and initial treatment of iron deficiency anemia (IDA) in female adolescents with heavy menstrual bleeding (HMB) in our center. Retrospective cohort study of electronic medical records via search of administrative records using International Classification of Diseases Ninth Revision codes for IDA or unspecified anemia and disorders of menstruation. Children's Medical Center in Dallas, Texas. One hundred seven patients with HMB and concomitant IDA (median age, 14.4 years) who presented to the outpatient, emergency department, and/or inpatient settings. The median initial hemoglobin concentration for all patients (n = 107) was 7.4 g/dL, and most (74%, n = 79) presented to the emergency department or via inpatient transfer. Symptomatic IDA was treated with blood transfusion in 46 (43%, n = 46). Ferrous sulfate was the most commonly prescribed oral iron therapy. Seven patients received intravenous iron therapy either initially or after oral iron treatment failure. Combined oral contraceptives were commonly prescribed for abnormal uterine bleeding, yet 10% of patients (n = 11) received no hormonal therapy during their initial management. Evaluation for underlying bleeding disorders was inconsistent. Severe anemia because of IDA and HMB resulting in urgent medical care, including hospitalization and blood transfusion, is a common but underemphasized problem in adolescent girls. In addition to prevention and early diagnosis, meaningful efforts to improve initial management of adolescents with severe HMB and IDA are necessary. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  20. The use of 111In-labelled platelets for scintigraphic localization of gastrointestinal bleeding with special reference to occult bleeding

    International Nuclear Information System (INIS)

    Gjerloeff Schmidt, K.; Waever Rasmussen, J.; Grove, O.; Andersen, D.

    1986-01-01

    Gamma-camera imaging of the abdomen after injection of autologous 111 In-labelled platelets was applied for localization of gastrointestinal bleeding in a study of 22 patients. In 15 studies showing scintigraphic signs of bleeding, the clinical presentation included occult bleeding in 6, melaena in 4, and bloody stools in 5 patients. Scintigraphy could be done repeatedly for up to 1 week after a single tracer injection. The time interval between the injection and scintigraphic visualization of bleeding ranged from 10 min to 68 h, being longest in cases of occult bleeding. In most cases the scintigraphic findings were supported by other diagnostic modalities, including surgical removal of presumed sources of bleeding. In seven studies without scintigraphic signs of bleeding, a probable source of bleeding was identified by other means in one patient. The 111 In-platelet method seems to be a promising method for localization of gastrointestinal bleeding which may prove particularly useful in cases of occult or recurrent bleeding

  1. Enteral alimentation and gastrointestinal bleeding in mechanically ventilated patients.

    Science.gov (United States)

    Pingleton, S K; Hadzima, S K

    1983-01-01

    The incidence of upper gastrointestinal (GI) bleeding in mechanically ventilated ICU patients receiving enteral alimentation was reviewed and compared to bleeding occurring in ventilated patients receiving prophylactic antacids or cimetidine. Of 250 patients admitted to our ICU during a 1-yr time period, 43 ventilated patients were studied. Patients in each group were comparable with respect to age, respiratory diagnosis, number of GI hemorrhage risk factors, and number of ventilator, ICU, and hospital days. Twenty-one patients had evidence of GI bleeding. Fourteen of 20 patients receiving antacids and 7 of 9 patients receiving cimetidine had evidence of GI bleeding. No bleeding occurred in 14 patients receiving enteral alimentation. Complications of enteral alimentation were few and none required discontinuation of enteral alimentation. Our preliminary data suggest the role of enteral alimentation in critically ill patients may include not only protection against malnutrition but also protection against GI bleeding.

  2. Timing of onset of gastrointestinal bleeding in the ICU

    DEFF Research Database (Denmark)

    Granholm, A; Lange, T; Anthon, C T

    2018-01-01

    BACKGROUND: Critically ill patients are at risk of gastrointestinal bleeding, but clinically important gastrointestinal bleeding is rare. The majority of intensive care unit (ICU) patients receive stress ulcer prophylaxis (SUP), despite uncertainty concerning the balance between benefit and harm....... For approximately half of ICU patients with gastrointestinal bleeding, onset is early, ie within the first two days of the ICU stay. The aetiology of gastrointestinal bleeding and consequently the balance between benefit and harm of SUP may differ between patients with early vs late gastrointestinal bleeding...... will describe baseline characteristics and assess the time to onset of the first clinically important episode of GI bleeding accounting for survival status and allocation to SUP or placebo. In addition, we will describe differences in therapeutic and diagnostic procedures used in patients with clinically...

  3. Use of heparin in the investigation of obscure gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Mernagh, J.R.; O'Donovan, N.; Somers, S.; Gill, G.; Sridhar, S.

    2001-01-01

    To determine if the administration of heparin improves the predictive value of angiography in the investigation of obscure gastrointestinal (GI) bleeding. 18 patients with a history of chronic GI bleeding were investigated with angiography. For 6 patients, the cause of GI bleeding was established with angiography; the 12 patients who had negative results were given heparin for 24 h and were reassessed with angiography. After heparin administration, the source of GI bleeding was determined with angiography for 6 of the remaining 12 patients. Thus, heparinization increased diagnostic yield from 33% (6 of 18) to 67% (12 of 18). No significant complications, such as uncontrolled GI bleeding, occurred. Heparinization improves the diagnostic yield of angiography when obscure GI bleeding is being investigated. (author)

  4. 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.

  5. Entanglement in a parametric converter

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Su-Yong; Qamar, Shahid; Lee, Hai-Woong; Zubairy, M Suhail [Center for Quantum Physics, COMSATS Institute of Information Technology, Islamabad (Pakistan)], E-mail: shahid_qamar@pieas.edu.pk, E-mail: zubairy@physics.tamu.edu

    2008-07-28

    In this paper, we consider a parametric converter as a source of entangled radiation. We examine recently derived conditions (Hillery and Zubairy 2006 Phys. Rev. Lett. 96 050503, Duan et al 2000 Phys. Rev. Lett. 84 2722) for determining when the two output modes in a parametric converter are entangled. We show that for different initial field states, the two criteria give different conditions that ensure that the output states are entangled. We also present an input-output calculation for the entanglement of the output field.

  6. Radiotherapy Can Cause Haemostasis in Bleeding Skin Malignancies

    Directory of Open Access Journals (Sweden)

    Helena Sung-In Jang

    2012-01-01

    Full Text Available Radiotherapy (RT can cause haemostasis in select cases of malignant bleeding. We present two cases where RT was used to prevent fatal exsanguination from bleeding skin malignancies. Treatment was with radical intent in one case and palliative intent in the other. The dose used in both cases was 20 Gray (Gy in 5 fractions. To our knowledge, this is the first report of radiation-induced haemostasis in bleeding skin malignancies.

  7. The role of endoscopy in pediatric gastrointestinal bleeding

    OpenAIRE

    Franke, Markus; Gei?, Andrea; Greiner, Peter; Wellner, Ulrich; Richter-Schrag, Hans-J?rgen; Bausch, Dirk; Fischer, Andreas

    2016-01-01

    Background and study aims: Gastrointestinal bleeding in children and adolescents accounts for up to 20?% of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents. Patients and methods: Pediat...

  8. Assessing Bleeding Risk in Patients Taking Anticoagulants

    Science.gov (United States)

    Shoeb, Marwa; Fang, Margaret C.

    2013-01-01

    Anticoagulant medications are commonly used for the prevention and treatment of thromboembolism. Although highly effective, they are also associated with significant bleeding risks. Numerous individual clinical factors have been linked to an increased risk of hemorrhage, including older age, anemia, and renal disease. To help quantify hemorrhage risk for individual patients, a number of clinical risk prediction tools have been developed. These risk prediction tools differ in how they were derived and how they identify and weight individual risk factors. At present, their ability to effective predict anticoagulant-associated hemorrhage remains modest. Use of risk prediction tools to estimate bleeding in clinical practice is most influential when applied to patients at the lower spectrum of thromboembolic risk, when the risk of hemorrhage will more strongly affect clinical decisions about anticoagulation. Using risk tools may also help counsel and inform patients about their potential risk for hemorrhage while on anticoagulants, and can identify patients who might benefit from more careful management of anticoagulation. PMID:23479259

  9. Vascular parenchymal sources of upper gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Savastano, S.; Feltrin, G.P.; Miotto, D.; Chiesura-Corona, M.; Rubaltelli, L.; Candiani, F.

    Fourteen cases of upper gastrointenstinal bleeding (UGIB) were reviewed: 6 (group A) were caused by pancreatitis, 3 (group B) by hemobilia, and 5 (group C) by rupture of esophageal varices due to arterioportal shunts. Elective endoscopy carried out in 7 patients in groups A and B was negative; in 2 actively bleeding patients in group A emergency endoscopy could not detect the source of hemorrhage. Endoscopy was carried out in 4 patients in group C for diagnosis and sclerosis, but severe hemorrhage recurred in spite of treatment. Ultrasonography (US) and computed tomography (CT) were carried out prior to angiography in 5 and 4 patients, respectively, and always suggested a parenchymal lesion. All patients underwent angiography. Transcatheter control of the hemorrhage was attempted as an emergency in 2 patients (as a presurgical step in one); elective embolization was the treatment of choice for 8 patients, with good results in 6. This study suggests the usefulness of US and CT both in the detection of parenchymal lesions causing UGIB not clarified by endoscopy, and in the selection of patients for angiographic treatment.

  10. Vascular parenchymal sources of upper gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Savastano, S.; Feltrin, G.P.; Miotto, D.; Chiesura-Corona, M.; Rubaltelli, L.; Candiani, F.

    1989-01-01

    Fourteen cases of upper gastrointenstinal bleeding (UGIB) were reviewed: 6 (group A) were caused by pancreatitis, 3 (group B) by hemobilia, and 5 (group C) by rupture of esophageal varices due to arterioportal shunts. Elective endoscopy carried out in 7 patients in groups A and B was negative; in 2 actively bleeding patients in group A emergency endoscopy could not detect the source of hemorrhage. Endoscopy was carried out in 4 patients in group C for diagnosis and sclerosis, but severe hemorrhage recurred in spite of treatment. Ultrasonography (US) and computed tomography (CT) were carried out prior to angiography in 5 and 4 patients, respectively, and always suggested a parenchymal lesion. All patients underwent angiography. Transcatheter control of the hemorrhage was attempted as an emergency in 2 patients (as a presurgical step in one); elective embolization was the treatment of choice for 8 patients, with good results in 6. This study suggests the usefulness of US and CT both in the detection of parenchymal lesions causing UGIB not clarified by endoscopy, and in the selection of patients for angiographic treatment. (orig.)

  11. Risk of gastrointestinal bleeding during anticoagulant treatment.

    Science.gov (United States)

    Lanas-Gimeno, Aitor; Lanas, Angel

    2017-06-01

    Gastrointestinal bleeding (GIB) is a major problem in patients on oral anticoagulation therapy. This issue has become even more pressing since the introduction of direct oral anticoagulants (DOACs) in 2009. Areas covered: Here we review current evidence related to GIB associated with oral anticoagulants, focusing on randomized controlled trials, meta-analyses, and post-marketing observational studies. Dabigatran 150 mg twice daily and rivaroxaban 20 mg once daily increase the risk of GIB compared to warfarin. The risk increase with edoxaban is dose-dependent, while apixaban shows apparently, no increased risk. We summarize what is known about GIB risk factors for individual anticoagulants, the location of GIB in patients taking these compounds, and prevention strategies that lower the risk of GIB. Expert opinion: Recently there has been an important shift in the clinical presentation of GIB. Specifically, upper GIB has decreased with the decreased incidence of peptic ulcers due to the broad use of proton pump inhibitors and the decreased prevalence of H. pylori infections. In contrast, the incidence of lower GIB has increased, due in part to colonic diverticular bleeding and angiodysplasia in the elderly. In this population, the addition of oral anticoagulation therapy, especially DOACs, seems to increase the risk of lower GIB.

  12. Bevacizumab for Refractory Gastrointestinal Bleeding in Rendu-Osler-Weber Disease

    Science.gov (United States)

    Bernardes, Carlos; Santos, Sara; Loureiro, Rafaela; Borges, Verónica; Ramos, Gonçalo

    2018-01-01

    Rendu-Osler-Weber disease, also known as hereditary hemorrhagic telangiectasia, is a rare autosomal dominant disorder which is often characterized by recurrent epistaxis, mucocutaneous and gastrointestinal telangiectasias, and visceral arteriovenous malformations. Patients with gastrointestinal involvement can present with a wide spectrum of severity, which may vary from uncomplicated iron deficiency anemia to continuous and refractory bleeding. We present the case of a 62-year-old female, who was admitted with anemia following several episodes of melena, and whose endoscopic examination revealed multiple angiodysplasias in the stomach and small bowel. Despite endoscopic and medical treatment attempts with hormonal agents and octreotide, she developed persistent hemorrhage and severe anemia, requiring frequent red blood cell transfusions. Immediately after initiating bevacizumab (7.5 mg/kg, every 3 weeks), complete cessation of bleeding episodes was observed. Currently, after 1 year of follow-up, she maintained sustained remission without the occurrence of adverse events. PMID:29662934

  13. AC-DC PFC Converter Using Combination of Flyback Converter and Full-bridge DC-DC Converter

    Directory of Open Access Journals (Sweden)

    Moh. Zaenal Efendi

    2014-06-01

    Full Text Available This paper presents a combination of power factor correction converter using Flyback converter and Full-bridge dc-dc converter in series connection. Flyback converter is operated in discontinuous conduction mode so that it can serve as a power factor correction converter and meanwhile Full-bridge dc-dc converter is used for dc regulator. This converter system is designed to produce a 86 Volt of output voltage and 2 A of output current. Both simulation and experiment results show that the power factor of this converter achieves up to 0.99 and meets harmonic standard of IEC61000-3-2. Keywords: Flyback Converter, Full-bridge DC-DC Converter, Power Factor Correction.

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

    International Nuclear Information System (INIS)

    Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo

    2012-01-01

    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.

  15. Evaluation of rectal bleeding factors associated with prostate brachytherapy

    International Nuclear Information System (INIS)

    Aoki, Manabu; Miki, Kenta; Sasaki, Hiroshi; Kido, Masato; Shirahama, Jun; Takagi, Sayako; Kobayashi, Masao; Honda, Chikara; Kanehira, Chihiro

    2009-01-01

    The purpose of this study was to analyze rectal bleeding prognostic factors associated with prostate brachytherapy (PB) or in combination with external-beam radiation therapy (EBRT) and to examine dosimetric indications associated with rectal bleeding. The study included 296 patients followed up for >36 months (median, 48 months). PB was performed alone in 252 patients and in combination with EBRT in 44 patients. PB combined with EBRT is indicated for patients with a Gleason score >6. The prescribed dose was 144 Gy for monotherapy and 110 Gy for PB+EBRT (44-46 Gy). Although 9.1% who received monotherapy had 2.3% grade 2 rectal bleeding, 36.3% who received combined therapy had 15.9% grade 2 rectal bleeding. Combined therapy was associated with higher incidence of rectal bleeding (P=0.0049) and higher percentage of grade 2 bleeding (P=0.0005). Multivariate analysis revealed that R-150 was the only significant factor for rectal bleeding, and modified Radiation Therapy Oncology Group (RTOG) grade in monotherapy and biologically equivalent dose (BED) were significant for combined therapy. Moreover, grade 2 rectal bleeding increased significantly at D90 >130 Gy. Although R-150 was the significant prognostic factor for rectal bleeding and modified RTOG rectal toxicity grade, BED was the significant prognostic factor for modified RTOG rectal toxicity grade. (author)

  16. Photocoagulation in the treatment of bleeding peptic ulcer

    Science.gov (United States)

    Otto, Wlodzimierz; Paczkowski, Pawel M.

    1996-03-01

    The authors present their experience in the endoscopic laser photocoagulation of bleeding peptic ulcer. From 1991 to June 1995, 203 patients admitted for UGI bleeding from peptic ulcer have been treated by this method. The source of bleeding was confirmed by endoscopy. The patients were divided into two groups: actively bleeding peptic ulcer (group IA and IB according to Forrest's classification) and ulcer with stigmata of recent bleeding (group IIA/IIB). The former group consisted of 106 patients, among whom over 40 percent (45 patients) presented signs of hypovolemic shock on admission. Nd:YAG laser (Surgical Laser Technologies) was used in a continuous mode with a contact (8 - 20 watts) or non-contact (over 50 watts) method of coagulation. In actively bleeding patients photocoagulation resulted in stopping the hemorrhage in 95 (90%). Recurrent bleeding occurred in 16 cases; in 9 of them it was stopped by repeated photocoagulation. In this group 18 patients required surgical intervention. The mortality was of 10.3% (11 patients). In 97 patients with recent bleeding stigmata photocoagulation provoked heavy hemorrhage in 3 (in 2 cases stopped by prolonged coagulation). In 9 of the remaining 94 patients recurrent bleeding occurred. Nine patients required surgical intervention. Mortality in this group was of 6%.

  17. Appendiceal hemorrhage – An uncommon cause of lower gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Ching-Chung Chiang

    2011-06-01

    Full Text Available Lower gastrointestinal bleeding is a common disease among elderly patients. The common sources of lower gastrointestinal bleeding include vascular disease, Crohn’s disease, neoplasms, inflammatory bowel disease, hemorrhoids, and ischemic colitis. Lower gastrointestinal bleeding arising from the appendix is an extremely rare condition. We report a case of appendiceal hemorrhage in a young male. Diagnosis was made by multidetector computerized tomography during survey for hematochezia. The patient recovered well after appendectomy. The histological finding revealed focal erosion of appendix mucosa with bleeding.

  18. 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.

  19. 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.

  20. 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.

  1. Current-to-frequency converter

    Energy Technology Data Exchange (ETDEWEB)

    Glowacki, S W [Institute of Nuclear Research, Warsaw (Poland)

    1981-07-15

    A current-to-frequency converter covering the range from 3 x 10/sup -10/ A up to 3 x 10/sup -5/ A of the input current is described. The circuit operates with nuclear detectors featuring a high internal resistance.

  2. Materials for thermionic energy converters

    NARCIS (Netherlands)

    Wolff, L.R.; Hermans, J.M.; Adriaansen, J.K.M.; Gubbels, G.H.M.; Vincenzini, P.

    1987-01-01

    This paper deals with the design and construction of a combustion heated Thermionic Energy Converter (TEC). Main components of this TEC are: 1. A ''Hot Shell'' protecting the TEC from the combustion environment 2. A ''Ceramic Seal'' electrically insulating the emitter from the collector 3. A

  3. Smart AD and DA Converters

    NARCIS (Netherlands)

    Roermund, van A.H.M.; Hegt, J.A.; Harpe, P.J.A.; Radulov, G.I.; Zanikopoulos, A.; Doris, K.; Quinn, P.J.

    2005-01-01

    In this paper, a concept is proposed to solve the problems related to the embedding of AD and DA converters in system-on-chips, FPGAs or other VLSI solutions. Problems like embedded testing, yield, reliability and reduced design space become crucial bottlenecks in the integration of high-performance

  4. Charge-pump voltage converter

    Science.gov (United States)

    Brainard, John P [Albuquerque, NM; Christenson, Todd R [Albuquerque, NM

    2009-11-03

    A charge-pump voltage converter for converting a low voltage provided by a low-voltage source to a higher voltage. Charge is inductively generated on a transfer rotor electrode during its transit past an inductor stator electrode and subsequently transferred by the rotating rotor to a collector stator electrode for storage or use. Repetition of the charge transfer process leads to a build-up of voltage on a charge-receiving device. Connection of multiple charge-pump voltage converters in series can generate higher voltages, and connection of multiple charge-pump voltage converters in parallel can generate higher currents. Microelectromechanical (MEMS) embodiments of this invention provide a small and compact high-voltage (several hundred V) voltage source starting with a few-V initial voltage source. The microscale size of many embodiments of this invention make it ideally suited for MEMS- and other micro-applications where integration of the voltage or charge source in a small package is highly desirable.

  5. 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.

  6. Impedance interactions in bidirectional cascaded converter

    DEFF Research Database (Denmark)

    Tian, Yanjun; Loh, Poh Chiang; Chen, Zhe

    2016-01-01

    A cascaded converter is built by connecting one elementary converter to another. Output impedance of one converter will therefore interact with input impedance of the other converter. This interaction will change when power flow reverses. To compare this difference, an investigation is performed...

  7. The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them?

    Science.gov (United States)

    Munro, Malcolm G; Critchley, Hilary O D; Fraser, Ian S

    2012-10-01

    In November 2010, the International Federation of Gynecology and Obstetrics formally accepted a new classification system for causes of abnormal uterine bleeding in the reproductive years. The system, based on the acronym PALM-COEIN (polyps, adenomyosis, leiomyoma, malignancy and hyperplasia-coagulopathy, ovulatory disorders, endometrial causes, iatrogenic, not classified) was developed in response to concerns about the design and interpretation of basic science and clinical investigation that relates to the problem of abnormal uterine bleeding. A system of nomenclature for the description of normal uterine bleeding and the various symptoms that comprise abnormal bleeding has also been included. This article describes the rationale, the structured methods that involved stakeholders worldwide, and the suggested use of the International Federation of Gynecology and Obstetrics system for research, education, and clinical care. Investigators in the field are encouraged to use the system in the design of their abnormal uterine bleeding-related research because it is an approach that should improve our understanding and management of this often perplexing clinical condition. Copyright © 2012. Published by Mosby, Inc.

  8. Iron Deficiency without Anemia: A Common Yet Under-Recognized Diagnosis in Young Women with Heavy Menstrual Bleeding.

    Science.gov (United States)

    Johnson, Stephen; Lang, Abigail; Sturm, Mollie; O'Brien, Sarah H

    2016-12-01

    To assess the proportion of iron deficiency that is not detected with a screening hemoglobin or complete blood count (CBC) alone in young women with heavy menstrual bleeding. Retrospective review of electronic medical records. Nationwide Children's Hospital in Columbus, Ohio. One hundred fourteen young women aged 9-19 years consecutively referred to a young women's hematology clinic with a complaint of heavy menstrual bleeding. Fifty-eight (50.9%) of all patients had ferritin iron deficiency. Of the 58 patients with iron deficiency, only 24 (41.4%) were anemic and 25 (46.3%) were microcytic. The sensitivity of hemoglobin alone and CBC alone for identifying women with ferritin iron deficiency if they were overweight or obese (odds ratio, 2.81; 95% CI, 1.25-6.29) compared with patients with normal body mass index. Age at presentation for heavy menstrual bleeding, presence of an underlying bleeding disorder, and median household income were not significantly associated with iron deficiency. In adolescents with heavy menstrual bleeding, fewer than half of iron deficiency cases are detected when screening is performed with hemoglobin or blood count alone. Measuring ferritin levels in at-risk patients might allow for earlier implementation of iron therapy and improvement in symptoms. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  9. Converter Monitoring Unit for Retrofit of Wind Power Converters

    DEFF Research Database (Denmark)

    Rannestad, Bjorn; Maarbjerg, Anders Eggert; Frederiksen, Kristian

    2018-01-01

    A Converter Monitoring Unit (CMU), which will enable condition monitoring of wind turbine converters is presented in this paper. Reducing the cost of corrective maintenance by means of condition monitoring is a way of lowering Operation & Maintenance (O&M) costs for wind turbine systems....... The CMU must be able to detect a broad range of failure modes related to Insulated Gate Bipolar Transistor (IGBT) power modules and associated gate drives. IGBT collector-emitter on-state voltage (vceon) and current (ic) is sampled in the CMU and used for detection of emerging failures. A new method...... for compensation of unwanted inductive voltage drop in the vceon measurement path is presented, enabling retrofitting of CMUs in existing wind turbines. Finally, experimental results obtained on a prototype CMU are presented. Experimentally the vceon dependency to IGBT junction temperature and deterioration...

  10. Risk of bleeding with dabigatran in atrial fibrillation.

    Science.gov (United States)

    Hernandez, Inmaculada; Baik, Seo Hyon; Piñera, Antonio; Zhang, Yuting

    2015-01-01

    It remains unclear whether dabigatran etexilate mesylate is associated with higher risk of bleeding than warfarin sodium in real-world clinical practice. To compare the risk of bleeding associated with dabigatran and warfarin using Medicare data. In this retrospective cohort study, we used pharmacy and medical claims in 2010 to 2011 from a 5% random sample of Medicare beneficiaries. We identified participants as those newly diagnosed as having atrial fibrillation from October 1, 2010, through October 31, 2011, and who initiated dabigatran or warfarin treatment within 60 days of initial diagnosis. We followed up patients until discontinued use or switch of anticoagulants, death, or December 31, 2011. Dabigatran users (n = 1302) and warfarin users (n = 8102). We identified any bleeding events and categorized them as major and minor bleeding by anatomical site. Major bleeding events included intracranial hemorrhage, hemoperitoneum, and inpatient or emergency department stays for hematuria, gastrointestinal, or other hemorrhage. We used a propensity score weighting mechanism to balance patient characteristics between 2 groups and Cox proportional hazards regression models to evaluate the risk of bleeding. We further examined the risk of bleeding for 4 subgroups of high-risk patients: those 75 years or older, African Americans, those with chronic kidney disease, and those with more than 7 concomitant comorbidities. Dabigatran was associated with a higher risk of bleeding relative to warfarin, with hazard ratios of 1.30 (95% CI, 1.20-1.41) for any bleeding event, 1.58 (95% CI, 1.36-1.83) for major bleeding, and 1.85 (95% CI, 1.64-2.07) for gastrointestinal bleeding. The risk of intracranial hemorrhage was higher among warfarin users, with a hazard ratio of 0.32 (95% CI, 0.20-0.50) for dabigatran compared with warfarin. Dabigatran was consistently associated with an increased risk of major bleeding and gastrointestinal hemorrhage for all subgroups analyzed. The risk of

  11. 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.

  12. Increased bleeding risk during percutaneous coronary interventions by arterial hypertension.

    Science.gov (United States)

    Ndrepepa, Gjin; Groha, Philipp; Lahmann, Anna L; Lohaus, Raphaela; Cassese, Salvatore; Schulz-Schüpke, Stefanie; Kufner, Sebastian; Mayer, Katharina; Bernlochner, Isabell; Byrne, Robert A; Fusaro, Massimiliano; Laugwitz, Karl-Ludwig; Schunkert, Heribert; Kastrati, Adnan

    2016-08-01

    We aimed to assess the association between arterial hypertension and bleeding in patients undergoing percutaneous coronary intervention (PCI). The impact of arterial hypertension on bleeding risk of patients with coronary artery disease undergoing PCI is unknown. This study included 14,180 patients who underwent PCI. Bleeding was defined using the Bleeding Academic Research Consortium (BARC) criteria. Arterial hypertension was defined as treatment with antihypertensive drugs or a systolic blood pressure >140 mm Hg and/or diastolic blood pressure value >90 mm Hg documented on at least 2 occasions. The primary outcome was bleeding rate within 30 days of PCI. Overall, 11,066 patients (78.0%) had arterial hypertension. Bleeding events occurred in 1,232 patients with arterial hypertension and 278 patients without arterial hypertension (11.1% vs 8.9%; odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.11-1.46, P arterial hypertension and 175 patients without arterial hypertension (6.6% vs 5.6%: OR = 1.19 [1.01-1.41], P = 0.049). Non-access-site bleeding occurred in 502 patients with and 103 patients without arterial hypertension (4.5% vs 3.3%; OR = 1.39 [1.12-1.72], P = 0.003). After adjustment, arterial hypertension was significantly associated with any bleeding (adjusted OR = 1.41 [1.19-1.67], P arterial hypertension increased the risk of non-access-site bleeding (P = 0.002), whereas systolic blood pressure at the time of PCI increased the risk of access site bleeding (P = 0.018). Arterial hypertension is associated with increased risk of bleeding during PCI procedures. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  13. Parametric study of laser photovoltaic energy converters

    Science.gov (United States)

    Walker, G. H.; Heinbockel, J. H.

    1987-01-01

    Photovoltaic converters are of interest for converting laser power to electrical power in a space-based laser power system. This paper describes a model for photovoltaic laser converters and the application of this model to a neodymium laser silicon photovoltaic converter system. A parametric study which defines the sensitivity of the photovoltaic parameters is described. An optimized silicon photovoltaic converter has an efficiency greater than 50 percent for 1000 W/sq cm of neodymium laser radiation.

  14. Bidirectional dc-to-dc Power Converter

    Science.gov (United States)

    Griesbach, C. R.

    1986-01-01

    Solid-state, series-resonant converter uses high-voltage thyristors. Converter used either to convert high-voltage, low-current dc power to lowvoltage, high current power or reverse. Taking advantage of newly-available high-voltage thyristors to provide better reliability and efficiency than traditional converters that use vacuum tubes as power switches. New converter essentially maintenance free and provides greatly increased mean time between failures. Attractive in industrial applications whether or not bidirectional capability is required.

  15. Tranexamic acid for upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

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

    2014-01-01

    Background Tranexamic acid reduces haemorrhage through its antifibrinolytic effects. In a previous version of the present review, we found that tranexamic acid may reduce mortality. This review includes updated searches and new trials.Objectives To assess the effects of tranexamic acid versus......-effect and random-effects model meta-analyses and presented results as risk ratios (RRs) with 95% confidence intervals (CIs) and used I² as a measure of between-trial heterogeneity. We analysed tranexamic acid versus placebo or no intervention and tranexamic acid versus antiulcer drugs separately. To analyse...... sources of heterogeneity and robustness of the overall results, we performed subgroup, sensitivity and sequential analyses.Main results We included eight randomised controlled trials on tranexamic acid for upper gastrointestinal bleeding. Additionally, we identified one large ongoing pragmatic randomised...

  16. Obliteration of gastric bleeding varices with NBCA

    International Nuclear Information System (INIS)

    Jiang Zaibo; Li Zhengran; Qian Jiesheng; Zhu Kangshun; Huang Mingsheng; Zhao Dabing; Pang Pengfei; Guan Shouhai; Shan Hong

    2007-01-01

    Objective: To study the feasibility of obliteration with NBCA(N-Butyl-2-Cyanoacrylate)for the treatment of gastric bleeding varices in terminal stage of portal hypertension. Methods: All 17 cases of upper gastrointestinal hemorrhage with portal hypertension, mean age 54 years, including 11 cases of advanced hepatocellular carcinoma with portal venous tumor emboli, 6 eases of cirrhosis and 3 cases with moderate to severe ascites; were selected for this study. According to the Child-Pugh classification, 3 cases were in class B and 14 cases in class C at admission. Left gastric, posterior and short gastric varices were shown in all patients on CT or MRI enhancement scannings, together with splenorenal and gastrorenal shunts in 3 and 3 cases respectively. Seven cases were approached through right midaxillary line transhepatic route, 4 cases through infra-cartilago ensiformis transhepatic route, and 6 cases through transsplenic approach. Nine eases took scheduled operation, and 8 cases under emergency operation. According to blood flow rate and variceal internal diameter, the proportion 1:4 of NBCA and lipiodol was selected for the embolization. The survival and symptom relief of the patients were followed up. Results: All cases were successfully engaged in embolization with NBCA, with all varices disappeared on post-operation angiography and CT enhancement scanning during follow-up. Pressure of portal vein rised 3 cmH 2 O after operation with one case having with transient irritable cough. The average survival time was over 5 months during 3-12 months follow-up. Four cases died postoperatively because of hepatic function exhaustion. Conclusion: Utilization of NBCA in obliteration for gastric bleeding varices is effective, feasible and reliable; with less complication, Keeping strict indications would surely raise the long-term efficacy. (authors)

  17. Packing of Renal Fossa: Useful Technique for Intractable Bleeding ...

    African Journals Online (AJOL)

    There is no documented study to indicate the role of prolonged packing of renal fossa (24 to 48 hours) to control bleeding in life threating haemorrhage following open pyelolithotomy without compromise in the renal functions. On the contrary emergency nephrectomy was performed for intractable bleeding during renal stone ...

  18. The role of nuclear medicine in acute gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Robinson, P.

    1993-01-01

    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. 99 Tc 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. 99 Tc 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. Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension

    Science.gov (United States)

    Biecker, Erwin

    2013-01-01

    Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. The management of acute bleeding has changed over the last years. Patients are managed with a combination of endoscopic and pharmacologic treatment. The endoscopic treatment of choice for esophageal variceal bleeding is variceal band ligation. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the time point of endoscopy. The first-line treatment for primary prophylaxis of esophageal variceal bleeding is nonselective beta blockers. Pharmacologic therapy is recommended for most patients; band ligation is an alternative in patients with contraindications for or intolerability of beta blockers. Treatment options for secondary prophylaxis include variceal band ligation, beta blockers, a combination of nitrates and beta blockers, and combination of band ligation and pharmacologic treatment. A clear superiority of one treatment over the other has not been shown. Bleeding from portal hypertensive gastropathy or ectopic varices is less common. Treatment options include beta blocker therapy, injection therapy, and interventional radiology. PMID:27335828

  20. 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....

  1. 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....

  2. Recombinant activated factor VII for uncontrolled bleeding postcardiac surgery

    Directory of Open Access Journals (Sweden)

    Aly Makram Habib

    2016-10-01

    Conclusion: In this analysis, rFVIIa succefully reduced the chest tube bleeding and blood products transfused during severe post cardiac surgical bleeding. However, safety of rFVIIa remains unclear. Prospective controlled trials are still needed to confirm the role of rFVIIa.

  3. Risk Stratification for Bleeding Complications in Patients With Venous Thromboembolism

    DEFF Research Database (Denmark)

    Brown, Joshua D; Goodin, Amie J; Lip, Gregory Y H

    2018-01-01

    BACKGROUND: The Hypertension, Abnormal renal/liver function, Stroke, Bleeding, Labile International Normalized Ratio (INR), Elderly, Drugs or alcohol use (HAS-BLED) score has strong predictive validity for major bleeding complications, but limited validation has been conducted in venous thromboem...

  4. Clinical approach to a patient with abnormal uterine bleeding

    African Journals Online (AJOL)

    bleeding, type, appearance, duration, cyclicity and associated ... Clinical approach. In all cases where the main complaint is that of excessive menstrual bleeding, an immediate differentiation must be made between acute severe blood loss and chronic excessive ... management rules can be implemented. In such patients ...

  5. Bleeding Peptic Ulcer - Tertiary Center Experience: Epidemiology, Treatment and Prognosis.

    Science.gov (United States)

    Budimir, Ivan; Stojsavljević, Sanja; Hrabar, Davor; Kralj, Dominik; Bišćanin, Alen; Kirigin, Lora Stanka; Zovak, Mario; Babić, Žarko; Bohnec, Sven; Budimir, Ivan

    2017-12-01

    The aim of this study was to demonstrate epidemiological, clinical and endoscopic characteristics of acute upper gastrointestinal bleeding (UGIB) with special reference to peptic ulcer bleeding (PUB). The study included 2198 consecutive patients referred to our emergency department due to acute UGIB from January 2008 to December 2012. All patients underwent urgent upper GI endoscopy within 24 hours of admission, and 842 patients diagnosed with PUB were enrolled and prospectively followed-up. The cumulative incidence of UGIB was 126/100,000 in the 5-year period. Two out of five patients had a bleeding peptic ulcer; in total, 440 (52.3%) had bleeding gastric ulcer, 356 (42.3%) had bleeding duodenal ulcer, 17 (2%) had both bleeding gastric and duodenal ulcers, and 29 (3.5%) patients had bleeding ulcers on gastroenteric anastomoses. PUB was more common in men. The mean patient age was 65.9 years. The majority of patients (57%) with PUB were taking agents that attenuate the cytoprotective function of gastric and duodenal mucosa. Rebleeding occurred in 77 (9.7%) patients and 47 (5.9%) patients required surgical intervention. The 30-day morality was 5.2% and 10% of patients died from uncontrolled bleeding and concomitant diseases. In conclusion, PUB is the main cause of UGIB, characterized by a significant rebleeding rate and mortality.

  6. 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.

  7. Bleeding complications during anticoagulant treatment in patients with cancer

    NARCIS (Netherlands)

    Kamphuisen, Pieter W.; Beyer-Westendorf, Jan

    Patients with cancer have an increased risk of bleeding complications, of which some are fatal. This risk is influenced by chemotherapy, cancer type and stage, thrombocytopenia, renal function, and previous bleeding. Since many cancer patients receive anticoagulant treatment for prophylaxis or

  8. 21 CFR 864.6100 - Bleeding time device.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bleeding time device. 864.6100 Section 864.6100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Manual Hematology Devices § 864.6100 Bleeding time device...

  9. A sensitive venous bleeding model in haemophilia A mice

    DEFF Research Database (Denmark)

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

    2012-01-01

    Haemostatic effect of compounds for treating haemophilia can be evaluated in various bleeding models in haemophilic mice. However, the doses of factor VIII (FVIII) for normalizing bleeding used in some of these models are reported to be relatively high. The aim of this study was to establish a se...

  10. 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).

  11. EPIDEMIOLOGICAL CORRELATES OF POSTMENOPAUSAL BLEEDING IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Sonia Arora

    2012-06-01

    Full Text Available Background: A woman is considered menopausal after 12 months of amenorrhea. The most feared symptom during menopause is postmenopausal bleeding which unless proved otherwise indicates genital malignancy. Objectives: To study Socio-demographic factors related to postmenopausal bleeding and to find time lapse between bleeding and reporting of these cases. Material and Methods: This cross sectional was done in the Department of Obstetrics & Gynecology, Pt. J. N. M. Medical College & DR. B. R. Ambedkar Memorial, Hospital, Raipur (C. G. The participants were 146 women who came with the complaint of postmenopausal bleeding. A detailed, preceded, pre-tested, structured, close ended questionnaire was used to collect the data. By interviewing these women, information was collected about different demographic factors like age, socio-economic status, parity etc. The collected data was put in the master chart and analyzed. Results: The proportion of postmenopausal bleeding cases was 3.5% .Maximum cases(50% with postmenopausal bleeding were found in the age group of 45-54yrs . 60 % of patients were from rural areas and 62% were illiterate. 65% of the patients were grand multipara (Parity4. Most of the patients belonged to lower socioeconomic strata. Almost half (48% of patients presented after, more than 6 months since the first episode of bleeding . Conclusions: The proportion of postmenopausal bleeding is high, requiring immediate investigation. Lack of awareness led to very late presentation of most of the patients, so education at community level is required to reduce this time lapse for earlier diagnosis and management

  12. Bleeding gastrointestinal stromal tumour of the stomach complicated ...

    African Journals Online (AJOL)

    Inferior vena cava filter insertion was not possible due to non-availability. Coexistence of DVT needing anticoagulation and bleeding gastric GIST requiring urgent resection presented a management dilemna. Despite the risk, the patient was taken for an emergency tumor resection primarily to stop the bleeding and facilitate ...

  13. Value of Adjusted Blood Requirement Index in determining failure to control bleed in patients with variceal bleeding.

    Science.gov (United States)

    Abid, Shahab; Khalid, Abdullah B; Awan, Safia; Shah, Hasnain A; Hamid, Saeed; Jafri, Wasim

    2015-03-01

    Variceal bleeding is a serious complication in patients with cirrhosis. Among the criteria that were proposed in Baveno conferences, the Adjusted Blood Requirement Index (ABRI) has not been validated prospectively in clinical practice. We therefore aim to evaluate the measurement of ABRI as a marker of failure to control bleeding and to evaluate the consistency of ABRI in relation to other criteria of failure to control variceal bleeding. All patients with variceal bleeding who presented to Aga Khan University Hospital from January 2010 to December 2012 who were administered transfusion of packed red blood cells were included after obtaining informed consent. All patients were managed as per the standard protocol with intravenous terlipressin along with band ligation and injection of cyanoacrylate in cases of esophageal and fundal varices, respectively. Hemoglobin and hematocrit were measured every 6 h for 48 h and then every 12 h until 5 days of index bleed in each patient. Packed cells were transfused if hemoglobin decreased below 8 g/dl. The number of blood units transfused, change in hemoglobin values, and ABRI were calculated after each unit of blood transfusion till 120 h. In patients in whom bleed could not be controlled, an ABRI value of 0.75 or more was compared with other Baveno IV-based parameters that define failure to control variceal bleeding. During the study period, 137 eligible patients with variceal bleed were admitted. The mean age of the patients was 52±12 years. The majority of patients (50.4%) were in Child-Pugh class B, followed by 38% in Child-Pugh class C. According to the Baveno IV criteria, overall failure to control acute variceal bleeding occurred in 52 (37.9%) patients. Excluding ABRI, failure to control bleeding was found in 22/137 (16%) patients, whereas ABRI-based criteria showed that in 34/137 (24.8%) patients, bleeding could not be controlled. There were only four (2.9%) patients with variceal bleeding in whom ABRI and

  14. Early lactate clearance for predicting active bleeding in critically ill patients with acute upper gastrointestinal bleeding: a retrospective study.

    Science.gov (United States)

    Wada, Tomoki; Hagiwara, Akiyoshi; Uemura, Tatsuki; Yahagi, Naoki; Kimura, Akio

    2016-08-01

    Not all patients with upper gastrointestinal bleeding (UGIB) require emergency endoscopy. Lactate clearance has been suggested as a parameter for predicting patient outcomes in various critical care settings. This study investigates whether lactate clearance can predict active bleeding in critically ill patients with UGIB. This single-center, retrospective, observational study included critically ill patients with UGIB who met all of the following criteria: admission to the emergency department (ED) from April 2011 to August 2014; had blood samples for lactate evaluation at least twice during the ED stay; and had emergency endoscopy within 6 h of ED presentation. The main outcome was active bleeding detected with emergency endoscopy. Classification and regression tree (CART) analyses were performed using variables associated with active bleeding to derive a prediction rule for active bleeding in critically ill UGIB patients. A total of 154 patients with UGIB were analyzed, and 31.2 % (48/154) had active bleeding. In the univariate analysis, lactate clearance was significantly lower in patients with active bleeding than in those without active bleeding (13 vs. 29 %, P bleeding is derived, and includes three variables: lactate clearance; platelet count; and systolic blood pressure at ED presentation. The rule has 97.9 % (95 % CI 90.2-99.6 %) sensitivity with 32.1 % (28.6-32.9 %) specificity. Lactate clearance may be associated with active bleeding in critically ill patients with UGIB, and may be clinically useful as a component of a prediction rule for active bleeding.

  15. Radiated EMI from power converters

    Directory of Open Access Journals (Sweden)

    Arnautovski-Toševa Vesna

    2005-01-01

    Full Text Available With the continuous increase of switching frequency together with the ongoing trend to higher complexity and functionality, power converters as a part of electronic systems have raised more and more electromagnetic energy pollution to the local system environment. In the same time, stringent demands are imposed on the designers of new circuits that electromagnetic interference (EMI has to be suppressed at its source before it is allowed to propagate into other circuits and systems. In this paper, the authors present a full-wave numerical method for calculation and simulation of electromagnetic field radiated by power converter circuitry. The main objective is to analyze the layout geometry in order to obtain competitive PCB layout that will enable suitably attenuated level of the radiated electric field to safe level. By this it would be possible to ensure reliable operation of the sensitive electronic components in the proximity.

  16. Vibration converter with magnetic levitation

    Science.gov (United States)

    Gladilin, A. V.; Pirogov, V. A.; Golyamina, I. P.; Kulaev, U. V.; Kurbatov, P. A.; Kurbatova, E. P.

    2015-05-01

    The paper presents a mathematical model, the results of computational and theoretical research, and the feasibility of creating a vibration converter with full magnetic levitation in the suspension of a high-temperature superconductor (HTSC). The axial and radial stability of the active part of the converter is provided by the interaction of the magnetic field of ring-shaped permanent magnets and a hollow cylinder made of the ceramic HTSC material. The force is created by a system of current-carrying coils whose magnetic field is polarized by permanent magnets and interacts with induced currents in the superconducting cylinder. The case of transition to the superconducting state of HTSC material in the field of the permanent magnets (FC mode) is considered. The data confirm the outlook for the proposed technical solutions.

  17. Painless Urethral Bleeding During Penile Erection in an Adult Man With Klippel-Trenaunay Syndrome: A Case Report.

    Science.gov (United States)

    Lei, Hongen; Guan, Xing; Han, Hu; Qian, Xiaosong; Zhou, Xiaoguang; Zhang, Xiaodong; Tian, Long

    2018-06-01

    Klippel-Trenaunay syndrome (KTS) is a rare congenital vascular disorder characterized by a triad of cutaneous port wine capillary malformations, varicose veins, and hemihypertrophy of bone and soft tissues. To report on a rare case of KTS in an adult man manifested by painless urethral bleeding during penile erection briefly review the clinical presentation and management of the genitourinary forms of this syndrome. On presentation, the clinical features of this patient, including medical history, signs and symptoms, and imaging examinations, were recorded. After diagnosis and initial treatment, a literature review of the urethral features of KTS was performed and is discussed in this report. A 35-year-old man with KTS presented with painless urethral bleeding during penile erection that was associated with posterior urethral vascular malformations. The coagulation method was used to treat the malformation, and no urethral bleeding or gross hematuria occurred during a postoperative follow-up period of 6 months. This case demonstrates that coagulation therapy and careful follow-up can be adequate treatment approaches for urethral features of KTS. However, the long-term efficacy of coagulation for this disorder should be investigated further. Lei H, Guan X, Han H, et al. Painless Urethral Bleeding During Penile Erection in an Adult Man With Klippel-Trenaunay Syndrome: A Case Report. Sex Med 2018;6:180-183. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  18. BLEEDING AND STARVING: fasting and delayed refeeding after upper gastrointestinal bleeding

    OpenAIRE

    FONSECA,Jorge; MEIRA,Tânia; NUNES,Ana; SANTOS,Carla Adriana

    2014-01-01

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. See more: http://creativecommons.org/licenses/by-nc/3.0//deed.en "Context - Early refeeding after nonvariceal upper gastrointestinal bleeding is safe and reduces hospital stay/costs. Objective - The aim of this study was obtain...

  19. Status of advanced bremsstrahlung converters

    International Nuclear Information System (INIS)

    Halbleib, J.A.

    1980-01-01

    This paper is an attempt to review the somewhat ill-defined area of advanced converter research in a more or less chronological fashion. Section 2 reviews the early B/sub z/ work that was motivated by the CASINO project. More recent work makes liberal use of technology from ICF research using REBs is discussed in Sec. 3. Section 4 discusses possible directions for future research, some of which are being actively pursued at Sandia National Laboratories (SNL) and elsewhere

  20. Posterior epistaxis: Common bleeding sites and prophylactic electrocoagulation.

    Science.gov (United States)

    Liu, Juan; Sun, Xicai; Guo, Limin; Wang, Dehui

    2016-01-01

    Posterior epistaxis is a frequent emergency, and the key to efficient management is identification of the bleeding point. We performed a retrospective study of 318 patients with posterior epistaxis treated with endoscopic bipolar electrocautery during a 4-year period. Distribution of the bleeding sites was recorded. Patients with no definite bleeding sites in the first operation were assigned to Group A (n = 39) and Group B (n = 34). Patients in Group A were only observed in the ward. Patients in Group B were given prophylactic electrocoagulation at the common bleeding points. Of the 318 patients, bleeding sites were successfully identified and coagulated in 263 patients. All of them were located posteriorly, with 166 on the lateral nasal wall, 86 on the septum, and 11 on the anterior face of the sphenoid sinus. The rebleeding rate of Group B (8.8%) was lower than that of Group A (38.5%) (p < 0.01).

  1. Resin bleed improvement on surface mount semiconductor device

    Science.gov (United States)

    Rajoo, Indra Kumar; Tahir, Suraya Mohd; Aziz, Faieza Abdul; Shamsul Anuar, Mohd

    2018-04-01

    Resin bleed is a transparent layer of epoxy compound which occurs during molding process but is difficult to be detected after the molding process. Resin bleed on the lead on the unit from the focused package, SOD123, can cause solderability failure at end customer. This failed unit from the customer will be considered as a customer complaint. Generally, the semiconductor company has to perform visual inspection after the plating process to detect resin bleed. Mold chase with excess hole, split cavity & stepped design ejector pin hole have been found to be the major root cause of resin bleed in this company. The modifications of the mold chase, changing of split cavity to solid cavity and re-design of the ejector pin proposed were derived after a detailed study & analysis conducted to arrive at these solutions. The solutions proposed have yield good results during the pilot run with zero (0) occurrence of resin bleed for 3 consecutive months.

  2. Diagnosis and management of upper gastrointestinal bleeding in children.

    Science.gov (United States)

    Owensby, Susan; Taylor, Kellee; Wilkins, Thad

    2015-01-01

    Upper gastrointestinal bleeding is an uncommon but potentially serious, life-threatening condition in children. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. The clinician needs to determine carefully whether any blood or possible blood reported by a child or adult represents true upper gastrointestinal bleeding because most children with true upper gastrointestinal bleeding require admission to a pediatric intensive care unit. After the diagnosis is established, the physician should start a proton pump inhibitor or histamine 2 receptor antagonist in children with upper gastrointestinal bleeding. Consideration should also be given to the initiation of vasoactive drugs in all children in whom variceal bleeding is suspected. An endoscopy should be performed once the child is hemodynamically stable. © Copyright 2015 by the American Board of Family Medicine.

  3. Scintigraphy in gastrointestinal bleeding in the pediatric population

    International Nuclear Information System (INIS)

    Hall, T.R.; Miller, J.H.; Sty, J.R.

    1986-01-01

    Gastrointestinal (GI) tract bleeding in the pediatric population is not uncommon, especially in chronically ill patients. A total of 29 patients with GI tract bleeding were studied scintigraphically using Tc-99m-labeled red blood cells (RBCs) or sulfur colloid (SC). The patients ranged in age from 3 weeks to 20 years, with an equal sex distribution. Of 19 patients studied with Tc-99m-labeled RBCs using an in vitro labeling technique, evidence of GI tract bleeding was documented scintigraphically in 15. Tc-99m-labeled SC scans in the remaining ten patients demonstrated GI tract bleeding in six. The Tc-99m RBC method was slightly more sensitive than the Tc-99m SC method. Advantages of using labeled RBCs include increased sensitivity in detecting upper abdominal bleeding, ability to delay imaging for up to 18-24 hours, and the use of provocative testing

  4. Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer

    Science.gov (United States)

    Kim, Young-Il

    2015-01-01

    Tumor bleeding is not a rare complication in patients with inoperable gastric cancer. Endoscopy has important roles in the diagnosis and primary treatment of tumor bleeding, similar to its roles in other non-variceal upper gastrointestinal bleeding cases. Although limited studies have been performed, endoscopic therapy has been highly successful in achieving initial hemostasis. One or a combination of endoscopic therapy modalities, such as injection therapy, mechanical therapy, or ablative therapy, can be used for hemostasis in patients with endoscopic stigmata of recent hemorrhage. However, rebleeding after successful hemostasis with endoscopic therapy frequently occurs. Endoscopic therapy may be a treatment option for successfully controlling this rebleeding. Transarterial embolization or palliative surgery should be considered when endoscopic therapy fails. For primary and secondary prevention of tumor bleeding, proton pump inhibitors can be prescribed, although their effectiveness to prevent bleeding remains to be investigated. PMID:25844339

  5. Computerized simulation of converter process

    Energy Technology Data Exchange (ETDEWEB)

    Jalkanen, H; Suomi, M L; Wallgren, M [Helsinki Univ. of Technology, Otaniemi (Finland). Lab. of Metallurgy

    1997-12-31

    Converter process is essentially an oxidising refining process aiming in addition to (1) the primary refining action, decarburisation of high carbon iron melt, also to (2) maximal elimination of impurity elements, especially silicon, phosphorus and sulphur, (3) melting of substantial amounts of scrap using the extra heat released in oxidation reactions and (4) to exact final steel temperature control, optimal for further treatments. `Quantitative modelling of such a complex non-stationary chemical process as oxygen converting necessitates extensive formulation of chemical and thermal evolution of the process in connection with the technological properties of the reactor and the process control measures. A comprehensive converter simulation program like CONSIM-3. 1 and its preceding versions that is based on the theoretical and practical knowledge on the process can be used for (1) educating specialists and smelter personnel, (2) planning of the blowing programs, (3) developing and testing of process control systems and after some elaboration and restructuring (4) it can be integrated to static or dynamic process control systems. (orig.) SULA 2 Research Programme; 10 refs.

  6. Computerized simulation of converter process

    Energy Technology Data Exchange (ETDEWEB)

    Jalkanen, H.; Suomi, M.L.; Wallgren, M. [Helsinki Univ. of Technology, Otaniemi (Finland). Lab. of Metallurgy

    1996-12-31

    Converter process is essentially an oxidising refining process aiming in addition to (1) the primary refining action, decarburisation of high carbon iron melt, also to (2) maximal elimination of impurity elements, especially silicon, phosphorus and sulphur, (3) melting of substantial amounts of scrap using the extra heat released in oxidation reactions and (4) to exact final steel temperature control, optimal for further treatments. `Quantitative modelling of such a complex non-stationary chemical process as oxygen converting necessitates extensive formulation of chemical and thermal evolution of the process in connection with the technological properties of the reactor and the process control measures. A comprehensive converter simulation program like CONSIM-3. 1 and its preceding versions that is based on the theoretical and practical knowledge on the process can be used for (1) educating specialists and smelter personnel, (2) planning of the blowing programs, (3) developing and testing of process control systems and after some elaboration and restructuring (4) it can be integrated to static or dynamic process control systems. (orig.) SULA 2 Research Programme; 10 refs.

  7. Development of a Compact Matrix Converter

    Directory of Open Access Journals (Sweden)

    J. Bauer

    2009-01-01

    Full Text Available This paper deals with the development of a matrix converter. Matrix converters belong to the category of direct frequency converters. A converter does not contain DC-link and the output voltage is provided by direct switching of voltage from the input phases. This is enabled by 9 bidirectional switches, which are provided by anti-serial connection of 18 IGBT transistors. The absence of a DC-link is great advantage of the matrix converter, but it also increases the requirements on the converter control. For this reason a new prototype of a matrix converter is being developed with sophisticated modern components (FPGA, Power PC equipped in the control part of the converter. The converter will be used for testing new control algorithms and commutation methods. 

  8. [High risk factors of upper gastrointestinal bleeding after neurosurgical procedures].

    Science.gov (United States)

    Zheng, Kang; Wu, Gang; Cheng, Neng-neng; Yao, Cheng-jun; Zhou, Liang-fu

    2005-12-21

    To analyze high risk factors of postoperative upper gastrointestinal (GI) bleeding after neurosurgery so as to give guidance for prevention of GI bleeding. A questionnaire was developed to investigate the medical records of 1500 patients who were hospitalized and underwent neurosurgical operations in 1997. Logistic regression analysis was made. 1430 valid questionnaires were obtained. Postoperative upper GI bleeding occurred in 75 patients (5.24%). The incidence of upper GI bleeding were 6.64% (54/813) in the male patients and 3.40% (21/617) in the female persons (P = 0.007); 9.88% (41/415) in those aged > 50 and 3.35% in those aged hematoma, intraventricular hemorrhage, subdural hematoma, and extradural hematoma were 15.7%, 10.0%, 6.00%, and 2.94% respectively (P = 0.02). The incidence of upper GI bleeding of the patients with tumors of fourth ventricle of cerebrum, brainstem, cerebral hemisphere, and sellar hypothalamus were 15.79% (3/19), 7.89%, 5.71%, and 3.74% respectively. In the emergent cases, the incidence of upper GI bleeding was higher in those with hypertension. The incidence of upper GI bleeding was 5.46% in the patients undergoing adrenocortical hormone treatment, significantly higher than that in those who did not receive such treatment (2.13%). Patients who are at high risk of developing postoperative upper GI bleeding including that: age greater than 50 years; male; Glasgow Coma Score less than 10 pre and post operation; The lesion was located in brain stem and forth ventricle; Hypertensive cerebral hemorrhage; Intracerebral and intraventricular hemorrhagic brain trauma; Postoperative pneumonia, brain edema, encephalic high pressure, pyogenic infection of the central nervous system and other postoperative complications. The mortality of patients with postoperative upper GI bleeding was evidently higher than that of the patients without postoperative upper GI bleeding.

  9. Immunosuppressive agents are associated with peptic ulcer bleeding.

    Science.gov (United States)

    Tomizawa, Minoru; Shinozaki, Fuminobu; Hasegawa, Rumiko; Shirai, Yoshinori; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Ishige, Naoki

    2017-05-01

    Peptic ulcer bleeding can be fatal. Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids and immunosuppressive agents are administered for long-term usage. The present study assessed the association between peptic ulcer bleeding and administration of NSAIDs, corticosteroids and immunosuppressive agents. Furthermore, the efficacy of lowering the risk of peptic ulcer bleeding with proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA) was evaluated. Medical records were retrospectively analyzed for patients subjected to an upper gastrointestinal (GI) endoscopy performed at the National Hospital Organization Shimoshizu Hospital (Yotsukaido, Japan) from October 2014 to September 2015. During this period, a total of 1,023 patients underwent an upper GI endoscopy. A total of 1,023 patients, including 431 males (age, 68.1±12.9 years) and 592 females (age, 66.4±12.3 years), who had been administered NSAIDs, corticosteroids, immunosuppressive agents, PPIs and H2RAs, were respectively enrolled. Endoscopic findings of the patients were reviewed and their data were statistically analyzed. Logistic regression analysis was used to determine the odds ratio of peptic ulcer bleeding for each medication; immunosuppressive agents had an odds ratio of 5.83, which was larger than that for NSAIDs (4.77). The Wald test was applied to confirm the correlation between immunosuppressive agents and peptic ulcer bleeding. Furthermore, χ 2 tests were applied to the correlation between peptic ulcer bleeding and administration of PPIs or H2RAs. Immunosuppressive agents had the largest χ 2 , and the P-value was 0.03. Administration of PPIs was significantly correlated with non-peptic ulcer bleeding (P=0.02); furthermore, a tendency toward non-peptic ulcer bleeding with administration of H2RA was indicated, but it was not statistically significant (P=0.12). In conclusion, immunosuppressive agents were correlated with peptic ulcer bleeding and PPIs were effective at

  10. Bleeding spectrum in children with moderate or severe von Willebrand disease: Relevance of pediatric-specific bleeding

    NARCIS (Netherlands)

    Sanders, Yvonne V.; Fijnvandraat, Karin; Boender, Johan; Mauser-Bunschoten, Evelien P.; van der Bom, Johanna G.; de Meris, Joke; Smiers, Frans J.; Granzen, Bernd; Brons, Paul; Tamminga, Rienk Y. J.; Cnossen, Marjon H.; Leebeek, Frank W. G.

    2015-01-01

    The bleeding phenotype of children with von Willebrand disease (VWD) needs to be characterized in detail to facilitate diagnosis during childhood and aid in the planning and assessment of treatment strategies. The objective was to evaluate the occurrence, type, and severity of bleeding in a large

  11. The analysis of the causes of uterine bleeding occurred after cesarean section and the evaluation of interventional therapy for bleeding

    International Nuclear Information System (INIS)

    Hu Peng; Li Yuwei; Li Yunhui; Luo Bin; Wen Wen; Yang Bo

    2011-01-01

    Objective: to analyze the causes of uterine hemorrhage occurred after cesarean section and to investigate the value of angiography and transcatheter artery embolization (TAE) in the diagnosis and treatment of postpartum hemorrhage after cesarean section. Methods: During the period from Jan. 2001 to Dec. 2011, a total of 65 cases suffering from uterine bleeding after cesarean section had underwent uterine arteriography to clarify the diagnosis, which was followed by transcatheter uterine artery embolization (TUAE). The clinical data, the causes of bleeding and the angiographic features were retrospectively analyzed. Results: The causes of uterine bleeding after cesarean section included uterine artery pseudoaneurysm (n=26), uterine atony (n=18), placental factors (n=11), gestational hypertension (n=8), coexisting uterine fibroids (n=1) and uterine bleeding of unknown reason (n=1). Uterine artery angiography revealed contrast extravasation in all patients except one patient. The angiographic findings confirmed the diagnosis of uterine artery bleeding after cesarean section. The bleeding stopped after TUAE, and the patients were in stable condition. No serious complications occurred. Conclusion: Pseudoaneurysm is the primary cause of postpartum uterine hemorrhage after cesarean section. Transcatheter uterine artery angiography can promptly and reliably determine the causes of bleeding, and, at the same time, embolization therapy can be carried out to effectively stop the bleeding. (authors)

  12. Simulation Results of Double Forward Converter

    Directory of Open Access Journals (Sweden)

    P. Vijaya KUMAR

    2009-12-01

    Full Text Available This work aims to find a better forward converter for DC to DC conversion.Simulation of double forward converter in SMPS system is discussed in this paper. Aforward converter with RCD snubber to synchronous rectifier and/or to current doubleris also discussed. The evolution of the forward converter is first reviewed in a tutorialfashion. Performance parameters are discussed including operating principle, voltageconversion ratio, efficiency, device stress, small-signal dynamics, noise and EMI. Itscircuit operation and its performance characteristics of the forward converter with RCDsnubber and double forward converter are described and the simulation results arepresented.

  13. 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.; Urbanus, R. T.; Roest, M.; Boven, Leonie A; Fijnheer, R.

    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

  14. ABNORMAL UTERINE BLEEDING- UTILITY OF DILATATION AND CURETTAGE IN IDENTIFYING ISOLATED ENDOMETRIAL PATHOLOGY

    Directory of Open Access Journals (Sweden)

    Radhika Gollapudi

    2016-12-01

    Full Text Available BACKGROUND Abnormal uterine bleeding is defined as any bleeding not conforming to the normal cyclical pattern as well as to the normal amount and frequency of menstrual cycle. Abnormal uterine bleeding can occur due to gynaecological as well as medical causes. Gynaecological causes include organic and nonorganic factors. It has various clinical presentations such as menorrhagia, polymenorrhagia, metrorrhagia and intermenstrual bleeding. Dilatation and Curettage (D and C is a safe and effective outpatient procedure performed in patients with AUB. It provides endometrial tissue for examination of histological variations of endometrium thus guiding in further management. MATERIALS AND METHODS This is a retrospective study of patients presenting with AUB over a period of one year (2015-2016 done in the Department of Obstetrics and Gynaecology at a tertiary care hospital. 89 patients with complaints of AUB attributable to isolated endometrial cause were included in the study. Patients with AUB due to vaginal, cervical causes, leiomyomas, adnexal pathology, medical causes and complications of pregnancy were excluded from the study. A structured proforma regarding the patient’s complaints, pattern of bleeding, medical, surgical history and a general systemic and pelvic examination was used to evaluate all patients. RESULTS Among all the patients who presented with AUB during the study period, 89 patients were identified to have isolated endometrial pathology as a cause of abnormal uterine bleeding. In our study, age of patients presenting with AUB ranged from 24 years to 70 years. AUB was most commonly seen in the age group of 41-50 years (42.6%. Menorrhagia in 32.5% was the most common presentation of AUB. The commonest histopathological finding was proliferative phase endometrium (25.84% followed by secretory phase endometrium (19.1%. Hyperplasia was observed in 19.1%, which included simple hyperplasia (6.74%, complex hyperplasia without atypia in

  15. [Relapse of bleeding ulcer in a 15 year-old boy with collagenous gastritis].

    Science.gov (United States)

    Haase, Anne-Mette; Kelsen, Jens

    2012-06-18

    Collagenous gastritis (CG) is a rare disorder. Two patient groups are known: 1) Children and young adults, presenting with anaemia and abdominal pain, and 2) adults presenting with watery diarrhoea. In the latter group, CG is frequently associated with collagenous colitis and/or coeliac disease. This case concerns a 15-year-old boy with a bleeding ulcer. The biopsies from corpus ventriculi showed a thickened subepithelial collagen band (> 10 micrometres), and the patient was diagnosed with CG. Ulcers are rarely linked to CG. CG should be considered when ulcers are found in children and young adults.

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

    Science.gov (United States)

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

    2013-09-21

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

  17. 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.

  18. [Management of intractable epistaxis and bleeding points localization].

    Science.gov (United States)

    Yang, Da-Zhang; Cheng, Jing-Ning; Han, Jun; Shu, Ping; Zhang, Hua

    2005-05-01

    To investigate the common nasal bleeding points and the management of intractable epistaxis. The bleeding points and its correlation with age distribution, surgical techniques as well as its effects were studied retrospectively in 92 patients, in whom the bleeding points were not found by routine nasal endoscopy and the hemorrhage was not controlled with standard nasal packing. The bleeding points were found in the following different sites: superior wall of inferior nasal meatus (56.5%, 52/92), olfactory cleft of nasal septum (27.2%, 25/92), posterosuperior wall of middle nasal meatus (8.7%, 8/92) and uncertain (7.6%, 7/92). The results showed that the bleeding points had correlation with age. Epistaxis was well controlled by electrocoagulation in 83 cases, gelfoam packing in 8 cases, and transcatheter maxillary artery embolization in 1 case. There were no complications during a followed-up for 1 - 3 months after management. Among the 92 cases, the numbers of treatment needed to stop bleeding were 82 cases (89.1%) after 1 time of treatment, 9 cases (9.8%) after 2 times and in one case (1.1%) after 4 times. Endoscopy combined with displacement of the middle and inferior turbinate gives good visualization and direct management of the deeply-sited bleeding points, which were difficult in localization. The combined method provides an effective and safe way to control intractable epistaxis.

  19. Auxiliary resonant DC tank converter

    Science.gov (United States)

    Peng, Fang Z.

    2000-01-01

    An auxiliary resonant dc tank (ARDCT) converter is provided for achieving soft-switching in a power converter. An ARDCT circuit is coupled directly across a dc bus to the inverter to generate a resonant dc bus voltage, including upper and lower resonant capacitors connected in series as a resonant leg, first and second dc tank capacitors connected in series as a tank leg, and an auxiliary resonant circuit comprising a series combination of a resonant inductor and a pair of auxiliary switching devices. The ARDCT circuit further includes first clamping means for holding the resonant dc bus voltage to the dc tank voltage of the tank leg, and second clamping means for clamping the resonant dc bus voltage to zero during a resonant period. The ARDCT circuit resonantly brings the dc bus voltage to zero in order to provide a zero-voltage switching opportunity for the inverter, then quickly rebounds the dc bus voltage back to the dc tank voltage after the inverter changes state. The auxiliary switching devices are turned on and off under zero-current conditions. The ARDCT circuit only absorbs ripples of the inverter dc bus current, thus having less current stress. In addition, since the ARDCT circuit is coupled in parallel with the dc power supply and the inverter for merely assisting soft-switching of the inverter without participating in real dc power transmission and power conversion, malfunction and failure of the tank circuit will not affect the functional operation of the inverter; thus a highly reliable converter system is expected.

  20. Electromechanical converters for electric vehicles

    Science.gov (United States)

    Ambros, T.; Burduniuc, M.; Deaconu, S. I.; Rujanschi, N.

    2018-01-01

    The paper presents the analysis of various constructive schemes of synchronous electromechanical converters with permanent magnets fixed on the rotor and asynchronous with the short-circuit rotor. Various electrical stator winding schemes have also been compared, demonstrating the efficiency of copper utilization in toroidal windings. The electromagnetic calculus of the axial machine has particularities compared to the cylindrical machine, in the paper is presented the method of correlating the geometry of the cylindrical and axial machines. In this case the method and recommendations used in the design of such machines may be used.

  1. Power electronics converters and regulators

    CERN Document Server

    Dokić, Branko L

    2015-01-01

    This book is the result of the extensive experience the authors gained through their year-long occupation at the Faculty of Electrical Engineering at the University of Banja Luka. Starting at the fundamental basics of electrical engineering, the book guides the reader into this field and covers all the relevant types of converters and regulators. Understanding is enhanced by the given examples, exercises and solutions. Thus this book can be used as a textbook for students, for self-study or as a reference book for professionals.

  2. Tamoxifen treatment of bleeding irregularities associated with Norplant use.

    Science.gov (United States)

    Abdel-Aleem, Hany; Shaaban, Omar M; Amin, Ahmed F; Abdel-Aleem, Aly M

    2005-12-01

    To evaluate the possible role of tamoxifen (selective estrogen receptor modulators, SERM) in treating bleeding irregularities associated with Norplant contraceptive use. Randomized clinical trial including 100 Norplant users complaining of vaginal bleeding irregularities. The trial was conducted in the Family Planning Clinic of Assiut University Hospital. Women were assigned at random to receive tamoxifen tablets (10 mg) twice daily for 10 days or similar placebo. Women were followed-up for 3 months. The end points were percentage of women who stopped bleeding during treatment, bleeding/spotting days during the period of follow-up, effect of treatment on their lifestyle, and side effects and discontinuation of contraception. There was good compliance with treatment. At the end of treatment, a significantly higher percentage of tamoxifen users stopped bleeding in comparison to the control group (88% vs. 68%, respectively; p=.016). Women who used tamoxifen had significantly less bleeding and/or spotting days than women who used placebo, during the first and second months. During the third month, there were no significant differences between the two groups. Women who used tamoxifen reported improvement in performing household activities, religious duties and in sexual life, during the first 2 months. In the third month, there were no differences between the two groups. There were no significant differences between tamoxifen and placebo groups in reporting side effects. In the group who used tamoxifen, two women discontinued Norplant use because of bleeding vs. nine women in the placebo group. Tamoxifen use at a dose of 10 mg twice daily orally, for 10 days, has a beneficial effect on vaginal bleeding associated with Norplant use. In addition, the bleeding pattern was better in women who used tamoxifen for the following 2 months after treatment. However, these results have to be confirmed in a larger trial before advocating this line of treatment.

  3. Importance of histopathological examination of endometrium in Dysfunctional Uterine Bleeding.

    Directory of Open Access Journals (Sweden)

    Dr. Yaminee Rana

    2017-12-01

    Full Text Available Introduction: Abnormal uterine bleeding is a common condition affecting women of reproductive age that has significant social and economic impact. Dysfunctional uterine bleeding (DUB is defined as abnormal uterine bleeding in the absence of organic disease. Dysfunctional uterine bleeding is one of the most commonly encountered gynaecological problems. Objectives: This study is done to evaluate the histopathological pattern of the endometrial biopsies of patients with dysfunctional uterine bleeding and its correlation with clinical data. Methods: The present prospective study included evaluation of 208 cases of dysfunctional uterine bleeding in the Department of Pathology, B. J. Medical College, Ahmedabad over a period of 10 months, from January 2017 to October 2017. Women presenting with abnormal uterine bleeding were included in the study. Those women in which bleeding is secondary to systemic causes, organic causes and due to cervical and vaginal causes were excluded. The specimens were processed, embedded and cut into sections of 3-4 microns. The histopathological patterns were studied. Results: Age distribution varied from 18 years to 70 years, majority of the patients were between 21 to 30 years. Among the cases of DUB, proliferative phase accounted for 66.3% and secretory phase accounted for 21.3%. 18 cases (8.6% of atrophic endometrium, four cases (1.9% of irregular shedding and two cases of luteal phase insufficiency were received. Conclusion: Dysfunctional uterine bleeding is a common and debilitating condition in women of reproductive age. Endometrial biopsy could be effectively used as the first diagnostic step in DUB and thus ensures correct management.

  4. OAM mode converter in twisted fibers

    DEFF Research Database (Denmark)

    Usuga Castaneda, Mario A.; Beltran-Mejia, Felipe; Cordeiro, Cristiano

    2014-01-01

    We analyze the case of an OAM mode converter based on a twisted fiber, through finite element simulations where we exploit an equivalence between geometric and material transformations. The obtained converter has potential applications in MDM. © 2014 OSA.......We analyze the case of an OAM mode converter based on a twisted fiber, through finite element simulations where we exploit an equivalence between geometric and material transformations. The obtained converter has potential applications in MDM. © 2014 OSA....

  5. A new concept of thermionic converter

    International Nuclear Information System (INIS)

    Musa, G.

    1978-10-01

    The parameters of a new type of thermionic converter which has a number of concentric electrodes, is computed. The obtained theoretical efficiency of this new type of converter is nearly the efficiency of the ideal thermionic converter. The obtained results are explained by the reduction of the radiation loss from the emitter due to the electrode configuration. Efficiencies as high as 20% are expected from this type of converter now in construction. (author)

  6. Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

    International Nuclear Information System (INIS)

    Ramon Banos Madrid; Fernando Alberca de las Parras; Angel Vargas Acosta and others

    2006-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  8. Breast cancer recurrence after reoperation for surgical bleeding

    DEFF Research Database (Denmark)

    Pedersen, Rikke Nørgaard; Bhaskaran, K; Heide-Jørgensen, U

    2017-01-01

    BACKGROUND: Bleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. This study investigated whether reoperation for postoperative bleeding is associated with breast cancer recurrence. METHODS: Using the Danish Breast Cancer Group...... database and the Danish National Patient Register (DNPR), a cohort of women with incident stage I-III breast cancer, who underwent breast-conserving surgery or mastectomy during 1996-2008 was identified. Information on reoperation for bleeding within 14 days of the primary surgery was retrieved from...

  9. Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

    International Nuclear Information System (INIS)

    Banos Madrid, Ramon; Alberca de las Parras, Fernando; Vargas Acosta, Angel and others

    2006-01-01

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

  10. Transvaginal Ultrasound for the Diagnosis of Abnormal Uterine Bleeding.

    Science.gov (United States)

    Wheeler, Karen C; Goldstein, Steven R

    2017-03-01

    Transvaginal ultrasound is the first-line imaging test for the evaluation of abnormal uterine bleeding in both premenopausal and postmenopausal women. Transvaginal ultrasound can be used to diagnose structural causes of abnormal bleeding such as polyps, adenomyosis, leiomyomas, hyperplasia, and malignancy, and can also be beneficial in making the diagnosis of ovulatory dysfunction. Traditional 2-dimensional imaging is often enhanced by the addition of 3-dimension imaging with coronal reconstruction and saline infusion sonohysterography. In this article we discuss specific ultrasound findings and technical considerations useful in the diagnosis of abnormal uterine bleeding.

  11. Clival chordoma manifesting as nasal bleeding. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kitai, Ryuhei; Yoshida, Kazuhiko; Kubota, Toshihiko; Sato, Kazufumi; Handa, Yuji; Kasahara, Kazuma [University of Fukui, Department of Neurosurgery, Fukui (Japan); Nakajima, Hirofumi [Tsuruga Municipal Hospital, Department of Neurosurgery, Fukui (Japan)

    2005-05-01

    Chordoma is a rare cartilaginous tumor, for which bleeding presentation is unusual. We report a case of rare hemorrhaged clival chordoma, which was diagnosed correctly by magnetic resonance imaging. A 32-year-old man presented with nasal bleeding. The tumor was totally removed via a trans-sphenoidal approach, from which the surgical specimen confirmed chordoma. Epistaxis seemed to be caused by the spreading of the intratumoral hemorrhage into the sphenoid sinus. This case demonstrates the importance of an exact differential diagnostic evaluation, including chordoma, by use of modern imaging techniques for nasal bleeding. (orig.)

  12. Clival chordoma manifesting as nasal bleeding. A case report

    International Nuclear Information System (INIS)

    Kitai, Ryuhei; Yoshida, Kazuhiko; Kubota, Toshihiko; Sato, Kazufumi; Handa, Yuji; Kasahara, Kazuma; Nakajima, Hirofumi

    2005-01-01

    Chordoma is a rare cartilaginous tumor, for which bleeding presentation is unusual. We report a case of rare hemorrhaged clival chordoma, which was diagnosed correctly by magnetic resonance imaging. A 32-year-old man presented with nasal bleeding. The tumor was totally removed via a trans-sphenoidal approach, from which the surgical specimen confirmed chordoma. Epistaxis seemed to be caused by the spreading of the intratumoral hemorrhage into the sphenoid sinus. This case demonstrates the importance of an exact differential diagnostic evaluation, including chordoma, by use of modern imaging techniques for nasal bleeding. (orig.)

  13. Spectrometric analog-to-digital converter

    International Nuclear Information System (INIS)

    Ormandzhiev, S.I.; Jordanov, V.T.

    1988-01-01

    Converter of digit-by-digit counterbalancing with slipping dial with number of channels equal to total number of states of the main digital-to-analog converter of digit-by-digit counterbalancing systems is presented. Algorithm for selection of digital-to-analog converters, which must be used by means of computer is suggested

  14. A novel series-resonant converter topology

    NARCIS (Netherlands)

    Tilgenkamp, N.V.; Haan, de S.W.H.; Huisman, H.

    1987-01-01

    A converter topology based on the principles of seriesresonant (SR) power conversion is described in which the input and output of this converter have one terminal in common, and the transformer is omitted. Both the underlying theory and associated waveforms are presented. The converter is suitable

  15. Molten-salt converter reactors

    International Nuclear Information System (INIS)

    Perry, A.M.

    1975-01-01

    Molten-salt reactors appear to have substantial promise as advanced converters. Conversion ratios of 0.85 to 0.9 should be attainable with favourable fuel cycle costs, with 235 U valued at $12/g. An increase in 235 U value by a factor of two or three ($10 to $30/lb. U 3 O 8 , $75/SWU) would be expected to increase the optimum conversion ratio, but this has not been analyzed in detail. The processing necessary to recover uranium from the fuel salt has been partially demonstrated in the MSRE. The equipment for doing this would be located at the reactor, and there would be no reliance on an established recycle industry. Processing costs are expected to be quite low, and fuel cycle optimization depends primarily on inventory and burnup or replacement costs for the fuel and for the carrier salt. Significant development problems remain to be resolved for molten-salt reactors, notably the control of tritium and the elimination of intergranular cracking of Hastelloy-N in contact with tellurium. However, these problems appear to be amenable to solution. It is appropriate to consider separating the development schedule for molten-salt reactors from that for the processing technology required for breeding. The Molten-Salt Converter Reactor should be a useful reactor in its own right and would be an advance towards the achievement of true breeding in thermal reactors. (author)

  16. Hybrid thermionic-photovoltaic converter

    Energy Technology Data Exchange (ETDEWEB)

    Datas, A. [Instituto de Energía Solar, Universidad Politécnica de Madrid, 28040 Madrid (Spain)

    2016-04-04

    A conceptual device for the direct conversion of heat into electricity is presented. This concept hybridizes thermionic (TI) and thermophotovoltaic (TPV) energy conversion in a single thermionic-photovoltaic (TIPV) solid-state device. This device transforms into electricity both the electron and photon fluxes emitted by an incandescent surface. This letter presents an idealized analysis of this device in order to determine its theoretical potential. According to this analysis, the key advantage of this converter, with respect to either TPV or TI, is the higher power density in an extended temperature range. For low temperatures, TIPV performs like TPV due to the negligible electron flux. On the contrary, for high temperatures, TIPV performs like TI due to the great enhancement of the electron flux, which overshadows the photon flux contribution. At the intermediate temperatures, ∼1650 K in the case of this particular study, I show that the power density potential of TIPV converter is twice as great as that of TPV and TI. The greatest impact concerns applications in which the temperature varies in a relatively wide range, for which averaged power density enhancement above 500% is attainable.

  17. Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: a modelling study.

    Science.gov (United States)

    Oakland, Kathryn; Jairath, Vipul; Uberoi, Raman; Guy, Richard; Ayaru, Lakshmana; Mortensen, Neil; Murphy, Mike F; Collins, Gary S

    2017-09-01

    Acute lower gastrointestinal bleeding is a common reason for emergency hospital admission, and identification of patients at low risk of harm, who are therefore suitable for outpatient investigation, is a clinical and research priority. We aimed to develop and externally validate a simple risk score to identify patients with lower gastrointestinal bleeding who could safely avoid hospital admission. We undertook model development with data from the National Comparative Audit of Lower Gastrointestinal Bleeding from 143 hospitals in the UK in 2015. Multivariable logistic regression modelling was used to identify predictors of safe discharge, defined as the absence of rebleeding, blood transfusion, therapeutic intervention, 28 day readmission, or death. The model was converted into a simplified risk scoring system and was externally validated in 288 patients admitted with lower gastrointestinal bleeding (184 safely discharged) from two UK hospitals (Charing Cross Hospital, London, and Hammersmith Hospital, London) that had not contributed data to the development cohort. We calculated C statistics for the new model and did a comparative assessment with six previously developed risk scores. Of 2336 prospectively identified admissions in the development cohort, 1599 (68%) were safely discharged. Age, sex, previous admission for lower gastrointestinal bleeding, rectal examination findings, heart rate, systolic blood pressure, and haemoglobin concentration strongly discriminated safe discharge in the development cohort (C statistic 0·84, 95% CI 0·82-0·86) and in the validation cohort (0·79, 0·73-0·84). Calibration plots showed the new risk score to have good calibration in the validation cohort. The score was better than the Rockall, Blatchford, Strate, BLEED, AIMS65, and NOBLADS scores in predicting safe discharge. A score of 8 or less predicts a 95% probability of safe discharge. We developed and validated a novel clinical prediction model with good discriminative

  18. Valuing Convertible Bonds Based on LSRQM Method

    Directory of Open Access Journals (Sweden)

    Jian Liu

    2014-01-01

    Full Text Available Convertible bonds are one of the essential financial products for corporate finance, while the pricing theory is the key problem to the theoretical research of convertible bonds. This paper demonstrates how to price convertible bonds with call and put provisions using Least-Squares Randomized Quasi-Monte Carlo (LSRQM method. We consider the financial market with stochastic interest rates and credit risk and present a detailed description on calculating steps of convertible bonds value. The empirical results show that the model fits well the market prices of convertible bonds in China’s market and the LSRQM method is effective.

  19. Improvements of the base bleed effect using reactive particles

    Energy Technology Data Exchange (ETDEWEB)

    Bournot, Herve; Daniel, Eric [Polytech' Marseille, IUSTI UMR CNRS 6595, 5, rue E. Fermi, Technopole de Chateau Gombert, 13453 Marseille cedex 13 (France); Cayzac, Roxan [Giat Industries, 7, Route de Guerry, F-18023 Bourges cedex (France)

    2006-11-15

    A numerical study of the base drag reduction of axisymmetric body projectiles in supersonic flight using a base bleed injection is presented in this paper. Unsteady computations of compressible viscous flow have been achieved in order to investigate the coupled effect of the bleed temperature and the bleed mass flow rate on the base pressure. The idea developed in the study, consists in the addition of metallic particles in the propellant composition used to provide the additional mass injected in order to obtain the lowest base drag. Indeed, for a low mass addition, a significant increase of the mixture energy is expected due to the particles combustion. Base flow with reactive two-phase injection is then simulated. Results show the ability of the method to describe such flows and the efficiency of the particles combustion to increase the base bleed reducing drag effect. (author)

  20. Breast cancer recurrence after reoperation for surgical bleeding

    DEFF Research Database (Denmark)

    Pedersen, Rikke Nørgaard; Bhaskaran, K; Heide-Jørgensen, U

    2017-01-01

    BACKGROUND: Bleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. This study investigated whether reoperation for postoperative bleeding is associated with breast cancer recurrence. METHODS: Using the Danish Breast Cancer Group...... database and the Danish National Patient Register (DNPR), a cohort of women with incident stage I-III breast cancer, who underwent breast-conserving surgery or mastectomy during 1996-2008 was identified. Information on reoperation for bleeding within 14 days of the primary surgery was retrieved from.......i. 0·89 to 1·26). The estimates did not vary by site of breast cancer recurrence. CONCLUSION: In this large cohort study, there was no evidence of an association between reoperation for bleeding and breast cancer recurrence....

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    Antithrombotic therapy is a cornerstone of treatment in patients with cardiovascular disease with bleeding being the most feared complication. This review describes the risk of bleeding related to different combinations of antithrombotic drugs used for cardiovascular disease: acute coronary...... syndrome (ACS), atrial fibrillation (AF), cerebrovascular (CVD) and peripheral arterial disease (PAD). Different risk assessment schemes and bleeding definitions are compared. The HAS-BLED risk score is recommended in patients with AF and in ACS patients with AF. In patients with ACS with or without...... a stent dual antiplatelet therapy with a P2Y12 receptor antagonist and acetylsalicylic acid (ASA) is recommended for 12 months, preferable with prasugrel or ticagrelor unless there is an additional indication of warfarin or increased risk of bleeding. In patients with AF, warfarin is recommended...

  2. No impact of fish oil supplements on bleeding risk

    DEFF Research Database (Denmark)

    Begtrup, Katrine Munk; Krag, Andreas Engel; Hvas, Anne-Mette

    2017-01-01

    Abstract Introduction: Fish oil supplementation may inhibit platelet aggregation and can potentially increase the risk of bleeding. The aim of the present systematic review was to evaluate the effect of fish oil supplements on haemostasis and bleeding risk, and to provide recommendations on whether...... of the included studies were randomised controlled trials or included a control group. Overall, fish oil supplements reduced platelet aggregation in healthy subjects. Fish oil exposure in surgical patients did not increase bleeding or blood transfusions either during or after surgery. Conclusion: Fish oil...... supplements reduced platelet aggregation in healthy subjects. This biochemical effect was not reflected in increased bleeding risk during or after surgery evaluated in randomised controlled trials. Consequently, this systematic review does not support the need for discontinuation of fish oil supplements prior...

  3. Thrombelastography Early Amplitudes in bleeding and coagulopathic trauma patients

    DEFF Research Database (Denmark)

    Laursen, Thomas Holst; Meyer, Martin A S; Meyer, Anna Sina P

    2018-01-01

    BACKGROUND: Early amplitudes in the viscoelastic hemostatic assays Thrombelastography (TEG) and Rotation Thromboelastometry (ROTEM) provide fast results, which is critical in resuscitation of bleeding patients. This study investigated associations between TEG early amplitudes and standard TEG var...

  4. 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...... and Science Citation Index were combined. Intention-to-treat random effect meta-analyses were performed and results presented as RRs with 95% confidence intervals. RESULTS: Seven double-blind randomized trials on tranexamic acid vs. placebo were included. Of 1754 patients randomized, 21% were excluded. Only...... 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...

  5. Modern issues on the treatment of peptic ulcer bleedings

    Directory of Open Access Journals (Sweden)

    Potakhin S.N.

    2014-03-01

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

  6. A rare cause of recurrent gastrointestinal bleeding: mesenteric hemangioma

    Directory of Open Access Journals (Sweden)

    Zeytunlu Murat

    2009-01-01

    Full Text Available Abstract Lower gastrointestinal hemorrhage accounts for approximately 20% of gastrointestinal hemorrhage. The most common causes of lower gastrointestinal hemorrhage in adults are diverticular disease, inflammatory bowel disease, benign anorectal diseases, intestinal neoplasias, coagulopathies and arterio-venous malformations. Hemangiomas of gastrointestinal tract are rare. Mesenteric hemangiomas are also extremely rare. We present a 25-year-old female who was admitted to the emergency room with recurrent lower gastrointestinal bleeding. An intraluminal bleeding mass inside the small intestinal segment was detected during explorative laparotomy as the cause of the recurrent lower gastrointestinal bleeding. After partial resection of small bowel segment, the histopathologic examination revealed a cavernous hemagioma of mesenteric origin. Although rare, gastrointestinal hemangioma should be thought in differential diagnosis as a cause of recurrent lower gastrointestinal bleeding.

  7. Rectal bleeding and its management after irradiation for cervix cancer

    International Nuclear Information System (INIS)

    Chun, Mi Son; Kang, Seung Hee; Kil, Hoon Jong; Oh, Young Taek; Sohn, Jeong Hye; Ryu, Hee Suk; Lee, Kwang Jae; Jung, Hye Young

    2002-01-01

    Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. The study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. A total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The point A dose from the HDR brachytherapy was 28 Gy to 30 Gy (4 Gy x 7, or 5 Gy x 6). The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months (12 ∼ 86 months). The incidence of rectal bleeding was 12.7% (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was 8.5%. Most complications (92.6%) developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding: an icruCRBED greater than 100 Gy (19.7% vs. 4.2%), an EBRT dose to the parametrium over 55 Gy (22.1% vs. 5.1%) and higher stages of III and IV (31.8% vs. 10.5%). In the multivariate analysis, the icruCRBED was the only significant factor (ρ > 0.0432). The total

  8. Anode reactive bleed and injector shift control strategy

    Science.gov (United States)

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

    2012-01-03

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

  9. Post-biliary sphincterotomy bleeding despite covered metallic stent deployment

    Directory of Open Access Journals (Sweden)

    Gianfranco Donatelli

    2016-05-01

    Full Text Available Objectives: Several endoscopic techniques have been proposed for the management of post-sphincterotomy bleeding. Lately, self-expandable metal stents deployment has gained popularity especially as a rescue therapy when other endoscopic techniques fail. Methods-results: We report the case report of a massive post-sphincterotomy bleeding in a patient with a self-expandable metal stent in the biliary tree. Despite the presence of a correctly positioned self-expandable metal stent, a new endoscopic session was required to control the bleeding. Conclusions: Self-expandable metal stent may be useful to manage post-endoscopic sphincterotomy bleeding. However, up to now there is no specifically designed self-expandable metal stent for such complication. Large new designed self-expandable metal stent may be a useful tool for biliary endoscopist.

  10. ENDOSCOPIC DIAGNOSIS AND THERAPY IN GASTRO-ESOPAGEAL VARICEAL BLEEDING

    Science.gov (United States)

    Sanyal, Arun J.

    2016-01-01

    Gastroesophageal variceal hemorrhage is a medical emergency with high morbidity and mortality. Endoscopic therapy is the mainstay of management of bleeding varices. It requires attention to technique and the appropriate choice of therapy for a given patient at a given point in time. Subjects must be monitored continuously after initiation of therapy for control of bleeding and second line definitive therapies introduced quickly if endoscopic and pharmacologic treatment fails. PMID:26142034

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  12. Endovascular treatment of nonvariceal acute arterial upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Andersen, Poul Erik; Duvnjak, Stevo

    2010-01-01

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

  13. Transarterial embolization for management of severe postcoital bleeding

    Directory of Open Access Journals (Sweden)

    Armen Eskandari

    2016-08-01

    Full Text Available Objectives: Postcoital bleeding is an uncommon cause of gynecologic hemorrhage; however, it can be severe in a majority of cases necessitating surgical management. Methods: We report a case of severe postcoital bleeding in a young woman requiring blood transfusion. Results: Hemostasis was achieved using subselective embolization of cervical artery by metallic coils. Conclusion: Our case demonstrates a minimally invasive treatment for control of non-obstetric hemorrhage.

  14. [Three methods for controlling presacral massive bleeding during pelvic operations].

    Science.gov (United States)

    Wang, Xiaoxue; Liu, Zhimin; Xie, Shangkui; Ren, Donglin; Wu, Yin'ai

    2017-12-25

    To evaluate three different methods for controlling presacral massive bleeding during pelvic operations. Clinical data of 11 patients with presacral massive bleeding during pelvic operation at The Sixth Affiliated Hospital of Sun Yat-sen University and 157 Branch Hospital of Guangzhou General Hospital of Guangzhou Military Command from January 2001 to January 2016 were analyzed retrospectively. Hemostasis methods for presacral massive bleeding during operation included gauze packing (whole pressure), drawing pin (local pressure) and absorbable gauze (absorbable gauze was adhered to bleeding position with medical glue after local pressure). Efficacy of these 3 methods for controlling bleeding was evaluated and compared. Ten patients were male and 1 was female with average age of 65.2 (40 to 79) years old. Eight cases were rectal cancer, 2 were presacral malignancies and 1 was rectal benign lesion. Bleeding volume during operation was 300 to 2 500 (median 800) ml. From 2001 to 2012, 4 cases received gauze packing, of whom, 3 cases were scheduled Dixon resection before operation and then had to be referred to Hartman resection; 3 cases died of systemic failure due to postoperative chronic errhysis and infection, and 1 underwent re-operation. At the same time from 2001 to 2012, 5 cases received drawing pin, of whom, bleeding of 3 cases was successfully controlled and Dixon resection was completed. In other 2 cases with hemostasis failure, 1 case underwent re-operation following the use of gauze packing, and another 1 case received absorbable gauze hemostasis. All the 5 patients were healing. From 2013 to 2016, 2 cases completed scheduled anterior resection of rectum after successful hemostasis with absorbable gauze and were healing and discharged. Gauze packing hemostasis is a basic method for controlling presacral massive bleeding. Drawing pin and absorbable gauze hemostasis are more precise and may avoid the change of surgical procedure. But drawing pin has the

  15. Abnormal uterine bleeding in reproductive-aged women.

    Science.gov (United States)

    Matthews, Michelle L

    2015-03-01

    Abnormal uterine bleeding is a common medical condition with several causes. The International Federation of Gynecology and Obstetrics published guidelines in 2011 to develop universally accepted nomenclature and a classification system. In addition, the American College of Obstetrics and Gynecology recently updated recommendations on evaluation of abnormal uterine bleeding and indications for endometrial biopsies. This article reviews both medical and surgical treatments, including meta-analysis reviews of the most effective treatment options. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Upper gastrointestinal bleeding: Five-year experience from one centre

    Directory of Open Access Journals (Sweden)

    Jovanović Ivan

    2008-01-01

    Full Text Available Introduction Acute upper gastrointestinal bleeding is the commonest emergency managed by gastroenterologists. Objective To assess the frequency of erosive gastropathy and duodenal ulcer as a cause of upper gastrointestinal (GI bleeding as well as its relation to age, gender and known risk factors. METHOD We conducted retrospective observational analysis of emergency endoscopy reports from the records of the Emergency Department of Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, during the period from 2000 to 2005. Data consisted of patients' demographics, endoscopic findings and potential risk factors. Results During the period 2000-2005, three thousand nine hundred and fifty four emergency upper endoscopies were performed for acute bleeding. In one quarter of cases, acute gastric erosions were the actual cause of bleeding. One half of them were associated with excessive consumption of salicylates and NSAIDs. In most of the examined cases, bleeding stopped spontaneously, while 7.6% of the cases required endoscopic intervention. Duodenal ulcer was detected as a source of bleeding in 1320 (33.4% patients and was significantly associated with a male gender (71.8% and salicylate or NSAID abuse (59.1% (χ2-test; p=0.007. Conclusion Erosive gastropathy and duodenal ulcer represent a significant cause of upper gastrointestinal bleeding accounting for up to 60% of all cases that required emergency endoscopy during the 5- year period. Consumption of NSAIDs and salicylates was associated more frequently with bleeding from a duodenal ulcer than with erosive gastropathy leading to a conclusion that we must explore other causes of erosive gastropathy more thoroughly. .

  17. Trends in Acute Nonvariceal Upper Gastrointestinal Bleeding in Dialysis Patients

    Science.gov (United States)

    Yang, Ju-Yeh; Lee, Tsung-Chun; Montez-Rath, Maria E.; Paik, Jane; Chertow, Glenn M.; Desai, Manisha

    2012-01-01

    Impaired kidney function is a risk factor for upper gastrointestinal (GI) bleeding, an event associated with poor outcomes. The burden of upper GI bleeding and its effect on patients with ESRD are not well described. Using data from the US Renal Data System, we quantified the rates of occurrence of and associated 30-day mortality from acute, nonvariceal upper GI bleeding in patients undergoing dialysis; we used medical claims and previously validated algorithms where available. Overall, 948,345 patients contributed 2,296,323 patient-years for study. The occurrence rates for upper GI bleeding were 57 and 328 episodes per 1000 person-years according to stringent and lenient definitions of acute, nonvariceal upper GI bleeding, respectively. Unadjusted occurrence rates remained flat (stringent) or increased (lenient) from 1997 to 2008; after adjustment for sociodemographic characteristics and comorbid conditions, however, we found a significant decline for both definitions (linear approximation, 2.7% and 1.5% per year, respectively; Pupper GI bleeding episodes and were more likely to receive blood transfusions during an episode. Overall 30-day mortality was 11.8%, which declined significantly over time (relative declines of 2.3% or 2.8% per year for the stringent and lenient definitions, respectively). In summary, despite declining trends worldwide, crude rates of acute, nonvariceal upper GI bleeding among patients undergoing dialysis have not decreased in the past 10 years. Although 30-day mortality related to upper GI bleeding declined, perhaps reflecting improvements in medical care, the burden on the ESRD population remains substantial. PMID:22266666

  18. Seven cases of upper gastrointestinal bleeding after cold biopsy

    OpenAIRE

    Alneaimi, Khaled; Abdelmoula, Ali; Vincent, Magalie; Savale, Camille; Baye, Birane; Lesur, Gilles

    2016-01-01

    Background and study aims: Routine biopsy of the upper gastrointestinal tract is performed with increasing frequency. It is generally considered to be safe without significant complication. However, gastrointestinal bleeding as a result of cold biopsy is a known complication. We report seven cases of upper gastrointestinal bleeding after cold biopsy and discuss clinical data, risks factors, severity and management of this event. We suggest that physicians must be more cautious with this rare ...

  19. Converting pest insects into food

    DEFF Research Database (Denmark)

    Offenberg, Hans Joachim; Wiwatwittaya, Decha

    2010-01-01

    Canopy dwelling weaver ants (Oecophylla spp.) are used to control a variety of pests in a number of tropical tree crops. What is less familiar is the existence of commercial markets where these ants and their brood are sold for (i) human consumption, (ii) pet food or (iii) traditional medicine...... on management, 32-115 kg ant brood (mainly new queens) was harvested per ha per year without detrimental effect on colony survival and worker ant densities. This suggest that ant biocontrol and ant harvest can be sustainable integrated in plantations and double benefits derived. As ant production is fuelled...... by pest insects, problematic pests are converted into food and additional earnings. To assess the profitability of providing additional food for the ants, O. smaragdina food conversion efficiency (ECI) was estimated in the laboratory. This estimate suggests the feeding of weaver ants in ant farms...

  20. Efficiency of Capacitively Loaded Converters

    DEFF Research Database (Denmark)

    Andersen, Thomas; Huang, Lina; Andersen, Michael A. E.

    2012-01-01

    This paper explores the characteristic of capacitance versus voltage for dielectric electro active polymer (DEAP) actuator, 2kV polypropylene film capacitor as well as 3kV X7R multi layer ceramic capacitor (MLCC) at the beginning. An energy efficiency for capacitively loaded converters...... is introduced as a definition of efficiency. The calculated and measured efficiency curves for charging DEAP actuator, polypropylene film capacitor and X7R MLCC are provided and compared. The attention has to be paid for the voltage dependent capacitive load, like X7R MLCC, when evaluating the charging...... polypropylene film capacitor can be the equivalent capacitive load. Because of the voltage dependent characteristic, X7R MLCC cannot be used to replace the DEAP actuator. However, this type of capacitor can be used to substitute the capacitive actuator with voltage dependent property at the development phase....

  1. Transcatheter embolization for treatment of acute lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Uflacker, R.

    1987-01-01

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

  2. Evaluation and management of abnormal uterine bleeding in premenopausal women.

    Science.gov (United States)

    Sweet, Mary Gayle; Schmidt-Dalton, Tarin A; Weiss, Patrice M; Madsen, Keith P

    2012-01-01

    Up to 14 percent of women experience irregular or excessively heavy menstrual bleeding. This abnormal uterine bleeding generally can be divided into anovulatory and ovulatory patterns. Chronic anovulation can lead to irregular bleeding, prolonged unopposed estrogen stimulation of the endometrium, and increased risk of endometrial cancer. Causes include polycystic ovary syndrome, uncontrolled diabetes mellitus, thyroid dysfunction, hyperprolactinemia, and use of antipsychotics or antiepileptics. Women 35 years or older with recurrent anovulation, women younger than 35 years with risk factors for endometrial cancer, and women with excessive bleeding unresponsive to medical therapy should undergo endometrial biopsy. Treatment with combination oral contraceptives or progestins may regulate menstrual cycles. Histologic findings of hyperplasia without atypia may be treated with cyclic or continuous progestin. Women who have hyperplasia with atypia or adenocarcinoma should be referred to a gynecologist or gynecologic oncologist, respectively. Ovulatory abnormal uterine bleeding, or menorrhagia, may be caused by thyroid dysfunction, coagulation defects (most commonly von Willebrand disease), endometrial polyps, and submucosal fibroids. Transvaginal ultrasonography or saline infusion sonohysterography may be used to evaluate menorrhagia. The levonorgestrel-releasing intrauterine system is an effective treatment for menorrhagia. Oral progesterone for 21 days per month and nonsteroidal anti-inflammatory drugs are also effective. Tranexamic acid is approved by the U.S. Food and Drug Administration for the treatment of ovulatory bleeding, but is expensive. When clear structural causes are identified or medical management is ineffective, polypectomy, fibroidectomy, uterine artery embolization, and endometrial ablation may be considered. Hysterectomy is the most definitive treatment.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-12-15

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

  4. Transvaginal sonography in abnormal uterine bleeding and correlation to hysteroscopy

    International Nuclear Information System (INIS)

    Saeed, S.; Shah, S.; Ali, H.; Khan, S.; Ehsan, N.; Ahmed, S.Z.

    2017-01-01

    To correlate results of Transvaginal sonography with those of hysteroscopy and biopsy in abnormal uterine bleeding to estimate the accuracy and analytical values of non-invasive transvaginal sonography in abnormal uterine bleeding. Methodology: This cross-sectional Study was carried out at BMCH, Quetta, Balochistan, Pakistan from March 2013 to February 2014 and included 200 patients of abnormal uterine bleeding. Exclusion criteria were pregnancy, virginity, local bleeding of perineal or vaginal origin. Hysteroscopy and biopsy and Transvaginal Ultrasound (TVS) were performed in all. Result: The most common type of bleeding was found to be menorrhagia in 39% while the least common type was postmenopausal bleeding in 9%. Mean endometrial thickness was 11.64 mm and it was noted that at less than 14mm thickness no serious pathology was found. Sensitivity of TVS for endometrial hyperplasia was found to be 66.66% while specificity was 100%. Positive analytical value was 100% while negative value was 100%. Overall sensitivity calculated for TVS was 94.44%, specificity 98.55%, PPV was 81.93% and NPV 98.55%. Conclusion: Sensitivity and specificity of TVS were lower than hysteroscopy and biopsy but the difference was not significant. TVS can be used as first line investigation while hysteroscopy and biopsy may be left for cases of high risk or in those cases where some positive findings could be found on TVS. (author)

  5. Circular waveguide mode converters at 140 GHz

    International Nuclear Information System (INIS)

    Trulsen, J.; Woskoboinikow, P.; Temkin, R.J.

    1986-01-01

    A unified derivation of the coupled mode equations for circular waveguide is presented. Also, approximate design criteria for TE/sub 0n/ to TE/sub 0n'/ axisymmetric, TE 01 to TE 11 wriggle, and TE 01 to TM 11 bend converters are reviewed. Numerically solving the coupled mode equations, an optimized set of mode converters has been designed for conversion of a 2 millimeter wave TE 03 mode into TE 11 . This set consists of axisymmetric TE 03 to TE 02 and TE 02 to TE 01 converters followed by a wriggle TE 01 to TE 11 converter. This mode converter set was fabricated and tested using a 3 kW, 137 GHz gyrotron. A TE 11 mode purity of better than 97% was achieved. The TE 01 to TE 11 wriggle converter was experimentally optimized for a measured conversion efficiency of better than 99% not including ohmic losses

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

    Science.gov (United States)

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

    2014-03-01

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

  7. What is the recurrence rate of postmenopausal bleeding in women who have a thin endometrium during a first episode of postmenopausal bleeding?

    NARCIS (Netherlands)

    van Doorn, H. C.; Timmermans, A.; Opmeer, B. C.; Kruitwagen, R. F. M. P.; Dijkhuizen, F. P. H. L. J.; Kooi, G. S.; van de Weijer, P. H. M.; Mol, B. W. J.

    2008-01-01

    Objective. To determine the incidence and significance of recurrent postmenopausal bleeding among women diagnosed with an endometrial thickness <= 4 mm after a first episode of postmenopausal bleeding. Methods. Consecutive patients not using hormone replacement therapy (HRT) presenting with a first

  8. Major bleeding and intracranial hemorrhage risk prediction in patients with atrial fibrillation: Attention to modifiable bleeding risk factors or use of a bleeding risk stratification score? A nationwide cohort study.

    Science.gov (United States)

    Chao, Tze-Fan; Lip, Gregory Y H; Lin, Yenn-Jiang; Chang, Shih-Lin; Lo, Li-Wei; Hu, Yu-Feng; Tuan, Ta-Chuan; Liao, Jo-Nan; Chung, Fa-Po; Chen, Tzeng-Ji; Chen, Shih-Ann

    2018-03-01

    While modifiable bleeding risks should be addressed in all patients with atrial fibrillation (AF), use of a bleeding risk score enables clinicians to 'flag up' those at risk of bleeding for more regular patient contact reviews. We compared a risk assessment strategy for major bleeding and intracranial hemorrhage (ICH) based on modifiable bleeding risk factors (referred to as a 'MBR factors' score) against established bleeding risk stratification scores (HEMORR 2 HAGES, HAS-BLED, ATRIA, ORBIT). A nationwide cohort study of 40,450 AF patients who received warfarin for stroke prevention was performed. The clinical endpoints included ICH and major bleeding. Bleeding scores were compared using receiver operating characteristic (ROC) curves (areas under the ROC curves [AUCs], or c-index) and the net reclassification index (NRI). During a follow up of 4.60±3.62years, 1581 (3.91%) patients sustained ICH and 6889 (17.03%) patients sustained major bleeding events. All tested bleeding risk scores at baseline were higher in those sustaining major bleeds. When compared to no ICH, patients sustaining ICH had higher baseline HEMORR 2 HAGES (p=0.003), HAS-BLED (pbleeding scores, c-indexes were significantly higher compared to MBR factors (pbleeding. C-indexes for the MBR factors score was significantly lower compared to all other scores (De long test, all pbleeding risk scores for major bleeding (all pbleeding risk scores had modest predictive value for predicting major bleeding but the best predictive value and NRI was found for the HAS-BLED score. Simply depending on modifiable bleeding risk factors had suboptimal predictive value for the prediction of major bleeding in AF patients, when compared to the HAS-BLED score. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  9. Focal intestinal lymphangiectasia: An unusual cause of acute overt obscure gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Ashish Kumar Jha

    2014-01-01

    Full Text Available Detection of bleeding lesion in a patient of acute overt obscure gastrointestinal bleeding is a real challenge. Recently, authors have showed superiority of urgent capsule endoscopy (CE over angiography in patients with acute overt obscure gastrointestinal bleeding. Focal type of intestinal lymphangiectasia is a rare cause of acute gastrointestinal bleeding. Here, we describe a case of focal lymphangiectasia who presented to us with acute overt obscure gastrointestinal bleeding and diagnosed by urgent CE.

  10. The Clinical Outcomes of Lower Gastrointestinal Bleeding Are Not Better than Those of Upper Gastrointestinal Bleeding.

    Science.gov (United States)

    Kwak, Min Seob; Cha, Jae Myung; Han, Yong Jae; Yoon, Jin Young; Jeon, Jung Won; Shin, Hyun Phil; Joo, Kwang Ro; Lee, Joung Il

    2016-10-01

    The incidence of lower gastrointestinal bleeding (LGIB) is increasing; however, predictors of outcomes for patients with LGIB are not as well defined as those for patients with upper gastrointestinal bleeding (UGIB). The aim of this study was to identify the clinical outcomes and the predictors of poor outcomes for patients with LGIB, compared to outcomes for patients with UGIB. We identified patients with LGIB or UGIB who underwent endoscopic procedures between July 2006 and February 2013. Propensity score matching was used to improve comparability between LGIB and UGIB groups. The clinical outcomes and predictors of 30-day rebleeding and mortality rate were analyzed between the two groups. In total, 601 patients with UGIB (n = 500) or LGIB (n = 101) were included in the study, and 202 patients with UGIB and 101 patients with LGIB were analyzed after 2:1 propensity score matching. The 30-day rebleeding and mortality rates were 9.9% and 4.5% for the UGIB group, and 16.8% and 5.0% for LGIB group, respectively. After logistic regression analysis, the Rockall score (P = 0.013) and C-reactive protein (CRP; P = 0.047) levels were significant predictors of 30-day mortality in patients with LGIB; however, we could not identify any predictors of rebleeding in patients with LGIB. The clinical outcomes for patients with LGIB are not better than clinical outcomes for patients with UGIB. The clinical Rockall score and serum CRP levels may be used to predict 30-day mortality in patients with LGIB.

  11. Ocean floor mounting of wave energy converters

    Science.gov (United States)

    Siegel, Stefan G

    2015-01-20

    A system for mounting a set of wave energy converters in the ocean includes a pole attached to a floor of an ocean and a slider mounted on the pole in a manner that permits the slider to move vertically along the pole and rotate about the pole. The wave energy converters can then be mounted on the slider to allow adjustment of the depth and orientation of the wave energy converters.

  12. Vacuum-insulated catalytic converter

    Science.gov (United States)

    Benson, David K.

    2001-01-01

    A catalytic converter has an inner canister that contains catalyst-coated substrates and an outer canister that encloses an annular, variable vacuum insulation chamber surrounding the inner canister. An annular tank containing phase-change material for heat storage and release is positioned in the variable vacuum insulation chamber a distance spaced part from the inner canister. A reversible hydrogen getter in the variable vacuum insulation chamber, preferably on a surface of the heat storage tank, releases hydrogen into the variable vacuum insulation chamber to conduct heat when the phase-change material is hot and absorbs the hydrogen to limit heat transfer to radiation when the phase-change material is cool. A porous zeolite trap in the inner canister absorbs and retains hydrocarbons from the exhaust gases when the catalyst-coated substrates and zeolite trap are cold and releases the hydrocarbons for reaction on the catalyst-coated substrate when the zeolite trap and catalyst-coated substrate get hot.

  13. Mortality in high-risk patients with bleeding Mallory-Weiss syndrome is similar to that of peptic ulcer bleeding. Results of a prospective database study.

    Science.gov (United States)

    Ljubičić, Neven; Budimir, Ivan; Pavić, Tajana; Bišćanin, Alen; Puljiz, Zeljko; Bratanić, Andre; Troskot, Branko; Zekanović, Dražen

    2014-04-01

    The aim of this study was to identify the predictive factors influencing mortality in patients with bleeding Mallory-Weiss syndrome in comparison with peptic ulcer bleeding. Between January 2005 and December 2009, 281 patients with endoscopically confirmed Mallory-Weiss syndrome and 1530 patients with peptic ulcer bleeding were consecutively evaluated. The 30-day mortality and clinical outcome were related to the patients' demographic data, endoscopic, and clinical characteristics. The one-year cumulative incidence for bleeding Mallory-Weiss syndrome was 7.3 cases/100,000 people and for peptic ulcer bleeding 40.4 cases/100,000 people. The age-standardized incidence for both bleeding Mallory-Weiss syndrome and peptic ulcer bleeding remained unchanged during the observational five-year period. The majority of patients with bleeding Mallory-Weiss syndrome were male patients with significant overall comorbidities (ASA class 3-4). Overall 30-day mortality rate was 5.3% for patients with bleeding Mallory-Weiss syndrome and 4.6% for patients with peptic ulcer bleeding (p = 0.578). In both patients with bleeding Mallory-Weiss syndrome and peptic ulcer bleeding, mortality was significantly higher in patients over 65 years of age and those with significant overall comorbidities (ASA class 3-4). The incidence of bleeding Mallory-Weiss syndrome and peptic ulcer bleeding has not changed over a five-year observational period. The overall 30-day mortality was almost equal for both bleeding Mallory-Weiss syndrome and peptic ulcer bleeding and was positively correlated to older age and underlying comorbid illnesses.

  14. Semi-automatic logarithmic converter of logs

    International Nuclear Information System (INIS)

    Gol'dman, Z.A.; Bondar's, V.V.

    1974-01-01

    Semi-automatic logarithmic converter of logging charts. An original semi-automatic converter was developed for use in converting BK resistance logging charts and the time interval, ΔT, of acoustic logs from a linear to a logarithmic scale with a specific ratio for subsequent combining of them with neutron-gamma logging charts in operative interpretation of logging materials by a normalization method. The converter can be used to increase productivity by giving curves different from those obtained in manual, pointwise processing. The equipment operates reliably and is simple in use. (author)

  15. Multilevel converters for 10 MW Wind Turbines

    DEFF Research Database (Denmark)

    Ma, Ke; Blaabjerg, Frede

    2011-01-01

    Several promising multi-level converter configurations for 10 MW Wind Turbines both with direct drive and one-stage gear box drive using Permanent Magnet Synchronous Generator (PMSG) are proposed, designed and compared. Reliability is a crucial indicator for large scale wind power converters...... that the three-level and five-level H-bridge converter topologies both have potential to achieve improved thermal performances compared to the three-level Neutral-Point-Clamped converter topology in the wind power application....

  16. Commutation Processes in Multiresonant ZVS Bridge Converter

    Directory of Open Access Journals (Sweden)

    Miroslaw Luft

    2008-01-01

    Full Text Available The analysis of the multiresonant ZVS DC/DC bridge converter is presented. The control system of the converter is basedon the method of frequency control at the constant time of transistor turn-off with a phase shift. The operation of the circuit is givenand the operating range of the converter is defined where ZVS switching operation is assured. Control characteristics are given andthe converter’s efficiency is defined. The circuit’s operation is analysed on the basis of results of the converter simulation tests using Simplorer programme.

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

    Directory of Open Access Journals (Sweden)

    Jan Yi-Yin

    2006-01-01

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

  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. Endovascular management for significant iatrogenic portal vein bleeding.

    Science.gov (United States)

    Kim, Jong Woo; Shin, Ji Hoon; Park, Jonathan K; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu-Bo

    2017-11-01

    Background Despite conservative treatment, hemorrhage from an intrahepatic branch of the portal vein can cause hemodynamic instability requiring urgent intervention. Purpose To retrospectively report the outcomes of hemodynamically significant portal vein bleeding after endovascular management. Material and Methods During a period of 15 years, four patients (2 men, 2 women; median age, 70.5 years) underwent angiography and embolization for iatrogenic portal vein bleeding. Causes of hemorrhage, angiographic findings, endovascular treatment, and complications were reported. Results Portal vein bleeding occurred after percutaneous liver biopsy (n = 2), percutaneous radiofrequency ablation (n = 1), and percutaneous cholecystostomy (n = 1). The median time interval between angiography and percutaneous procedure was 5 h (range, 4-240 h). Common hepatic angiograms including indirect mesenteric portograms showed active portal vein bleeding into the peritoneal cavity with (n = 1) or without (n = 2) an arterioportal (AP) fistula, and portal vein pseudoaneurysm alone with an AP fistula (n = 1). Successful transcatheter arterial embolization (n = 2) or percutaneous transhepatic portal vein embolization (n = 2) was performed. Embolic materials were n-butyl cyanoacrylate alone (n = 2) or in combination with gelatin sponge particles and coils (n = 2). There were no major treatment-related complications or patient mortality within 30 days. Conclusion Patients with symptomatic or life-threatening portal vein bleeding following liver-penetrating procedures can successfully be managed with embolization.

  20. Spontaneous bleeding from liver after open heart surgery.

    Science.gov (United States)

    Mir, Najeeb H; Shah, Mian T; Obeid, Mahmoud Ali; Gallo, Ricardo; Aliter, Hashem

    2013-01-01

    Intra-abdominal hemorrhage after open heart surgery is very uncommon in routine clinical practice. There are case reports of having bleeding from spleen or liver after starting low molecular weight heparin (LMWH) postoperatively. Our patient is a 58-year-old man with mitral valve regurgitation, who underwent mitral valve repair and developed intra-abdominal hemorrhage 8h after open heart surgery. The exploratory laparotomy revealed the source of bleeding from ruptured sub-capsular liver hematoma and oozing from raw areas of the liver surface. Liver packing was done to control the bleeding. The gastrointestinal complications after open heart surgery are rare and spontaneous bleeding from spleen has been reported. This is the first case from our hospital to have intra-abdominal hemorrhage after open heart surgery. Spontaneous bleeding from liver is a possible complication after open heart surgery. We submit the case for the academic interest and to discuss the possible cause of hemorrhage. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. Analysis of bleeding saps and radioactive measurements of deciduous trees

    International Nuclear Information System (INIS)

    Gomernik-Besser, E.

    1993-07-01

    Samples of bleeding sap of Betula pendula Roth, Betula lutea L., Betula papyrifera L., Betula mandshuria L., Salix melichoferi Saut., Cornus florida L., Evodea velutina L., Vitis amurensis L., Acer tartaricum L., Aesculus parviflora L., and Juglans regia L. in the botanical garden in Graz have been collected during springs of 1987, 1988, and 1989. After a special treatment (ion-exchange and freeze-drying) the bleeding saps have been searched for the compounds of sugars, amino acids and organic acids by gaschromatrography. LAMMA-spectra showed the ion composition, and radioactivity measurements on leaves of the trees have also been made. In all bleeding saps sugars could be identified in various concentrations, mainly glucose and fructose. All trees showed nearly the same acid spectrum, and the most common ingredient was malic acid. In the bleeding saps of the Betulaceae and Juglans regia the major constituent was citrulline. In Acer tartaricum allantoine was present in large concentration. In Evodea velutina, Aesculus parviflora, Vitis amurensis and Cornus florida glutamin could be identified in large concentration. After the reactor accident of Tschernobyl in April 1986 the number of synthetic radionuclides increased and they could be identified. The LAMMA-spectra showed high contents of potassium and calcium in the bleeding saps. (author)

  2. Analysis of bleeding saps and radioactive measurements of deciduous trees

    International Nuclear Information System (INIS)

    Gomernik-Besser, E.

    1993-07-01

    Samples of bleeding sap of Betula pendula Roth, Betula lutea L., Betula papyrifera L., Betula mandshuria L., Salix mielichoferi Saut., Cornus florida L., Evodea velutina L., Vitis amurensis L., Acer tartaricum L., Aesculus parviflora L., and Juglans regia L. in the botanical garden in Graz have been collected during springs of 1987, 1988, and 1989. After a special treatment (ion-exchange and freeze-drying) the bleeding saps have been searched for the compounds of sugars, amino acids and organic acids by gas-chromatrography. LAMMA-spectra showed the ion composition, and radioactivity measurements on leaves of the trees have also been made. In all bleeding saps sugars could be identified in various concentrations, mainly glucose and fructose. All trees showed nearly the same acid spectrum, and the most common ingredient was malic acid. In the bleeding saps of the Betulaceae and Juglans regia the major constituent was citrulline. In Acer tartaricum allantoine was present in large concentration. In Evodea velutina, Aesculus parviflora, Vitis amurensis and Cornus florida glutamin could be identified in large concentration. After the reactor accident of Tschernobyl in April 1986 the number of synthetic radionuclides increased and they could be identified. The LAMMA-spectra showed high contents of kalium and calcium in the bleeding saps. (author)

  3. Lack of bleeding in patients with severe factor VII deficiency.

    Science.gov (United States)

    Barnett, J Mark; Demel, Kurt C; Mega, Anthony E; Butera, James N; Sweeney, Joseph D

    2005-02-01

    Factor VII deficiency, although rare, is now recognized as the most common autosomal recessive inherited factor deficiency. It is usually considered to be associated with bleeding only in the severely affected subject and heterozygotes (>10%) are not considered at risk. The general recommendation for surgery is to achieve a FVII level in excess of 15% (0.15 1U/mL). We present three cases of severe factor VII deficiency, each of whom appeared hemostatically competent based on clinical history. Subject 1 is a 33 year-old African-American female with a baseline FVII of American female with a factor VII level of 9% who underwent an elective left total hip replacement without any factor replacement and had no excessive bleeding, but who sustained a pulmonary embolism postoperatively. Subject 3 is a 19-year-old African-American male with a baseline FVII of 1% with a history of active participation in football without noticeable injury and who underwent an emergent appendectomy without bleeding. These three cases represent individuals with the severe form of FVII deficiency who did not exhibit excessive bleeding when challenged with surgical procedures. The clinical history would appear the most valuable tool in predicting the likelihood of bleeding in these patients, and we suggest that the presumption that all patients with severe FVII deficiency should receive replacement therapy before surgical procedures may not be valid in all cases. Copyright 2005 Wiley-Liss, Inc.

  4. Bleed water testing program for controlled low strength material

    International Nuclear Information System (INIS)

    Langton, C.A.

    1996-01-01

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

  5. Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Chua, A. E.; Ridley, L. J.

    2008-01-01

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

  6. DSA diagnosis and interventional management of postoperative bleeding

    International Nuclear Information System (INIS)

    Li Yuwei; Zhang Fuqiang; Li Yunhui; Yuan Liang; Si Guangyan; Liu Lili

    2009-01-01

    Objective: To discuss the clinical application of DSA and interventional management in diagnosing and treating the bleeding after surgery. Methods: The clinical data and the interventional management of 14 patients with DSA-proved postoperative bleeding, encountered during the period of Aug. 2005-Jan. 2008, were retrospectively analyzed. The surgeries included subtotal gastrectomy (n=4), pancreatoduodenectomy (n=3), cesarean section (n=2), nephrolithotomy (n=3), heminephrectomy (n=1), internal hemorrhoidectomy (n=1). Results: Seventeen arterial bleeding sites were demonstrated, including gastroduodenal (n=2), left gastric (n=4), phrenic (n=1), short gastric (n=1), superior mesenteric (n=2), renal (n=4), uterine (n=2) and internal pudendal (n=1) artery. The diagnosis was confirmed with DSA in all 14 patients, of which embolization was successfully carried out in 13 in one session (92.8%). The remaining one case had to be operated again to stop the bleeding because of the failure of the superselective catheterization. No serious complications, such as organ necrosis or visceral dysfunction, occurred. Conclusion: As a safe, minimally-invasive and effective technique, DSA and interventional management are very helpful in diagnosing and treating the bleeding after surgery. (authors)

  7. Vitamin K deficiency bleeding presenting as nodular purpura in infancy: A rare and life-threatening entity

    Directory of Open Access Journals (Sweden)

    Pratik Gahalaut

    2013-01-01

    Full Text Available Vitamin K deficiency bleeding (VKDB disorder is an uncommon entity, which occurs due to inadequate activity of vitamin K-dependant coagulation factors. An 8-months-old exclusively breast-fed male infant presented with multiple, purpuric and nodular non-collapsible swellings on trunk of 4 days duration. Investigations revealed raised activated partial thromboplastin time and prothrombintime. Fibrinogen level and platelet counts were normal. Late VKDB usually presents as intra-cranial or mucosal hemorrhages. [1] Though skin and mucosal bleeding may occur in 1/3 rd of infants with VKDB, ′nodular purpura′ is not the common presenting feature. Earlier recognition of VKDB and immediate investigation/treatment helps prevent the potentially fatal outcome of the disease. Very little is mentioned about this entity in dermatology literature.

  8. Histological Pattern Of Endometrial Samples In Postmenopausal Women With Abnormal Uterine Bleeding.

    Science.gov (United States)

    Deeba, Farhat; Shaista; Khan, Bushra

    2016-01-01

    Abnormal uterine bleeding is one of the most common clinical problems in gynaecological practice and is an indicator of various underlying disorders. An endometrial biopsy should be done in all women over 35 years with AUB to rule out endometrial cancer or pre-malignant lesion and to initiate treatment. However, wide range of histological patterns on endometrial biopsy offer a diagnostic challenge to practicing pathologists. The objective of this study was to determine histological patterns of endometrium in postmenopausal women with abnormal uterine bleeding. This cross-sectional study was conducted in the department of obstetrics and gynaecology, Benazir Bhutto Shaheed women and children teaching hospital, Abbottabad from 15/11/2014 to 14/05/2015. This study involved 110 postmenopausal women presenting with abnormal uterine bleeding. A written informed consent was obtained from every patient. The mean age of the patients was 61.60±6.17 years and the mean duration of AUB was 5.20±2.80 years. Most of the patients were para 6 (28.2%) and para 5 (28.2%) followed by para 4 (18.2%) and para 3 (17.3%) while only 8.2% were para 1. The most common histological pattern observed was complex hyperplasia without atypia (30.9%) followed by atrophic endometrium (24.5%), simple hyperplasia (23.6%), malignancy (12.7%), complex hyperplasia with atypia (4.5%) and benign endometrial polyp (3.6%). When stratified the data, there was no significant difference of histological patterns across various age groups (p=.673), duration of AUB (p=.064) and parity (p=.242). The most common histological pattern observed in postmenopausal women with AUB was complex hyperplasia without atypia (30.9%) followed by atrophic endometrium (24.5%), simple hyperplasia (23.6%), malignancy (12.7%), complex hyperplasia with atypia (4.5%) and benign endometrial polyp (3.6%).

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

    International Nuclear Information System (INIS)

    Thorne, D.A.; Datz, F.L.; Remley, K.; Christian, P.E.

    1987-01-01

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

  10. Effects of Aglumin on the rectal bleeding following radiotherapy

    International Nuclear Information System (INIS)

    Yamashita, Michitaka; Tanaka, Motoshi; Yoshimura, Osamu; Matsubayashi, Shigeru

    1978-01-01

    Aglumin was administered to 20 cases which had rectal bleeding following radiotherapy. The results were as follows. Rectal bleeding decreased in 16 of 20 cases (80%): remarkably effective, 15%; effective, 25%; slightly effective, 40%. Bleeding time decreased in 11 cases (55%). Rumpel-Leede test gave remarkable improvement in 10 of 14 cases which had been abnormal (71.4%). Platelet increased in 18 of 20 cases (90%). Liver function test and peripheral blood findings showed no remarkable changes. No side effects such as intestinal disturbance etc were noted. In the series of symptomatic treatment for rectal disturbance resulting from radiotherapy, this drug had considerable effect of hemostasis. It was concluded that this drug is useful in combined use with other antiphlogistics, analgesic, and hematinic etc. (Ueda, J.)

  11. 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

  12. What is the best diagnostic approach for obscure gastrointestinal bleeding?

    International Nuclear Information System (INIS)

    Juliao Banos, Fabian

    2010-01-01

    For the gastroenterologist, the study of patients with obscure gastrointestinal bleeding is a diagnostic challenge. Using recent definitions as starting point for locating and defining the type of obscure bleeding allows better study and classification of these individuals. Since 25% of the causes of obscure gastrointestinal bleeding are within the reach of upper endoscopy and total colonoscopy, we are compelled to make good clinical evaluations and establish quality parameters for performance of these procedures. With the emergence of new techniques such as capsule endoscopy and balloon enteroscopy, the study of the small intestine with higher performance than previously available through imaging studies is now possible in our environment. Rational sequential use of these diagnostic tools, exhaustive reviews of capsule endoscopy images plus and adequate training in performing balloon enteroscopy including the two-way approach when necessary, will help us to establish and treat the cause in most patients with this condition.

  13. Computed tomography diagnosis of active bleeding into the thyroid gland.

    Science.gov (United States)

    Veverková, Lucia; Bakaj-Zbrožková, Lenka; Hallamová, Lucie; Heřman, Miroslav

    2013-10-01

    Fine-needle biopsy of the thyroid gland is the most common interventional procedure used to diagnose thyroid diseases. Serious complications are rare in this procedure. They comprise an infection with abscess formation and hemorrhage. To date, only a few case reports have described an ultrasound diagnosis of active bleeding into the thyroid gland. We established such a diagnosis using computed tomography (CT). A 74-year-old woman presented to the emergency department of our hospital with complications after fine-needle biopsy of the thyroid gland. Ultrasound revealed a large hematoma surrounding the gland. A subsequent CT scan confirmed the presence of hematoma and, moreover, showed active bleeding. This finding prompted rapid surgical intervention. CT has the capability to show active bleeding into the thyroid gland.

  14. Step-Up DC-DC converters

    DEFF Research Database (Denmark)

    Forouzesh, Mojtaba; Siwakoti, Yam P.; Gorji, Saman A.

    2017-01-01

    on the general law and framework of the development of next-generation step-up dc-dc converters, this paper aims to comprehensively review and classify various step-up dc-dc converters based on their characteristics and voltage-boosting techniques. In addition, the advantages and disadvantages of these voltage...

  15. Present trends in HVDC converter station design

    Energy Technology Data Exchange (ETDEWEB)

    Carlsson, Lennart; Asplund, Gunnar; Bjorklund, Hans; Flisberg, Gunnar [ABB Power Systems AB, Ludvika (Sweden)

    1994-12-31

    HVDC converter station technology has developed rapidly to satisfy increasing requirements during past 10 - 15 years, but there has not been any dramatic changes since thyristor valves were introduced in the mid 70s. This paper describes some recent and expected future developments, that will substantiality change and simplify future converter stations. (author) 4 refs., 7 figs.

  16. Luminescent converter of neodymium laser radiation

    International Nuclear Information System (INIS)

    Ryba-Romanowski, W.; Golab, S.

    1992-01-01

    The new luminescent converter of neodymium laser radiation has been worked out. Activated inorganic compounds of ytterbium and erbium ions has been used as luminescent agent. The multi-component inorganic glass containing tellurium oxide as well as boron, sodium, magnesium and zinc oxides has been applied as a converter matrix

  17. Time-Interleaved Analog to Digital Converters

    NARCIS (Netherlands)

    Louwsma, S.M.; van Tuijl, Adrianus Johannes Maria; Nauta, Bram

    2010-01-01

    This book describes the research carried out by our PhD student Simon Louwsma at the University of Twente, The Netherlands in the field of high-speed Analogto- Digital (AD) converters. AD converters are crucial circuits for modern systems where information is stored or processed in digital form. Due

  18. Switched-mode converters (one quadrant)

    CERN Document Server

    Barrade, P

    2006-01-01

    Switched-mode converters are DC/DC converters that supply DC loads with a regulated output voltage, and protection against overcurrents and short circuits. These converters are generally fed from an AC network via a transformer and a conventional diode rectifier. Switched-mode converters (one quadrant) are non-reversible converters that allow the feeding of a DC load with unipolar voltage and current. The switched-mode converters presented in this contribution are classified into two families. The first is dedicated to the basic topologies of DC/DC converters, generally used for low- to mid-power applications. As such structures enable only hard commutation processes, the main drawback of such topologies is high commutation losses. A typical multichannel evolution is presented that allows an interesting decrease in these losses. Deduced from this direct DC/DC converter, an evolution is also presented that allows the integration of a transformer into the buck and the buck–boost structure. This enables an int...

  19. Controller for a wave energy converter

    Science.gov (United States)

    Wilson, David G.; Bull, Diana L.; Robinett, III, Rush D.

    2015-09-22

    A wave energy converter (WEC) is described, the WEC including a power take off (PTO) that converts relative motion of bodies of the WEC into electrical energy. A controller controls operation of the PTO, causing the PTO to act as a motor to widen a wave frequency spectrum that is usable to generate electrical energy.

  20. Full range ZVS DC-DC converter

    International Nuclear Information System (INIS)

    Upadhyay, Rinki; Badapanda, M.K.; Hannurkar, P.R.

    2011-01-01

    A 500 V, 24 Amp DC-DC converter with digital signal processor (DSP) based control and protection has been designed, fabricated and tested. Its power circuit consists of IGBT based single phase inverter bridge, ferrite transformer and diode rectifier. All IGBTs in the inverter bridge are operated in zero voltage switching (ZVS) mode to minimize switching losses thereby increasing the efficiency of the converter significantly. The efficiency of this converter is measured to be greater than 97% at full load. In a conventional full bridge inverter, typically ZVS is achieved under full load condition while at light load ZVS is lost. An auxiliary LC circuit has been intentionally incorporated in this converter to achieve ZVS even at light loaded conditions. Detailed simulation of the converter circuit is carried out and crucial waveforms have been presented in this paper. Microchip make dsPIC30F2020 DSP is employed to provide phase shifted PWMs to IGBTs in the inverter bridge. All the crucial parameters are also monitored by this DSP and in case of any unfavorable conditions, the converter is tripped off. Suitable experiments were carried out in this DC-DC converter under different loaded conditions and a close match between the simulated and experimental results were obtained. Such DC-DC converters can be connected in series or parallel for the development of solid state modular power supplies for various applications. (author)

  1. Passive Resonant Bidirectional Converter with Galvanic Barrier

    Science.gov (United States)

    Rosenblad, Nathan S. (Inventor)

    2014-01-01

    A passive resonant bidirectional converter system that transports energy across a galvanic barrier includes a converter using at least first and second converter sections, each section including a pair of transfer terminals, a center tapped winding; a chopper circuit interconnected between the center tapped winding and one of the transfer terminals; an inductance feed winding interconnected between the other of the transfer terminals and the center tap and a resonant tank circuit including at least the inductance of the center tap winding and the parasitic capacitance of the chopper circuit for operating the converter section at resonance; the center tapped windings of the first and second converter sections being disposed on a first common winding core and the inductance feed windings of the first and second converter sections being disposed on a second common winding core for automatically synchronizing the resonant oscillation of the first and second converter sections and transferring energy between the converter sections until the voltage across the pairs of transfer terminals achieves the turns ratio of the center tapped windings.

  2. Modeling and Simulation of Matrix Converter

    DEFF Research Database (Denmark)

    Liu, Fu-rong; Klumpner, Christian; Blaabjerg, Frede

    2005-01-01

    This paper discusses the modeling and simulation of matrix converter. Two models of matrix converter are presented: one is based on indirect space vector modulation and the other is based on power balance equation. The basis of these two models is• given and the process on modeling is introduced...

  3. What to do when she's bleeding through: the recognition, evaluation, and management of abnormal uterine bleeding in adolescents.

    Science.gov (United States)

    Bennett, Alyssa R; Gray, Susan H

    2014-08-01

    This article reviews the current understanding and management of abnormal uterine bleeding (AUB) in adolescents. The readers will learn a practical approach to the evaluation and treatment of mild-to-severe uterine bleeding. In 2011, a new classification system was proposed to standardize the terminology used to describe AUB. This system is based on the pattern and etiology of bleeding and has been adopted by other organizations. The term dysfunctional uterine bleeding has been replaced by AUB. The negative effect of AUB on adolescents' quality of life is now well established. The levonorgestrel-releasing intrauterine system is considered a first-line treatment for heavy menstrual bleeding and should be considered, especially in those adolescents who may also need contraception. AUB is a common adolescent complaint that can vary from mild to life-threatening if not recognized and treated promptly. This article reviews the appropriate assessment and management of AUB and proposes a practical algorithm that can be used in an office or hospital setting.

  4. Neurosurgical management in children with bleeding diathesis: auditing neurological outcome.

    Science.gov (United States)

    Zakaria, Zaitun; Kaliaperumal, Chandrasekaran; Crimmins, Darach; Caird, John

    2018-01-01

    OBJECTIVE The aim of this study was to assess the outcome of neurosurgical treatment in children with bleeding diathesis and also to evaluate the current management plan applied in the authors' service. METHODS The authors retrospectively analyzed all cases in which neurosurgical procedures were performed in pediatric patients presenting with intracranial hematoma due to an underlying bleeding tendency over a 5-year period at their institution. They evaluated the patients' neurological symptoms from the initial referral, hematological abnormalities, surgical treatment, neurological outcome, and scores on the Pediatric Glasgow Outcome Scale-Extended (GOS-E Peds) obtained 1 year after the last operation. RESULTS Five patients with a bleeding diathesis who underwent surgery for intracranial hematoma were identified; the diagnosis was hemophilia A in 3 cases, idiopathic thrombocytopenic purpura in 1 case, and severe aplastic anemia in 1 case. Intracerebral hematoma (ICH) (n = 4) and acute subdural hematoma (n = 1) were confirmed on radiological investigations. In 2 of the 4 patients with ICH, the diagnosis of bleeding diathesis was made for the first time on presentation. Four patients (all male) were younger than 2 years; the patient with severe aplastic anemia and spontaneous ICH was 15 years old and female. The duration of symptoms varied from 24 hours to 5 days. Neurological examination at 1 year's follow-up showed complete recovery (GOS-E Peds score of 1) in 3 cases and mild weakness (GOS-E Peds score of 2) in 2 cases. CONCLUSIONS Neurosurgical management of patients with bleeding diathesis should be carried out in a tertiary-care setting with multidisciplinary team management, including members with expertise in neuroimaging and hematology, in addition to neurosurgery. Early diagnosis and prompt treatment of a bleeding diathesis is crucial for full neurological recovery.

  5. Dosimetric Analysis of Radiation-induced Gastric Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Feng, Mary, E-mail: maryfeng@umich.edu [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Normolle, Daniel [Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Pan, Charlie C. [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Dawson, Laura A. [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Amarnath, Sudha [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Ensminger, William D. [Department of Internal Medicine, Division of Hematology Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Lawrence, Theodore S.; Ten Haken, Randall K. [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States)

    2012-09-01

    Purpose: Radiation-induced gastric bleeding has been poorly understood. In this study, we described dosimetric predictors for gastric bleeding after fractionated radiation therapy. Methods and Materials: The records of 139 sequential patients treated with 3-dimensional conformal radiation therapy (3D-CRT) for intrahepatic malignancies were reviewed. Median follow-up was 7.4 months. The parameters of a Lyman normal tissue complication probability (NTCP) model for the occurrence of {>=}grade 3 gastric bleed, adjusted for cirrhosis, were fitted to the data. The principle of maximum likelihood was used to estimate parameters for NTCP models. Results: Sixteen of 116 evaluable patients (14%) developed gastric bleeds at a median time of 4.0 months (mean, 6.5 months; range, 2.1-28.3 months) following completion of RT. The median and mean maximum doses to the stomach were 61 and 63 Gy (range, 46-86 Gy), respectively, after biocorrection of each part of the 3D dose distributions to equivalent 2-Gy daily fractions. The Lyman NTCP model with parameters adjusted for cirrhosis predicted gastric bleed. Best-fit Lyman NTCP model parameters were n=0.10 and m=0.21 and with TD{sub 50} (normal) = 56 Gy and TD{sub 50} (cirrhosis) = 22 Gy. The low n value is consistent with the importance of maximum dose; a lower TD{sub 50} value for the cirrhosis patients points out their greater sensitivity. Conclusions: This study demonstrates that the Lyman NTCP model has utility for predicting gastric bleeding and that the presence of cirrhosis greatly increases this risk. These findings should facilitate the design of future clinical trials involving high-dose upper abdominal radiation.

  6. The timing of neovascularization in fingertip replantation by external bleeding.

    Science.gov (United States)

    Han, Seung-Kyu; Chung, Heung-Soo; Kim, Woo-Kyung

    2002-09-15

    To overcome venous congestion in fingertip replantation with no venous anastomosis, the authors have used a salvage procedure that consists of continuous external bleeding through a stab incision on the paraungual area and dripping a heparinized saline solution at the incision site to maintain external bleeding. Because this method requires continuous bleeding for a certain period of time, it may be a great burden on the patient; therefore, it is most important to minimize the duration of bleeding. Many authors have studied the timing of the new venous channel formation of the flap. However, to our knowledge, a study on fingertip replantations has not yet been performed. From June of 1985 to November of 1999, the authors performed fingertip replantations on 144 fingers of 137 patients using our salvage procedure at Korea University Guro Hospital. Among the 144 fingers, 101 fingers of 96 patients were successfully transplanted, including those with partial necrosis. The authors reviewed the medical records of these 101 fingers retrospectively; they compared and analyzed the necessary duration of external bleeding according to sex, age, level of injury, cause of amputation, and the type of injury. The average period of the salvage procedure was 7.6 days. Regarding age, the shortest period (5.5 days) was required for patients younger than 10 years. On the basis of the types of injuries, the duration of bleeding was shortest for the guillotine injury group (5.9 days) compared with crush (8.2 days) or avulsion (8.0 days) injuries. Sex and level of injury did not make much difference in the duration of the procedure.

  7. Dosimetric Analysis of Radiation-induced Gastric Bleeding

    International Nuclear Information System (INIS)

    Feng, Mary; Normolle, Daniel; Pan, Charlie C.; Dawson, Laura A.; Amarnath, Sudha; Ensminger, William D.; Lawrence, Theodore S.; Ten Haken, Randall K.

    2012-01-01

    Purpose: Radiation-induced gastric bleeding has been poorly understood. In this study, we described dosimetric predictors for gastric bleeding after fractionated radiation therapy. Methods and Materials: The records of 139 sequential patients treated with 3-dimensional conformal radiation therapy (3D-CRT) for intrahepatic malignancies were reviewed. Median follow-up was 7.4 months. The parameters of a Lyman normal tissue complication probability (NTCP) model for the occurrence of ≥grade 3 gastric bleed, adjusted for cirrhosis, were fitted to the data. The principle of maximum likelihood was used to estimate parameters for NTCP models. Results: Sixteen of 116 evaluable patients (14%) developed gastric bleeds at a median time of 4.0 months (mean, 6.5 months; range, 2.1-28.3 months) following completion of RT. The median and mean maximum doses to the stomach were 61 and 63 Gy (range, 46-86 Gy), respectively, after biocorrection of each part of the 3D dose distributions to equivalent 2-Gy daily fractions. The Lyman NTCP model with parameters adjusted for cirrhosis predicted gastric bleed. Best-fit Lyman NTCP model parameters were n=0.10 and m=0.21 and with TD 50 (normal) = 56 Gy and TD 50 (cirrhosis) = 22 Gy. The low n value is consistent with the importance of maximum dose; a lower TD 50 value for the cirrhosis patients points out their greater sensitivity. Conclusions: This study demonstrates that the Lyman NTCP model has utility for predicting gastric bleeding and that the presence of cirrhosis greatly increases this risk. These findings should facilitate the design of future clinical trials involving high-dose upper abdominal radiation.

  8. Gastrointestinal bleeding after intracerebral hemorrhage: a retrospective review of 808 cases.

    Science.gov (United States)

    Yang, Tie-Cheng; Li, Jian-Guo; Shi, Hong-Mei; Yu, Dong-Ming; Shan, Kai; Li, Li-Xia; Dong, Xiao-Yan; Ren, Tian-Hua

    2013-10-01

    This study examined the incidence and risk factors for gastrointestinal (GI) bleeding after spontaneous intracerebral hemorrhage (ICH). The available medical records of patients with ICH admitted from June 2008 to December 2009 for any episode of GI bleeding, possible precipitating factors and administration of ulcer prophylaxis were reviewed. The prevalence of GI bleeding was 26.7%, including 3 cases of severe GI bleeding (0.35%). Patients with GI bleeding had significantly longer hospital stay and higher in-hospital mortality compared with patients without GI bleeding. Multivariate logistic regression analyses showed that age, Glasgow Coma Scale scores, sepsis and ICH volume were independent predictors of GI bleeding. About 63.4% of patients with ICH received stress ulcer prophylaxis. GI bleeding occurred frequently after ICH, but severe events were rare. Age, Glasgow Coma Scale score, sepsis and ICH volume were independent predictors of GI bleeding occurring after ICH.

  9. A novel power converter for photovoltaic applications

    Science.gov (United States)

    Yuvarajan, S.; Yu, Dachuan; Xu, Shanguang

    A simple and economical power conditioner to convert the power available from solar panels into 60 Hz ac voltage is described. The raw dc voltage from the solar panels is converted to a regulated dc voltage using a boost converter and a large capacitor and the dc output is then converted to 60 Hz ac using a bridge inverter. The ratio between the load current and the short-circuit current of a PV panel at maximum power point is nearly constant for different insolation (light) levels and this property is utilized in designing a simple maximum power point tracking (MPPT) controller. The controller includes a novel arrangement for sensing the short-circuit current without disturbing the operation of the PV panel and implementing MPPT. The switching losses in the inverter are reduced by using snubbers. The results obtained on an experimental converter are presented.

  10. Step-Up DC-DC converters

    DEFF Research Database (Denmark)

    Forouzesh, Mojtaba; Siwakoti, Yam P.; Gorji, Saman A.

    2017-01-01

    on the general law and framework of the development of next-generation step-up dc-dc converters, this paper aims to comprehensively review and classify various step-up dc-dc converters based on their characteristics and voltage-boosting techniques. In addition, the advantages and disadvantages of these voltage......DC-DC converters with voltage boost capability are widely used in a large number of power conversion applications, from fraction-of-volt to tens of thousands of volts at power levels from milliwatts to megawatts. The literature has reported on various voltage-boosting techniques, in which......-boosting techniques and associated converters are discussed in detail. Finally, broad applications of dc-dc converters are presented and summarized with comparative study of different voltage-boosting techniques....

  11. A review of Indirect Matrix Converter Topologies

    Directory of Open Access Journals (Sweden)

    Salem Rahmani

    2015-08-01

    Full Text Available Abstract—Matrix Converter (MC is a modern direct AC/AC electrical power converter without dc-link capacitor. MC is operated in four quadrant, assuring a control of the output voltage, amplitude and frequency. The matrix converter has recently attracted significant attention among researchers and it has become increasing attractive for applications of wind energy conversion, military power supplies, induction motor drives, etc. Recently, different MC topologies have been proposed and developed which have their own advantages and disadvantages. Matrix converter can be classified as direct and indirect structures. The direct one has been elaborated in previous work. In this paper the indirect MCs are reviewed. Different characteristics of the indirect MC topologies are mentioned to show the strengths and weaknesses of such converter topologies.

  12. Outcomes of Propofol Sedation During Emergency Endoscopy Performed for Upper Gastrointestinal Bleeding.

    Science.gov (United States)

    Park, Chan Hyuk; Han, Dong Soo; Jeong, Jae Yoon; Eun, Chang Soo; Yoo, Kyo-Sang; Jeon, Yong Cheol; Sohn, Joo Hyun

    2016-03-01

    Although propofol-based sedation can be used during emergency endoscopy for upper gastrointestinal bleeding (UGIB), there is a potential risk of sedation-related adverse events, especially in patients with variceal bleeding. We compared adverse events related to propofol-based sedation during emergency endoscopy between patients with non-variceal and variceal bleeding. Clinical records of patients who underwent emergency endoscopy for UGIB under sedation were reviewed. Adverse events, including shock, hypoxia, and paradoxical reaction, were compared between the non-variceal and variceal bleeding groups. Of 703 endoscopies, 539 and 164 were performed for non-variceal and variceal bleeding, respectively. Shock was more common in patients with variceal bleeding compared to those with non-variceal bleeding (12.2 vs. 3.5%, P bleeding (non-variceal bleeding vs. variceal bleeding: hypoxia, 3.5 vs. 1.8%, P = 0.275; paradoxical reaction interfering with the procedure, 4.1 vs. 5.5%, P = 0.442). Although shock was more common in patients with variceal bleeding compared to those with non-variceal bleeding, most cases could be controlled without procedure interruption. Paradoxical reaction, rather than shock or hypoxia, was the most common cause of procedure interruption in patients with variceal bleeding, but the rate did not differ between patients with non-variceal and variceal bleeding.

  13. [Prevention of gastrointestinal bleeding in patients with advanced burns].

    Science.gov (United States)

    Vagner, D O; Krylov, K M; Verbitsky, V G; Shlyk, I V

    2018-01-01

    To reduce the incidence of gastrointestinal bleeding in patients with advanced burns by developing a prophylactic algorithm. The study consisted of retrospective group of 488 patients with thermal burns grade II-III over 20% of body surface area and prospective group of 135 patients with a similar thermal trauma. Standard clinical and laboratory examination was applied. Instrumental survey included fibrogastroduodenoscopy, endoscopic pH-metry and invasive volumetric monitoring (PICCO plus). Statistical processing was carried out with Microsoft Office Excel 2007 and IBM SPSS 20.0. New algorithm significantly decreased incidence of gastrointestinal bleeding (p<0.001) and mortality rate (p=0.006) in patients with advanced burns.

  14. 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......). A reduced number of patients needed blood transfusions in the RxDx group, although this was not statistically significant (19% vs. 38%, respectively; p = .13). Initial heparin dose was significantly reduced in the RxDx group (250 mg; range, 100-375 mg) compared with the control group (300 mg; range, 200...

  15. Premenopausal abnormal uterine bleeding and risk of endometrial cancer.

    Science.gov (United States)

    Pennant, M E; Mehta, R; Moody, P; Hackett, G; Prentice, A; Sharp, S J; Lakshman, R

    2017-02-01

    Endometrial biopsies are undertaken in premenopausal women with abnormal uterine bleeding but the risk of endometrial cancer or atypical hyperplasia is unclear. To conduct a systematic literature review to establish the risk of endometrial cancer and atypical hyperplasia in premenopausal women with abnormal uterine bleeding. Search of PubMed, Embase and the Cochrane Library from database inception to August 2015. Studies reporting rates of endometrial cancer and/or atypical hyperplasia in women with premenopausal abnormal uterine bleeding. Data were independently extracted by two reviewers and cross-checked. For each outcome, the risk and a 95% CI were estimated using logistic regression with robust standard errors to account for clustering by study. Sixty-five articles contributed to the analysis. Risk of endometrial cancer was 0.33% (95% CI 0.23-0.48%, n = 29 059; 97 cases) and risk of endometrial cancer or atypical hyperplasia was 1.31% (95% CI 0.96-1.80, n = 15 772; 207 cases). Risk of endometrial cancer was lower in women with heavy menstrual bleeding (HMB) (0.11%, 95% CI 0.04-0.32%, n = 8352; 9 cases) compared with inter-menstrual bleeding (IMB) (0.52%, 95% CI 0.23-1.16%, n = 3109; 14 cases). Of five studies reporting the rate of atypical hyperplasia in women with HMB, none identified any cases. The risk of endometrial cancer or atypical hyperplasia in premenopausal women with abnormal uterine bleeding is low. Premenopausal women with abnormal uterine bleeding should first undergo conventional medical management. Where this fails, the presence of IMB and older age may be indicators for further investigation. Further research into the risks associated with age and the cumulative risk of co-morbidities is needed. Contrary to practice, premenopausal women with heavy periods or inter-menstrual bleeding rarely require biopsy. © 2016 The Authors BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal

  16. Management of bleeding and open wounds in athletes.

    Science.gov (United States)

    Hoogenboom, Barbara J; Smith, Danny

    2012-06-01

    Bleeding or open wounds of the integumentary system occur frequently in athletics. Integumentary wounds vary from minor scrapes, blisters, and small punctures to more serious lacerations and arterial wounds that could threaten the life of the athlete. The Sports physical therapist (PT) must realize that integumentary wounds and subsequent bleeding can occur in many sports, and assessment and care of such trauma is an essential skill. The purpose of this "On the Sidelines" clinical commentary is to review types of integumentary wounds that may occur in sport and their acute management. 5.

  17. Spironolactone use and the risk of upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

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

    2008-01-01

    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT * Recent studies have suggested an increased risk of upper gastrointestinal bleeding (UGB) in spironolactone users. * We conducted this population-based case-control study to confirm the association between spironolactone use and acute nonvaricose UGB alone...... is not modified by high cumulative doses or by concurrent use of antithrombotic or nonsteroidal anti-inflammatory drugs. AIMS Recent studies have suggested an increased risk of upper gastrointestinal bleeding (UGB) in spironolactone users. The aim was to confirm the association, identify the risk factors...

  18. Enteroclysis in the evaluation of suspected small intestinal bleeding

    International Nuclear Information System (INIS)

    Rex, D.K.; Lappas, J.C.; Maglinte, D.D.; Malczewski, M.C.; Kopecky, K.A.; Cockerill, E.M.

    1989-01-01

    One hundred twenty-five consecutive enteroclysis studies performed for the indication of gastrointestinal bleeding were reviewed. The overall yield of positive studies was low (10%) but important lesions were found. Patients with unequivocally normal evaluations of the upper gastrointestinal tract and colon had the highest yield of positive enteroclysis studies (20%). Neither the specific type of bleeding, the presence or absence of abdominal symptoms or physical examination findings, nor the results of laboratory tests were associated with a positive or negative enteroclysis study

  19. Structured imaging technique in the gynecologic office for the diagnosis of abnormal uterine bleeding.

    Science.gov (United States)

    Dueholm, Margit; Hjorth, Ina Marie D

    2017-04-01

    The aim in the diagnosis of abnormal uterine bleeding (AUB) is to identify the bleeding cause, which can be classified by the PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy (and hyperplasia), Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic and Not otherwise classified) classification system. In a gynecologic setting, the first step is most often to identify structural abnormalities (PALM causes). Common diagnostic options for the identification of the PALM include ultrasonography, endometrial sampling, and hysteroscopy. These options alone or in combination are sufficient for the diagnosis of most women with AUB. Contrast sonography with saline or gel infusion, three-dimensional ultrasonography, and magnetic resonance imaging may be included. The aim of this article is to describe how a simple structured transvaginal ultrasound can be performed and implemented in the common gynecologic practice to simplify the diagnosis of AUB and determine when additional invasive investigations are required. Structured transvaginal ultrasound for the identification of the most common endometrial and myometrial abnormalities and the most common ultrasound features are described. Moreover, situations where magnetic resonance imaging may be included are described. This article proposes a diagnostic setup in premenopausal women for the classification of AUB according to the PALM-COEIN system. Moreover, a future diagnostic setup for fast-track identification of endometrial cancer in postmenopausal women based on a structured evaluation of the endometrium is described. Copyright © 2016. Published by Elsevier Ltd.

  20. Abnormal uterine bleeding: advantages of formal classification to patients, clinicians and researchers.

    Science.gov (United States)

    Madhra, Mayank; Fraser, Ian S; Munro, Malcolm G; Critchley, Hilary O D

    2014-07-01

    To highlight the advantages of formal classification of causes of abnormal uterine bleeding from a clinical and scientific perspective. Review and recommendations for local implementation. In the past, research in the field of menstrual disorders has not been funded adequately with respect to the impact of symptoms on individuals, healthcare systems and society. This was confounded by a diverse terminology, which lead to confusion between clinical and scientific groups, ultimately harming the underlying evidence base. To address this, a formal classification system (PALM-COEIN) for the causes of abnormal uterine bleeding has been published for worldwide use by FIGO (International Federation of Gynecology and Obstetrics). This commentary explains problems created by the prior absence of such a system, the potential advantages stemming from its use, and practical suggestions for local implementation. The PALM-COEIN classification is applicable globally and, as momentum gathers, will ameliorate recurrence of historic problems, and harmonise reporting of clinical and scientific research to facilitate future progress in women's health. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

  1. 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

    BACKGROUND: Treatment with vitamin K antagonists is associated with increased morbidity and mortality. Reversal therapy with prothrombin complex concentrate (PCC) is used increasingly and is recommended in the treatment of patients with bleeding complications undertaking surgical interventions......, as 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...... 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...

  2. Electromagnetic Compatibility of Matrix Converter System

    Directory of Open Access Journals (Sweden)

    S. Fligl

    2006-12-01

    Full Text Available The presented paper deals with matrix converters pulse width modulation strategies design with emphasis on the electromagnetic compatibility. Matrix converters provide an all-silicon solution to the problem of converting AC power from one frequency to another, offering almost all the features required of an ideal static frequency changer. They possess many advantages compared to the conventional voltage or current source inverters. A matrix converter does not require energy storage components as a bulky capacitor or an inductance in the DC-link, and enables the bi-directional power flow between the power supply and load. The most of the contemporary modulation strategies are able to provide practically sinusoidal waveforms of the input and output currents with negligible low order harmonics, and to control the input displacement factor. The perspective of matrix converters regarding EMC in comparison with other types of converters is brightly evident because it is no need to use any equipment for power factor correction and current and voltage harmonics reduction. Such converter with proper control is properly compatible both with the supply mains and with the supplied load. A special digital control system was developed for the realized experimental test bed which makes it possible to achieve greater throughput of the digital control system and its variability.

  3. Underwater noise from a wave energy converter

    DEFF Research Database (Denmark)

    Tougaard, Jakob

    A recent addition to the anthropogenic sources of underwater noise is offshore wave energy converters. Underwater noise was recorded from the Wavestar wave energy converter located at Hastholm, Denmark (57°7.73´N, 8°37.23´E). The Wavestar is a full-scale test and demonstration converter...... in full operation and start and stop of the converter. Median broad band (10 Hz – 20 kHz) sound pressure level (Leq) was 123 dB re. 1 Pa, irrespective of status of the wave energy converter (stopped, running or starting/stopping). The most pronounced peak in the third-octave spectrum was in the 160 Hz...... significant noise above ambient could be detected above the 250 Hz band. The absolute increase in noise above ambient was very small. L50 third-octave levels in the four bands with the converter running were thus only 1-2 dB above ambient L50 levels. The noise recorded 25 m from the wave energy converter...

  4. CAS - CERN Accelerator School: Power Converters

    CERN Document Server

    2015-01-01

    These proceedings collate lectures given at the twenty-eighth specialized course organised by the CERN Accelerator School (CAS). The course was held at the Hotel du Parc, Baden, Switzerland from 7 - 14 May 2014, in collaboration with the Paul Scherrer Institute. Following introductory lectures on accelerators and the requirements on power converters, the course covered components and topologies of the different types of power converters needed for particle accelerators. Issues of design, control and exploitation in a sometimes-hostile environment were addressed. Site visits to ABB and PSI provided an insight into state-of-the-art power converter production and operation, while topical seminars completed the programme.

  5. High-power converters and AC drives

    CERN Document Server

    Wu, Bin

    2017-01-01

    This new edition reflects the recent technological advancements in the MV drive industry, such as advanced multilevel converters and drive configurations. It includes three new chapters, Control of Synchronous Motor Drives, Transformerless MV Drives, and Matrix Converter Fed Drives. In addition, there are extensively revised chapters on Multilevel Voltage Source Inverters and Voltage Source Inverter-Fed Drives. This book includes a systematic analysis on a variety of high-power multilevel converters, illustrates important concepts with simulations and experiments, introduces various megawatt drives produced by world leading drive manufacturers, and addresses practical problems and their mitigations methods.

  6. Field Data Logger Prototype for Power Converters

    DEFF Research Database (Denmark)

    Chaudhary, Sanjay; Ghimire, Pramod; Thøgersen, Paul Bach

    2014-01-01

    and subsequent analysis of the data. This paper presents the development of a low cost prototype field data logger prototype using Raspberry PI and industrial sensors. The functionalities of the data logger prototype are described. An online rainflow count algorithm has been implemented as well.......Mission profile data is very important for the cost effective and reliable design of power converters. The converter design can be improved on the basis of actual field data. Actual mission profile data can be collected for the power converters using field data loggers over a long period of time...

  7. Synchronous Control of Modular Multilevel Converters

    DEFF Research Database (Denmark)

    Oleschuk, Valentin; Blaabjerg, Frede; Bose, Bimal K.

    2002-01-01

    A novel method of direct synchronous pulsewidth modulation (PWM) is applied for control of modular multilevel converters consisting from three standard triphase inverter modules along with an 0.33 p.u. output transformer. The proposed method provides synchronisation of the voltage waveforms...... for each module and the composed voltage at the output of the converter. Multilevel output voltage of the converter has quarter-wave symmetry during the whole range including the zone of overmodulation. Both continuous and discontinuous versions of synchronous PWM, based on vector approach...

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

    Science.gov (United States)

    Kirchgesner, T; Danse, E; Tombal, B

    2013-09-01

    Hematuria is one of the most frequent minor complications after prostatic biopsy. We would like to report the case of a 68-year-old patient with massive hematuria after prostatic biopsy and intravesical active prostate bleeding diagnosed in B-mode ultrasonography. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  9. Does any relationship exist between self reported gingival bleeding ...

    African Journals Online (AJOL)

    Conclusion: Data from this survey revealed an established relationship between gingival bleeding, perceived dental and gingival health, tooth brushing force, professional instruction on tooth brushing, perception of the condition of teeth in relation to daily tooth brushing, worry about the color of gingiva, and satisfaction with ...

  10. Knee arthroplasty and bleeding: when to remove drainages.

    Science.gov (United States)

    Ares, Oscar; Seijas, Roberto; Hernandez, Alberto; Castellet, Enric; Sallent, Andrea

    2013-02-01

    The aim of this study is an attempt to clarify the productive time of drainages as we find that the use of drains in knee arthroplasty is controversial, and there is no consensus regarding their length-time maintenance. We analysed the survival curve of bleeding within three surgical techniques for knee arthroplasty and the effect of two variables on survival curve. One hundred and eighty-eight out of 234 knees were included in the study, and patients were divided into three groups according to the surgical technique: conventional total knee arthroplasty (TKA), subvastus TKA and unicompartmental knee arthroplasty. Variables of study were type of surgery, number and placement of drains. Mean of survival curve for postoperative bleeding time was 16 h (95 % CI: 15.4; 16.6). The risk for longer bleeding increased 1.38-fold with each additional drain used (95 % CI 1.1; 1.8). According to the present study, drains can be safely removed at around 17 h postoperative. Bleeding time reduces as less drains are applied. Therapeutic study, Level III.

  11. Oral contraception and menstrual bleeding during treatment of venous thromboembolism

    DEFF Research Database (Denmark)

    Klok, F A; Schreiber, K; Stach, K

    2017-01-01

    contraception (OC) during the anticoagulation treatment period. Also, experts reached consensus on treating patients with anticoagulation-associated abnormal uterine bleeding with tranexamic acid, although this is not supported by strong evidence from the literature. No consensus was reached on the optimal...

  12. Emergency Backwards Whipple for Bleeding: Formidable and Definitive Surgery

    Directory of Open Access Journals (Sweden)

    Cristian Lupascu

    2017-01-01

    Full Text Available Introduction. During the past decades, the safety of pancreatoduodenectomy has improved, with low mortality and reduced morbidity, particularly in centers with extensive experience. Emergency pancreatoduodenectomy is an uncommon event, for treatment of pancreaticoduodenal trauma, bleeding, or perforation. We herein present a single center experience concerning nontrauma emergency pancreatoduodenectomy for pancreaticoduodenal bleeding. Methods. From January 2007 to December 2015, from a population of 134 PD (70 males and 64 females, mean age 62.2, range 34–82, 5 patients (3.7%; 2 males and 3 females, mean age 64, range 57–70 underwent one-stage emergency pancreatoduodenectomy for uncontrollable nontrauma pancreaticoduodenal bleeding in our tertiary center. Results. All the 5 patients underwent a backwards Whipple with a morbidity of 60% and a mortality of 20% (1/5. The other 4 patients were recovered and discharged with a median postoperative length of stay of 17 days (range 14–23. Conclusion. Emergency pancreatoduodenectomy is a definitive life-saving procedure allowing for a rapid control of bleeding when other less invasive approaches (transcatheter arterial embolization or interventional endoscopy are exhausted, unavailable, or unsafe. It should be particularly considered in neoplastic disease and tailored by surgeons with a high level of experience in pancreatic surgery.

  13. New oral anticoagulant-induced bleeding: clinical presentation and management

    NARCIS (Netherlands)

    Levy, Jerrold H.; Levi, Marcel

    2014-01-01

    Bleeding is a significant complication of anticoagulant therapy. With the emergence of new oral anticoagulants (NOACs; ie, direct factor IIa or Xa inhibitors), this risk is further compounded by the lack of validated reversal strategies for these agents. Emerging postmarketing evidence suggests that

  14. Selective serotonin reuptake inhibitors and risk for gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Batić-Mujanović Olivera

    2014-01-01

    Full Text Available The most of the known effects of selective serotonin reuptake inhibitors, beneficial or harmful, are associated with the inhibitory action of the serotonin reuptake transporter. This mechanism is present not only in neurons, but also in other cells such as platelets. Serotoninergic mechanism seems to have an important role in hemostasis, which has long been underestimated. Abnormal activation may lead to a prothrombotic state in patients treated with selective serotonin reuptake inhibitors. On one hand there may be an increased risk of bleeding, and on the other hand reduction in thrombotic risk may be possible. Serotonin is critical to maintain a platelet haemostatic function, such as platelet aggregation. Evidences from the studies support the hypothesis that antidepressants with a relevant blockade of action of serotonin reuptake mechanism may increase the risk of bleeding, which can occur anywhere in the body. Epidemiological evidences are, however, the most robust for upper gastrointestinal bleeding. It is estimated that this bleeding can occur in 1 in 100 to 1 in 1.000 patient-years of exposure to the high-affinity selective serotonin reuptake inhibitors, with very old patients at the highest risk. The increased risk may be of particular relevance when selective serotonin reuptake inhibitors are taken simultaneously with nonsteroidal anti-inflammatory drugs, low dose of aspirin or warfarin.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-05-15

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

  16. Predictors of post operative bleeding and blood transfusion in ...

    African Journals Online (AJOL)

    blood requirements. Objective: To evaluate the impact of some perioperative predictors of post-operative bleeding, and blood transfusion after heart surgery and offer suggestions on preventive measures. Design and Methods: A prospective analytical study. The perioperative factors studied were haemoglobin level, ...

  17. Profiling lifetime episodes of upper gastrointestinal bleeding among ...

    African Journals Online (AJOL)

    Profiling lifetime episodes of upper gastrointestinal bleeding among patients from rural Sub-Saharan Africa where schistosoma mansoni is endemic. ... female sex, history of blood transfusion, abdominal collaterals, esophageal varices, pattern x periportal fibrosis, anemia, and thrombocytopenia) significantly associated ...

  18. Small bowel enteroscopy and intraoperative enteroscopy for obscure gastrointestinal bleeding.

    Science.gov (United States)

    Lewis, B S; Wenger, J S; Waye, J D

    1991-02-01

    Intraoperative endoscopy (IOE) is accepted as the ultimate diagnostic procedure for completely evaluating the small bowel in patients with obscure gastrointestinal (GI) bleeding. Small bowel enteroscopy (SBE) has been reported useful in the nonsurgical evaluation of the small intestine in these patients, but findings may be limited because of incomplete small bowel intubation and a lack of tip deflection. Twenty-three patients underwent 25 SBE exams and subsequently had 25 IOE exams during surgical exploration for continued bleeding. Patients' bleeding histories averaged 2 yr, with an average transfusion requirement of 27 units. Findings on IOE were the same as with SBE in 17/22 (77%) of examinations. We conclude that SBE and IOE are comparable in depth of insertion and ability to detect small vascular ectasias. Both procedures missed pathology due to limited visibility and the evanescent nature of ectasias. Long-term success in abolishing bleeding with these combined techniques can be expected in 55% of these patients. SBE should precede surgery, since the finding of diffuse ectasias precludes any benefit from operative intervention.

  19. Improving Quality of Care in Peptic Ulcer Bleeding

    DEFF Research Database (Denmark)

    Rosenstock, Steffen J; Møller, Morten H; Larsson, Heidi Jeanet

    2013-01-01

    OBJECTIVES:The treatment of peptic ulcer bleeding (PUB) is complex, and mortality remains high. We present results from a nationwide initiative to monitor and improve the quality of care (QOC) in PUB.METHODS:All Danish hospitals treating PUB patients between 2004 and 2011 prospectively registered...

  20. Anaesthesia care for emergency endoscopy for peptic ulcer bleeding

    DEFF Research Database (Denmark)

    Duch, Patricia; Haahr, Camilla; Møller, Morten Hylander

    2016-01-01

    OBJECTIVE: Currently, no standard approach exists to the level of monitoring or presence of staff with anaesthetic expertise required during emergency esophago-gastro-duodenoscopy (EGD) for peptic ulcer bleeding (PUB). We assess the association between anaesthesia care and mortality. We further...