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Sample records for risk varices features

  1. Prospective comparison of three risk scoring systems in non-variceal and variceal upper gastrointestinal bleeding.

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

    2016-04-01

    Data regarding the efficacy of the Glasgow Blatchford score (GBS), full Rockall score (FRS) and pre-endoscopic Rockall scores (PRS) in comparing non-variceal and variceal upper gastrointestinal bleeding (UGIB) are limited. Our aim was to determine the performance of these three risk scores in predicting the need for treatment, mortality, and re-bleeding among patients with non-variceal and variceal UGIB. During January, 2010 and September, 2011, patients with UGIB from 11 hospitals were prospectively enrolled. The GBS, FRS, and PRS were calculated. Discriminative ability for each score was assessed using the receiver operated characteristics curve (ROC) analysis. A total of 981 patients presented with acute UGIB, 225 patients (22.9%) had variceal UGIB. The areas under the ROC (AUC) of the GBS, FRS, and PRS for predicting the need for treatment were 0.77, 0.69, and 0.61 in non-variceal versus 0.66, 0.66, and 0.59 in variceal UGIB. The AUC for predicting mortality and re-bleeding during admission were 0.66, 0.80, and 0.76 in non-variceal versus 0.63, 0.57, and 0.63 in variceal UGIB. AUC score was not statistically significant for predicting need for therapy and clinical outcome in variceal UGIB. The GBS ≤ 2 and FRS ≤ 1 identified low-risk non-variceal UGIB patients for death and re-bleeding during hospitalization. In contrast to non-variceal UGIB, the GBS, FRS, and PRS were not precise scores for assessing the need for therapy, mortality, and re-bleeding during admission in variceal UGIB. © 2015 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  2. Portal hypertension in children: High-risk varices, primary prophylaxis and consequences of bleeding.

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    Duché, Mathieu; Ducot, Béatrice; Ackermann, Oanez; Guérin, Florent; Jacquemin, Emmanuel; Bernard, Olivier

    2017-02-01

    Primary prophylaxis of bleeding is debated for children with portal hypertension because of the limited number of studies on its safety and efficacy, the lack of a known endoscopic pattern carrying a high-risk of bleeding for all causes, and the assumption that the mortality of a first bleed is low. We report our experience with these issues. From 1989 to 2014, we managed 1300 children with portal hypertension. Endoscopic features were recorded; high-risk varices were defined as: grade 3 esophageal varices, grade 2 varices with red wale markings, or gastric varices. Two hundred forty-six children bled spontaneously and 182 underwent primary prophylaxis. The results of primary prophylaxis were reviewed as well as bleed-free survival, overall survival and life-threatening complications of bleeding. High-risk varices were found in 96% of children who bled spontaneously and in 11% of children who did not bleed without primary prophylaxis (pportal hypertension. Life-threatening complications of bleeding were recorded in 19% of children with cirrhosis and high-risk varices who bled spontaneously. Ten-year probabilities of bleed-free survival after primary prophylaxis in children with high-risk varices were 96% and 72% for non-cirrhotic causes and cirrhosis respectively. Ten-year probabilities of overall survival after primary prophylaxis were 100% and 93% in children with non-cirrhotic causes and cirrhosis respectively. In children with portal hypertension, bleeding is linked to the high-risk endoscopic pattern reported here. Primary prophylaxis of bleeding based on this pattern is fairly effective and safe. In children with liver disease, the risk of bleeding from varices in the esophagus is linked to their large size, the presence of congestion on their surface and their expansion into the stomach but not to the child's age nor to the cause of portal hypertension. Prevention of the first bleed in children with high-risk varices can be achieved by surgery or endoscopic

  3. Vocal fold varices and risk of hemorrhage.

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    Tang, Christopher Guan-Zhong; Askin, Gülce; Christos, Paul J; Sulica, Lucian

    2016-05-01

    To establish risk of hemorrhage in patients with varices compared to those without, determine additional risk factors, and make evidence-based treatment recommendations. Retrospective cohort study. Patients who were vocal performers presenting for care during a 24-month period were analyzed to determine incidence of hemorrhage. Patients with varices were compared to those without. Demographic information and examination findings (presence, location, character, and size of varices; presence of mucosal lesions or paresis) were analyzed to determine predictors of hemorrhage. A total of 513 patients (60.4% female, mean age 36.6 years ± 13.95 years) were evaluated; 14 patients presenting with hemorrhage were excluded. One hundred and twelve (22.4%) patients had varices; 387 (77.6%) did not. The rate of hemorrhage in patients with varices was 2.68% at 12 months compared to 0.8% in patients without. Cox proportional hazard regression analysis revealed a hazard ratio of 10.1 for patients with varix developing hemorrhage compared to nonvarix patients (P hemorrhage was 3.3 cases per 1,000 person-months for varix patients compared to 0.5 cases per 1,000 person-months in the nonvarix group. There was no significant difference in the incidence of paresis, mucosal lesions, location of varix (left or right side; medial or lateral), or varix morphology (pinpoint, linear, lake) between patients who hemorrhaged and those that did not. The presence of varices increases the risk of hemorrhage. Varix patients had 10 times the rate of hemorrhage compared to nonvarix patients, although the overall incidence is low. This data may be used to inform treatment of patients with varices. 4. Laryngoscope, 126:1163-1168, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

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

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    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....

  5. Clinicopathological Features and Treatment of Ectopic Varices with Portal Hypertension

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    Takahiro Sato

    2011-01-01

    Full Text Available Bleeding from ectopic varices, which is rare in patients with portal hypertension, is generally massive and life-threatening. Forty-three patients were hospitalized in our ward for gastrointestinal bleeding from ectopic varices. The frequency of ectopic varices was 43/1218 (3.5% among portal hypertensive patients in our ward. The locations of the ectopic varices were rectal in thirty-two, duodenal in three, intestinal in two, vesical in three, stomal in one, and colonic in two patients. Endoscopic or interventional radiologic treatment was performed successfully for ectopic varices. Hemorrhage from ectopic varices should be kept in mind in patients with portal hypertension presenting with lower gastrointestinal bleeding.

  6. Variceal recurrence, rebleeding and survival after injection ...

    African Journals Online (AJOL)

    This study tested the validity of the hypothesis that eradication of oesophageal varices by repeated injection sclerotherapy would reduce recurrent variceal bleeding and death from bleeding oesophageal varices in a high risk cohort of patients with portal hypertension and cirrhosis. Patients and Methods: 306 alcoholic ...

  7. Bleeding esophageal varices

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    ... 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 ...

  8. Asymptomatic Esophageal Varices Should Be Endoscopically Treated

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    Nib Soehendra

    1998-01-01

    Full Text Available Endoscopic treatment has generally been accepted in the management of bleeding esophageal varices. Both the control of acute variceal bleeding and elective variceal eradication to prevent recurrent bleeding can be achieved via endoscopic methods. In contrast to acute and elective treatment, the role of endoscopic therapy in asymptomatic patients who have never had variceal bleeding remains controversial because of the rather disappointing results obtained from prophylactic sclerotherapy. Most published randomized controlled trials showed that prophylactic sclerotherapy had no effect on survival. In some studies, neither survival rate nor bleeding risk was improved. In this article, the author champions the view that asymptomatic esophageal varices should be endoscopically treated.

  9. Efficacy of endoscopic histoacryl injection in treatment of gastric variceal bleeding caused by regional portal hypertension

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    TANG Shanhong

    2015-08-01

    Full Text Available Objective To analyze the efficacy of endoscopic histoacryl injection in the treatment of gastric variceal bleeding caused by regional portal hypertension. Methods The endoscopic features and efficacy of endoscopic histoacryl injection were examined and compared in two groups of patients admitted to our hospital from June 2012 to December 2012. One of the groups included 6 patients with gastric variceal bleeding caused by regional portal hypertension and the other group included 6 patients with gastric variceal bleeding caused by hepatitis B cirrhosis-related portal hypertension. Between-group comparison of categorical data was made by Fisher′s test. Results In patients with regional portal hypertension, five of them had severe isolated gastric varices (IGV and one had severe IGV with mild esophageal varices. All six patients with hepatitis B cirrhosis-related portal hypertension had severe IGV and the endoscopic features were similar to those of patients with regional portal hypertension. Significant differences were observed between the group with regional portal hypertension and the group with hepatitis B cirrhosis related portal hypertension in short-term response rate (1/6 vs 6/6, P=0.015 and long-term response rate (0/6 vs 5/6, P=0.015. Conclusion The gastric varices caused by regional portal hypertension has a fast progression rate and a high bleeding risk. The efficacy of endoscopic histoacryl injection in patients with this type of gastric varices is poor.

  10. Esophageal variceal ligation for hemostasis of acute variceal bleeding

    African Journals Online (AJOL)

    Introduction: Endoscopic variceal ligation is widely accepted as the optimum endoscopic treatment for esophageal variceal hemorrhage. In Morocco, there are no data regarding the efficacy of this technique. Our aim was to evaluate the effectiveness and safety of endoscopic variceal ligation in the management of ...

  11. Hemothorax following Uncomplicated Endoscopic Variceal Sclerotherapy and Ligation for Esophageal Varices

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    Tomoko Ochiai

    2017-09-01

    Full Text Available Endoscopic variceal sclerotherapy and ligation are standard treatment modalities used for the management of esophageal varices. Reportedly, sclerotherapy and ligation are associated with complications such as hematuria, pulmonary thrombus formation, pleural effusion, renal dysfunction, and esophageal stenosis. However, hemothorax following sclerotherapy and ligation has not yet been reported. We treated a patient who presented with liver cirrhosis and polycythemia vera and later developed hemothorax following the above-mentioned procedures. An 86-year-old man diagnosed with liver cirrhosis due to chronic hepatitis type B and alcohol abuse underwent variceal sclerotherapy using ethanolamine oleate to treat his esophageal varices. Oozing from the esophageal varices continued even after the sclerotherapy procedure; therefore, we performed endoscopic variceal ligation. The patient developed left-sided hemothorax within 24 h after treatment of his varices, and an emergency thoracotomy was performed. A pulmonary ligament of the left lung was bulging and ripping because of mediastinal hematoma, and oozing was noted. Cessation of bleeding was noted after the laceration of the left pulmonary ligament had been sutured. Ours is the first case of hemothorax reported in a patient following an uncomplicated procedure of sclerotherapy and ligation.

  12. A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices.

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    Ryan, Barbara M; Stockbrugger, Reinhold W; Ryan, J Mark

    2004-04-01

    Gastric varices (GV) occur in 20% of patients with portal hypertension either in isolation or in combination with esophageal varices (EV). There is no consensus for optimum treatment of GV and because they comprise an inhomogeneous entity, accurate classification is vital to determine the appropriate management. Gastroesophageal varices (GOV) are classified as GOV1 (EV extending down to cardia or lesser curve) or GOV2 (esophageal and fundal varices). Isolated gastric varices (IGV) may be located in the fundus (IGV1) or elsewhere in the stomach (IGV2). GV possibly bleed less frequently than EV, but GV bleeding is typically difficult to control, associated with a high risk for rebleeding, and high mortality. Fundal varices, large GV (>5 mm), presence of a red spot, and Child's C liver status are associated with a high risk for bleeding. GOV1 have a much lower risk for bleeding. A portosystemic pressure gradient of > or =12 mm Hg is not necessary for GV bleeding, probably related to the high frequency of spontaneous gastrorenal shunts in these patients. GOV1 should be treated as for EV. First-line treatment of bleeding fundal varices is endoscopic variceal obturation. TIPS is currently second-line acute treatment and is used for prevention of rebleeding. The role of some newer interventional radiologic techniques requires further appraisal. This review describes the pathophysiology, diagnosis, natural history, endoscopic, and interventional radiologic treatment options for GV.

  13. Psuedotumoral gastric varices

    International Nuclear Information System (INIS)

    Yoon, Yong Kyu; Kim, Choon Won

    1974-01-01

    The roentgenographic recognition of gastric varices often is difficult, even when there is a history of liver disease or splenomegaly without demonstrable esophageal varices. An apparant polypoid filling defect with exaggerated mucosal folds in proximal portion of the gastric body and funds on upper GI series, accompanied by hematemesis and splenomegly should suggest the presence of pseudotumoral gastric varices. We have an experience a case of polypoid filling defects in gastric fundus of psudotumoral gastric varices of 49 years old Korean woman, which was diagnosed by surgical and histopathological findings

  14. A simplified clinical risk score predicts the need for early endoscopy in non-variceal upper gastrointestinal bleeding.

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    Tammaro, Leonardo; Buda, Andrea; Di Paolo, Maria Carla; Zullo, Angelo; Hassan, Cesare; Riccio, Elisabetta; Vassallo, Roberto; Caserta, Luigi; Anderloni, Andrea; Natali, Alessandro

    2014-09-01

    Pre-endoscopic triage of patients who require an early upper endoscopy can improve management of patients with non-variceal upper gastrointestinal bleeding. To validate a new simplified clinical score (T-score) to assess the need of an early upper endoscopy in non variceal bleeding patients. Secondary outcomes were re-bleeding rate, 30-day bleeding-related mortality. In this prospective, multicentre study patients with bleeding who underwent upper endoscopy were enrolled. The accuracy for high risk endoscopic stigmata of the T-score was compared with that of the Glasgow Blatchford risk score. Overall, 602 patients underwent early upper endoscopy, and 472 presented with non-variceal bleeding. High risk endoscopic stigmata were detected in 145 (30.7%) cases. T-score sensitivity and specificity for high risk endoscopic stigmata and bleeding-related mortality was 96% and 30%, and 80% and 71%, respectively. No statistically difference in predicting high risk endoscopic stigmata between T-score and Glasgow Blatchford risk score was observed (ROC curve: 0.72 vs. 0.69, p=0.11). The two scores were also similar in predicting re-bleeding (ROC curve: 0.64 vs. 0.63, p=0.4) and 30-day bleeding-related mortality (ROC curve: 0.78 vs. 0.76, p=0.3). The T-score appeared to predict high risk endoscopic stigmata, re-bleeding and mortality with similar accuracy to Glasgow Blatchford risk score. Such a score may be helpful for the prediction of high-risk patients who need a very early therapeutic endoscopy. Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  15. Identifying Emergency Department Patients at Low Risk for a Variceal Source of Upper Gastrointestinal Hemorrhage.

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    Klein, Lauren R; Money, Joel; Maharaj, Kaveesh; Robinson, Aaron; Lai, Tarissa; Driver, Brian E

    2017-11-01

    Assessing the likelihood of a variceal versus nonvariceal source of upper gastrointestinal bleeding (UGIB) guides therapy, but can be difficult to determine on clinical grounds. The objective of this study was to determine if there are easily ascertainable clinical and laboratory findings that can identify a patient as low risk for a variceal source of hemorrhage. This was a retrospective cohort study of adult ED patients with UGIB between January 2008 and December 2014 who had upper endoscopy performed during hospitalization. Clinical and laboratory data were abstracted from the medical record. The source of the UGIB was defined as variceal or nonvariceal based on endoscopic reports. Binary recursive partitioning was utilized to create a clinical decision rule. The rule was internally validated and test characteristics were calculated with 1,000 bootstrap replications. A total of 719 patients were identified; mean age was 55 years and 61% were male. There were 71 (10%) patients with a variceal UGIB identified on endoscopy. Binary recursive partitioning yielded a two-step decision rule (platelet count > 200 × 10 9 /L and an international normalized ratio [INR] study must be externally validated before widespread use, patients presenting to the ED with an acute UGIB with platelet count of >200 × 10 9 /L and an INR of upper gastrointestinal hemorrhage. © 2017 by the Society for Academic Emergency Medicine.

  16. Efficacy of carvedilol versus propranolol versus variceal band ligation for primary prevention of variceal bleeding.

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    Abd ElRahim, Ayman Yosry; Fouad, Rabab; Khairy, Marwa; Elsharkawy, Aisha; Fathalah, Waleed; Khatamish, Haytham; Khorshid, Omayma; Moussa, Mona; Seyam, Moataz

    2018-01-01

    Band ligation and propranolol are the current therapies for primary prevention of variceal bleeding. Carvedilol is a rising nonselective beta-blocker used for reducing portal pressure with favorable outcome. The aim of this study to assess the efficacy of carvedilol, propranolol, and band ligation for primary prevention of variceal bleeding based on the effect of each regimen on progression of Child score and portal hypertensive gastropathy after 1 year. The study included 264 cirrhotic patients with medium/large-sized varices who were candidates for primary prophylaxis of variceal bleeding. Patients were randomly divided into three groups: group I: band ligation; group II: propranolol; group III: carvedilol. Group I showed higher success rate of 75 %, followed by group III with 70.2 % and group II with 65.2 %. Risk of bleeding was comparable between the three groups, with group II carrying the highest rate of complications (34.7 %) followed by group III (14.2 %) and finally group I (5.7 %). After 1 year of follow-up, Child score did not improve in any of the studied groups, while portal hypertensive gastropathy significantly increased in group I but decreased in groups II and III. Band ligation is the best treatment option for primary prevention of variceal bleeding with minimal complications. Carvedilol is a good pharmaceutical alternative medicine to propranolol with lesser side-effects. Progress of liver disease as represented by Child score is not affected by any of the primary variceal prophylactic regimens, although medical treatment reduces portal hypertensive gastropathy. Choice of treatment depends on patient will, compliance with treatment, and endoscopist competence.

  17. Prevention and management of gastroesophageal varices.

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    Seo, Yeon Seok

    2018-03-01

    Bleeding from gastroesophageal varices is a serious complication in patients with liver cirrhosis and portal hypertension. Although there has been significance improvement in the prognosis of variceal bleeding with advancement in diagnostic and therapeutic modalities for its management, mortality rate still remains high. Therefore, appropriate prevention and rapid, effective management of bleeding from gastroesophageal varices is very important. Recently, various studies about management of gastoesophageal varices, including prevention of development and aggravation of varices, prevention of first variceal bleeding, management of acute variceal bleeding, and prevention of variceal rebleeding, have been published. The present article reviews published articles and practice guidelines to present the most optimal management of patients with gastroesophageal varices.

  18. 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)

  19. Prevention of Esophageal Variceal Rebleeding

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    Gin-Ho Lo

    2006-12-01

    Full Text Available The rate of rebleeding of esophageal varices remains high after cessation of acute esophageal variceal hemorrhage. Many measures have been developed to prevent the occurrence of rebleeding. When considering their effectiveness in reduction of rebleeding, the associated complications cannot be neglected. Due to unavoidable high incidence of complications, shunt surgery and endoscopic injection sclerotherapy are now rarely used. Transjugular intrahepatic portosystemic stent shunt was developed to replace shunt operation but is now reserved for rescue therapy. Nonselective beta-blockers alone or in combination with isosorbide mononitrate and endoscopic variceal ligation are currently the first choices in the prevention of variceal rebleeding. The combination of nonselective beta-blockers and endoscopic variceal ligation appear to enhance the efficacy. With the advent of newly developed measures, esophageal variceal rebleeding could be greatly reduced and the survival of cirrhotics with bleeding esophageal varices could thereby be prolonged.

  20. Prediction of esophageal varices and variceal hemorrhage in patients with acute upper gastrointestinal bleeding.

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    Rockey, Don C; Elliott, Alan; Lyles, Thomas

    2016-03-01

    In patients with upper gastrointestinal bleeding (UGIB), identifying those with esophageal variceal hemorrhage prior to endoscopy would be clinically useful. This retrospective study of a large cohort of patients with UGIB used logistic regression analyses to evaluate the platelet count, aspartate aminotransferase (AST) to platelet ratio index (APRI), AST to alanine aminotransferase (ALT) ratio (AAR) and Lok index (all non-invasive blood markers) as predictors of variceal bleeding in (1) all patients with UGIB and (2) patients with cirrhosis and UGIB. 2233 patients admitted for UGIB were identified; 1034 patients had cirrhosis (46%) and of these, 555 patients (54%) had acute UGIB due to esophageal varices. In all patients with UGIB, the platelet count (cut-off 122,000/mm(3)), APRI (cut-off 5.1), AAR (cut-off 2.8) and Lok index (cut-off 0.9) had area under the curve (AUC)s of 0.80 0.82, 0.64, and 0.80, respectively, for predicting the presence of varices prior to endoscopy. To predict varices as the culprit of bleeding, the platelet count (cut-off 69,000), APRI (cut-off 2.6), AAR (cut-off 2.5) and Lok Index (0.90) had AUCs of 0.76, 0.77, 0.57 and 0.73, respectively. Finally, in patients with cirrhosis and UGIB, logistic regression was unable to identify optimal cut-off values useful for predicting varices as the culprit bleeding lesion for any of the non-invasive markers studied. For all patients with UGIB, non-invasive markers appear to differentiate patients with varices from those without varices and to identify those with a variceal culprit lesion. However, these markers could not distinguish between a variceal culprit and other lesions in patients with cirrhosis. Copyright © 2016 American Federation for Medical Research.

  1. Endoscopic ultrasound coil placement of gastric varices: Emerging modality for recurrent bleeding gastric varices

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    Yogesh Harwani

    2014-01-01

    Full Text Available Gastric varices are the probable source of bleeding in 10-36% of patients, with acute variceal bleeding and carry high mortality and rebleeding rates. Till date, cyanoacrylate glue injection is considered as the standard of care but has high complication rate. Endoscopic ultrasound (EUS guided coil placement is a new emerging technique of management of gastric varices. In this case report, we detail the EUS guided coil placement for management of gastric varices after failed glue injections.

  2. Profilaxis preprimaria de la hemorragia por varices Pre-primary prophylaxis of variceal bleeding

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    R. González-Alonso

    2007-12-01

    Full Text Available La formación de colaterales portosistémicas, en especial en la unión esofagogástrica, es una de las consecuencias más graves de la hipertensión portal. El aumento de la presión portal es la fuerza más importante que dirige la formación de varices esofagogástricas, siendo necesario para que esto ocurra que la presión portal (estimada por el gradiente de presión venosa hepática alcance un valor mínimo de 10 mmHg. Posteriormente, la hiperemia esplácnica también contribuye al desarrollo de las varices. Las colaterales portosistémicas se forman por repermeabilización de vasos preexistentes, remodelado vascular y angiogénesis. El objetivo de la profilaxis preprimaria es evitar o retrasar la formación de varices esofagogástricas. En modelos experimentales de hipertensión portal, la administración precoz de vasoconstrictores esplácnicos como los beta-bloqueantes, de inhibidores de la síntesis de óxido nítrico o de sustancias anti-angiogénicas, inhibe la formación de colaterales portosistémicas. Sin embargo, los ensayos clínicos con beta-bloqueantes realizados en pacientes con cirrosis sin varices con objeto de retrasar su formación no han alcanzado los resultados esperados.Portosystemic collateral formation, particularly at the gastroesophageal junction, is a most serious consequence of portal hypertension. Increased portal pressure is the most significant force underlying gastroesophageal variceal formation, to which end portal pressure (estimated from the hepatic venous pressure gradient must reach at least 10 mmHg. Subsequently, splanchnic hyperemia also contributes to variceal development. Portoystemic collaterals result from repermeabilization of pre-extant vessels, vascular remodeling, and angiogenesis. The goal of pre-primary prophylaxis is preventing or delaying the formation of gastroesophageal varices. In experimental models of portal hypertension, early administration of splanchnic vasoconstrictors such as beta

  3. Pharmacologic influence on esophageal varices

    International Nuclear Information System (INIS)

    Lunderquist, A.; Owman, T.

    1983-01-01

    Selective catherization of the left gastric vein was performed after percutaneous transhepatic portography (PTP) in patients with portal hypertension and esophageal varices. Following the hypothesis that drugs increasing the lower esophageal sphincter (LES) pressure may obstruct the variceal blood flow throught the lower esophagus, the effect of different drugs (i.e., intravenous injection of vasopressin, pentagastrin, domperidone and somatostatin and subcutaneous injection of metacholine) on the variceal blood flow was examined. Vasopressin did not change the variceal blood flow; pentagastrine, with its known effect of increasing the LES pressure produced a total interruption of the flow in four of eight patients; domperiodone, also known to increase the LES pressure obstructed the variceal blood flow in the only patient examined with this drug; somatostatin has no reported action on the LES but blocked the flow in one of two patients; and metacholine, reported to increase the LES pressure did not produce any change in the flow in the three patients examined. LES pressure was recorded before and during vasopressin infusion in seven patients with portal hypertension and esophageal varices. No reaction on the pressure was found. The patient number in the study is small and the results are nonuniform but still they suggest that drugs increasing the LES tonus might be useful to control variceal blood flow. (orig.)

  4. Gastric Varices Bleed at Lower Portosystemic Pressure Gradients than Esophageal Varices.

    Science.gov (United States)

    Morrison, Joseph D; Mendoza-Elias, Nasya; Lipnik, Andrew J; Lokken, R Peter; Bui, James T; Ray, Charles E; Gaba, Ron C

    2018-05-01

    To quantify and compare portosystemic pressure gradients (PSGs) between bleeding esophageal varices (EV) and gastric varices (GV). In a single-center, retrospective study, 149 patients with variceal bleeding (90 men, 59 women, mean age 52 y) with EV (n = 69; 46%) or GV (n = 80; 54%) were selected from 320 consecutive patients who underwent successful transjugular intrahepatic portosystemic shunt (TIPS) creation from 1998 to 2016. GV were subcategorized using the Sarin classification as gastroesophageal varices (GEV) (n = 57) or isolated gastric varices (IGV) (n = 23). PSG before TIPS was measured from the main portal vein to the right atrium. PSGs were compared across EV, GEV, and IGV groups using 1-way analysis of variance. Overall mean baseline PSG was 21 mm Hg ± 6. PSG was significantly higher in patients with EV versus GV (23 mm Hg vs 19 mm Hg; P IGV (16 mm Hg); this difference was statistically significant (P IGV 17 mm Hg; P IGV bled versus 9% (5/57) of GEV and 3% (2/69) of EVs (P = .169). Mean final PSG after TIPS was 8 mm Hg (IGV 6 mm Hg vs EV and GEV 8 mm Hg; P = .005). GV bleed at lower PSGs than EV. EV, GEV, and IGV bleeding is associated with successively lower PSGs. These findings highlight distinct physiology, anatomy, and behavior of GV compared with EV. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

  5. Thrombosis of orbital varices; Trombosis de varices orbitarias

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    Boschi Oyhenart, J.; Tenyi, A.; Boschi Pau, J. [Hospital Italiano, Montevideo (Uruguay)

    2002-07-01

    Orbital varices are venous malformations produced by an abnormal dilatation of one or more orbital veins, probably associated with congenital weakness of the vascular wall. They are rare lesions, usually occurring in young patients, that produce intermittent proptosis related to the increase in the systemic venous pressure. The presence of hemorrhage or thrombosis is associated with rapid development of proptosis, pain and decreased ocular motility. We report the cases of two adult patients with orbital varices complicated by thrombosis in whom the diagnosis was based on computed tomography. The ultrasound and magnetic resonance findings are also discussed. (Author) 16 refs.

  6. Controlling Oesophageal Variceal Bleeding by Reloading ...

    African Journals Online (AJOL)

    A special reloading kit (produced by McGown; USA) was used to reload previously used and sterilized Opti-vu caps from Saeed six shooter variceal band ligators (North Carolina, USA). Subjects with oesophageal varices underwent banding of the varices down the lower 5cm of the oesophagus using this technique.

  7. Role of endoscopic ultrasonography in treatment and prognostic evaluation of esophageal and gastric varices

    Directory of Open Access Journals (Sweden)

    LI Shuang

    2016-12-01

    Full Text Available Through a comprehensive evaluation of collateral circulation establishment in portal hypertension, endoscopic ultrasonography (EUS not only helps to predict and evaluate the risks of first bleeding from esophageal and gastric varices and recurrence and rebleeding after treatment, but also guides and participates in the treatment of varices. This article introduces the unique advantages of EUS in the treatment and prognostic evaluation of esophageal and gastric varices and provides an important reference for individualized treatment of patients with liver cirrhosis complicated by esophageal and gastric varices. EUS also helps to improve treatment safety and response rate. EUS for the systematic treatment of portal hypertension has become a hot research topic in recent years.

  8. 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

  9. Radionuclide transit in esophageal varices

    International Nuclear Information System (INIS)

    Yeh, S.H.; Wang, S.J.; Wu, L.C.; Liu, R.S.; Tsai, Y.T.; Chiang, T.T.

    1985-01-01

    This study assessed esophageal motility in patients with esophageal varices by radionuclide transit studies. Data were acquired in list mode after an oral dose of 0.5 mCi Tc-99m sulfur colloid in 10 ml of water in the supine position above a low-energy all-purpose collimator of a gamma camera. The condensed image (CI) superimposed with a centroid curve was also produced in each case. Twenty-five normal subjects (N) and 32 patients (pts) with esophageal varices by endoscopy (large varices in Grades IV and V in 8 and small varices in Grade III or less in 24) were studied. TMTT, RTT, RF, and RI were all significantly increased in pts as compared to N. Especially, the transit time for the middle third (6.7 +- 2.6 sec vs 3.5 +- 0.9 sec in N, rho < 0.005) had the optimal sensitivy and specificity of 88% each at the cutoff value of 4.2 sec as determined by ROC analysis. In summary, radionuclide transit disorders occur in the majority of pts with esopageal varices. The middle RTT and CI are both optimal in sensitivity and specificity for detecting the abnormalities

  10. The role of collateral veins detected by endosonography in predicting the recurrence of esophageal varices after endoscopic treatment: a systematic review.

    Science.gov (United States)

    Masalaite, Laura; Valantinas, Jonas; Stanaitis, Juozas

    2014-07-01

    Endoscopic therapy is the principal method of treatment for esophageal varices. The recurrence of varices is still common following endoscopic treatment. The aim was to identify predictive factors for variceal recurrence detected by endosonography. We performed a systematic review of studies published prior to June 2013. Studies analyzing gastroesophageal collateral veins as risk factors for variceal recurrence after endoscopic treatment were included. The primary outcome was to identify predictive factors for variceal recurrence investigated by endosonography. After a full-text review, 13 studies were included in our analysis. Analysis of risk factors was not possible for all studies included. Perforating veins and periesophageal collateral veins were related to a higher risk of variceal recurrence (OR = 3.93; 95 % CI 1.06-14.51; I (2) = 96 %; OR = 2.29; 95 % CI 1.58-3.33; I (2) = 55 %). Analysis of cardiac intramural veins and paragastric/cardiac collateral veins showed the same trend, but without reaching statistical significance because of the small group size and wide CI (OR = 3.72; 95 % CI 0.14-101.53; I (2) = 91 %; OR = 1.85; 95 % CI 0.84-4.07; I (2) = 0 %). Analysis of other collateral veins as risk factors for variceal recurrence and analysis of risk factors with regard to the endoscopic treatment method was not possible because of the limited number of cases and different methodologies. A positive association between variceal recurrence and type and grade of collateral veins, investigated by endosonography, was demonstrated. Endosonography is a promising tool for predicting recurrence of esophageal varices following endoscopic treatment. These findings should be interpreted with caution because of the heterogeneity of the studies.

  11. Color Doppler evaluation of left gastric vein hemodynamics in cirrhosis with portal hypertension and its correlation with esophageal varices and variceal bleed

    International Nuclear Information System (INIS)

    Adithan, Subathra; Venkatesan, Bhuvaneswari; Sundarajan, Elangovan; Kate, Vikram; Kalayarasan, Raja

    2010-01-01

    The purpose of this study was to assess the value of Doppler evaluation of left gastric vein hemodynamics when monitoring portal hypertension patients, by correlating Doppler ultrasonography (USG) parameters with the severity of esophageal varices and occurrence of variceal bleeding. This study was carried out on 100 patients using Doppler USG and endoscopy. Forty-seven of these were patients with cirrhosis with portal hypertension, who had not had a recent variceal bleed (group 1) and 26 were patients with cirrhosis with portal hypertension, with a recent history of bleeding (group 2). The control group comprised of 27 subjects who did not have liver disease or varices on endoscopy (group 3). The hemodynamic parameters, namely the diameter of the left gastric vein and the direction and flow velocity in the vessel, were compared in these groups, with the grade of esophageal varices. Hepatofugal flow velocity in the left gastric vein was higher in patients with large-sized varices compared to those patients with small-sized varices (P < 0.001). The left gastric vein hepatofugal flow velocity was higher in patients with a recent variceal bleed than in those patients without a history of a recent variceal bleed (P < 0.0149). Large-sized varices were more commonly found in patients with a history of a recent variceal bleed (P < 0.0124). Left gastric vein hemodynamics were found to correlate with the severity of the varices and the occurrence of recent variceal bleed in patients with cirrhosis with portal hypertension. Evaluation of the left gastric vein portal dynamics could be helpful in monitoring the progress of the disease in these patients

  12. An observational study on oesophageal variceal endoscopic ...

    African Journals Online (AJOL)

    An observational study on oesophageal variceal endoscopic injection sclerotherapy in patients with portal hypertension seen at the Centre for Clinical Research, ... The report concludes that variceal injection sclerotherapy is a useful method of treating oesophageal varices and can be performed on an out patient basis.

  13. Ectopic Varices in Colonic Stoma: MDCT Findings

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jae Woong; Lee, Chang Hee; Kim, Kyeong Ah; Park, Cheol Min; Kim, Jin Yong [Guro Hospital of Korea University, Seoul (Korea, Republic of)

    2006-12-15

    We describe the 2D reformatted and 3D volume rendered images by MDCT in a patient with an episode of acute bleeding from the colonic stoma. This case indicates that the 2D reformatted and 3D volume rendered images are useful to detect this rare complication of portal hypertension, and they help to tailor adequate treatment for the patients with bleeding from stomal varices. Ectopic varices are an uncommon cause of gastrointestinal hemorrhage, but they account for up to 5% of all variceal bleedings (1). Bleeding from stomal varices has been reported in up to 20% of the patients suffering with chronic liver failure with permanent stoma (2). However, the diagnosis of stomal varices is difficult because bleeding from stoma may also be associated with lower gastrointestinal bleeding. To the best of our knowledge, the 2D reformatted and 3D volume rendered images by MDCT for visualization of ectopic stomal varices have not been previously reported in the medical literature.

  14. Perivesical varices and portal hypertension: imaging study; Varices perivesiculares e hipertension postal. Estudio por imagen

    Energy Technology Data Exchange (ETDEWEB)

    Mallorquin Jimenez, F; Medina Benitez, A; Lopez Machado, E; Pardo Moreno, M D; Garrido Moreno, C; Pastor Rull, J [Servicio de Radiodiagnostico, Hospital General de Especialidades Virgen de la Nieve, Granada (Spain)

    1995-07-01

    Nine patients with portal hypertension syndrome and Perivesical varices are studied retrospectively by means of imaging techniques including ultrasound, duplex Doppler, color Doppler, CT and angiography. All the patients presented portal thrombosis and thickening of the bladder wall. These collaterals either represent a shunting of hepato pedal flow or correspond to blood stasis associated with said syndrome. Ultrasound, whether involving duplex Doppler or color Doppler techniques, is highly useful to detect the presence of Perivesical varices which appear as tubular or rounded hypo echogenic areas in the bladder wall. Given the association of this entity with bladder wall thickening, it should be taken into account in any clinical situation involving said change, especially in patients with portal hypertension; moreover knowledge of its presence is of great importance when the possibility of creating shunts by means of interventional or surgical vascular procedures or other types of abdominal procedures are being considered because of the risk of bleeding. (Author)

  15. Hand-assisted laparoscopic Hassab's procedure for esophagogastric varices with portal hypertension.

    Science.gov (United States)

    Kobayashi, Takashi; Miura, Kohei; Ishikawa, Hirosuke; Soma, Daiki; Zhang, Zhengkun; Ando, Takuya; Yuza, Kizuki; Hirose, Yuki; Katada, Tomohiro; Takizawa, Kazuyasu; Nagahashi, Masayuki; Sakata, Jun; Kameyama, Hitoshi; Wakai, Toshifumi

    2017-10-23

    Laparoscopic surgery for patients with portal hypertension is considered to be contraindicated because of the high risk of massive intraoperative hemorrhaging. However, recent reports have shown hand-assisted laparoscopic surgery for devascularization and splenectomy to be a safe and effective method of treating esophagogastric varices with portal hypertension. The aim of this study is to evaluate the efficacy of hand-assisted laparoscopic devascularization and splenectomy (HALS Hassab's procedure) for the treatment of esophagogastric varices with portal hypertension. From 2009 to 2016, seven patients with esophagogastric varices with portal hypertension were treated with hand-assisted laparoscopic devascularization and splenectomy in our institute. Four men and three women with a median age of 61 years (range 35-71) were enrolled in this series. We retrospectively reviewed the medical records for the perioperative variables, postoperative mortality and morbidity, and postoperative outcomes of esophagogastric varices. The median operative time was 455 (range 310-671) min. The median intraoperative blood loss was 695 (range 15-2395) ml. The median weight of removed spleen was 507 (range 242-1835) g. The conversion rate to open surgery was 0%. The median postoperative hospital stay was 21 (range 13-81) days. During a median 21 (range 3-43) months of follow-up, the mortality rate was 0%. Four postoperative complications (massive ascites, enteritis, intra-abdominal abscess, and intestinal ulcer) were observed in two patients. Those complications were treated successfully without re-operation. Esophagogastric varices in all patients disappeared or improved. Bleeding from esophagogastric varices was not observed during the follow-up period. Although our data are preliminary, hand-assisted laparoscopic devascularization and splenectomy proved an effective procedure for treating esophagogastric varices in patients with portal hypertension.

  16. Prevalence of Oesophageal Varices in Newly Diagnosed Chronic ...

    African Journals Online (AJOL)

    Background: Variceal bleeding is an important complication of portal ... This study was carried out to document the occurrence of oesophageal varices and its ... They had upper gastrointestinal endoscopy to detect and characterize varices.

  17. Esophageal varices in cirrhotics on dynamic computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Miyazaki, Masaru; Takahashi, Osamu; Shimura, Tadanori

    1985-07-01

    Dynamic CT was performed on fifteen cirrhotics. The cirrhotics with esophageal varices were compared with those without esophageal varices in regard to the enhanced capacity of the liver and the spleen and the declining ratio of the spleen following the enhancement. Both the liver and the spleen in cirrhotics were enhanced less than non-cirrhotics, especially in those with esophageal varices (p<0.01). Splenic declining ratio following splenic enhancement clearly distinguish cirrhotics with esophageal varices from those without esophageal varices (p<0.01). These parameters on dynamic CT could be useful for the diagnosis of portal hypertension in cirrhotics.

  18. Esophageal variceal ligation in the secondary prevention of variceal ...

    African Journals Online (AJOL)

    Pan African Medical Journal ... Introduction: Long-term outcome of patients after band ligation have been poorly defined. ... endoscopic band ligation, liver cirrhosis, complication of band ligation, esophageal varices, secondary prevention ...

  19. Predictive value of CT for first esophageal variceal bleeding in patients with cirrhosis: Value of para-umbilical vein patency

    Energy Technology Data Exchange (ETDEWEB)

    Calame, Paul [Department of Radiology, University Hospitals of Besançon (France); Ronot, Maxime, E-mail: maxime.ronot@aphp.fr [Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine (France); University Paris Diderot, Sorbonne Paris Cité, Paris (France); INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris (France); Bouveresse, Sébastien [Department of Radiology, University Hospitals of Besançon (France); Cervoni, Jean-Paul [Department of Hepatology, University Hospitals of Besançon (France); Vilgrain, Valérie [Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine (France); University Paris Diderot, Sorbonne Paris Cité, Paris (France); INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris (France); Delabrousse, Éric [Department of Radiology, University Hospitals of Besançon (France)

    2017-02-15

    Highlights: • Large PUV are more frequent in patients without variceal bleeding and in those low-risk esophageal varices. • The PUV diameter is smaller in patients who experience variceal bleeding. • The imaging score could help to identify cirrhotic patients at high-risk for EVH. • Cirrhotic patients with high imaging score should be referred for treatment. - Abstract: Purpose: To evaluate if the presence/size of a para-umbilical vein (PUV) on computed tomography (CT) are associated with a first esophageal variceal hemorrhage (EVH) in patients with cirrhosis and whether imaging features can help identify patients at increased risk of EVH. Materials and methods: From January 2010 to June 2012 patients with cirrhosis who underwent CT and upper gastrointestinal endoscopy within six months were included. The presence/size of PUV was noted. PUV >5 mm were considered large (LPUV). Association with a first EVH was searched for, and validated in a prospective cohort of 55 patients. Results: 172 patients (113 men, mean 60 ± 12 yo) were included. Forty-three patients (25%) experienced a first EVH. LPUV were more frequent in the group without EVH (27% vs. 7%, p = 0.005). At multivariate analysis, factors associated with a first EVH were spleen size > 135 mm (Odd Ratio [OR] = 1.32 [95% confident interval [CI] 1.16–1.51], p < 0.001), ascites (OR = 4.07 [95%CI-1.84–9.01], p = 0.001) and small/absent PUV (OR = 3.06 [95%CI-1.86–5.05], p < 0.001). An imaging score combining these factors was significantly associated with first EVH in the study and the validation cohorts (EVH in 0%, 19%, and 33% when score 0–1, 2–3, and 4–5, respectively). Conclusions: A simple imaging score combining the PUV and spleen size, and the presence of ascites could help to identify cirrhotic patients at high-risk for EVH.

  20. Predictive value of CT for first esophageal variceal bleeding in patients with cirrhosis: Value of para-umbilical vein patency

    International Nuclear Information System (INIS)

    Calame, Paul; Ronot, Maxime; Bouveresse, Sébastien; Cervoni, Jean-Paul; Vilgrain, Valérie; Delabrousse, Éric

    2017-01-01

    Highlights: • Large PUV are more frequent in patients without variceal bleeding and in those low-risk esophageal varices. • The PUV diameter is smaller in patients who experience variceal bleeding. • The imaging score could help to identify cirrhotic patients at high-risk for EVH. • Cirrhotic patients with high imaging score should be referred for treatment. - Abstract: Purpose: To evaluate if the presence/size of a para-umbilical vein (PUV) on computed tomography (CT) are associated with a first esophageal variceal hemorrhage (EVH) in patients with cirrhosis and whether imaging features can help identify patients at increased risk of EVH. Materials and methods: From January 2010 to June 2012 patients with cirrhosis who underwent CT and upper gastrointestinal endoscopy within six months were included. The presence/size of PUV was noted. PUV >5 mm were considered large (LPUV). Association with a first EVH was searched for, and validated in a prospective cohort of 55 patients. Results: 172 patients (113 men, mean 60 ± 12 yo) were included. Forty-three patients (25%) experienced a first EVH. LPUV were more frequent in the group without EVH (27% vs. 7%, p = 0.005). At multivariate analysis, factors associated with a first EVH were spleen size > 135 mm (Odd Ratio [OR] = 1.32 [95% confident interval [CI] 1.16–1.51], p < 0.001), ascites (OR = 4.07 [95%CI-1.84–9.01], p = 0.001) and small/absent PUV (OR = 3.06 [95%CI-1.86–5.05], p < 0.001). An imaging score combining these factors was significantly associated with first EVH in the study and the validation cohorts (EVH in 0%, 19%, and 33% when score 0–1, 2–3, and 4–5, respectively). Conclusions: A simple imaging score combining the PUV and spleen size, and the presence of ascites could help to identify cirrhotic patients at high-risk for EVH.

  1. 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.

  2. A Randomized Controlled Study of Fuzheng Huayu Capsule for Prevention of Esophageal Variceal Bleeding in Patients with Liver Cirrhosis

    Directory of Open Access Journals (Sweden)

    Jie Gu

    2013-01-01

    Full Text Available To elucidate the role of Fuzheng Huayu Capsule, a herbal formula, in the prevention of esophageal variceal bleeding in cirrhotic patients, a multicenter randomized and placebo-controlled trial was carried out. One hundred forty-six cirrhotic patients with esophageal varices were enrolled to compare the probability of upper gastrointestinal bleeding and survival between Fuzheng Huayu Capsule group and controlled group for the duration of 2 years. The results demonstrated that the FZHYC could effectively reduce the risk of variceal bleeding and improve survival rates for cirrhotic patients with varices, especially the combination of the capsule and Propranolol, which presented a better effect; FZHYC could reduce the varices size in patients with small ones. Its effect may be related to the amelioration of hepatic fibrosis.

  3. Frequency of rectal varices in patients with cirrhosis

    International Nuclear Information System (INIS)

    Zuberi, F.F; Khan, M.A.; Zuberi, B.F.; Khan, M.H.

    2004-01-01

    Objective: To document the frequency of rectal varices in patients with cirrhosis of liver and compare it with that of oesophageal varices in liver and to compare the frequency of rectal varices with non-cirrhotic controls. Patients and Methods: All patients of confirmed cirrhosis of liver, presenting during the study period, were selected for initial workup. On the basis of upper gastrointestinal (GI) endoscopy, patients were segregated into those with oesophageal varices group-A) and those without them (Group-B). A matched control group (Group-C) was added, which consisted of patients of irritable bowel syndrome (IBS) who underwent sigmoidoscopic/colonoscopic examination during the study period. Fiberoptic sigmoidoscopy was done in all selected patients. Statistical analysis for continuous variables was done by student's 't' test while non-continuous variables were analyzed by Mann-Whitney-U test. Results: A total of 104 patients (males 61; females 43) were included. Hepatic encephalopathy grade was significantly lower in group-B (p < 0.0001). Grade-I varices were seen in 13 patients, Grade-II in 38 and Grade-III in 33 patients of Group-A. Rectal varices were present in 59.9% of patients in Group-A as compared to Group-B in which no one had them (p < 0.0001). Conclusion: Rectal varices are common in patients of portal hypertension. (author)

  4. Outcome of the Pediatric Patients with Portal Cavernoma: The Retrospective Study for 10 Years Focusing on Recurrent Variceal Bleeding

    Directory of Open Access Journals (Sweden)

    Hongjie Guo

    2016-01-01

    Full Text Available Background. Portal cavernoma (PC is the most critical condition with risk or variceal hemorrhage in pediatric patients. We retrospectively investigated the patients with PC focusing on the predictors for recurrent variceal bleeding. Methods. Between July 2003 and June 2013, we retrospectively enrolled all consecutive patients admitted to our department with a diagnosis of PC without abdominal malignancy or liver cirrhosis. The primary endpoint of this observational study was recurrent variceal bleeding. Independent predictors of recurrent variceal bleeding were identified using the logistic regression model. Results. A total of 157 patients were enrolled in the study. During the follow-up period, 24 patients exhibited onset of recurrent variceal bleeding. Acute variceal bleeding was subjected to conservative symptomatic treatment and emergency endoscopic sclerotherapy. Surgical procedure selection was based on the severity of vascular dilation and collateral circulation. Multivariate logistic regression analysis demonstrated that the presence of ascites, collateral circulation, and portal venous pressure were independent prognostic factors of recurrent variceal bleeding for patients with portal cavernoma. Conclusions. The presence of ascites, collateral circulation, and portal venous pressure evaluation are important and could predict the postsurgical recurrent variceal bleeding in patients with portal cavernoma.

  5. Non-variceal upper gastrointestinal bleeding in cirrhotic patients in Nile Delta.

    Science.gov (United States)

    Gabr, Mamdouh Ahmed; Tawfik, Mohamed Abd El-Raouf; El-Sawy, Abd Allah Ahmed

    2016-01-01

    Acute upper gastrointestinal bleeding (AUGIB) in cirrhotic patients occurs mainly from esophageal and gastric varices; however, quite a large number of cirrhotic patients bleed from other sources as well. The aim of the present work is to determine the prevalence of non-variceal UGIB as well as its different causes among the cirrhotic portal hypertensive patients in Nile Delta. Emergency upper gastrointestinal (UGI) endoscopy for AUGIB was done in 650 patients. Out of these patients, 550 (84.6%) patients who were proved to have cirrhosis were the subject of the present study. From all cirrhotic portal hypertensive patients, 415 (75.5%) bled from variceal sources (esophageal and gastric) while 135 (24.5%) of them bled from non-variceal sources. Among variceal sources of bleeding, esophageal varices were much more common than gastric varices. Peptic ulcer was the most common non-variceal source of bleeding. Non-variceal bleeding in cirrhosis was not frequent, and sources included peptic ulcer, portal hypertensive gastropathy, and erosive disease of the stomach and duodenum.

  6. Transcatheter Embolotherapy with N-Butyl Cyanoacrylate for Ectopic Varices

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin Woo; Kim, Hyo-Cheol, E-mail: angiointervention@gmail.com; Jae, Hwan Jun, E-mail: jaemdphd@gmail.com; Jung, Hyun-Seok; Hur, Saebeom; Lee, Myungsu; Chung, Jin Wook [Seoul National University Hospital, Department of Radiology, Seoul National University College of Medicine (Korea, Republic of)

    2015-04-15

    PurposeTo address technical feasibility and clinical outcome of transcatheter embolotherapy with N-butyl cyanoacrylate (NBCA) for bleeding ectopic varices.MethodsThe institutional review board approved this retrospective study and waived informed consent. From January 2004 to June 2013, a total of 12 consecutive patients received transcatheter embolotherapy using NBCA for bleeding ectopic varices in our institute. Clinical and radiologic features of the endovascular procedures were comprehensively reviewed.ResultsPreprocedural computed tomography images revealed ectopic varices in the jejunum (n = 7), stoma (n = 2), rectum (n = 2), and duodenum (n = 1). The 12 procedures consisted of solitary embolotherapy (n = 8) and embolotherapy with portal decompression (main portal vein stenting in 3, transjugular intrahepatic portosystemic shunt in 1). With regard to vascular access, percutaneous transhepatic access (n = 7), transsplenic access (n = 4), and transjugular intrahepatic portosystemic shunt tract (n = 1) were used. There was no failure in either the embolotherapy or the vascular accesses (technical success rate, 100 %). Two patients died within 1 month from the procedure from preexisting fatal medical conditions. Only one patient, with a large varix that had been partially embolized by using coils and NBCA, underwent rebleeding 5.5 months after the procedure. The patient was retreated with NBCA and did not undergo any bleeding afterward for a follow-up period of 2.5 months. The remaining nine patients did not experience rebleeding during the follow-up periods (range 1.5–33.2 months).ConclusionTranscatheter embolotherapy using NBCA can be a useful option for bleeding ectopic varices.

  7. Oesophageal variceal band ligation using a Saeed Six-Shooter ...

    African Journals Online (AJOL)

    Background: Oesophageal varices are common sequelae of cirrhosis, which when they bleed can be difficult to control. Oesophageal variceal band ligation, being the best modality for controlling variceal bleeding has not been common practice in West Africa, a region recognized to have a high prevalence of liver diseases.

  8. Perivesical varices and portal hypertension: imaging study

    International Nuclear Information System (INIS)

    Mallorquin Jimenez, F.; Medina Benitez, A.; Lopez Machado, E.; Pardo Moreno, M.D.; Garrido Moreno, C.; Pastor Rull, J.

    1995-01-01

    Nine patients with portal hypertension syndrome and Perivesical varices are studied retrospectively by means of imaging techniques including ultrasound, duplex Doppler, color Doppler, CT and angiography. All the patients presented portal thrombosis and thickening of the bladder wall. These collaterals either represent a shunting of hepato pedal flow or correspond to blood stasis associated with said syndrome. Ultrasound, whether involving duplex Doppler or color Doppler techniques, is highly useful to detect the presence of Perivesical varices which appear as tubular or rounded hypo echogenic areas in the bladder wall. Given the association of this entity with bladder wall thickening, it should be taken into account in any clinical situation involving said change, especially in patients with portal hypertension; moreover knowledge of its presence is of great importance when the possibility of creating shunts by means of interventional or surgical vascular procedures or other types of abdominal procedures are being considered because of the risk of bleeding. (Author)

  9. Color doppler findings of gastric varices compared with findings on computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Sato, Takahiro; Yamazaki, Katsu; Toyota, Jouji; Karino, Yoshiyasu; Ohmura, Takumi; Suga, Toshihiro [Sapporo Kosei General Hospital (Japan)

    2002-08-01

    The aim of this study was to evaluate the hemodynamics of gastric varices. We evaluated the detection rates of gastric varices, inflowing vessels to gastric varices, and outflowing vessels from gastric varices in 24 patients with gastric varices, using color Doppler sonography, and compared these findings with computed tomography findings. Eighteen patients had F2-type varices and 6 had F3-type, classified according to the Japanese Research Society for Portal Hypertension. Fourteen patients had fundal varices, and 10 had cardiac and fundal varices. The detection rates of collateral veins using color Doppler sonography were as follows: gastric varices were detected in all 24 patients (100%); inflowing vessels, in 21 of the 24 patients (87.5%); and outflowing vessels, in 18 of the 24 patients (75.0%). The detection rates of collateral veins, using computed tomography, were: gastric varices were detected in all 24 patients (100%); inflowing vessels, in all 24 patients (100%); and outflowing vessles, in 21 of the 24 patients (87.5%). The color Doppler findings agreed perfectly with the computed tomography findings in 13 of the 24 patients (54.2%). Although color Doppler sonography is a useful, noninvasive modality for evaluating the hemodynamics of gastric varices, it falls short in visualizing the detailed hemodynamics of the inflowing and outflowing vessels of gastric varices in half of the patients when compared with computed tomography. (author)

  10. Thrombosis of orbital varices

    International Nuclear Information System (INIS)

    Boschi Oyhenart, J.; Tenyi, A.; Boschi Pau, J.

    2002-01-01

    Orbital varices are venous malformations produced by an abnormal dilatation of one or more orbital veins, probably associated with congenital weakness of the vascular wall. They are rare lesions, usually occurring in young patients, that produce intermittent proptosis related to the increase in the systemic venous pressure. The presence of hemorrhage or thrombosis is associated with rapid development of proptosis, pain and decreased ocular motility. We report the cases of two adult patients with orbital varices complicated by thrombosis in whom the diagnosis was based on computed tomography. The ultrasound and magnetic resonance findings are also discussed. (Author) 16 refs

  11. Costs and clinical outcomes of primary prophylaxis of variceal bleeding in patients with hepatic cirrhosis: a decision analytic model.

    Science.gov (United States)

    Saab, Sammy; DeRosa, Vincent; Nieto, Jose; Durazo, Francisco; Han, Steven; Roth, Bennett

    2003-04-01

    Current guidelines recommend upper endoscopic screening for patients with hepatic cirrhosis and primary prophylaxis with a nonselective beta-blocker for those with large varices. However, only 25% of cirrhotics develop large varices. Thus, the aim of this study is to evaluate the most cost-effective approach for primary prophylaxis of variceal hemorrhage. Using a Markov model, we compared the costs and clinical outcomes of three strategies for primary prophylaxis of variceal bleeding. In the first strategy, patients were given a beta-blocker without undergoing upper endoscopy. In the second strategy, patients underwent upper endoscopic screening; those found to have large varices were treated with a beta-blocker. In the third strategy, no prophylaxis was used. Selected sensitivity analyses were performed to validate outcomes. Our results show screening prophylaxis was associated with a cost of $37,300 and 5.72 quality-adjusted life yr (QALYs). Universal prophylaxis was associated with a cost of $34,100 and 6.65 QALYs. The no prophylaxis strategy was associated with a cost of $36,600 and 4.84 QALYs. The incremental cost-effectiveness ratio was $800/QALY for the endoscopic strategy relative to the no prophylaxis strategy. Screening endoscopy was cost saving when the compliance, bleed risk without beta-blocker, and variceal bleed costs were increased, and when the discount rate, bleed risk on beta-blockers, and cost of upper endoscopy were decreased. In contrast, the universal prophylaxis strategy was persistently cost saving relative to the no prophylaxis strategy. In comparing the strategies, sensitivity analysis on the death rates from variceal hemorrhage did not alter outcomes. Our results provide economic and clinical support for primary prophylaxis of esophageal variceal bleeding in patients with hepatic cirrhosis. Universal prophylaxis with beta-blocker is preferred because it is consistently associated with the lowest costs and highest QALYs.

  12. Comparison of computed tomography and endoscopy in the diagnosis and grading of esophageal varices; value of computed tomography for predict prognosis of chronic liver disease

    International Nuclear Information System (INIS)

    Ko, Gi Young; Park, Cheol Min; Lee, Jin Seong; Hyun, Chang Dong; Lee, Moon Gyu; Auh, Yong Ho; Kim, Hae Ryun

    1996-01-01

    To evaluate the sensitivity and specificity of conventional CT of abdomen in the detection of esophageal varices, and to correlate CT grade of esophageal varices with prognosis and risk for bleeding. Both CT and endoscopy were performed in 100 patients. Endoscopy revealed that while 54 patients had varices, 46 did not. CT criteria of variceal grading were follows;(1) wallthickening of more than 5 mm or irregular wall contour(grade 1):(2) intraluminal protruding tubular structures with contrast enhancement(grade II);(3) confluent varices in the wall of esophagus or multiplied paraesophageal collaterals(gradeIII). CT were reviewed by three radiologists without reference to clinical and endoscopic data. Sensitivity and specificity of CT in the detection of esophageal varices were 80%, retrospectively. CT and endoscopic grades agreed with each other in 68% of patients, and there was high correlation between CT and endoscopy. (Gamma statistics, p=0.828). No history or endoscopic evidence of variceal bleeding was present on grade I, but there was a high incidence on grade II(35%) and on grade III(50%)(MH Chi-Square, Ridit scores=50.561, p=0.000). Abdominal CT is useful in the detection of esophageal varices, and can predict the risk factors of bleeding in patients with chronic liver diseases

  13. Portographic Evaluation for Recurrent Esophagogastric Varices Following Devascularization Surgery

    International Nuclear Information System (INIS)

    Hsieh, J.-S.; Huang, C.-J.; Wang, J.-Y.; Huang, T.-J.

    1996-01-01

    Purpose: To investigate, by transhepatic portography, the changes in portosystemic collaterals and recurrent esophagogastric varices after devascularization surgery. Methods: Thirty-five patients, who had undergone devascularization surgery 2 - 8 years previously, underwent follow-up portography and the collaterals and drainage routes were compared with preoperative portography results. Results: Newly formed collaterals were present in 30 of 35 patients and the origins and drainage routes differed from preoperative ones. Most common were new collaterals arising from the junction of the portal and superior mesenteric veins; the next most frequent arose from a main portal branch, the portal trunk, or the superior mesenteric vein. New collaterals with recurrent varices were seen in 20 patients and without varices in 10; 5 patients had no collaterals or varices.Conclusion: Since the development of new collaterals is common in portal hypertensive patients following devascularization surgery, regular follow-up for recurrent varices is necessary

  14. Ectopic Varices in the Gastrointestinal Tract: Short- and Long-Term Outcomes of Percutaneous Therapy

    International Nuclear Information System (INIS)

    Macedo, Thanila A.; Andrews, James C.; Kamath, Patrick S.

    2005-01-01

    To evaluate the results of percutaneous management of ectopic varices, a retrospective review was carried out of 14 patients (9 men, 5 women; mean age 58 years) who between 1992 and 2001 underwent interventional radiological techniques for management of bleeding ectopic varices. A history of prior abdominal surgery was present in 12 of 14 patients. The interval between the surgery and percutaneous intervention ranged from 2 to 38 years. Transhepatic portal venography confirmed ectopic varices to be the source of portal hypertension-related gastrointestinal bleeding. Embolization of the ectopic varices was performed by a transhepatic approach with coil embolization of the veins draining into the ectopic varices. Transjugular intrahepatic portosystemic shunt (TIPS) was performed in the standard fashion. Eighteen procedures (12 primary coil embolizations, 1 primary TIPS, 2 re-embolizations, 3 secondary TIPS) were performed in 13 patients. One patient was not a candidate for percutaneous treatment. All interventions but one (re-embolization) were technically successful. In 2 of 18 interventions, re-bleeding occurred within 72 hr (both embolization patients). Recurrent bleeding (23 days to 27 months after initial intervention) was identified in 9 procedures (8 coil embolizations, 1 TIPS due to biliary fistula). One patient had TIPS revision because of ultrasound surveillance findings. New encephalopathy developed in 2 of 4 TIPS patients. Percutaneous coil embolization is a simple and safe treatment for bleeding ectopic varices; however, recurrent bleeding is frequent and reintervention often required. TIPS can offer good control of bleeding at the expense of a more complex procedure and associated risk of encephalopathy

  15. [Varices of the vocal cord: report of 21 cases].

    Science.gov (United States)

    Li, Jin-rang; Sun, Jian-jun

    2006-04-01

    To study the diagnosis and treatment of varices of the vocal cord. The clinical data of 21 cases with varix of vocal cord were analyzed. All the patients presented hoarseness. There were 15 female and 6 male cases with their ages ranged from 23 to 68 years (median 44 years old). The varix was found on the right vocal cord in 12 cases, on the left vocal cord in 9 cases. Isolated varix existed on the vocal cord in 10 cases, varix with vocal cord polyps or nodules in 10 cases, varix with vocal cord paralysis in 1 case. All the patients were diagnosed under the laryngovideoscopy. The lesions appeared on the superior surface of the vocal cord. Varices manifested as abnormally dilated capillary running in the anterior to posterior direction in 6 cases, as clusters of capillary in 3 cases, as a dot or small sheet or short line of capillary in 12 cases. The varices were disappeared in 2 of 8 cases with vocal cord varices and polyps after removed the polyps. The varices of others patients had no change after following up for more than 6 months, but one patient happened hemorrhage of the contralateral vocal cord. Varices are most commonly seen in female. Laryngovideoscopy is the key in determining the vocal fold varices. Management of patients with a varix includes medical therapy, speech therapy, and occasionally surgical vaporization.

  16. Comparison of Endoscopic Variceal Ligation and Nadolol Plus Isosorbide-5-mononitrate in the Prevention of First Variceal Bleeding in Cirrhotic Patients

    Directory of Open Access Journals (Sweden)

    Huay-Min Wang

    2006-10-01

    Conclusion: Our preliminary results suggest that endoscopic variceal ligation is similar to the combination of nadolol plus ISMN with regard to effectiveness and safety in the prevention of first variceal bleeding in patients with cirrhosis.

  17. Balloon-occluded retrograde transvenous obliteration versus endoscopic injection sclerotherapy for isolated gastric varices: a comparative study.

    Science.gov (United States)

    Emori, Keigo; Toyonaga, Atsushi; Oho, Kazuhiko; Kumamoto, Masafumi; Haruta, Tsuyoshi; Inoue, Hiroto; Morita, Yukihiko; Mitsuyama, Keiichi; Tsuruta, Osamu; Sata, Michio

    2014-01-01

    Isolated gastric varices (IGV) have a lower risk of bleeding than esophageal varices, however IGV bleeding is associated with a higher mortality than bleeding of esophageal varices. In recent years, two widely used treatments for IGV have been balloon-occluded retrograde transvenous obliteration (B-RTO) and endoscopic injection sclerotherapy (EIS) using cyanoacrylate or ethanolamine oleate (EO). This study compared these two treatment methods for IGV. The subjects were 112 patients who were treated at our hospital for IGV bleeding between October 1990 and December 2003. Forty-nine (49) patients were treated with B-RTO and 63 patients with EIS. These two patient groups were compared as regards content of treatment, post-treatment incidence of variceal bleeding, incidence of IGV rebleeding, survival rate, cause of death, and complications. Multivariate analysis was performed on post-treatment variceal bleeding and survival. Although EO was used in higher amounts in the B-RTO group than in the EIS group, the B-RTO group had a significantly lower number of treatment sessions and a significantly shorter treatment period (pIGV rebleeding after treatment than the B-RTO group. Treatment method was the only independent prognostic factor of IGV bleeding after treatment (p=0.024). The two groups did not differ significantly in the percentage of patients with aggravated esophageal varices after treatment. Bleeding from ectopic varices was not observed in any patient. There was no significant difference in survival by treatment method. The presence of hepatocellular carcinoma was the only independent prognostic factor for survival (p=0.003). It is concluded that B-RTO was more effective than EIS in the eradication of IGV and prevention of IGV recurrence and rebleeding.

  18. Outcomes of pregnancies complicated by liver cirrhosis, portal hypertension, or esophageal varices.

    Science.gov (United States)

    Puljic, Anela; Salati, Jennifer; Doss, Amy; Caughey, Aaron B

    2016-01-01

    To evaluate pregnancy outcomes in women with liver cirrhosis, portal hypertension, or esophageal varices. We analyzed a retrospective cohort of 2,284,218 pregnancies in 2005-2009 recorded in the California Birth Registry database. Utilizing ICD-9 codes we analyzed the following outcomes for liver cirrhosis, portal hypertension, or esophageal varices in pregnancy: preeclampsia (PET), preterm delivery (PTD; Portal hypertension in pregnancy was associated with PTD, LBW, NND, and PPH. Non-bleeding esophageal varices in pregnancy were not associated with the outcomes assessed in a statistically significant manner. One case of bleeding esophageal varices was observed, resulting in PTD with a LBW infant. There were three cases of concomitant portal hypertension or concomitant esophageal varices with cirrhosis in pregnancy. Pregnancy in women with concomitant liver cirrhosis, portal hypertension, or esophageal varices can be successful. However, pregnancy outcomes are worse and may warrant closer antenatal monitoring and patient counseling. Cirrhosis in pregnancy with concomitant portal hypertension or esophageal varices is rare.

  19. Endoscopic Sclerotherapy for Bleeding Oesophageal Varices: Experience in Gezira State, Sudan

    Directory of Open Access Journals (Sweden)

    Moawia Elbalal Mohammed

    2011-01-01

    Full Text Available Introduction Bleeding due to oesophageal varices is the most common cause of upper gastrointestinal tract haemorrhage in Gezira State, Central Sudan. Endoscopic injection sclerotherapy (EST is a valuable therapeutic modality for the management of variceal bleeding. Other options for treatment such as variceal band ligation are either expensive or unavailable. Objectives A retrospective study to evaluate the outcome of (EST in the management of bleeding oesophageal varices due to portal hypertension in Gezira State, the centre of a developing country, Sudan. Methods A total of 1073 patients, during 2001-2010, were carefully selected particularly those with bleeding oesophageal varices consequent to portal hypertension. EST was performed using a standard technique and ethanolamine oleate (5% was utilized as sclerosing agent. Results There were 777 males (72.4% and 296 females (27.6% in a ratio of 2.6. The causes of portal hypertension were found to be schistosomal periportal fibrosis (PPF in 1001 (93.3% patients, liver cirrhosis in 60 (5.5% mixed PPF and cirrhosis in seven (0.7% and portal vein thrombosis in five (0.5% patients. Full obliteration of varices required a mean of four sessions with a range of 2-6. In the present study 350 (32.6% patients have been followed up until complete sclerosis of varices. Conclusion This study provides evidence that endoscopic injection sclerotherapy is an important component in the management of bleeding oesophageal varices caused by hypertension. It is a safe and effective procedure.

  20. The clinical value of 3D dynamic contrast enhanced MR angiography on haemorrhage of esophageal and gastric varices compared with endoscopy

    International Nuclear Information System (INIS)

    Wu Zhou; Liang Biling; Li Yong; Zhong Jinglian; Ye Ruixin; Wang Dongye; Li Chuqiang; Yuan Yuhong

    2010-01-01

    gastric varices in non-bleeding group (n=7). The ratio of adventitial gastric varices in bleeding group was not significantly different from that of non-bleeding group (P=0.340). Conclusions: 3D DCE MRA can display and differentiate the esophagogastric varices both inside and outside of the wall by three dimensional reconstruction. The esophagogastric varices both inside and outside of the wall by three dimensional reconstruction. The results of 3D DCE MRA and endoscopy have good correlation. It is of importance in evaluating the esophageal varices outside of the wall, because they may indicate decreased risk of haemorrhage in patients with severe degree of esophageal varices. (authors)

  1. Endoscopic Color Doppler Ultrasonographic Evaluation of GastricVarices Secondary to Left-Sided Portal Hypertension

    Science.gov (United States)

    Sato, Takahiro; Yamazaki, Katsu; Kimura, Mutsuumi; Toyota, Jouji; Karino, Yoshiyasu

    2014-01-01

    Gastric varices that arise secondary to the splenic vein occlusion can result in gastrointestinal hemorrhaging. Endoscopic color Doppler ultrasonography (ECDUS) was performed in 16 patients with gastric varices secondary to splenic vein occlusion. This study retrospectively evaluated the role of ECDUS in the diagnosis of gastric varices secondary to splenic vein occlusion. Thirteen patients had co-existing pancreatic diseases: 8 with chronic pancreatitis, 4 with cancer of the pancreatic body or tail and 1 with severe acute pancreatitis. Of the remaining 3 patients, 1 had myeloproliferative disease, 1 had advanced gastric cancer, and the third had splenic vein occlusion due to an obscure cause. The endoscopic findings of gastric varices were: variceal form (F) classified as enlarged tortuous (F2) in 12 cases and large, coil-shaped (F3) in 4 cases, and positive for erosion or red color sign of the variceal surface in 4 cases and negative in 12 cases. ECDUS color flow images of gastric variceal flow clearly depicted a round fundal region at the center, with varices expanding to the curvatura ventriculi major of the gastric body in all 16 cases. The velocities of F3 type gastric varices were significantly higher than those of the F2 type. The wall thickness of varices positive for erosion or red color sign was significantly less than the negative cases. I conclude that ECDUS color flow images of gastric variceal flow depicted specific findings of gastric varices secondary to splenic vein occlusion at the round fundal region at the center, with varices expanding to the curvatura ventriculi major of the gastric body. PMID:26852679

  2. Ileal Varices Treated with Balloon-Occluded Retrograde Transvenous Obliteration.

    Science.gov (United States)

    Sato, Takahiro; Yamazaki, Katsu; Toyota, Jouji; Karino, Yoshiyasu; Ohmura, Takumi; Akaike, Jun

    2009-04-01

    A 55-year-old man with hepatitis B virus antigen-positive liver cirrhosis was admitted to our hospital with anal bleeding. Colonoscopy revealed blood retention in the entire colon, but no bleeding lesion was found. Computed tomography images showed that vessels in the ileum were connected to the right testicular vein, and we suspected ileal varices to be the most probable cause of bleeding. We immediately performed double balloon enteroscopy, but failed to find any site of bleeding owing to the difficulty of fiberscope insertion with sever adhesion. Using a balloon catheter during retrograde transvenous venography, we found ileal varices communicating with the right testicular vein (efferent vein) with the superior mesenteric vein branch as the afferent vein of these varices. We performed balloon occluded retrograde transvenous obliteration by way of the efferent vein of the varices and have detected no further bleeding in this patient one year after treatment.

  3. Base of tongue varices associated with portal hypertension

    OpenAIRE

    Jassar, P; Jaramillo, M; Nunez, D

    2000-01-01

    A symptomatic case of tongue base varices in a patient with portal hypertension secondary to liver cirrhosis is presented. There are no previously documented cases in the world literature. Oesophageal varices may not be the only source of expectorated blood in a patient with portal hypertension.


Keywords: portal hypertension; lingual; tongue; varicose vein

  4. 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...

  5. Endovascular obliteration of bleeding duodenal varices in patients with liver cirrhosis

    Energy Technology Data Exchange (ETDEWEB)

    Zamora, Carlos Armando; Sugimoto, Koji; Tsurusaki, Masakatsu; Izaki, Kenta; Fukuda, Tetsuya; Matsumoto, Shinichi; Kawasaki, Ryota; Taniguchi, Takanori; Sugimura, Kazuro [Kobe University School of Medicine, Department of Radiology, Kobe-shi, Hyogo-ken (Japan); Kuwata, Yoichiro [Nishi-Kobe Medical Center, Department of Radiology, Kobe-shi, Hyogo-ken (Japan); Hirota, Shozo [Hyogo Medical College, Department of Radiology, Nishinomiya-shi, Hyogo-ken (Japan)

    2006-01-01

    The purpose of this paper is to describe our experience with endovascular obliteration of duodenal varices in patients with liver cirrhosis and portal hypertension. Balloon-occluded transvenous retrograde and percutaneous transhepatic anterograde embolizations were performed for duodenal varices in five patients with liver cirrhosis, portal hypertension, and decreased liver function. All patients had undergone previous endoscopic treatments that failed to stop bleeding and were poor surgical candidates. Temporary balloon occlusion catheters were used to achieve accumulation of an ethanolamine oleate-iopamidol mixture inside the varices. Elimination of the varices was successful in all patients. Retrograde transvenous obliteration via efferent veins to the inferior vena cava was enough to achieve adequate sclerosant accumulation in three patients. A combined anterograde-retrograde embolization was used in one patient with balloon occlusion of afferent and efferent veins. Transhepatic embolization through the afferent vein was performed in one patient under balloon occlusion of both efferent and afferent veins. There was complete variceal thrombosis and no bleeding was observed at follow-up. No major complications were recorded. Endovascular obliteration of duodenal varices is a feasible and safe alternative procedure for managing patients with portal hypertension and hemorrhage from this source. (orig.)

  6. The Significance of Variceal Haemorrhage in Ghana: A Retrospective Review.

    Science.gov (United States)

    Archampong, T N A; Tachi, K; Agyei, A A; Nkrumah, K N

    2015-09-01

    This study describes the burden of bleeding oesophageal varices at the main tertiary referral centre in Accra. Retrospective design to describe the endoscopic spectrum and review mortality data following acute upper gastro-intestinal bleeding at the Korle-Bu Teaching Hospital. Endoscopic data was reviewed in the Endoscopy Unit between 2007 and 2010. Mortality data was collated from the Department of Medicine between 2010 and 2013. The study questionnaire compiled clinical and demographic characteristics, endoscopic diagnoses, length of hospital admission and treatment regimens. Aetiology and time-trend analysis of mortality rates following acute upper gastro-intestinal bleeding; variceal bleeding treatment modalities. On review of the endoscopic diagnoses, gastro-oesophageal varices were identified in 21.9% of cases followed by gastritis 21.7%, duodenal ulcer, 17.0%, and gastric ulcer, 13.2%. Gastro-oesophageal varices were the predominant cause of death from acute upper gastro-intestinal haemorrhage from 46% in 2010 to 76% in 2013. Outcomes following acute upper gastro-intestinal bleeding were dismal with some 38% of fatalities occurring within the first 24 hours. Injection sclerotherapy was the dominant endoscopic modality for secondary prevention of variceal bleeding in comparison with band ligation, mainly as a result of cost and availability. At the tertiary centre in Accra, variceal bleeding is an increasingly common cause of acute upper gastro-intestinal haemorrhage in comparison with previous reviews in Ghana. Its significantly high in-hospital mortality reflects inadequate facilities to deal with this medical emergency. A strategic approach to care with endoscopic services equipped with all the necessary therapeutic interventions will be vital in improving the outcomes of variceal bleeding in Ghana.

  7. Outcome of band ligation in oesophageal varices

    International Nuclear Information System (INIS)

    Abbasi, A.; Bhutto, A.R.; Bhatti, K.I.; Mahmood, K.; Lal, K.

    2013-01-01

    Objective: To find out the outcome og band ligation of oesophageal varices in decompensated chronic liver disease patients. Methods: The quasi experimental study was conducted at the Jinnah Postgraduate Medical Centre, Karachi, and Civil Hospital, Karachi, unit from September 2007 to August 2011. Subjects were eligible if they had a diagnosis of cirrhosis based on history, physical examination, biochemical parameters and liver biopsy in some cases. Patients with advanced cirrhosis (Child-Pugh class C), antibodies against human immunodeficiency virus, hepatocellular carcinoma, portal vein thrombosis evident on ultrasonography, parenteral drug addiction, current alcohol abuse, previous or current treatment with β-blockers were excluded from the study. All patients were asked about alcohol intake and tested to determine the cause of liver cirrhosis. Tests for other causes of cirrhosis were carried out only if there was a suggestive clue. All patients under-went upper gastrointestinal endoscopy after consent. SPSS 15 was used for statistical analysis. Results: The age of the 173 patients who met the inclusion criteria ranged from 15 to 85 years, with a mean of 48.39+-13.38 years. There were 112 (64.7%) males. High-grade varices were seen in 130 (75.1%) patients, while low-grade varices were observed in 43 (24.9%) on first endoscopy. At initial endoscopy, 111 (64.2%) patients had portal hypertensive gastropathy. The patients were followed up for a mean period of 5.20+-2.67 months. Variceal obliteration was achieved in 138 (79.8%), while 33 (19.1%) cases developed re-bleeding. Mean number of endoscopy sessions for these patients were 2.28+-.918 with a maximum of 4. Conclusion: Band ligation eradicated oesophageal varices with less complications and a lower re-bleeding rate, but at the same time eradication was associated with more frequent development of portal hypertensive gastropathy. (author)

  8. 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)

  9. Ascending colonic variceal bleeding: utility of phase-contrast MR portography in diagnosis and follow-up after treatment with TIPS and variceal embolization

    International Nuclear Information System (INIS)

    Chevallier, P.; Motamedi, J.P.; Oddo, F.; Padovani, B.; Demuth, N.; Caroli-Bosc, F.X.

    2000-01-01

    The authors describe the discovery of ascending colonic variceal veins via celiomesenteric diagnostic angiography following a bout of melena in a 44-year-old woman. Magnetic resonance imaging, including phase-contrast MR venography, allowed visualization of the portal and systemic veins immediately after the initial angiograms. The hemorrhagic episode did not resolve until after transjugular intrahepatic shunt insertion and selective variceal embolization through the shunt. At 1 week-, 3 months-, and 6 months post treatment, follow-up MR venography no longer revealed the presence of colonic varices. Colonoscopy at 6 months was normal and the patient did not have any further episodes of bleeding until a liver transplantation was performed after 9 months. (orig.)

  10. Trans-anastomotic porto-portal varices in patients with gastrointestinal haemorrhage

    International Nuclear Information System (INIS)

    Mitchell, A.W.M.; Jackson, J.E.

    2000-01-01

    AIM: Porto-portal varices are commonly seen in patients with segmental extra-hepatic portal hypertension and develop to provide a collateral circulation around an area of portal venous obstruction. It is not well recognized that such communications may also develop across surgical anastomoses and be the source of gastrointestinal haemorrhage. The possible mode of development of such communications has not been previously discussed. MATERIALS AND METHODS: Over a 3-year period between 1995 and 1998, porto-portal varices were demonstrated across surgical anastomoses in four patients who were referred for the investigation of acute (two), acute-on-chronic (one) and chronic gastrointestinal bleeding (one). Their medical notes and the findings at angiography were reviewed. RESULTS: Three patients had segmental portal hypertension due to extra-hepatic portal vein (one) or superior mesenteric vein (two) stenosis/occlusion. One patient had mild portal hypertension due to hepatic fibrosis secondary to congenital biliary atresia. At angiography all patients were shown to have varices crossing previous surgical anastomoses. These varices were presumed to be the cause of bleeding in three of the four patients; the site of bleeding in the fourth individual was not determined. CONCLUSIONS: Trans-anastomotic porto-portal varices are rare. They develop in the presence of extra-hepatic portal hypertension and presumably arise within peri-anastomotic inflammatory tissue. Such varices may be difficult to manage and their prognosis is poor when bleeding occurs. Mitchell, A.W.M., Jackson, J.E. (2000)

  11. Banding ligation versus beta-blockers for primary prevention in oesophageal varices in adults

    DEFF Research Database (Denmark)

    Gluud, Lise Lotte; Krag, Aleksander

    2012-01-01

    Non-selective beta-blockers are used as a first-line treatment for primary prevention in patients with medium- to high-risk oesophageal varices. The effect of non-selective beta-blockers on mortality is debated and many patients experience adverse events. Trials on banding ligation versus non...

  12. Endoscopic variceal band ligation: a local experience | Jani | East ...

    African Journals Online (AJOL)

    Objective: To evaluate the results of endoscopic variceal band ligation (EVBL) in the local set-up. Design: Retrospective analysis of data of all patients who had EVBL. Setting: Patients having EVBL at the office endoscopy suite. The Nairobi Hospital, the Aga Khan Hospital and M.P Shah Hospital. Methods: The varices were ...

  13. Excess Long-Term Mortality following Non-Variceal Upper Gastrointestinal Bleeding: A Population-Based Cohort Study

    Science.gov (United States)

    Crooks, Colin John; Card, Timothy Richard; West, Joe

    2013-01-01

    Background It is unclear whether an upper gastrointestinal bleed is an isolated gastrointestinal event or an indicator of a deterioration in a patient's overall health status. Therefore, we investigated the excess causes of death in individuals after a non-variceal bleed compared with deaths in a matched sample of the general population. Methods and Findings Linked longitudinal data from the English Hospital Episodes Statistics (HES) data, General Practice Research Database (GPRD), and Office of National Statistics death register were used to define a cohort of non-variceal bleeds between 1997 and 2010. Controls were matched at the start of the study by age, sex, practice, and year. The excess risk of each cause of death in the 5 years subsequent to a bleed was then calculated whilst adjusting for competing risks using cumulative incidence functions. 16,355 patients with a non-variceal upper gastrointestinal bleed were matched to 81,523 controls. The total 5-year risk of death due to gastrointestinal causes (malignant or non-malignant) ranged from 3.6% (≤50 years, 95% CI 3.0%–4.3%) to 15.2% (≥80 years, 14.2%–16.3%), representing an excess over controls of between 3.6% (3.0%–4.2%) and 13.4% (12.4%–14.5%), respectively. In contrast the total 5-year risk of death due to non-gastrointestinal causes ranged from 4.1% (≤50 years, 3.4%–4.8%) to 46.6% (≥80 years, 45.2%–48.1%), representing an excess over controls of between 3.8% (3.1%–4.5%) and 19.0% (17.5%–20.6%), respectively. The main limitation of this study was potential misclassification of the exposure and outcome; however, we sought to minimise this by using information derived across multiple linked datasets. Conclusions Deaths from all causes were increased following an upper gastrointestinal bleed compared to matched controls, and over half the excess risk of death was due to seemingly unrelated co-morbidity. A non-variceal bleed may therefore warrant a careful assessment of co

  14. Gallblader varices in children with portal cavernoma: duplex-Doppler and color Doppler ultrasound studies

    International Nuclear Information System (INIS)

    Muro, D.; Sanguesa, C.; Lopez, A.

    1998-01-01

    To determine the prevalence of varices in the gallbladder wall, observed by duplex-Doppler and color Doppler ultrasound, in children with cavernoma of the portal vein. Nineteen patients with portal hypertension were studied prospectively by duplex-Doppler and color Doppler ultrasound: 12 of the patients had developed a cavernoma of the portal vein. The presence of peri vesicular varices was assessed in the group of patients with portal cavernoma. Duplex-Doppler and color Doppler ultrasound disclosed the presence of varices in gallbladder wall in nine of the 12 patients (75%). The varices appeared as anechoic and serpiginous areas, and Doppler ultrasound revealed slowed venous flow. However, the three patients in whom gallbldder varices were not detected presented collateral gastric ciculation and spontaneous splenorenal shunt. Gallbladder varices are common in children with portal vein cavernoma; they present hepatopetal flow. Their developments is not related to the size of the portal cavernoma, the presence of spontaneous portosystemic shunts, or endoscopic obliteration of gastric and esophageal varices. The detection of gallbladder varices in patients with portal hypertension who are to undergo biliary surgery is highly important for the surgeon, helping to avoid perioperative complications. (Author) 15 refs

  15. Association of left renal vein variations and pelvic varices in abdominal MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Koc, Zafer [Baskent University, Adana Teaching and Medical Research Center, Department of Radiology, Adana (Turkey); Baskent Universitesi Adana Hastanesi, Adana (Turkey); Ulusan, Serife; Oguzkurt, Levent [Baskent University, Adana Teaching and Medical Research Center, Department of Radiology, Adana (Turkey)

    2007-05-15

    The aim of this study was to determine whether left renal vein (LRV) variation is associated with pelvic varices and left ovarian vein (LOV) reflux. Routine abdominal multidetector-row computed tomography scans of 324 women without symptoms of pelvic congestion syndrome were analyzed. Presence and type of LRV variants (circumaortic [CLRV] or retroaortic [RLRV]) were recorded. Diameters of the LRV, ovarian veins (OVs), and parauterine veins were measured and a specific LRV diameter ratio was calculated for each patient. Presence and severity of pelvic varices and LOV reflux were noted. Pelvic varices were detected in 59 (18%) of the total of 324 women, in 7 (37%) of the 19 women with RLRVs, in 7 (29%) of the 24 women with CLRVs, and in 45 (16%) of the 281 women with normal LRVs. The frequency of pelvic varices in the women with LRV variation was significantly higher than that in the group with normal LRV anatomy (33 vs. 16%; p=0.009). The frequency of pelvic varices in the women with RLRVs was also significantly higher than that in the group with normal LRV anatomy (p=0.02). LRV diameter ratio was correlated with presence of pelvic varices and presence of LOV reflux (p=0.0001 for both). This study revealed an association between pelvic varices and LRV variations in a population of predominantly multiparous women. (orig.)

  16. Association of left renal vein variations and pelvic varices in abdominal MDCT

    International Nuclear Information System (INIS)

    Koc, Zafer; Ulusan, Serife; Oguzkurt, Levent

    2007-01-01

    The aim of this study was to determine whether left renal vein (LRV) variation is associated with pelvic varices and left ovarian vein (LOV) reflux. Routine abdominal multidetector-row computed tomography scans of 324 women without symptoms of pelvic congestion syndrome were analyzed. Presence and type of LRV variants (circumaortic [CLRV] or retroaortic [RLRV]) were recorded. Diameters of the LRV, ovarian veins (OVs), and parauterine veins were measured and a specific LRV diameter ratio was calculated for each patient. Presence and severity of pelvic varices and LOV reflux were noted. Pelvic varices were detected in 59 (18%) of the total of 324 women, in 7 (37%) of the 19 women with RLRVs, in 7 (29%) of the 24 women with CLRVs, and in 45 (16%) of the 281 women with normal LRVs. The frequency of pelvic varices in the women with LRV variation was significantly higher than that in the group with normal LRV anatomy (33 vs. 16%; p=0.009). The frequency of pelvic varices in the women with RLRVs was also significantly higher than that in the group with normal LRV anatomy (p=0.02). LRV diameter ratio was correlated with presence of pelvic varices and presence of LOV reflux (p=0.0001 for both). This study revealed an association between pelvic varices and LRV variations in a population of predominantly multiparous women. (orig.)

  17. Does domperidon influence the haemodynamics of oesophageal varices. Beeinflusst Domperidon die Haemodynamik von Oesophagusvarizen

    Energy Technology Data Exchange (ETDEWEB)

    Hoevels, J [Staedtische Krankenanstalten Bielefeld (Germany, F.R.). Klinik fuer Roentgendiagnostik und Nuklearmedizin

    1989-04-01

    In three patients with portal venous hypertension and oesophageal varices the effect of domperidon on the haemodynamics of the varices was studied. Following transhepatic catheterisation of the left gastric vein the perfusion of the oesophageal varices before and after the application of domperidon was evaluated angiographically. No decrease of the perfusion of the oesophageal varices secondary to domperidon was observed using this method. (orig.).

  18. Septic Complication After Balloon-Occluded Retrograde Transvenous Obliteration of Duodenal Variceal Bleeding

    International Nuclear Information System (INIS)

    Akasaka, Thai; Shibata, Toshiya; Isoda, Hiroyoshi; Taura, Kojiro; Arizono, Shigeki; Shimada, Kotaro; Togashi, Kaori

    2010-01-01

    We report a 64-year-old woman with duodenal varices who underwent balloon-occluded retrograde transvenous obliteration (B-RTO) complicated by intraprocedural variceal rupture. The patient developed shivering and a fever higher than 40 o C 3 days after the B-RTO procedure. A blood culture grew Entereobacter cloacoe. This case represents a rare septic complication of B-RTO for duodenal varices.

  19. Percutaneous Trans-hepatic Obliteration for Bleeding Esophagojejunal Varices After Total Gastrectomy and Esophagojejunostomy

    International Nuclear Information System (INIS)

    Boku, Michiko; Sugimoto, Koji; Nakamura, Tetsu; Kita, Yasufumi; Zamora, Carlos A.; Sugimura, Kazuro

    2006-01-01

    A 72-year-old man who had undergone a total gastrectomy with a Roux-en-Y esophagojejunostomy for gastric cancer 6 years earlier presented to our hospital with massive hematemesis and melena. Endoscopic examination indicated esophageal varices with cherry-red spots and hemorrhage arising from beyond the anastomosis. Abdominal contrast-enhanced computed tomography and angiography revealed a dilated vein in the elevated jejunal limb supplying the varices. Percutaneous trans-hepatic obliteration (PTO) of the varices through the jejunal vein was performed using microcoils, ethanolamine oleate, and gelatin sponge cubes. Ten days after the procedure, endoscopic examination revealed reduction and thrombosis of the varices. We consider PTO to be an effective alternative method for treating ruptured esophagojejunal varices after total gastrectomy

  20. Acute variceal haemorrhage in the United Kingdom: patient characteristics, management and outcomes in a nationwide audit.

    Science.gov (United States)

    Jairath, Vipul; Rehal, Sunita; Logan, Richard; Kahan, Brennan; Hearnshaw, Sarah; Stanworth, Simon; Travis, Simon; Murphy, Michael; Palmer, Kelvin; Burroughs, Andrew

    2014-05-01

    Despite advances in treatment, acute variceal haemorrhage remains life-threatening. To describe contemporary characteristics, management and outcomes of patients with cirrhosis and acute variceal haemorrhage and risk factors for rebleeding and mortality. Multi-centre clinical audit conducted in 212 UK hospitals. In 526 cases of acute variceal haemorrhage, 66% underwent endoscopy within 24h with 64% (n=339) receiving endoscopic therapy. Prior to endoscopy, 57% (n=299) received proton pump inhibitors, 44% (n=232) vasopressors and 27% (n=144) antibiotics. 73% (n=386) received red cell transfusion, 35% (n=184) fresh frozen plasma and 14% (n=76) platelets, with widely varying transfusion thresholds. 26% (n=135) experienced further bleeding and 15% (n=80) died by day 30. The Model for End Stage Liver Disease score was the best predictor of mortality (area under the receiver operating curve=0.74, Prisk stratification tools are required to identify patients needing more intensive support. Copyright © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  1. Application of Balloon-Occluded Retrograde Transvenous Obliteration to Gastric Varices Complicating Refractory Ascites

    International Nuclear Information System (INIS)

    Fukuda, Tetsuya; Hirota, Shozo; Matsumoto, Shinichi; Sugimoto, Koji; Fujii, Masahiko; Tsurusaki, Masakatsu; Izaki, Kenta; Sugimura, Kazuro

    2004-01-01

    We report two cases of gastric varices complicated by massive ascites that disappeared after balloon-occluded retrograde transvenous obliteration (B-RTO). The first patient had progressive gastric varices that continued to enlarge even after three episodes of esophagogastric variceal bleeding, and the second patient was admitted to our hospital because of the bleeding from gastric varices. After B-RTO procedures in both patients, significant improvement of the ascites, hepatic function reserve, and hypoalbuminemia was observed. Although further experience is needed, our experience points to the likelihood of the amelioration of ascites after B-RTO

  2. The difference of variceal distribution in the portal hypertension on CT between hemorrhagic and nonhemorrhagic groups

    International Nuclear Information System (INIS)

    Lee, Hwa Yeon; Yoo, Seung Min; Lim, Sang Joon; Lee, Jong Beum; Kim, Yang Soo; Choi, Young Hee; Choi, Yun Sun

    1997-01-01

    To determine whether there is any difference in variceal distribution between patients with and without a history of esophageal variceal bleeding. To compare the distribution of varices, abdominal CT scans of 24 patients with a history of esophageal variceal bleeding (hemorrhagic group) and 90 patients without a history of bleeding (non-hemorrhagic group) were retrospectively assessed. The most common varices in both the hemorrhagic (n=21, 87.5%) and nonhemorrhagic group (n=53, 58.9%) were coronary varices, with a statistically significant frequency (p<.01). Esophageal varices were also more common in the hemorrhagic than the nonhemorrhagic group (n=19, 79.2% vs n=36, 40.0% : P<.005). Splenorenal shunts were more common in the nonhemorrhagic (n=8, 8.9%) than in the hemorrhagic group (n=0, 0%)(P<.05). Other types of varice such as paraumbilical (n=10, 41.7% vs n=21, 23.3%), perisplenic (n=6, 25% vs n=15, 16.7%) and retroperitoneal-paravertebral (n=11, 45.8% vs n=24, 26.7%) were more common in the hemorrhagic group, but without a statistically significant frequency. The frequency of coronary and esophageal varices was significant in patients with a history of esophageal variceal bleeding. In patients without such a history, splenorenal shunts were seen

  3. Bleeding 'downhill' esophageal varices associated with benign superior vena cava obstruction: case report and literature review.

    Science.gov (United States)

    Loudin, Michael; Anderson, Sharon; Schlansky, Barry

    2016-10-24

    Proximal or 'downhill' esophageal varices are a rare cause of upper gastrointestinal hemorrhage. Unlike the much more common distal esophageal varices, which are most commonly a result of portal hypertension, downhill esophageal varices result from vascular obstruction of the superior vena cava (SVC). While SVC obstruction is most commonly secondary to malignant causes, our review of the literature suggests that benign causes of SVC obstruction are the most common cause actual bleeding from downhill varices. Given the alternative pathophysiology of downhill varices, they require a unique approach to management. Variceal band ligation may be used to temporize acute variceal bleeding, and should be applied on the proximal end of the varix. Relief of the underlying SVC obstruction is the cornerstone of definitive treatment of downhill varices. A young woman with a benign superior vena cava stenosis due to a tunneled internal jugular vein dialysis catheter presented with hematemesis and melena. Urgent upper endoscopy revealed multiple 'downhill' esophageal varices with stigmata of recent hemorrhage. As there was no active bleeding, no endoscopic intervention was performed. CT angiography demonstrated stenosis of the SVC surrounding the distal tip of her indwelling hemodialysis catheter. The patient underwent balloon angioplasty of the stenotic SVC segment with resolution of her bleeding and clinical stabilization. Downhill esophageal varices are a distinct entity from the more common distal esophageal varices. Endoscopic therapies have a role in temporizing active variceal bleeding, but relief of the underlying SVC obstruction is the cornerstone of treatment and should be pursued as rapidly as possible. It is unknown why benign, as opposed to malignant, causes of SVC obstruction result in bleeding from downhill varices at such a high rate, despite being a less common etiology of SVC obstruction.

  4. EFFICACY OF THROMBIN FIBRIN GLUE AND SCLE ROSANT IN THE MANAGEMENT OF BLEEDI NG GASTRIC VARICES

    Directory of Open Access Journals (Sweden)

    Sanjay Gupta

    2015-01-01

    Full Text Available Gastric varices are noted in up to 20 % of patents with portal hypertension , and are more common in those with non - cirrhotic etiology 1 . They bleed at lower portal pressures , bleed more severely and are associated with higher rates of rebleed , encephalopathy and mortality 1,2,3 . Variceal obliteration using tissue adhesives such as N - butyl cyanoacrylate leading to plugging and thrombosis of the gastric varices is currently the first line management option for obliteration of the gastric varices 3 . Although various options have been proposed , gold standard for management of gastric variceal bleeds is yet to be defined. We theorized that injection of the gastric varices using thrombin based glue followed by injection of a sclerosant shall be effective in optimum sclerotherapy and eradication of gastric varices. MATERIAL AND METHODS : All patients presenting with gastric variceal bleed were offered sclerotherapy with Thrombin fibrin based glue and sclerosant (TFG/S . During the study period 18 patients were enrolled in the TGF/S group. 21 patients underwent variceal plugging with n - butyl cyanoacrylate (NBC . There was no significant difference in age/ sex , duration of bleed or time interval between onset of bleed and endotherapy. RESULTS: Patients undergoing endotherapy with TGF/S had less episodes of bleed , and greater eradication of varices. CONCLUSION: The results with thrombin / fibrin glue and sclerotherapy are highly encouraging. Well - designed trials need to be performed KEYWORDS:Gastric varices; Thrombin Sclerotherapy

  5. Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities: Case reports and literature review.

    Science.gov (United States)

    Park, Sang Woo; Cho, Eunae; Jun, Chung Hwan; Choi, Sung Kyu; Kim, Hyun Soo; Park, Chang Hwan; Rew, Jong Sun; Cho, Sung Bum; Kim, Hee Joon; Han, Mingui; Cho, Kyu Man

    2017-01-01

    Ectopic variceal bleeding is a rare (2-5%) but fatal gastrointestinal bleed in patients with portal hypertension. Patients with ectopic variceal bleeding manifest melena, hematochezia, or hematemesis, which require urgent managements. Definitive therapeutic modalities of ectopic varices are not yet standardized because of low incidence. Various therapeutic modalities have been applied on the basis of the experiences of experts or availability of facilities, with varying results. We have encountered eight cases of gastrointestinal ectopic variceal bleeding in five patients in the last five years. All patients were diagnosed with liver cirrhosis presenting melena or hematemesis. All patients were treated with various endoscopic modalities (endoscopic variceal obturation [EVO] with cyanoacrylate in five cases, endoscopic variceal band ligation (EVL) in two cases, hemoclipping in one case). Satisfactory hemostasis was achieved without radiologic interventions in all cases. EVO and EVL each caused one case of portal biliopathy, and EVL induced ulcer bleeding in one case. EVO generally accomplished better results of variceal obturations than EVL or hemoclipping, without serious adverse events. EVO may be an effective modality for control of ectopic variceal bleeding without radiologic intervention or surgery.

  6. Banding ligation versus beta-blockers as primary prophylaxis in esophageal varices

    DEFF Research Database (Denmark)

    Gluud, Lise L; Klingenberg, Sarah; Nikolova, Dimitrinka

    2007-01-01

    To compare banding ligation versus beta-blockers as primary prophylaxis in patients with esophageal varices and no previous bleeding.......To compare banding ligation versus beta-blockers as primary prophylaxis in patients with esophageal varices and no previous bleeding....

  7. [Comparison of band ligation with sclerotherapy for the treatment of bleeding esophageal varices].

    Science.gov (United States)

    Ríos, Eddy; Sierralta, Armando; Abarzúa, Marigraciela; Bastías, Joaquín; Barra, María Inés

    2012-06-01

    Endoscopic band ligation is the treatment of choice for bleeding esophageal varices. However it is not clear if this procedure is associated with less early and late mortality than sclerotherapy. To assess rates of re-bleeding and mortality in cohorts of patients with bleeding esophageal varices treated with endoscopic injection or band ligation. Analysis of medical records and endoscopy reports of two cohorts of patients with bleeding esophageal varices, treated between 1990 and 2010. Of these, 54 patients were treated with sclerotherapy and 90 patients with band ligation. A third cohort of 116 patients that did not require endoscopic treatment, was included. The mean analyzed follow up period was 2.5 years (range 1-16). Collection of data was retrospective for patients treated with sclerotherapy and prospective for patients treated with band ligation. Rates of re-bleeding and medium term mortality were assessed. During the month ensuing the first endoscopic treatment, re-bleeding was recorded in 39 and 72% of patients treated with band ligation and sclerotherapy, respectively (p < 0.01). The relative risk of bleeding after band ligation was 0.53 (95% confidence limits 0.390.73). Death rates until the end of follow up were 20 and 48% among patients with treated with band ligation and sclerotherapy, respectively (p < 0.01), with a relative risk of dying for patients subjected to band ligation of 0.41 (95% confidence limits 0.25-0.68). Band ligation was associated with lower rates of re-bleeding and mortality in these cohorts of patients.

  8. Splenomegaly and its Relation to Esophageal Varices in Patient with liver Cirrhosis

    International Nuclear Information System (INIS)

    Rasheid, S.A.; Hafez, E.N.; Al Kady, M.M.

    2013-01-01

    Liver cirrhosis has been associated with portal hypertension as a common complication with subsequent development of esophageal varices (EV).Bleeding due to rupture of esophageal varices (EV) is one of main cause of death in liver cirrhosis, that endoscopy screening is recommended. The aim of work was to determin the of the degree esophageal varices endoscopically in in 60 cirrhotic patients,(32 in Child-Pugh's class A, 16 in Child-Pugh's class B, and 12 in Child-Pugh's class C) who were examined clinically, laboratory , ultrasonography to and comparing them with the determines of the spleen ultrasonography and some biochemical data . Correlation analysis was done to assess this study. Of 60 patients, 20 were admitted to hospital because of acute gastro-intestinal bleeding and 40 without history of gastro-intestinal bleeding. The range age of patients was 30-65 years (average 48.4 ± 8.6 years), 6 (10%) patients with EV grade I, 14(23.4%) patients with grade II and 10 (16.6%) patients with grade III. Twinty patients having esophageal varices of different degrees, had no splenomegaly. A negative correlation was found between spleen diameter and the degree of EV (p < 0.05). The percentage of patients with varices increased with the severty of Liver cirrhosis: 6(18.8) of 32 patients in Child-Pugh class A,14 (87.5%) of 16 in Child-Pugh class B, and 10(83.3%) of 12 in Child-Pugh class C had varices.The degree of EV significantly correlated with Child-Puph score. Patients with varices had lower platelet counts comparison to those without varices (237.259 ± 100.305, 298.424 ± 103.09 respectively; p<0.001), and lower serum albumin comparison to those without varices (1.8 ± 0.92, 2.8 ± 0.83 respectively; p<0.001). The platelet count to spleen diameter ratio (PC/SD) in patients with EV were significantly Rasheid et. al., J. Rad. Res. Appl. Sci., 266 Vol. 6, No. 1B (2013) different from patients without EV (945.84±778.59, 686.26± 546.39 respectively; p<0.001).

  9. Clinical effect of esophageal variceal ligation in treatment of esophageal variceal bleeding in patients with liver cirrhosis

    Directory of Open Access Journals (Sweden)

    ZHANG Dongxu

    2017-01-01

    Full Text Available Objective To investigate the clinical effect of endoscopic esophageal variceal ligation (EVL in the treatment of esophageal variceal bleeding (EVB in patients with liver cirrhosis. MethodsA total of 84 liver cirrhosis patients with EVB who were admitted to The Third People′s Hospital of Shenzhen, Guangdong Medical University, from December 2010 to July 2013 were divided into ligation group (group A, treated with EVL combined with somatostatin and esomeprazole and control group (group B, treated with somatostatin and esomeprazole, with 42 patients in each group. The hemostasis rate, rebleeding rate, incidence rate of complications, and mortality rate were observed in both groups, as well as the variceal eradication rate after EVL and risk factors for early rebleeding. The t-test was used for comparison of normally distributed continuous data between two groups, and an analysis of variance was used for comparison between multiple groups; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, the Wilcoxon signed-rank sum test was used for comparison within each group, and the Kruskal-Wallis H test was used for comparison between multiple groups. The chi-square test or Fisher′s exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used to compare survival rates between groups. The logistic regression method was used to investigate the influencing factors for dichotomous data. ResultsThere was a significant difference in the hemostasis rate between groups A and B (97.62% vs 80.95%, P=0.029. Compared with group B, group A had significantly lower rebleeding rates in 1-2 years (15.38% vs 38.89%, χ2=5.323, P=0.021 and 2-3 years (15.38% vs 48.48%, χ2=10.448, P=0.001. A total of 14 patients (33.33% in group A and 7 patients (16.67% in group B experienced adverse events, and 4 patients in

  10. Banding ligation or beta-blockers for primary prevention of variceal bleeding?

    Directory of Open Access Journals (Sweden)

    Petre Cotoras Viedma

    2016-12-01

    Full Text Available Resumen La hemorragia digestiva alta variceal es una de las complicaciones más serias de la cirrosis hepática. Los betabloqueadores no selectivos y la ligadura endoscópica se consideran efectivos como estrategia de prevención primaria de hemorragia variceal, pero no hay consenso sobre cuál de las dos constituye la mejor opción. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos siete revisiones sistemáticas que en conjunto incluyen 21 estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la ligadura variceal probablemente disminuye el riesgo de sangrado digestivo variceal y se asocia a menos efectos adversos al ser comparada con betabloqueadores no selectivos, aunque probablemente no existen diferencias en términos de mortalidad.

  11. 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

  12. Meta-analysis: banding ligation and medical interventions for the prevention of rebleeding from oesophageal varices

    DEFF Research Database (Denmark)

    Thiele, Maja; Krag, A; Rohde, Ulrich

    2012-01-01

    In patients with oesophageal varices, the combination of endoscopic variceal ligation (EVL) and medical therapy is recommended as standard of care for prevention of rebleeding. The results of previous meta-analyses on this topic are equivocal.......In patients with oesophageal varices, the combination of endoscopic variceal ligation (EVL) and medical therapy is recommended as standard of care for prevention of rebleeding. The results of previous meta-analyses on this topic are equivocal....

  13. Correlation of Major Scan Findings and Esophageal Varices in Liver Cirrhosis

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, J S; Bahk, Y W; Lim, J L [Catholic University College of Medicine, Seoul (Korea, Republic of)

    1970-03-15

    In an endeavor to help understand some typical scan findings and portal hemodynamics in liver cirrhosis, several commonly occurring scan changes and esophageal varices as demonstrated by esophagram were correlated one another from quantitative and qualitative stand points. Clinical materials consisted of 34 patients with proven diagnosis of liver cirrhosis and esophageal varices. Liver scan was performed with colloidal 198-Au and the changes in the size and internal architecture of the Liver, splenic uptake and splenomegaly were graded and scored by repeated double-blind readings. The variceal changes on esophagrams were also graded according to the classification of Shanks and Kerley following modification. Of 34 patients, 91% showed definite reducing in liver volume(shrinkage) constituting the most frequent scan change. The splenic uptake and splenomegaly were noted in 73.5 and 79.4%, respectively. The present study revealed no positive correlation between the graded scan findings including shrinkage of the liver, splenic uptake or splenomegaly and severity of variceal changes of the esophagus. Exceptionally, however, apparently paradoxical correlation was noted between the severity of mottling and varices. Thus, in the majority(73.5%) of patients mottling were either absent or mild. This interesting observation is in favor of the view held by Christie et al. who consider the mottlings to be not faithful expression of actual scarring of the cirrhosis liver. This also would indicate that variceal changes are to be the results of intrahepatic arteriovenous shunting of blood with hypervolemic load to the portal system rather than simple hypertension secondary to fibrosis and shrinkage.

  14. Correlation of Major Scan Findings and Esophageal Varices in Liver Cirrhosis

    International Nuclear Information System (INIS)

    Ahn, J. S.; Bahk, Y. W.; Lim, J. L.

    1970-01-01

    In an endeavor to help understand some typical scan findings and portal hemodynamics in liver cirrhosis, several commonly occurring scan changes and esophageal varices as demonstrated by esophagram were correlated one another from quantitative and qualitative stand points. Clinical materials consisted of 34 patients with proven diagnosis of liver cirrhosis and esophageal varices. Liver scan was performed with colloidal 198-Au and the changes in the size and internal architecture of the Liver, splenic uptake and splenomegaly were graded and scored by repeated double-blind readings. The variceal changes on esophagrams were also graded according to the classification of Shanks and Kerley following modification. Of 34 patients, 91% showed definite reducing in liver volume(shrinkage) constituting the most frequent scan change. The splenic uptake and splenomegaly were noted in 73.5 and 79.4%, respectively. The present study revealed no positive correlation between the graded scan findings including shrinkage of the liver, splenic uptake or splenomegaly and severity of variceal changes of the esophagus. Exceptionally, however, apparently paradoxical correlation was noted between the severity of mottling and varices. Thus, in the majority(73.5%) of patients mottling were either absent or mild. This interesting observation is in favor of the view held by Christie et al. who consider the mottlings to be not faithful expression of actual scarring of the cirrhosis liver. This also would indicate that variceal changes are to be the results of intrahepatic arteriovenous shunting of blood with hypervolemic load to the portal system rather than simple hypertension secondary to fibrosis and shrinkage.

  15. Correlation Between Esophageal Varices and Lok Score as a Non-invasive Parameter in Liver Cirrhosis Patients

    Directory of Open Access Journals (Sweden)

    Iqbal Sungkar

    2016-09-01

    Full Text Available Bleeding from gastro-esophageal varices is the most serious and life-threatening complication of cirrhosis. Endoscopic surveillance of esophageal varices in cirrhotic patients is expensive and uncomfortable for the patients. Therefore, there is a particular need for non-invasive predictors for esophageal varices. The aim of the present study was to evaluate association of esophageal varices and Lok Score as non-invasive parameter in liver cirrhosis patients. This is a cross-sectional study of patients admitted at the Adam Malik hospital Medan between September to December 2014 with a diagnosis of cirrhosis based on clinical, biochemical examination, ultrasound, and gastroscopy. Lok Score was calculated for all patients, tabulated and analyzed. Among 76 patients with esophageal varices, 55.3% was due to hepatitis B virus (HBV. The majority of patients were Child C with only 13,2% being Child Pugh class A. Majority of the population had F2 esophageal varices (42.1%, F1 (32.9%, and F3 (25%. There is significance difference between Lok Score and grading of esophageal varices, in which Lok Score is higher in large esophageal varices compared with small esophageal varises (0.92 ± 0.14 vs. 0.70 ± 0.29; p = 0.001. Lok Score with cut-off point of > 0.9141 was highly predictive in the diagnosis large esophageal varices with a sensitivity of 74.5%, specificity of 72%, positive predictive value of 84%, negative predictive value 58%, and accuracy was 73.7%. Lok Score was significantly associated with esophageal varices. Lok Score is a good non-invasive predictor of large esophageal varices in cirrhotic patients.

  16. Right ovarian vein drainage variant: Is there a relationship with pelvic varices?

    International Nuclear Information System (INIS)

    Koc, Zafer; Ulusan, Serife; Oguzkurt, Levent

    2006-01-01

    Objective: To correlate right ovarian vein (ROV) variations that drain into the right renal vein (RRV) with the presence of pelvic varices. Materials and methods: Routine abdominal multidetector-row computed tomography scans of 324 women were analyzed for the presence and type of ROV variations in this retrospective study. The subjects were divided into 2 groups: those with ROV variations and those without such variations. The diameters of the subjects' ROV, left ovarian vein (LOV), and parauterine veins were measured. Pelvic varices and the presence and degree of ovarian vein reflux were noted and compared between the 2 groups. The χ 2 -test and the Pearson correlation test were used for statistical analysis. Results: Thirty-two (9.9%) of 324 women studied exhibited ROV variant that drained into the right renal vein, and the remaining subjects (90.1%) exhibited a normal pattern of ROV drainage that flowed directly into the inferior vena cava. Pelvic varices were identified in 59 (18%) of the subjects. Reflux was not observed in any patient without pelvic varices. Fifty-seven of 59 women exhibited ovarian vein reflux. In 56 of those 57 individuals, reflux occurred only in the LOV, and in 1 subject, reflux was noted predominantly in the ROV. No significant relationship between the presence of an ROV that drained into the right renal vein and pelvic varices was noted. Conclusion: Although right-sided pelvic varices associated with right ovarian vein drainage variations are rare, anatomic variations of the right ovarian vein are not. This study did not find an association between the presence of right ovarian vein and pelvic varices

  17. Right ovarian vein drainage variant: Is there a relationship with pelvic varices?

    Energy Technology Data Exchange (ETDEWEB)

    Koc, Zafer [Baskent Universitesi, Adana Hastanesi, Radyoloji Boeluemue, Serin Evler 39, Sok. No. 6 Yueregir, Adana (Turkey)]. E-mail: koczafer@gmail.com; Ulusan, Serife [Baskent Universitesi, Adana Hastanesi, Radyoloji Boeluemue, Serin Evler 39, Sok. No. 6 Yueregir, Adana (Turkey); Oguzkurt, Levent [Baskent Universitesi, Adana Hastanesi, Radyoloji Boeluemue, Serin Evler 39, Sok. No. 6 Yueregir, Adana (Turkey)

    2006-09-15

    Objective: To correlate right ovarian vein (ROV) variations that drain into the right renal vein (RRV) with the presence of pelvic varices. Materials and methods: Routine abdominal multidetector-row computed tomography scans of 324 women were analyzed for the presence and type of ROV variations in this retrospective study. The subjects were divided into 2 groups: those with ROV variations and those without such variations. The diameters of the subjects' ROV, left ovarian vein (LOV), and parauterine veins were measured. Pelvic varices and the presence and degree of ovarian vein reflux were noted and compared between the 2 groups. The {chi}{sup 2}-test and the Pearson correlation test were used for statistical analysis. Results: Thirty-two (9.9%) of 324 women studied exhibited ROV variant that drained into the right renal vein, and the remaining subjects (90.1%) exhibited a normal pattern of ROV drainage that flowed directly into the inferior vena cava. Pelvic varices were identified in 59 (18%) of the subjects. Reflux was not observed in any patient without pelvic varices. Fifty-seven of 59 women exhibited ovarian vein reflux. In 56 of those 57 individuals, reflux occurred only in the LOV, and in 1 subject, reflux was noted predominantly in the ROV. No significant relationship between the presence of an ROV that drained into the right renal vein and pelvic varices was noted. Conclusion: Although right-sided pelvic varices associated with right ovarian vein drainage variations are rare, anatomic variations of the right ovarian vein are not. This study did not find an association between the presence of right ovarian vein and pelvic varices.

  18. Alcohol Abuse Increases Rebleeding Risk and Mortality in Patients with Non-variceal Upper Gastrointestinal Bleeding.

    Science.gov (United States)

    Kärkkäinen, Jussi M; Miilunpohja, Sami; Rantanen, Tuomo; Koskela, Jenni M; Jyrkkä, Johanna; Hartikainen, Juha; Paajanen, Hannu

    2015-12-01

    No current data are available on rebleeding and mortality risk in patients who use alcohol excessively and are admitted for non-variceal upper gastrointestinal bleeding (NVUGIB). This information could help in planning interventions and follow-up protocols for these patients. This study provides contemporary data on the long-term outcome after first-time NVUGIB in alcohol abusers (AAs) compared to non-abusers (NAs). Consecutive patients hospitalized for their first acute gastrointestinal bleeding from 2009 through 2011 were retrospectively recorded and categorized as AA or NA. Risk factors for one-year mortality and rebleeding were identified, and patients were further monitored for long-term mortality until 2015. Alcohol abuse was identified in 19.7% of patients with NVUGIB (n = 518). The one-year rebleeding rate was 16.7% in AAs versus 9.1% in NAs (P = 0.027). Alcohol abuse was associated with a twofold increase in rebleeding risk (P = 0.025); the risk especially increased 6 months after the initial bleeding. The study groups did not differ significantly in 30-day (6.0%) or one-year mortality rates (20.5%). However, there was a tendency for higher overall mortality in AAs than NAs after adjustment of comorbidities. AAs with NVUGIB are at high risk of rebleeding, and mortality is increased in AA patients. A close follow-up strategy and long-term proton pump inhibitor therapy are recommended for AA patients with peptic ulcer or esophagitis.

  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. Gastroesophageal Variceal Filling and Drainage Pathways: An Angiographic Description of Afferent and Efferent Venous Anatomic Patterns

    Directory of Open Access Journals (Sweden)

    Ron C Gaba

    2015-01-01

    Full Text Available Varices commonly occur in liver cirrhosis patients and are classified as esophageal (EV, gastroesophageal (GEV, or isolated gastric (IGV varices. These vessels may be supplied and drained by several different afferent and efferent pathways. A working knowledge of variceal anatomy is imperative for Interventional Radiologists performing transjugular intrahepatic portosystemic shunt and embolization/obliteration procedures. This pictorial essay characterizes the angiographic anatomy of varices in terms of type and frequency of venous filling and drainage, showing that different varices have distinct vascular anatomy. EVs typically show left gastric vein filling and “uphill” drainage, and GEVs and IGVs exhibit additional posterior/short gastric vein contribution and “downhill” outflow. An understanding of these variceal filling and drainage pathways can facilitate successful portal decompression and embolization/obliteration procedures.

  1. Liver stiffness plus platelet count can be used to exclude high-risk oesophageal varices.

    Science.gov (United States)

    Ding, Nik S; Nguyen, Tin; Iser, David M; Hong, Thai; Flanagan, Emma; Wong, Avelyn; Luiz, Lauren; Tan, Jonathan Y C; Fulforth, James; Holmes, Jacinta; Ryan, Marno; Bell, Sally J; Desmond, Paul V; Roberts, Stuart K; Lubel, John; Kemp, William; Thompson, Alexander J

    2016-02-01

    Endoscopic screening for high-risk gastro-oesophageal varices (GOV) is recommended for compensated cirrhotic patients with transient elastography identifying increasing numbers of patients with cirrhosis without portal hypertension. Using liver stiffness measurement (LSM) ± platelet count, the aim was to develop a simple clinical rule to exclude the presence of high-risk GOV in patients with Child-Pugh A cirrhosis. A retrospective analysis of 71 patients with Child-Pugh A cirrhosis diagnosed by transient elastography (LSM >13.6 kPa) who underwent screening gastroscopy was conducted. A predictive model using LSM ± platelet count was assessed to exclude the presence of high-risk GOV (diameter >5 mm and/or the presence of high-risk stigmata) and validated using a second cohort of 200 patients from two independent centres. High-risk GOV were present in 10 (15%) and 16 (8%) of the training and validation cohorts, respectively, which was associated with LSM and Pl count (P < 0.05). A combined model based on LSM and Pl count was more accurate for excluding the presence of high-risk GOV than either alone (training cohort AUROC: 0.87 [0.77-0.96] vs. 0.78 [0.65-0.92] for LSM and 0.71 [0.52-0.90] for platelets) with the combination of LSM ≤25 kPa and Pl ≥100 having a NPV of 100% in both the training and validation cohorts. A total of 107 (39%) patients meet this criterion. The combination of LSM ≤25 kPa and Pl ≥100 can be used in clinical practice to exclude the presence of high-risk GOV in patients with Child-Pugh A cirrhosis. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Successful Embolization of Bleeding Ileal Varices with N-butyl Cyanoacrylate via a Recanalized Paraumbilical Vein.

    Science.gov (United States)

    Onishi, Yasuyuki; Kimura, Hiroyuki; Kanagaki, Mitsunori; Oka, Shojiro; Fukumoto, Genki; Otani, Tomoaki; Matsubara, Naoko; Kawabata, Kazuna; Namikawa, Mio; Matsumura, Takeshi; Kimura, Toshiyuki

    2018-04-23

    A 48-year-old woman with alcoholic liver cirrhosis was admitted to our hospital because of hematochezia and severe anemia. She had been hospitalized many times over the past year for hematochezia of unknown etiology. Contrast-enhanced CT demonstrated ileal varices, which were fed by several ileal veins. These feeding veins were selectively embolized with N-butyl cyanoacrylate (NBCA) via a recanalized paraumbilical vein. The paraumbilical vein instead of the portal vein was punctured to decrease the risk of bleeding complications because she had coagulopathy and ascites. We consider antegrade embolization of ileal varices with NBCA to be a feasible and effective treatment. Access via a paraumbilical vein is an alternative to the transhepatic approach.Level of Evidence Level V, case report.

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

    Science.gov (United States)

    Mungan, Zeynel

    2012-01-01

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

  4. Jejunal varices diagnosed by capsule endoscopy in patients with post-liver transplant portal hypertension.

    Science.gov (United States)

    Bass, Lee M; Kim, Stanley; Superina, Riccardo; Mohammad, Saeed

    2017-02-01

    Portal hypertension secondary to portal vein obstruction following liver transplant occurs in 5%-10% of children. Jejunal varices are uncommon in this group. We present a case series of children with significant GI blood loss, negative upper endoscopy, and jejunal varices detected by CE. Case series of patients who had CE for chronic GI blood loss following liver transplantation. Three patients who had their initial transplants at a median age of 7 months were identified at our institution presenting at a median age of 8 years (range 7-16 years) with a median Hgb of 2.8 g/dL (range 1.8-6.8 g/dL). Upper endoscopy was negative for significant esophageal varices, gastric varices, and bleeding portal gastropathy in all three children. All three patients had significant jejunal varices noted on CE in mid-jejunum. Jejunal varices were described as large prominent bluish vessels underneath visualized mucosa, one with evidence of recent bleeding. The results led to venoplasty of the portal vein in two patients and a decompressive shunt in one patient with resolution of GI bleed and anemia. CE is useful to diagnose intestinal varices in children with portal hypertension and GI bleeding following liver transplant. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Prevalence of gastric varices and portal hypertensive gastropathy in patients with Symmer's periportal fibrosis

    International Nuclear Information System (INIS)

    Mudawi, H.; Ali, Y.; El-Tahir, M.

    2008-01-01

    Symmer's periportal fibrosis secondary to schistosomiasis is a common cause of portal hypertension worldwide. Data on the prevalence of gastric variances and portal hypertensive gastropathy in this group of patients with portal of hypertension is relatively scarce. The aim of this study was to determine the prevalence of gastric varices and portal hypertensive gastropathy in patients presenting with portal hypertension secondary to Symmer's periportal fibrosis. In a prospective study, upper gastrointestinal endoscopy was carried out to determine the prevalence of gastric varices and portal hypertensive gastropathy in patients with portal hypertension secondary to Symmer's fibrosis. Of 143 patients studied, 24 patients (16.8%) had gastric varices (grade I in 10.5%, grade Ii in 6.3%) and 31 patients (21.7%) had portal hypertensive gastropathy (mild in 11.2%, severe in 10.5%). Gastric varices were more prevalent in patients with grade I and II esophageal varices and portal hypertensive gastropathy was more prevalent in those with grade III and IV esophageal varices, but the differences were not statistically significant. We conclude that both gastric varices and portal hypertensive gastropathy seem to have a lower prevalence in patients with portal hypertension secondary to Symmer's periportal fibrosis when compared to reported data in patients with portal hypertension secondary to liver cirrhosis and non-cirrhotic portal fibrosis. (author)

  6. Streptococcus sanguinis meningitis following endoscopic ligation for oesophageal variceal haemorrhage.

    Science.gov (United States)

    Liu, Yu-Ting; Lin, Chin-Fu; Lee, Ya-Ling

    2013-05-01

    We report a case of acute purulent meningitis caused by Streptococcus sanguinis after endoscopic ligation for oesophageal variceal haemorrhage in a cirrhotic patient without preceding symptoms of meningitis. Initial treatment with flomoxef failed. The patient was cured after 20 days of intravenous penicillin G. This uncommon infection due to S. sanguinis adds to the long list of infectious complications among patients with oesophageal variceal haemorrhage.

  7. Correlation between severity of portal hypertensive gastropathy and size of oesophageal varices in cirrhotic hepatitis-C patients

    International Nuclear Information System (INIS)

    Saleem, K.; Baig, F.A.; Javed, M.

    2018-01-01

    Portal hypertension can lead to oesophageal varices (EV) and portal hypertensive gastropathy (PHG). The aim of this study is to determine the relationship between severity of Portal hypertensive gastropathy and size of oesophageal varices. Methods: One hundred and ninety-five patients of hepatitis C positive chronic liver disease having oesophageal varices were assessed for severity of portal hypertensive gastropathy. Results: Mild Portal Hypertensive Gastropathy was observed in 16 (8.2 %), moderate in 54 (27.7 %) and severe in 120 (61.6 %) patients. Grade 1 Oesophageal Varices were present in 79 (40.5%) patients, grade 2 in 44(21.9%) patients, grade 3 in 62 (31.8%) and grade 4 in 10 (5.2%) patients. No significant correlation was observed between grades of gastropathy and size of varices. Conclusion: The frequency of portal hypertensive gastropathy was 97.5% in Hepatitis C positive cirrhotic patients having oesophageal varices. Severity of gastropathy is not related to the grade or size of oesophageal varices. (author)

  8. Thirty-Day Readmission Among Patients With Non-variceal Upper Gastrointestinal Hemorrhage and Effects on Outcomes.

    Science.gov (United States)

    Abougergi, Marwan S; Peluso, Heather; Saltzman, John R

    2018-03-28

    We aimed to determine the rate of hospital readmission within 30 days of non-variceal upper gastrointestinal hemorrhage and its impact on mortality, morbidity, and health care use in the United States. We performed a retrospective study using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmission Database for the year 2014 (data on 14.9 million hospital stays at 2048 hospitals in 22 states). We collected data on hospital readmissions of 203,220 adults who were hospitalized for urgent non-variceal upper gastrointestinal hemorrhage and discharged. The primary outcome was rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity (shock and prolonged mechanical ventilation) and resource use (length of stay and total hospitalization costs and charges). Independent risk factors for readmission were identified using Cox regression analysis. The 30-day rate of readmission was 13%. Only 18% of readmissions were due to recurrent non-variceal upper gastrointestinal bleeding. The rate of death among patients readmitted to the hospital (4.7%) was higher than that for index admissions (1.9%) (P upper endoscopy, and prolonged mechanical ventilation were associated with lower odds for readmission. In a retrospective study of patients hospitalized for non-variceal upper gastrointestinal hemorrhage, 13% are readmitted to the hospital within 30 days of discharge. Readmission is associated with higher mortality, morbidity, and resource use. Most readmissions are not for recurrent gastrointestinal bleeding. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Spencer A. Jenkins

    1996-01-01

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

  10. Circadian occurrence of variceal bleeding in patients with liver cirrhosis.

    Science.gov (United States)

    Siringo, S; Bolondi, L; Sofia, S; Hermida, R C; Gramantieri, L; Gaiani, S; Piscaglia, F; Carbone, C; Misitano, B; Corinaldesi, R

    1996-12-01

    Several clinical events have a rhythmicity over the 24 h period. We assessed the presence of periodic rhythm in the occurrence of haematemesis in patients with liver cirrhosis under different daylight regimens, namely during standard time and during daylight savings. Over a 48 month period there were 212 consecutive admissions of 118 cirrhotics with variceal bleeding. Complete data were available for 181 episodes of bleeding: 121 (66.9%) started with haematemesis and 60 (33.1%) started with melaena. One hundred and two (56%) episodes occurred during daylight savings and 79 (44%) occurred during standard time. The cosinor test showed a 24 h biphasic peak for the occurrence of haematemesis (09.45 and 21.45 h). Moreover, a biphasic diurnal asymmetric frequency was also found by multiple component rhythmometry. The time peaks of onset of variceal haemorrhage did not change significantly during standard time and daylight savings. Patients with more than one haematemesis episode significantly bled over the same time interval. The present study confirms that over the 24 h period variceal bleeding in cirrhotic patients occurs with a predictable rhythmicity that does not seem to be under the control of the light-dark cycle. The finding of a chronorisk for variceal haemorrhage addresses specific questions for pathophysiological studies as well as for new treatment strategies.

  11. A clinical predictor of varices and portal hypertensive gastropathy in patients with chronic liver disease

    Directory of Open Access Journals (Sweden)

    Yang Won Min

    2012-06-01

    Full Text Available Background/AimsThe aim of this study was to identify the parameters that could noninvasively predict the presence of esophageal/gastric varices and portal hypertensive gastropathy (PHG in patients with chronic liver disease (CLD, and to determine the accuracy of those parameters.MethodsWe retrospectively analyzed 232 patients with CLD who underwent both upper endoscopy and liver CT within an interval of 3 months. The multidimensional index (M-Index for spleen volume was obtained from the multiplication of splenic length, width, and thickness, as measured by computer tomography.ResultsThe multivariate analysis revealed that platelet, albumin, and M-Index were independently associated with the presence of varices and PHG. We combined three independent parameters, and developed a varices and portal hypertensive gastropathy (VAP scoring system (=[platelet count (/mm3×albumin (g/dL]/[M-Index (cm3]. The area under the receiver operating characteristic curve of the VAP score was 0.850 (95% confidence interval, 0.801-0.899. The VAP cut-off value of 861 had a sensitivity of 85.3%, a positive likelihood ratio of 3.17, and a negative predictive value of 86.4%. For predicting high-risk lesions for bleeding, with a cut-off value of 861 the sensitivity was 92.0%, the positive likelihood ratio was 2.20, and the negative predictive value was 96.4%.ConclusionsThe VAP score can predict the presence of varices and PHG in patients with CLD and may increase the cost-benefit of screening endoscopy in the clinical practice setting. A prospective validation study is necessary in the future.

  12. Frequency of gastric varices in patients with portal hypertension based on endoscopic findings

    International Nuclear Information System (INIS)

    Mir, A.W.; Chaudry, A.A.; Mir, S.; Ahmed, N.; Khan, A.A.; Shahzadi, M.

    2017-01-01

    To find out the frequency of gastric varices in patients with portal hypertension based on endoscopic findings. Study Design: Descriptive Study. Place and Duration of Study: Department of Gastroenterology, Military Hospital, Rawalpindi from Jan to Jun 2011. Material and Methods: All patients fulfilling the inclusion criteria were selected through consecutive sampling. The patients presenting with hematemesis, melena or ascites with portal hypertension on ultrasound abdomen were admitted in the hospital. The patients were first stabilized hemodynamically and then kept empty stomach for at least four hours before endoscopy. The patients were sedated with intravenous midazolam and endoscopic findings obtained were entered on the patient proforma. Results: The overall frequency of gastric varices was 11 percent, whereas 89 percent had no gastric varices. Conclusion: A large number of patients with portal hypertension have gastric varices. It is recommended that endoscopy be carried out in all patients with identified portal hypertension. (author)

  13. Predictors of a variceal source among patients presenting with upper gastrointestinal bleeding.

    Science.gov (United States)

    Alharbi, Ahmad; Almadi, Majid; Barkun, Alan; Martel, Myriam

    2012-04-01

    Patients with upper gastrointestinal bleeding (UGIB) require an early, tailored approach best guided by knowledge of the bleeding lesion, especially a variceal versus a nonvariceal source. To identify, by investigating a large national registry, variables that would be predictive of a variceal origin of UGIB using clinical parameters before endoscopic evaluation. A retrospective study was conducted in 21 Canadian hospitals during the period from January 2004 until the end of May 2005. Consecutive charts for hospitalized patients with a primary or secondary discharge diagnosis of UGIB were reviewed. Data regarding demographics, including historical, physical examination, initial laboratory investigations, endoscopic and pharmacological therapies administered, as well as clinical outcomes, were collected. Multivariable logistic regression modelling was performed to identify clinical predictors of a variceal source of bleeding. The patient population included 2020 patients (mean [± SD] age 66.3±16.4 years; 38.4% female). Overall, 215 (10.6%) were found to be bleeding from upper gastrointestinal varices. Among 26 patient characteristics, variables predicting a variceal source of bleeding included history of liver disease (OR 6.36 [95% CI 3.59 to 11.3]), excessive alcohol use (OR 2.28 [95% CI 1.37 to 3.77]), hematemesis (OR 2.65 [95% CI 1.61 to 4.36]), hematochezia (OR 3.02 [95% CI 1.46 to 6.22]) and stigmata of chronic liver disease (OR 2.49 [95% CI 1.46 to 4.25]). Patients treated with antithrombotic therapy were more likely to experience other causes of hemorrhage (OR 0.44 [95% CI 0.35 to 0.78]). Presenting historical and physical examination data, and initial laboratory tests carry significant predictive ability in discriminating variceal versus nonvariceal sources of bleeding.

  14. Evaluation of the formation of esophageal varices by per-rectal portal scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Ikeoka, Naoko; Monna, Takeyuki; Shiomi, Susumu; Kuroki, Tetsuo; Kobayashi, Kenzo; Ochi, Hironobu; Onoyama, Yasuto (Osaka City Univ. (Japan). Faculty of Medicine); Yamamoto, Sukeo

    1989-12-01

    Portal circulation in patients with liver diseases was evaluated by {sup 99m}Tc-pertechnetate per-rectal portal scintigraphy, and we retrospectively examined the relationship between the extent of abnormality in the portal circulation and the development of esophageal varices. The per-rectal portal shunt index (PRPSI) was calculated for 13 healthy subjects and 79 patients with chronic hepatitis and 214 with cirrhosis of the liver. In the healthy subjects, the mean PRPSI was 4.8%. In the patients with hepatitis, the mean PRPSI was 8.4%, and in the patients with cirrhosis, it was 48.5%. The PRPSI was significantly higher in the cirrhotic patients with esophageal varices than in those without it, and also in the cirrhotic patients with encephalopathy than in those without it. The cumulative incidence of esophageal varices in the 3 years of the study in patients whose PRPSI was 20% or over was significantly higher than that in patients whose PRPSI was under 20%. The results suggested that this non-invasive method should be useful for predictions of the formation of esophageal varices. (author).

  15. Evaluation of the formation of esophageal varices by per-rectal portal scintigraphy

    International Nuclear Information System (INIS)

    Ikeoka, Naoko; Monna, Takeyuki; Shiomi, Susumu; Kuroki, Tetsuo; Kobayashi, Kenzo; Ochi, Hironobu; Onoyama, Yasuto; Yamamoto, Sukeo.

    1989-01-01

    Portal circulation in patients with liver diseases was evaluated by 99m Tc-pertechnetate per-rectal portal scintigraphy, and we retrospectively examined the relationship between the extent of abnormality in the portal circulation and the development of esophageal varices. The per-rectal portal shunt index (PRPSI) was calculated for 13 healthy subjects and 79 patients with chronic hepatitis and 214 with cirrhosis of the liver. In the healthy subjects, the mean PRPSI was 4.8%. In the patients with hepatitis, the mean PRPSI was 8.4%, and in the patients with cirrhosis, it was 48.5%. The PRPSI was significantly higher in the cirrhotic patients with esophageal varices than in those without it, and also in the cirrhotic patients with encephalopathy than in those without it. The cumulative incidence of esophageal varices in the 3 years of the study in patients whose PRPSI was 20% or over was significantly higher than that in patients whose PRPSI was under 20%. The results suggested that this non-invasive method should be useful for predictions of the formation of esophageal varices. (author)

  16. Prognostic variables in patients with cirrhosis and oesophageal varices without prior bleeding

    DEFF Research Database (Denmark)

    Møller, Søren; Bendtsen, Flemming; Christensen, E

    1994-01-01

    As identification of patients at risk of bleeding or death is essential for prophylaxis, we determined the prognostic influence of various patient characteristics on the risk of bleeding and death. Fifty-five patients with cirrhosis and oesophageal varices without previous bleeding were included...... in the study and followed up after an average observation period of 446 days (range: 5-1211 days). A total of 55 clinical, biochemical, haemodynamic, and endoscopic variables were classified as systemic haemodynamic, portal haemodynamic, or metabolic. Using univariate analysis, the following variables showed....... The prognostic significance of central circulation time stresses the importance of the hyperdynamic systemic circulation in assessing the increased risk of bleeding or death.(ABSTRACT TRUNCATED AT 250 WORDS)...

  17. 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.

  18. Correlation of thrombocytopenia with grading of esophageal varices in chronic liver disease patients

    International Nuclear Information System (INIS)

    Abbasi, A.; Butt, N.; Bhutto, A.R.; Munir, S.M.

    2010-01-01

    To determine the severity of thrombocytopenia in different grades of esophageal varices. Study Design: Cross-sectional analytical study. Place and Duration of Study: Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, Ward-7 from January to December 2008. Methodology: Subjects were eligible if they had a diagnosis of cirrhosis. Patient with advanced cirrhosis (Child-Pugh class C), human immunodeficiency virus (HIV) infection, hepatocellular carcinoma, portal vein thrombosis, parenteral drug addiction, current alcohol abuse and previous or current treatment with b-blockers, diuretics and other vasoactive drugs were excluded from the study. All patients under went upper gastrointestinal endoscopy after consent. On the basis of platelet count patients were divided into four groups. Group I with platelets greater or equal to 20000/mm/sup 3/, Group II with values of 21000- 50000/mm/sup 3/, Group III with count of 51000-99000/mm/sup 3/ and Group IV with count of 100000-150000/mm/sup 3/. Correlation of severity of thrombocytopenia with the grading of esophageal varices was assessed using Spearman's correlation with r-values of 0.01 considered significant. Results: One hundred and two patients with thrombocytopenia and esophageal varices were included in the study. There were 62 (60.8%) males and 40 (39.2%) females. The mean age of onset of the disease in these patients was 49.49 +- 14.3 years with range of 11-85 years. Major causes of cirrhosis were hepatitis C (n=79, 77.5%), hepatitis B (n=12, 11.8%), mixed hepatitis B and C infection (n=8, 7.8%) and Wilson's disease (n=3,2.9%). Seven patients had esophageal grade I, 24 had grade II, 35 had grade III, and 36 had grade IV. Gastric varices were detected in 2 patients. Portal hypertensive gastropathy were detected in 87 patients. There was an inverse correlation of platelet count with grading of esophageal varices (r=-0.321, p < 0.001). Conclusion: The severity of thrombocytopenia increased as the grading of

  19. Surgical management of bleeding esopageal varices: the Tikur Anbessa hospital experience.

    Science.gov (United States)

    Kassa, Endale; Jhonson, Orval

    2005-10-01

    Surgery is one of the modalities of treatment of portal hypertension with bleeding esophageal varices. Between 1992 and 2003, a total of 33 patients with esophageal varices secondary to hepatic or pre-hepatic causes of portal hypertension underwent proto-azygeal disconnection surgery at Tikur Anbessa Hospital, Addis Ababa University. Twenty-five, (69. 7%) were men and 8 (24.3%) were women. Their age ranged between 13 and 54 years with a mean age of 24.3 years. Eighty two percent of the patients had hematemesis and melena. Thirty-two, (97%) patients had splenomegaly and of these; 27 (84%) had splenomegaqly with hyperslenism. Twenty-one, (63.6%) and 12 (36.6%) patients had child's A and B functional class, respectively. None of the patients was in class C. The condition of the liver as assessed macroscopically at surgery showed portal fibrosis in 22 (66.7%), cirrhosis in 3 (9.1%) and normal liver in 8 (24.2%) patients. There was no significant correlation between variceal bleeding episode and type of liver pathology. Four patients (12%) died after surgery and re-bleeding occurred in one (3%) patients. Porto-azygeal disconnection surgery can be done safely in patients with esophageal varices and good liver function in order to prevent further bleeding episode.

  20. Successful Treatment of Bleeding Gastric Varices with Splenectomy in a Patient with Splenic, Portal, and Mesenteric Thromboses

    Directory of Open Access Journals (Sweden)

    Lior Menasherian-Yaccobe

    2013-01-01

    Full Text Available A 59-year-old female with a history of multiple splanchnic and portal thromboses treated with warfarin underwent an esophagogastroduodenoscopy for cancer screening, and a polypoid mass was biopsied. One week later, she was admitted with upper gastrointestinal hemorrhage. Her therapeutic coagulopathy was reversed with fresh frozen plasma, and she was transfused with packed red blood cells. An esophagogastroduodenoscopy demonstrated an erosion of a gastric varix without evidence of recent bleeding. Conservative measures failed, and she continued to bleed during her stay. She was not considered a candidate for a shunt procedure; therefore, a splenectomy was performed. Postoperative esophagogastroduodenoscopy demonstrated near complete resolution of gastric varices. One year after discharge on warfarin, there has been no recurrence of hemorrhage. Gastric varices often arise from either portal hypertension or splenic vein thrombosis. Treatment of gastric variceal hemorrhage can be challenging. Transjugular intrahepatic portosystemic shunt is often effective for emergency control in varices secondary to portal hypertension. Splenectomy is the treatment for varices that arise from splenic vein thrombosis. However, treatment of gastric variceal hemorrhage in the context of multiple splanchnic and portal vein thromboses is more complicated. We report splenectomy as a successful treatment of gastric varices in a patient with multiple extrahepatic thromboses.

  1. Size of gastroesophageal varices: its behavior after the surgical treatment of portal hypertension

    Directory of Open Access Journals (Sweden)

    Strauss Edna

    1999-01-01

    Full Text Available The size of gastroesophageal varices is one of the most important factors leading to hemorrhage related to portal hypertension. An endoscopic evaluation of the size of gastroesophageal varices before and after different operations for portal hypertension was performed in 73 patients with schistosomiasis, as part of a randomized trial: proximal splenorenal shunt (PSS n=24, distal splenorenal shunt (DSS n=24, and esophagogastric devascularization with splenectomy (EGDS n=25. The endoscopic evaluation was performed before and up to 10 years after the operations. Variceal size was graded according to Palmer's classification: grade 1 -- up to 3 mm, grade 2 -- from 3 to 6 mm, grade 3 -- greater than 6 mm, and were analyzed in four anatomical locations: inferior, middle or superior third of the esophagus, and proximal stomach. The total number of points in the pre-operative grading minus the number of points in the post-operative grading gave a differential grading, allowing statistical comparison among the surgical groups. Good results, in terms of disappearance or decrease of variceal size, were observed more frequently after PSS than after DSS or EGDS - 95.8%, 83.3%, and 72%, respectively. When differential grading was analyzed, a statistically significant difference was observed between PSS and EGDS, but not between proximal and distal splenorenal shunts. In conclusion, shunt surgeries were more efficient than devascularization in diminishing variceal size.

  2. Percutaneous transhepatic obliteration of stomal variceal hemorrhage from an ileal conduct: Case report and brief literature review

    Energy Technology Data Exchange (ETDEWEB)

    Park, Seung Hyun; Lee, Shin Jae; Won, Jong Yun; Park, Sung Il; Lee, Do Yun; Kim, Man Deuk [Dept. of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Do Young [Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-11-15

    Variceal bleeding is an unusual complication of ileal conduits. We report a case in which recurrent stomal variceal hemorrhage from an ileal conduit for bladder cancer was successfully treated by percutaneous transhepatic obliteration (PTO) using microcoils and N-butyl cyanoacrylate. Therefore, PTO can be one treatment option to prevent recurrent stomal variceal bleeding from ileal conduits.

  3. Long-term effects of oral propranolol on splanchnic and systemic haemodynamics in patients with cirrhosis and oesophageal varices

    DEFF Research Database (Denmark)

    Bendtsen, F; Henriksen, Jens Henrik Sahl; Sørensen, T I

    1991-01-01

    1 year of treatment with propranolol, whereas a decrease in azygos blood flow was observed only in the propranolol group. The beneficial effect of propranolol on the risk of bleeding from oesophageal varices may, therefore, mostly be due to a selective decrease in collateral blood flow and thereby...

  4. An Unusual Reason for Gastric Variceal Hemorrhage: Wandering Spleen.

    Science.gov (United States)

    Köseoğlu, Hüseyin; Atalay, Roni; Büyükaşık, Naciye Şemnur; Canyiğit, Murat; Özer, Mehmet; Solakoğlu, Tevfik; Akın, Fatma Ebru; Bolat, Aylin Demirezer; Yürekli, Öykü Tayfur; Ersoy, Osman

    2015-12-01

    Wandering spleen is the displacement of the spleen due to the loss or weakening of the ligaments of the spleen and is seen very rarely with an incidence of less than 0.5 %. It can cause portal hypertension, but gastric variceal hemorrhage is a quite rare condition within the spectrum of this uncommon disease. We report a 22-year-old woman with wandering spleen presenting with life-threatening gastric variceal hemorrhage. Her diagnosis was made by computerized tomography. Endoscopic therapy was not adequate to stop the bleeding, and urgent splenectomy was performed. After surgery she has been well with no symptoms until now.

  5. Outcomes in variceal hemorrhage following the use of a balloon tamponade device

    Science.gov (United States)

    Nadler, Jonathan; Stankovic, Nikola; Uber, Amy; Holmberg, Mathias J.; Sanchez, Leon D.; Wolfe, Richard E.; Chase, Maureen; Donnino, Michael W.; Cocchi, Michael N.

    2017-01-01

    Background Variceal hemorrhage is associated with high morbidity and mortality. A balloon tamponade device (BTD), such as the Sengstaken-Blakemore or Minnesota tube, may be used in cases of variceal hemorrhage. While these devices may be effective at controlling acute bleeding, the effect on patient outcomes remains less clear. We sought to describe the number of patients with variceal hemorrhage and a BTD who survive to discharge, survive to one-year, and develop complications related to a BTD. Methods In this retrospective study, we identified patients at a single, tertiary care center who underwent placement of a BTD for upper gastrointestinal hemorrhage between 2003 and 2014. Patient characteristics and outcomes were summarized using descriptive statistics. Results 34 patients with a BTD were identified. Median age was 57.5 (IQR 47–63) and 76% (26/34) were male. Approximately 59% (20/34) of patients survived to discharge, and 41% (13/32) were alive after one year. Two patients were lost to follow-up. Of those surviving to discharge, 95% (19/20) had undergone transjugular intrahepatic portosystemic shunt (TIPS), while 36% (5/14) of patients who did not survive to discharge had TIPS (p < 0.01). One complication, an esophageal perforation, was identified and managed conservatively. Conclusion In this cohort of patients undergoing BTD placement for variceal hemorrhage, approximately 59% of patients were alive at discharge and 41% were alive after one year. Placement of a BTD as a temporizing measure in the management of acute variceal hemorrhage may be helpful, particularly when utilized as a bridge to more definitive therapy. PMID:28460805

  6. Outcomes in variceal hemorrhage following the use of a balloon tamponade device.

    Science.gov (United States)

    Nadler, Jonathan; Stankovic, Nikola; Uber, Amy; Holmberg, Mathias J; Sanchez, Leon D; Wolfe, Richard E; Chase, Maureen; Donnino, Michael W; Cocchi, Michael N

    2017-10-01

    Variceal hemorrhage is associated with high morbidity and mortality. A balloon tamponade device (BTD), such as the Sengstaken-Blakemore or Minnesota tube, may be used in cases of variceal hemorrhage. While these devices may be effective at controlling acute bleeding, the effect on patient outcomes remains less clear. We sought to describe the number of patients with variceal hemorrhage and a BTD who survive to discharge, survive to one-year, and develop complications related to a BTD. In this retrospective study, we identified patients at a single, tertiary care center who underwent placement of a BTD for upper gastrointestinal hemorrhage between 2003 and 2014. Patient characteristics and outcomes were summarized using descriptive statistics. 34 patients with a BTD were identified. Median age was 57.5 (IQR 47-63) and 76% (26/34) were male. Approximately 59% (20/34) of patients survived to discharge, and 41% (13/32) were alive after one year. Two patients were lost to follow-up. Of those surviving to discharge, 95% (19/20) had undergone transjugular intrahepatic portosystemic shunt (TIPS), while 36% (5/14) of patients who did not survive to discharge had TIPS (p<0.01). One complication, an esophageal perforation, was identified and managed conservatively. In this cohort of patients undergoing BTD placement for variceal hemorrhage, approximately 59% of patients were alive at discharge and 41% were alive after one year. Placement of a BTD as a temporizing measure in the management of acute variceal hemorrhage may be helpful, particularly when utilized as a bridge to more definitive therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. [Esophageal motor disorders in cirrhotic patients with esophageal varices non-submitted to endoscopic treatment].

    Science.gov (United States)

    Flores, Priscila Pollo; Lemme, Eponina Maria de Oliveira; Coelho, Henrique Sérgio Moraes

    2005-01-01

    The hepatic cirrhosis has as one of the main morbid-mortality causes, the portal hypertension with the development of esophageal varices, the possibility of a digestive hemorrhage and worsening of hepatic insufficiency. It is important to identify causal predictive or aggravating factors and if possible to prevent them. In the last years, it has been observed the association of esophageal motor disorders and gastro-esophageal reflux in cirrhotic patients with esophageal varices. To study the prevalence of the esophageal motility disorders and among them, the ineffective esophageal motility, in patients with hepatic cirrhosis and esophageal varices, without previous endoscopic therapeutic and the predictive factors. Prospectively, it has been evaluate 74 patients suffering from liver cirrhosis and esophagic varices, without previous endoscopic treatment. All of them were submitted to a clinical protocol, esophageal manometry and 55 patients also held the ambulatory esophageal pHmetry. Esophageal motility disorders have been found in 44 patients (60%). The most prevalent was the ineffective esophageal motility, observed in 28%. The abnormal reflux disease was diagnosed through the pHmetry in 35% of the patients. There were no correlation between the manometrical abnormality in general and the ineffective esophageal motility in particular and the esophageal or gastroesophageal reflux disease symptoms, the abnormal reflux, the disease seriousness, the ascites presence and the gauge of the varices. The majority of cirrhotic patients with non-treated esophageal varices present esophageal motor disorders. No predictive factor was found. The clinical relevance of these findings need more researches in the scope to define the real meaning of theses abnormalities.

  8. Bleeding Duodenal Varices Successfully Treated with Balloon-Occluded Retrograde Transvenous Obliteration (B-RTO) Assisted by CT During Arterial Portography

    International Nuclear Information System (INIS)

    Tsurusaki, Masakatsu; Sugimoto, Koji; Matsumoto, Shinichi; Izaki, Kenta; Fukuda, Tetsuya; Akasaka, Yoshinobu; Fujii, Masahiko; Hirota, Shozo; Sugimura, Kazuro

    2006-01-01

    A 60-year-old woman with massive hemorrhage from duodenal varices was transferred to our hospital for the purpose of transcatheter intervention. Although digital subtraction arterial portography could not depict the entire pathway of collateral circulation, the efferent route of the duodenal varices was clearly demonstrated on subsequent CT during arterial portography. Balloon-occluded retrograde transvenous obliteration (B-RTO) of the varices was performed via the efferent vein and achieved complete thrombosis of the varices

  9. Clinical outcomes and prognostic factors associated with survival after balloon-occluded retrograde transvenous obliteration of gastric varices

    International Nuclear Information System (INIS)

    Uozumi, Shojiro; Baba, Toshiyuki; Sai, Syouei; Seino, Noritaka; Hashimoto, Toshi; Honda, Minoru; Gokan, Takehiko; Imawari, Michio

    2011-01-01

    We evaluated clinical outcomes and prognostic factors associated with survival after balloon-occluded retrograde transvenous obliteration (B-RTO) of gastric varices in patients with portal hypertension. Of 50 patients with gastric varices who underwent B-RTO, 46 (94.0%) patients in whom B-RTO was technically successful were reviewed retrospectively. Gastric and esophageal varices after B-RTO were evaluated by contrast-enhanced computer tomography and endoscopy, respectively. Liver function parameters and Child-Pugh scores were estimated before and at 1 year after B-RTO. The cumulative survival rate was calculated, and univariate and multivariate analyses were used to assess the prognostic factors. No major complications occurred in any of the patients following B-RTO and no recurrence or bleeding of gastric varices was noted. Of the 42 patients who were followed up for the progression of esophageal varices, 13 (31.0%) had worsened varices and of these, 6 (14.3%) showed bleeding. Prothrombin activity had significantly improved at 1 year after B-RTO, although there were no changes in other liver function parameters. The overall cumulative survival rates at 1, 3, and 5 years after B-RTO were 91.6%, 70.9%, and 53.6%, respectively. Multivariate analysis identified the occurrence of advanced hepatocellular carcinoma (HCC) during the observation period as a prognostic factor for survival (hazard ratio=4.1497, 95% CI=1.32314-13.0319, P=0.0148). B-RTO of gastric varices is an effective treatment ensuring lower recurrence and bleeding rates; however, these patients require careful observation for progression of esophageal varices. The management of HCC is crucial for achieving long-term survival after B-RTO. (author)

  10. Optimizing logistics for balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices by doing away with the indwelling balloon: concept and techniques.

    Science.gov (United States)

    Saad, Wael E; Nicholson, David B

    2013-06-01

    Since the conception of balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices 25 years ago, the placement of an indwelling balloon for hours has been central to the BRTO procedure. Numerous variables and variations of the BRTO procedure have been described, including methods to reduce sclerosant, combining percutaneous transhepatic obliteration, varying sclerosant, and using multiple sclerosants within the same procedure. However, the consistent feature of BRTO has always remained the indwelling balloon. Placing an indwelling balloon over hours for the BRTO procedure is a logistical burden that taxes the interventional radiology team and hospital resources. Substituting the balloon with hardware (coils or Amplatzer vascular plugs [AVPs] or both) is technically feasible and its risks most likely correlate with gastrorenal shunt (GRS) size. The current authors use packed 0.018- or 0.035-in coils or both for small gastric variceal systems (GRS size A and B) and AVPs for GRS sizes up to size E (from size A-E). The current authors recommend an indwelling balloon (no hardware substitute) for very large gastric variceal system (GRS size F). Substituting the indwelling balloon for hardware in size F and potentially size E GRS can also be risky. The current article describes the techniques of placing up to 16-mm AVPs through balloon occlusion guide catheters and then deflating the balloon once it has been substituted with the AVPs. In addition, 22-mm AVPs can be placed through sheaths once the balloon occlusion catheters are removed to further augment the 16-mm Amplatzer occlusion. To date, there are no studies describing, let alone evaluating, the clinical feasibility of performing BRTO without indwelling balloons. The described techniques have been successfully performed by the current authors. However, the long-term safety and effectiveness of these techniques is yet to be determined. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Ultrathin disposable gastroscope for screening and surveillance of gastroesophageal varices in patients with liver cirrhosis: a prospective comparative study.

    Science.gov (United States)

    Huynh, Dep K; Toscano, Leanne; Phan, Vinh-An; Ow, Tsai-Wing; Schoeman, Mark; Nguyen, Nam Q

    2017-06-01

    This study aims to evaluate the role of unsedated, ultrathin disposable gastroscopy (TDG) against conventional gastroscopy (CG) in the screening and surveillance of gastroesophageal varices (GEVs) in patients with liver cirrhosis. Forty-eight patients (56.4 ± 1.3 years; 38 male, 10 female) with liver cirrhosis referred for screening (n = 12) or surveillance (n = 36) of GEVs were prospectively enrolled. Unsedated gastroscopy was initially performed with TDG, followed by CG with conscious sedation. The 2 gastroscopies were performed by different endoscopists blinded to the results of the previous examination. Video recordings of both gastroscopies were validated by an independent investigator in a random, blinded fashion. Endpoints were accuracy and interobserver agreement of detecting GEVs, safety, and potential cost saving. CG identified GEVs in 26 (54%) patients, 10 of whom (21%) had high-risk esophageal varices (HREV). Compared with CG, TDG had an accuracy of 92% for the detection of all GEVs, which increased to 100% for high-risk GEVs. The interobserver agreement for detecting all GEVs on TDG was 88% (κ = 0.74). This increased to 94% (κ = 0.82) for high-risk GEVs. There were no serious adverse events. Unsedated TDG is safe and has high diagnostic accuracy and interobserver reliability for the detection of GEVs. The use of clinic-based TDG would allow immediate determination of a follow-up plan, making it attractive for variceal screening and surveillance programs. (Clinical trial (ANZCTR) registration number: ACTRN12616001103459.). Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  12. 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 ...

  13. Esophagus after injection sclerotherapy of varices

    Energy Technology Data Exchange (ETDEWEB)

    Brambs, H J; Billmann, P; Hoppe-Seyler, P; Buechsel, R

    1985-11-01

    Endoscopic sclerotherapy of esophageal varices is a widely used procedure. It reduces the frequency of rebleeding and improves the survival of cirrhotics with portal hypertension. The intravariceal or paravariceal injection of sclerosing agents causes structural changes of the esophageal wall recognisable radiologically. Stricture is a late complication which occurs in about 10 percent. In residual dysphagia balloon dilatation is recommended.

  14. Fluoroscopically-guided foam sclerotherapy with sodium morrhuate for the treatment of lower extremity varices

    International Nuclear Information System (INIS)

    Wang Haiting; Jiang Zhongpu; Zhou Yi

    2011-01-01

    Objective: To evaluate fluoroscopically-guided foam sclerotherapy with injection of domestic sodium morrhuate in treating lower extremity varices. Methods: A total of 30 cases (39 diseased lower limbs) with lower extremity varices were enrolled in this study. Under fluoroscopic guidance foam sclerotherapy with injection of domestic sodium morrhuate was carried out in all patients. The obstructed condition of the great saphenous vein was observed during the following three months. Results: The technical success was achieved in all 39 patients. The mean dose of foam sclerosant used for each diseased limb was 5.9 ml (3.4-8.2 ml). Disappearance of blood flow reflux in lower extremity vein immediately after the treatment was seen in 35 patients (90%). Three months after the therapy, vascular sonography showed that the great saphenous vein was obstructed, and no serious complications occurred. Conclusion: For the treatment of lower extremity varices, fluoroscopically-guided foam sclerotherapy with injection of domestic sodium morrhuate is safe and effective with satisfactory results. This technique is a newly-developed micro-invasive therapy for lower extremity varices. (authors)

  15. A Rare Case of Gastric Variceal Hemorrhage Secondary to Infiltrative B-Cell Lymphoma

    Directory of Open Access Journals (Sweden)

    Adrienne Lenhart

    2016-10-01

    Full Text Available Portal hypertension commonly arises in the setting of advanced liver cirrhosis and is the consequence of increased resistance within the portal vasculature. Less commonly, left-sided noncirrhotic portal hypertension can develop in a patient secondary to isolated obstruction of the splenic vein. We present a rare case of left-sided portal hypertension and isolated gastric varices in a patient with large B-cell lymphoma, who was treated with splenic artery embolization. The patient is a 73-year-old male with no previous history of liver disease, who presented with coffee ground emesis and melena. On admission to hospital, he was found to have a hemoglobin level of 3.4 g/l. Emergent esophagogastroduodenoscopy showed isolated bleeding gastric varices (IGV1 by Sarin classification in the fundus and cardia with subsequent argon plasma coagulation injection. He was transferred to our tertiary center where work-up revealed normal liver function tests, and abdominal ultrasound showed patent hepatic/portal vasculature without cirrhosis. MRI demonstrated a large heterogeneously enhancing mass in the pancreatic tail, with invasion into the spleen and associated splenic vein thrombosis. Surgery consultation was obtained, but urgent splenectomy was not recommended. The patient instead underwent splenic artery embolization to prevent future bleeding from his known gastric varices. Pathology from a CT-guided biopsy was consistent with diffuse large B-cell lymphoma. PET imaging showed uptake in the splenic hilum/pancreatic tail region with no additional metastatic involvement. He was evaluated by the Hematology Department to initiate R-CHOP chemotherapy. During his outpatient follow-up, he reported no further episodes of melena or hematemesis. To the best of our knowledge, there have only been two published case reports of large B-cell lymphoma causing upper gastrointestinal bleeding from isolated gastric varices. These cases were treated with splenectomy or

  16. The clinical results of balloon-occluded retrograde transvenous obliteration in treatment of gastric varices compared with transjugular intrahepatic portosystemic shunt

    International Nuclear Information System (INIS)

    Lee, Nam Kyung; Kim, Chang Won; Jeon, Ung Bae; Kim, Suk; Lee, Jun Woo; Jo, Mong; Heo, Jeong

    2007-01-01

    To compare the clinical results of BRTO in the gastric varices with those of TIPS. From January 2004 to March 2006, eight patients who had been followed up for more than 1 month after BRTO were enrolled in this study. This study compared the clinical efficacy of BRTO with than of TIPS in 13 patients who had undergone TIPS from January 2000 to March 2006. The change in laboratory parameters before and after each procedure and the incidence of rebleeding, encephalopathy, asictes and varices were analyzed after each procedure. In the BRTO group, the level of albumin increased, and the levels of ammonia and the Child-Pugh score decreased. The TIPS group showed no improvement in the liver function. In the BRTO group, the gastric varices were eradicated in 7 patients. Gastric variceal rebleeding and encephalopathy did not occur. However, the esophageal varices worsened in 6 patients. In the TIPS group, rebleeding (n = 4), encephalopathy (n = 7) and a worsening of the gastric (n = 5) or esophageal varices (n = 2) occurred. BRTO improves the metabolic activity of the liver and has a lower incidence of encephalopathy. Hence, BRTO is a good alternative to TIPS in the gastric varices accompanied by a gastrorenal shunt although a treatment for a worsening of the esophageal varices may be needed after BRTO

  17. The clinical results of balloon-occluded retrograde transvenous obliteration in treatment of gastric varices compared with transjugular intrahepatic portosystemic shunt

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Nam Kyung; Kim, Chang Won; Jeon, Ung Bae; Kim, Suk; Lee, Jun Woo; Jo, Mong; Heo, Jeong [Pusan National University School of Medicine, Busan (Korea, Republic of)

    2007-03-15

    To compare the clinical results of BRTO in the gastric varices with those of TIPS. From January 2004 to March 2006, eight patients who had been followed up for more than 1 month after BRTO were enrolled in this study. This study compared the clinical efficacy of BRTO with than of TIPS in 13 patients who had undergone TIPS from January 2000 to March 2006. The change in laboratory parameters before and after each procedure and the incidence of rebleeding, encephalopathy, asictes and varices were analyzed after each procedure. In the BRTO group, the level of albumin increased, and the levels of ammonia and the Child-Pugh score decreased. The TIPS group showed no improvement in the liver function. In the BRTO group, the gastric varices were eradicated in 7 patients. Gastric variceal rebleeding and encephalopathy did not occur. However, the esophageal varices worsened in 6 patients. In the TIPS group, rebleeding (n = 4), encephalopathy (n = 7) and a worsening of the gastric (n = 5) or esophageal varices (n = 2) occurred. BRTO improves the metabolic activity of the liver and has a lower incidence of encephalopathy. Hence, BRTO is a good alternative to TIPS in the gastric varices accompanied by a gastrorenal shunt although a treatment for a worsening of the esophageal varices may be needed after BRTO.

  18. Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: A randomized, controlled trial

    DEFF Research Database (Denmark)

    Bosch, Jaime; Thabut, Dominique; Albillos, Agustín

    2008-01-01

    A beneficial effect of recombinant activated factor VII (rFVIIa) in Child-Pugh class B and C patients with cirrhosis who have variceal bleeding has been suggested. This randomized controlled trial assessed the efficacy and safety of rFVIIa in patients with advanced cirrhosis and active variceal...

  19. Prospective study of bacteremia rate after elective band ligation and sclerotherapy with cyanoacrylate for esophageal varices in patients with advanced liver disease.

    Science.gov (United States)

    Bonilha, Danielle Queiroz; Correia, Lucianna Motta; Monaghan, Marie; Lenz, Luciano; Santos, Marcus; Libera, Ermelindo Della

    2011-01-01

    Band ligation (BL) is the most appropriate endoscopic treatment for acute bleeding or prophylaxis of esophageal variceal bleeding. Sclerotherapy with N-butyl-2-cyanoacrylate (CY) can be an alternative for patients with advanced liver disease. Bacteremia is an infrequent complication after BL while the bacteremia rate following treatment with CY for esophageal varices remains unknown. To evaluate and compare the incidence of transient bacteremia between cirrhotic patients submitted to diagnostic endoscopy, CY and BL for treatment of esophageal varices. A prospective study comprising the period from 2004 to 2007 was conducted at Hospital of Universidade Federal de São Paulo, UNIFESP, SP, Brazil. Cirrhotic patients with advanced liver disease (Child-Pugh B or C) were enrolled. The patients were divided into two groups according treatment: BL Group (patients undergoing band ligation, n = 20) and CY Group (patients receiving cyanoacrylate injection for esophageal variceal, n = 18). Cirrhotic patients with no esophageal varices or without indication for endoscopic treatment were recruited as control (diagnostic group n = 20). Bacteremia was evaluated by blood culture at baseline and 30 minutes after the procedure. After 137 scheduled endoscopic procedures, none of the 58 patients had fever or any sign suggestive of infection. All baseline cultures were negative. No positive cultures were observed after CY or in the control group - diagnostic endoscopy. Three (4.6 %) positive cultures were found out of the 65 sessions of band ligation (P = 0.187). Two of these samples were positive for coagulase-negative staphylococcus, which could be regarded as a contaminant. The isolated microorganism in the other case was Klebsiella oxytoca. The patient in this case presented no evidence of immunodeficiency except liver disease. There was no significant difference in bacteremia rate between these three groups. BL or CY injection for non-bleeding esophageal varices may be considered

  20. Combined embolization with multiple materials for the treatment of esophagogastric varices: an analysis of clinical therapeutic effect

    International Nuclear Information System (INIS)

    Lu Yanping; Qin Haopu; Zhang Mengzeng

    2011-01-01

    Objective: To evaluate the clinical efficacy of percutaneous transhepatic combined embolization with multiple materials in treating esophagogastric varices. Methods: A total of 48 patients with esophagogastric varices complicated by bleeding due to ruptured varices were enrolled in this study. Percutaneous transhepatic combined embolization with Gelfoam, ethanol and stainless steel coils was carried out in all patients. The clinical results were analyzed. Results: Superselective catheterization and subsequent combined embolization procedure were successfully completed in all patients. In 17 patients with acute upper gastrointestinal bleeding, one died seven days after the treatment because of general failure. Postoperative gastroscopic examination was performed in 33 patients, which showed that esophagogastric varices were completely obliterated in 27 patients and markedly improved in six patients. A total of 35 patients were followed up for 4-36 months. During the follow-up period rebleeding occurred in 5 and death in 2 patients. Conclusion: For the treatment of esophagogastric varices, combined embolization with multiple materials is mini-invasive, safe and effective. It is of value to popularize this technique in clinical practice. (authors)

  1. Management of stomal varices with transvenous obliteration utilizing sodium tetradecyl sulfate foam sclerosis.

    Science.gov (United States)

    Saad, Wael E A; Schwaner, Sandra; Lippert, Allison; Sabri, Saher S; Al-Osaimi, Abdullah; Matsumoto, Alan H; Angle, John F; Caldwell, Stephen

    2014-12-01

    The management of parastomal varices is not established. Transjugular intrahepatic portosystemic shunt (TIPS) creation is the most commonly described treatment; however, the rebleed rate after TIPS is 21-37%. The purpose of the study is to determine the effectiveness of transvenous obliteration using sodium tetradecyl sulfate (STS) and to describe a new simplified technique in obliterating these varices. Four patients are presented who underwent transvenous obliteration using STS. One was obliterated using balloon occlusion from the systemic veins, the second was obliterated without balloon from a transhepatic antegrade approach, and the last two patients were obliterated using the direct antegrade technique. This simplified technique requires only a micropuncture kit (not requiring balloons or coils) and ultrasound transducer compression of the systemic draining veins, relying on high portal pressure to keep the sclerosant confined to the varices. The sclerosant is essentially trapped between the portal pressure and the ultrasound-transducer compression (10-15 min). Technical success was achieved in all four patients without procedural or postprocedural complications and no rebleeding for a mean follow-up of 17 (range 2-33) months. Transvenous obliteration of parastomal varices utilizing STS as a sclerosant is safe and effective. The newly described technique is simple, feasible, and requires minimal equipment (no balloons or coils or catheters).

  2. Therapeutic effects of percutaneous transhepatic variceal embolization combined with partial splenic embolization for portal hypertention

    International Nuclear Information System (INIS)

    Hua Yingxue; Yan Zhiping; Cheng Yongde; Qiao Delin; Zhou Bing; Chen Shiwei; Li Yong

    2007-01-01

    Objective: To evaluate the efficiency of percutaneous transhepatic variceal embolization (PTVE) combined with patial splenic embolization (PES)for portal hypertension. Methods: 30 patients with critical portal hypertension were divided randomly into two groups, 15 patients of A group underwent PSE PTVE combined with PSE and 15 of B group underwent PES only. The changes of collateral circulation of the two groups were compared via color Doppler ultrasonography pre-and postoperatively. Results: The hypersplenism was well controlled in both groups after PTVE and PSE. The varices of A group were embolized completely, the flow rate and velocity of portal blood stream were significantly reduced (P<0.05). In addition, the flow rate and velocity together with inner diameter of the azygous vein decreased (P<0.01), but no change shown on portal vein diameter, only with decrease of blood flow and velocity postoperatively were shown in the two groups (P<0.05). During 13-16 months follow-up, gastroesophageal variceal bleeding appeared in 2 patients and formation of portal thrombi in 1 patients of B group. There was no gastroesophageal variceal bleeding in A group but 2 patients appeared portal hypertensive gastroenteropathy (PHG)under endoscopic confirmations. Conclusion: PTVE combined PSE is very efficient for gastroesophageal variceal bleeding and hypersplenism due to portal hypertension, especially for patients with poor hepatic function, possessing simple, economic, less invasive properties and deserving to be recommended. (authors)

  3. Evaluation of percutaneous transhepatic gastroesophageal varices embolization

    International Nuclear Information System (INIS)

    Yao Hongxiang; Chen Gensheng; Sun Huiling; Zeng Yun; Yan Zhiping

    2008-01-01

    Objective: To evaluate the clinical application of percutaneous transheaptic gastroesophgeal varices embolization (PTVE) for treatment and prevention of acute upper gastrointestinal bleeding in patients with cirrhotic portal hypertension. Methods: 48 patients with cirrhotic portal hypertension and gastroesophageal varices were treated with PTVE for the prevention and control of upper gastrointestinal bleeding. Results: The technical success of PTVE was 97.9% and the rate of hemostasis was 100%. During the procedure, steel coil displacement occurred in 1 case, vagus nerve reflection with blood pressure degression and heart rate decline in 4 cases. After the procedure, 1 patients developed refractory ascites and 1 patients died of abdominal bleeding. 2 cases died of hepatic failure and 2 cases occurred rehaemorrhagia in fore 6 mon. after one year follow-up; 3 cases losed follow-up and 5 cases occurred rehaemorrhagia in the late 6 mon. Conclusion: PTVE is mini-invasive and efficient in treating acute upper gastrointestinal bleeding in patients with cirrhotic portal hypertension. Increase of technical success and decreases of morbidity can be achieved on the condition of' proper maneuver. (authors)

  4. Balloon occlusion retrograde transvenous obliteration of gastric varices in two-cirrhotic patients with portal vein thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Borhei, Peyman; Kim, Seung Kwon; Zukerman, Darryl A [Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis (United States)

    2014-02-15

    This report describes two non-cirrhotic patients with portal vein thrombosis who underwent successful balloon occlusion retrograde transvenous obliteration (BRTO) of gastric varices with a satisfactory response and no complications. One patient was a 35-year-old female with a history of Crohn's disease, status post-total abdominal colectomy, and portal vein and mesenteric vein thrombosis. The other patient was a 51-year-old female with necrotizing pancreatitis, portal vein thrombosis, and gastric varices. The BRTO procedure was a useful treatment for gastric varices in non-cirrhotic patients with portal vein thrombosis in the presence of a gastrorenal shunt.

  5. 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

  6. Endoscopic ultrasound-guided coil or glue injection in post-cyanoacrylate gastric variceal re-bleed.

    Science.gov (United States)

    Mukkada, Roy J; Antony, Rajesh; Chooracken, Mathew J; Francis, Jose V; Chettupuzha, Antony P; Mathew, Pradeep G; Augustine, Philip; Koshy, Abraham

    2018-04-09

    N-butyl-cyanoacrylate injection is recommended in bleeding/recently bled gastric varices. However, cyanoacrylate injection is associated with re-bleed in 25% to 50% of patients. Endoscopic ultrasound (EUS)-guided coil application is an emerging treatment modality for bleeding gastric varices. The aim of this study was to compare EUS-guided coil application combined with or without cyanoacrylate glue injection to injection alone in post-glue gastric variceal re-bleed. A retrospective analysis of a prospectively maintained database was performed. Thirty patients who re-bled after cyanoacrylate injection and who had EUS-guided coil application to gastric varices were included. The comparison was done with data of 51 patients who had only repeat cyanoacrylate injection. Both groups had a follow up for 12 months. EUS-guided coil application was done under endosonographic guidance. A single coil was placed in 7, two coils in each of 13 patients, three in 5, four in 3, five in one, and 6 coils in one patient. In addition, cyanoacrylate glue injection was given in 15 patients. Eight patients had repeat EUS-guided coil application 1 month later. Re-bleed and mortality were assessed. Coilng: Six out of 30 (20%) patients re-bled during follow up of 9 to 365 days. Three out of 30 (10%) died. One patient died 9 days after the procedure due to acute respiratory distress syndrome, one died 4 months after the procedure due to a re-bleed and one 5 months after the procedure due to spontaneous bacterial peritonitis. Glue only: 26/51 (51%) re-bled during follow up of 45 to 365 days. EUS-guided coil application resulted in significantly less re-bleed than glue-only (Kaplan-Meir survival analysis with log-rank test, z = 5.4, p guided coil application with/without cyanoacrylate injection for the obliteration of gastric varices is effective for post-cyanoacrylate gastric variceal re-bleed.

  7. Determination of frequency and treatment outcome in patients of fundal varices presenting with upper gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Naseer, M.; Khan, A.U.; Gillani, F.M.; Saeed, F.; Ahmed, S.

    2012-01-01

    Objective: To determine the frequency of fundal varices and treatment outcome with histoacryl in patients presenting with upper GI bleeding. Design: Single centre, retrospective study. Place and duration of study: Military Hospital Rawalpindi from Jan 2009 to July 2011. Methods: Total 1327 patients were included in the study. In 41(3.1%) patients fundal varices were diagnosed on upper GI endoscopy. The mean age of the patients was 48.1+-16.96 years. Minimum age was 12 years and maximum age was 85 years. Out of 41 patients 29 (70.73%) were male and 12 (29.3%) were female. GOV1 was seen in 28 (68.3%) patients, GOV2 in 10 (24.4%) patients, IGV1 in 2 (4.87%) patients, and IGV2 in 1 patient (2.43%). Conclusion: The frequency of fundal varices in our study was 3.1%, diagnosed on upper GI endoscopy. N-butyl-2-cyanoacrylate sclerotherapy was found to be highly effective for the treatment of active bleeding gastric varices. (author)

  8. Banding ligation versus no intervention for primary prevention in adults with oesophageal varices

    DEFF Research Database (Denmark)

    Yong, Charles Wei Kit; Vadera, Sonam; Morgan, Marsha Y.

    2017-01-01

    This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the beneficial and harmful effects of banding ligation versus no intervention in adults with cirrhosis and gastro-oesophageal varices that have not bled.......This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the beneficial and harmful effects of banding ligation versus no intervention in adults with cirrhosis and gastro-oesophageal varices that have not bled....

  9. Percutaneous transsplenic varices embolization for upper gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Zhang Qiang; Li Jingyu; Lu Junliang; Xu Liyang; Liu Tao

    2010-01-01

    Objective: To investigate the value of percutaneous transsplenic varices embolization (PTSVE) for treatment of upper gastrointestinal bleeding. Methods: Twenty cases with liver cirrhosis and portal hypertension suffered upper gastrointestinal bleeding. PTSVE was administered to them with hardener and coils. Among them, 8 cases had massive hepatocellular carcinoma (HCC) in right lobe; 10 cases with hepatocellular carcinoma had portal vein tumor thrombus and occlusion; the other two cases with liver cirrhosis had portal vein thrombosis. All of these cases were not suitable for percutaneous transhepatic varices embolization (PTHVE). PTSVE was performed under the guidance of fluoroscopy. Results: Technical success was achieved in 18 patients. A total of 35 gastric coronary veins were embolized. In all these cases, upper gastrointestinal bleeding stopped after PTSVE. There was no recurrence within 1 month follow-up. No serious complication occurred. Conclusion: PTSVE is a safe and efficient alternative treatment for upper gastrointestinal bleeding, especially for cases with portal vein occlusion or with massive HCC in right lobe of liver. (authors)

  10. Clinical value of acoustic radiation force impulse in quantitative prediction of the degree of esophageal varices in patients with liver cirrhosis

    Directory of Open Access Journals (Sweden)

    CHEN Min

    2018-01-01

    Full Text Available Objective To investigate the clinical value of acoustic radiation force impulse (ARFI in quantitative prediction of the degree of esophageal varices in patients with cirrhotic portal hypertension. Methods A total of 116 patients with liver cirrhosis who were admitted to 302 Hospital of PLA from October 2014 to February 2016 were enrolled. ARFI was used to measure real-time liver and spleen stiffness for all patients. With the degree of esophageal varices determined by gastroscopy as the gold standard for diagnosis, these patients were divided into non-varices group (EV0, 16 patients, mild varices group (EV1, 39 patients, moderate varices group (EV2, 26 patients, and severe varices group (EV3, 35 patients. The receiver operating characteristic (ROC curve was used to analyze the clinical value of liver/spleen ARFI in predicting the degree of esophageal varices. An analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, and the least significant difference Mann-Whitney U test was used for further comparison between any two groups; the chi-square test was used for comparison of categorical data between groups. The Spearman correlation analysis was used to investigate the correlation between the stiffness measured by ARFI and the degree of esophageal varices. Results The ARFI value of the spleen was 2.54±0.34 m/s for EV0 patients, 3.05±0.34 m/s for EV1 patients, 3.48±0.50 m/s for EV2 patients, and 3.69±0.33 m/s for EV3 patients (χ2=60.121,P<0.001. The ARFI value of the spleen was positively correlated with the grade of esophageal varices (r=0.713, P<0.001. The areas under the ROC curve for the ARFI value of the spleen in the diagnosis of ≥EV1, ≥EV2, or EV3 esophageal varices were 0.93, 0.88, and 0.83, respectively. There was no significant difference in the ARFI value of the liver between groups (P=0.085, and the ARFI value of the liver was not correlated with the degree of

  11. [Frequency and mortality by rebleeding in cirrhotic patients treated for bleeding esophagic varices in two hospitals in Lima Peru during years 2009 to 2011].

    Science.gov (United States)

    Pichilingue Reto, Catherina; Queirolo Rodriguez, Fiorella Sabrinna; Ruiz Llenque, José Jonathan; Bravo Paredes, Eduar; Guzmán Rojas, Patricia; Gallegos López, Roxana; Corzo Maldonado, Manuel Alejandro; Valdivia Roldán, Mario

    2013-01-01

    During the first 6 weeks after a variceal hemorrhage there is a 30-40% of probability of recurrence and those who rebleed 20- 30% die. Passed this period, the risk of rebleeding is of 60% and reaches a mortality of 60-70% in two years without treatment. Describe the frequency of rebleeding and mortality due to rebleeding in cirrhotic patients treated for variceal hemorrhage at Endoscopic Centers of Hospital Nacional Cayetano Heredia, Lima, Peru and Hospital Nacional Arzobispo Loayza, Lima, Peru during the years 2009-2011. The study type is a transversal, periodic and retrospective one in which were included 176 cirrhotic patients older than 14 years who have bleed for esophageal varices and that have received endoscopic therapy. The instruments used were a data sheet with all the information obtained from the clinical chart of each patient, the CHILD score to assess severity of hepatic disease, endoscopic informs and phone calls. The frequency of rebleeding before 6 weeks was 32.20% (56 patients). Also, the frequency of rebleeding after that time was 22.56% (37 patients). There was a mortality rate of 5.70% (10 patients) and a mortality rate due to rebleeding of 13.33% (6 patients). Variceal hemorrhage is an important cause of mobimortality in peruvian people. The frequency of rebleeding and mortality due to rebleeding resulted slightly lower than in other countries.

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

    Directory of Open Access Journals (Sweden)

    Moon Han Choi

    2013-09-01

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

  13. Plug-assisted retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage

    International Nuclear Information System (INIS)

    Chang, Min Yung; Kim, Man Deuk; Shin, Won Seon; Shin, Min Woo; Kim, Gyoung Min; Won, Jong Yun; Park, Sung Il; Lee, Do Yun; Kim, Tae Hwan

    2016-01-01

    To evaluate the feasibility, safety, and clinical outcomes of plug-assisted retrograde transvenous obliteration (PARTO) to treat gastric variceal hemorrhage in patients with portal hypertension. From May 2012 to June 2014, 19 patients (11 men and 8 women, median age; 61, with history of gastric variceal hemorrhage; 17, active bleeding; 2) who underwent PARTO using a vascular plug and a gelfoam pledget were retrospectively analyzed. Clinical and laboratory data were examined to evaluate primary (technical and clinical success, complications) and secondary (worsening of esophageal varix [EV], change in liver function) end points. Median follow-up duration was 11 months, from 6.5 to 18 months. The Wilcoxon signed-rank test was used to compare laboratory data before and after the procedure. Technical success (complete occlusion of the efferent shunt and complete filling of gastric varix [GV] with a gelfoam slurry) was achieved in 18 of 19 (94.7%) patients. The embolic materials could not reach the GV in 1 patient who had endoscopic glue injection before our procedure. The clinical success rate (no recurrence of gastric variceal bleeding) was the same because the technically failed patient showed recurrent bleeding later. Acute complications included fever (n = 2), fever and hypotension (n = 2; one diagnosed adrenal insufficiency), and transient microscopic hematuria (n = 3). Ten patients underwent follow-up endoscopy; all exhibited GV improvement, except 2 without endoscopic change. Five patients exhibited aggravated EV, and 2 of them had a bleeding event. Laboratory findings were significantly improved after PARTO. PARTO is technically feasible, safe, and effective for gastric variceal hemorrhage in patients with portal hypertension

  14. Plug-assisted retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Min Yung; Kim, Man Deuk; Shin, Won Seon; Shin, Min Woo; Kim, Gyoung Min; Won, Jong Yun; Park, Sung Il; Lee, Do Yun [Dept. of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Tae Hwan [Dept. of Radiology, National Health Insurance Serivce Ilsan Hospital, Goyang (Korea, Republic of)

    2016-04-15

    To evaluate the feasibility, safety, and clinical outcomes of plug-assisted retrograde transvenous obliteration (PARTO) to treat gastric variceal hemorrhage in patients with portal hypertension. From May 2012 to June 2014, 19 patients (11 men and 8 women, median age; 61, with history of gastric variceal hemorrhage; 17, active bleeding; 2) who underwent PARTO using a vascular plug and a gelfoam pledget were retrospectively analyzed. Clinical and laboratory data were examined to evaluate primary (technical and clinical success, complications) and secondary (worsening of esophageal varix [EV], change in liver function) end points. Median follow-up duration was 11 months, from 6.5 to 18 months. The Wilcoxon signed-rank test was used to compare laboratory data before and after the procedure. Technical success (complete occlusion of the efferent shunt and complete filling of gastric varix [GV] with a gelfoam slurry) was achieved in 18 of 19 (94.7%) patients. The embolic materials could not reach the GV in 1 patient who had endoscopic glue injection before our procedure. The clinical success rate (no recurrence of gastric variceal bleeding) was the same because the technically failed patient showed recurrent bleeding later. Acute complications included fever (n = 2), fever and hypotension (n = 2; one diagnosed adrenal insufficiency), and transient microscopic hematuria (n = 3). Ten patients underwent follow-up endoscopy; all exhibited GV improvement, except 2 without endoscopic change. Five patients exhibited aggravated EV, and 2 of them had a bleeding event. Laboratory findings were significantly improved after PARTO. PARTO is technically feasible, safe, and effective for gastric variceal hemorrhage in patients with portal hypertension.

  15. Gallbladder varices in extrahepatic portal venous obstruction: demonstration by intravenous

    International Nuclear Information System (INIS)

    Gulati, M.

    2002-01-01

    Full text: We performed a prospective study to determine frequency of presence of gallbladder varices (GBV) by intravenous CT portography (CTP) in patients with extrahepatic portal venous obstruction (EHPVO). 90 patients (age range: 2-55 years) with EHPVO (initially diagnosed on abdominal sonography) underwent CTP using a subsecond helical CT scanner. Axial overlapping sections of 2mm were obtained with collimation 3mm and table speed 4.5mm/sec (pitch 1.5). Presence and patterns of GBV were studied. CTP demonstrated GBV in 54 (60%) of 90 patients.GBV were said to be present when one or more of the following findings were seen: diffuse wall enhancement (26/90), pinpoint areas of enhancement in GB wall (33/90), obvious large collaterals in GB wall (8/90) and pericholecystic collaterals (49/90). Presence of GBV did not correlate with the site and extent of EHPVO. Contiguous intrahepatic collaterals extending from GB bed to intrahepatic portal vein branches were seen in 41 of 54 (76%) of patients with GBV, suggesting the role of GBV serving as bridging portoportal collaterals. Hepatic perfusion defects were seen in 5/54 patients with GBV and were not seen in remaining 36/90 patients of EHPVO. GB calculi were seen in only 4/54 cases with GBV (as determined on sonography) suggesting no increase in risk for cholelithiasis. GBV commonly develop as bridging collaterals in patients with EHPVO. CTP is very useful in detecting these varices and planning biliary surgery, given the frequency of iatrogenic surgical bleeding in these patients. Copyright (2002) Blackwell Science Pty Ltd

  16. Customization of laparoscopic gastric devascularization and splenectomy for gastric varices based on CT vascular anatomy.

    Science.gov (United States)

    Kawanaka, Hirofumi; Akahoshi, Tomohiko; Nagao, Yoshihiro; Kinjo, Nao; Yoshida, Daisuke; Matsumoto, Yoshihiro; Harimoto, Norifumi; Itoh, Shinji; Yoshizumi, Tomoharu; Maehara, Yoshihiko

    2018-01-01

    Laparoscopic gastric devascularization(Lap GDS) and splenectomy (SPL) for gastric varices is technically challenging because of highly developed collateral vessels and bleeding tendency. We investigated the feasibility of customization of Lap GDS and SPL based on CT vascular anatomy. We analyzed 61 cirrhotic patients with gastric varices who underwent Lap GDS and SPL between 2006 and 2014. Lap GDS was customized according to the afferent feeding veins (left gastric vein (LGV) and/or posterior gastric vein (PGV)/short gastric vein (SGV)) and efferent drainage veins (gastrorenal shunt and/or gastrophrenic shunt, or numerous retroperitoneal veins) based on CT imaging. Thirty-four patients with efferent drainage veins suitable for balloon-occluded retrograde transvenous obliteration (B-RTO) underwent B-RTO instead of surgical GDS, with subsequent Lap SPL. Among 27 patients with gastric varices unsuitable for B-RTO, 15 patients with PGV/SGV underwent Lap GDS of the greater curvature and SPL, and 12 patients with LGV or LGV/PGV/SGV underwent Lap GDS of the greater and lesser curvature and SPL. The mean operation time was 294 min and mean blood loss was 198 g. There was no mortality or severe morbidity. Gastric varices were eradicated in all 61 patients, with no bleeding or recurrence during a mean follow-up of 55.9 months. The cumulative 3-, 5-, and 7-year survival rates were 92, 82, and 64%, respectively. Lap GDS and SPL customized based on CT vascular anatomy is a safe and effective procedure for treating gastric varices.

  17. Treatment of Esophageal Variceal Hemorrhage with Self-Expanding Metal Stents as a Rescue Maneuver in a Swiss Multicentric Cohort

    Directory of Open Access Journals (Sweden)

    Fabienne C. Fierz

    2013-03-01

    Full Text Available Acute esophageal variceal bleeding in patients with portal hypertension remains a complication with a high mortality today. In cases refractory to standard therapy including endoscopic band ligation and pharmacological therapy, traditionally balloon tamponade has been used as salvage therapy. However, these techniques show several important limitations. Self-expanding metal stents (SEMS have been proposed as an alternative rescue treatment. The use of variceal stenting in 7 patients with a total of 9 bleeding episodes in three different Swiss hospitals is demonstrated. While immediate bleeding control is achieved in a high percentage of cases, the 5-day and 6-week mortality rate remain high. Mortality is strongly influenced by the severity of the underlying liver disease. Accordingly, our data represent a high-risk patient collective. Thanks to their safety and easy handling, SEMS are an interesting alternative to balloon tamponade as a bridging intervention to definitive therapy including the pre-hospital setting.

  18. Regression of esophageal varices and splenomegaly in two patients with hepatitis-C-related liver cirrhosis after interferon and ribavirin combination therapy

    Directory of Open Access Journals (Sweden)

    Soon Jae Lee

    2016-09-01

    Full Text Available Some recent studies have found regression of liver cirrhosis after antiviral therapy in patients with hepatitis C virus (HCV-related liver cirrhosis, but there have been no reports of complete regression of esophageal varices after interferon/peg-interferon and ribavirin combination therapy. We describe two cases of complete regression of esophageal varices and splenomegaly after interferon-alpha and ribavirin combination therapy in patients with HCV-related liver cirrhosis. Esophageal varices and splenomegaly regressed after 3 and 8 years of sustained virologic responses in cases 1 and 2, respectively. To our knowledge, this is the first study demonstrating that complications of liver cirrhosis, such as esophageal varices and splenomegaly, can regress after antiviral therapy in patients with HCV-related liver cirrhosis.

  19. Ektopiske varicer i den distale ileum som årsag til gastrointestinal blødning

    DEFF Research Database (Denmark)

    Thorup, Tine Juhl; Beier-Holgersen, Randi; Bruun, Jens

    2015-01-01

    Varices of the terminal ileum are not a common complication to portal hypertension but we describe a case where a 60-year-old male patient had massive, recurrent intestinal bleeding due to collateral blood supply from umbilical veins to varicose veins of the terminal ileum.......Varices of the terminal ileum are not a common complication to portal hypertension but we describe a case where a 60-year-old male patient had massive, recurrent intestinal bleeding due to collateral blood supply from umbilical veins to varicose veins of the terminal ileum....

  20. Peroral endoscopic myotomy for the treatment of achalasia in a patient with esophageal varices. A case report.

    Science.gov (United States)

    Shen, Naning; Wang, Xin; Zhang, Xiaoyin; Yao, Liping; Xie, Huahong; Zhang, Hongbo

    2017-06-01

    Achalasia is very uncommon, and rarely does achalasia co-exist with esophageal varices. We present a 62-year-old woman who was diagnosed with both achalasia and esophageal varices in December 2014 and had a past history of hematemesis. The patient's achalasia symptoms' Eckardt score was 9, and her hepatic function was Child-Pugh grade A6. After comprehensive assessment of the patient's health and discussion of the pros and cons of various therapies for achalasia, the patient underwent a peroral endoscopic myotomy. She was symptom-free after the operation and had no recurrence of achalasia symptoms at 20-month follow-up. No adverse events were reported. Peroral endoscopic myotomy for achalasia with esophageal varices has not been previously reported in the English literature.

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

    International Nuclear Information System (INIS)

    Vidal, V.; Joly, L.; Perreault, P.; Bouchard, L.; Lafortune, M.; Pomier-Layrargues, G.

    2006-01-01

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

  2. Antibiotic prophylaxis using third generation cephalosporins can reduce the risk of early rebleeding in the first acute gastroesophageal variceal hemorrhage: a prospective randomized study.

    Science.gov (United States)

    Jun, Chung-Hwan; Park, Chang-Hwan; Lee, Wan-Sik; Joo, Young-Eun; Kim, Hyun-Soo; Choi, Sung-Kyu; Rew, Jong-Sun; Kim, Sei-Jong; Kim, Young-Dae

    2006-10-01

    Bacterial infection may be a critical trigger for variceal bleeding. Antibiotic prophylaxis can prevent rebleeding in patients with acute gastroesophageal variceal bleeding (GEVB). The aim of the study was to compare prophylactic third generation cephalosporins with on-demand antibiotics for the prevention of gastroesophageal variceal rebleeding. In a prospective trial, patients with the first acute GEVB were randomly assigned to receive prophylactic antibiotics (intravenous cefotaxime 2 g q 8 hr for 7 days, prophylactic antibiotics group) or to receive the same antibiotics only when infection became evident (on-demand group). Sixty-two patients in the prophylactic group and 58 patients in the on-demand group were included for analysis. Antibiotic prophylaxis decreased infection (3.2% vs. 15.5%, p=0.026). The actuarial rebleeding rate in the prophylactic group was significantly lower than that in the on-demand group (33.9% vs. 62.1%, p=0.004). The difference of rebleeding rate was mostly due to early rebleeding within 6 weeks (4.8% vs. 20.7%, p=0.012). On multivariate analysis, antibiotic prophylaxis (relative hazard: 0.248, 95% confidence interval (CI): 0.067-0.919, p=0.037) and bacterial infection (relative hazard: 3.901, 95% CI: 1.053-14.448, p=0.042) were two independent determinants of early rebleeding. In conclusion, antibiotic prophylaxis using third generation cephalosporins can prevent bacterial infection and early rebleeding in patients with the first acute GEVB.

  3. Vascular plug-assisted retrograde transvenous obliteration for the management of gastric varices: Comparative effectiveness between gelatin sponge embolization and permanent sclerosant

    International Nuclear Information System (INIS)

    Lee, Ji Hyun; Jo, Jeong Hyun; Park, Jae Hyung; Park, Byeong Ho; Jung, Gyoo Sik

    2016-01-01

    To evaluate the short-term outcome of plug-assisted retrograde transvenous obliteration (PARTO) using vascular plugs and gelatin sponges in comparison with balloon-occluded retrograde transvenous obliteration (BRTO) for the management of gastric varices. From January 2005 to October 2014, 171 patients were referred for management of gastric varices, of which, 52 patients with hemodynamically stable gastric varices (48 recent bleeding; 4 primary prophylaxes) were evaluated. Of these, 38 received BRTO (men/women 23/15; mean age 61.3; Child-Pugh classes A/B/C = 11/25/2) and 14 underwent PARTO (men/women 11/3; mean age 63.4; Child-Pugh classes A/B/C = 9/4/1). The technical success rate, complications, variceal changes, liver function, and exacerbation of ascites/pleural effusion were compared between the 2 groups within 3 months after the procedure. The technical success rates were 92.1% in the BRTO and 100% in the PARTO group. Procedure-related early complications occurred in the BRTO group alone (8%, n = 3). Among patients with technical success, follow-up CT at 1 month was available for 98% (n = 48/49). Complete thrombosis of gastric varices was achieved in 97.1% in the BRTO and 100% in the PARTO group. Worsening of esophageal varices was observed in 24% of the BRTO group alone (n = 8). The albumin level increased significantly in both groups and aspartate aminotransferase/alanine aminotransferase level improved significantly in the PARTO group (p < 0.05). Exacerbation of ascites/pleural effusion was observed in both groups (35.2% vs. 21.4%, both p > 0.05). PARTO appears to be equivalent to BRTO for short-term management of gastric varices

  4. Vascular plug-assisted retrograde transvenous obliteration for the management of gastric varices: Comparative effectiveness between gelatin sponge embolization and permanent sclerosant

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Hyun; Jo, Jeong Hyun; Park, Jae Hyung; Park, Byeong Ho [Dept. of Radiology, Dong A University Hospital, Dong A University College of Medicine, Busan (Korea, Republic of); Jung, Gyoo Sik [Dept. of Radiology, Gospel Hospital, Kosin University College of Medicine, Busan (Korea, Republic of)

    2016-08-15

    To evaluate the short-term outcome of plug-assisted retrograde transvenous obliteration (PARTO) using vascular plugs and gelatin sponges in comparison with balloon-occluded retrograde transvenous obliteration (BRTO) for the management of gastric varices. From January 2005 to October 2014, 171 patients were referred for management of gastric varices, of which, 52 patients with hemodynamically stable gastric varices (48 recent bleeding; 4 primary prophylaxes) were evaluated. Of these, 38 received BRTO (men/women 23/15; mean age 61.3; Child-Pugh classes A/B/C = 11/25/2) and 14 underwent PARTO (men/women 11/3; mean age 63.4; Child-Pugh classes A/B/C = 9/4/1). The technical success rate, complications, variceal changes, liver function, and exacerbation of ascites/pleural effusion were compared between the 2 groups within 3 months after the procedure. The technical success rates were 92.1% in the BRTO and 100% in the PARTO group. Procedure-related early complications occurred in the BRTO group alone (8%, n = 3). Among patients with technical success, follow-up CT at 1 month was available for 98% (n = 48/49). Complete thrombosis of gastric varices was achieved in 97.1% in the BRTO and 100% in the PARTO group. Worsening of esophageal varices was observed in 24% of the BRTO group alone (n = 8). The albumin level increased significantly in both groups and aspartate aminotransferase/alanine aminotransferase level improved significantly in the PARTO group (p < 0.05). Exacerbation of ascites/pleural effusion was observed in both groups (35.2% vs. 21.4%, both p > 0.05). PARTO appears to be equivalent to BRTO for short-term management of gastric varices.

  5. Early initiation of beta blockers following primary endoscopic therapy for bleeding esophageal varices in cirrhotics

    International Nuclear Information System (INIS)

    Salim, A.; Malik, K.; Farooq, M.O.; Butt, U.; Butt, A.K.

    2017-01-01

    Beta-blockers provide secondary prophylaxis following endoscopic therapy for variceal bleeding. Guidelines recommend starting beta-blockers 6 days after endoscopy to prevent masking hemodynamic signs of rebleeding. We aimed to see safety of earlier initiation of beta-blockers. Methods: Cirrhotic patients with upper GI bleed were given I.V vasoactive agents until undergoing endoscopy. Patients with only esophageal varices as source of bleed were recruited. Vasoactive agents were discontinued following variceal banding. The patients were observed for 12-18 hours, discharged on oral carvedilol 6.25 mg BID and monitored for 6 weeks for rebleeding and mortality. Results: 50 patients were included, 27 (54%) male and 23 (46%) female. Average age was 43+3 years. Etiology of cirrhosis was HCV in 42 (84%), HBV in 6 (12%), HCV and HBV in 2 (4%) and indeterminate in 1 (2%) patient. 17 (34%) patients had Child A, 22 (44%) Child B and 11 (22%) had Child C disease. Hospital stay was under 24 hours in 24 (48%), 24-48 hours in 15 (30%) and 48-72 hours in 11 (22%) patients. 5 (10%) patients underwent EGD within 6 hours of admission, 28 (56%) within 12 hours, 14 (28%) within 24 hours and 3 (6%) within 36 hours. No rebleeding, mortality or drug related adverse effects were noted during 6 weeks after discharge. Conclusions:Our study proves possibility of shorter management of variceal bleeding by having a 12-18 hour monitoring after endoscopic banding, followed by beta-blocker initiation and discharge. This will safely reduce physical and financial burden on health services. Background: Beta-blockers provide secondary prophylaxis following endoscopic therapy for variceal bleeding. Guidelines recommend starting beta-blockers 6 days after endoscopy to prevent masking hemodynamic signs of re-bleeding. We aimed to see safety of earlier initiation of beta-blockers. Methods: Cirrhotic patients with upper GI bleed were given intravenous vasoactive agents until undergoing endoscopy. Patients

  6. Treatment of Non variceal Gastrointestinal Hemorrhage by Transcatheter Embolization

    International Nuclear Information System (INIS)

    Ali, M.; Ul Haq, T.; Salam, B.; Beg, M.; Sayani, R.; Azeemuddin, M.

    2013-01-01

    To investigate the sensitivity of mesenteric angiography, technical success of hemostasis, clinical success rate, and complications of transcatheter embolization for the treatment of acute non variceal gastrointestinal hemorrhage. Material and Methods. A retrospective review of 200 consecutive patients who underwent mesenteric arteriography for acute non variceal gastrointestinal hemorrhage between February 2004 and February 2011 was done. Results. Of 200 angiographic studies, 114 correctly revealed the bleeding site with mesenteric angiography. 47 (41%) patients had upper gastrointestinal hemorrhage and 67 (59%) patients had lower gastrointestinal hemorrhage. Out of these 114, in 112 patients (98%) technical success was achieved with immediate cessation of bleeding. 81 patients could be followed for one month. Clinical success was achieved in 72 out of these 81 patients (89%). Seven patients rebled. 2 patients developed bowel ischemia. Four patients underwent surgery for bowel ischemia or rebleeding. Conclusion. The use of therapeutic transcatheter embolization for treatment of acute gastrointestinal hemorrhage is highly successful and relatively safe with 98% technical success and 2.4% post embolization ischemia in our series. In 89% of cases it was definitive without any further intervention.

  7. von Willebrand factor as a novel noninvasive predictor of portal hypertension and esophageal varices in hepatitis B patients with cirrhosis.

    Science.gov (United States)

    Wu, Hao; Yan, Shiping; Wang, Guangchuan; Cui, Shaobo; Zhang, Chunqing; Zhu, Qiang

    2015-01-01

    At present, there is no perfect noninvasive method to assess portal hypertension and esophageal varices. Early predicting esophageal varices can provide evidence for managing cirrhotic patients. We aimed to further investigate von Willebrand factor (vWF) as a noninvasive predictor of portal hypertension, especially of esophageal varices. A total of 60 hepatitis B patients with cirrhosis and 45 healthy subjects were enrolled in this study. Levels of six markers were examined. All patients underwent hepatic venous pressure gradient (HVPG) and esophagogastroduodenoscopy. We evaluated the performance of six factors for diagnosis of portal hypertension and esophageal varices. The vWF levels in liver tissues were observed by immunohistochemistry. Correlations between the level of vWF in liver tissues and HVPG and between levels of vWF in tissues and plasma were examined. Cutoff values of plasma vWF (1510.5 mU/mL and 1701 mU/mL) showed high positive predictive value (PPV, 90.2% and 87.5%) in predicting clinically significant portal hypertension and severe portal hypertension. Cutoff values of vWF (1414 mU/ml and 1990 mU/mL, PPV 90.3% and 86.3%, respectively) were provided to detect the presence and degree of esophageal varices. Linear correlations were observed between levels of vWF in liver tissues and HVPG (r(2) = 0.552, p portal hypertension and esophageal varices in hepatitis B patients with cirrhosis. Increased levels of vWF in liver tissues may induce the elevated plasma vWF levels, but molecular mechanism is needed for further study.

  8. Safe and successful endoscopic initial treatment and long-term eradication of gastric varices by endoscopic ultrasound-guided Histoacryl (N-butyl-2-cyanoacrylate) injection

    OpenAIRE

    Gubler, Christoph; Bauerfeind, Peter

    2014-01-01

    OBJECTIVE: Optimal endoscopic treatment of gastric varices is still not standardized nowadays. Actively bleeding varices may prohibit a successful endoscopic injection therapy of Histoacryl® (N-butyl-2-cyanoacrylate). Since 2006, we have treated gastric varices by standardized endoscopic ultrasound (EUS) guided Histoacryl injection therapy without severe adverse events. MATERIAL AND METHODS: We present a large single-center cohort over 7 years with a standardized EUS-guided sclerotherapy o...

  9. A Modified APACHE II Score for Predicting Mortality of Variceal ...

    African Journals Online (AJOL)

    Conclusion: Modified APACHE II score is effective in predicting outcome of patients with variceal bleeding. Score of L 15 points and long ICU stay are associated with high mortality. Keywords: liver cirrhosis, periportal fibrosis, portal hypertension, schistosomiasis udan Journal of Medical Sciences Vol. 2 (2) 2007: pp. 105- ...

  10. Safe and successful endoscopic initial treatment and long-term eradication of gastric varices by endoscopic ultrasound-guided Histoacryl (N-butyl-2-cyanoacrylate) injection.

    Science.gov (United States)

    Gubler, Christoph; Bauerfeind, Peter

    2014-09-01

    Optimal endoscopic treatment of gastric varices is still not standardized nowadays. Actively bleeding varices may prohibit a successful endoscopic injection therapy of Histoacryl® (N-butyl-2-cyanoacrylate). Since 2006, we have treated gastric varices by standardized endoscopic ultrasound (EUS) guided Histoacryl injection therapy without severe adverse events. We present a large single-center cohort over 7 years with a standardized EUS-guided sclerotherapy of all patients with gastric varices. Application was controlled by fluoroscopy to immediately detect any glue embolization. Only perforating veins located within the gastric wall were treated. In the follow up, we repeated this treatment until varices were eradicated. Utmost patients (36 of 40) were treated during or within 24 h of active bleeding. About 32.5% of patients were treated while visible bleeding. Histoacryl injection was always technically successful and only two patients suffered a minor complication. Acute bleeding was stopped in all patients. About 15% (6 of 40) of patients needed an alternative rescue treatment in the longer course. Three patients got a transjugular portosystemic shunt and another three underwent an orthotopic liver transplantation. Mean long-term survival of 60 months was excellent. Active bleeding of gastric varices can be treated successfully without the necessity of gastric rinsing with EUS-guided injection of Histoacryl.

  11. Portal hypertension and variceal bleeding: Clinical and pharmacological aspects

    DEFF Research Database (Denmark)

    Hobolth, Lise

    2010-01-01

    Blødende esophagus varicer er en af den mest frygtede komplikationer til cirrose og portal hypertension pga. den høje mortalitet. Et klassisk studie fra 1981 opgjorde 6-ugers mortaliteten til 42%, hvoraf 75% døde indenfor den første uge. Gennem de sidste 2-3 årtier er der introduceret en række nye...

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

    DEFF Research Database (Denmark)

    Fabricius, Rasmus; Svenningsen, Peter; Hillingsø, Jens

    2016-01-01

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

  13. Development of Thrombus in a Systemic Vein after Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices

    International Nuclear Information System (INIS)

    Yoshimatsu, Rika; Yamagami, Takuji; Tanaka, Osamu; Miura, Hiroshi; Nishimura, Tsunehiko; Okuda, Kotaro; Hashiba, Mitsuoki

    2012-01-01

    To retrospectively evaluate the frequency and risk factors for developing thrombus in a systemic vein such as the infrarenal inferior vena cava or the iliac vein, in which a balloon-occluded retrograde transvenous obliteration (B-RTO) catheter was indwelled. Forty-nine patients who underwent B-RTO for gastric varices were included in this study. The B-RTO procedure was performed from the right femoral vein, and the B-RTO catheter was retained overnight in all patients. Pre- and post-procedural CT scans were retrospectively compared in order to evaluate the development of thrombus in the systemic vein in which the catheter was indwelled. Additionally, several variables were analyzed to assess risk factors for thrombus in a systemic vein. In all 49 patients (100%), B-RTO was technically successful, and in 46 patients (94%), complete thrombosis of the gastric varices was achieved. In 6 patients (12%), thrombus developed in the infrarenal inferior vena cava or the right common-external iliac vein. All thrombi lay longitudinally on the right side of the inferior vena cava or the right iliac vein. One of the aforementioned 6 patients required anticoagulation therapy. No symptoms suggestive of pulmonary embolism were observed. Prothrombin time-international normalized ratio and the addition of 5% ethanolamine oleate iopamidol, on the second day, were related to the development of thrombus. Development of a thrombus in a systemic vein such as the inferior vena cava or iliac vein, caused by indwelling of the B-RTO catheter, is relatively frequent. Physicians should be aware of the possibility of pulmonary embolism due to iliocaval thrombosis.

  14. Recurrent Bacteremia, a Complication of Cyanoacrylate Injection for Variceal Bleeding: Report of Two Cases and Review of the Literature

    Directory of Open Access Journals (Sweden)

    T. Galperine

    2009-01-01

    Full Text Available We report the first description of recurrent bacteremia in two patients after cyanoacrylate injection for gastric varices bleeding treated with antibiotics alone. Adapted and prolonged antibiotic treatment allowed a complete resolution of the infection with no relapse after more than 6 months. According to recent data, prophylactic antibiotics should be further investigated for patients with bleeding varices undergoing cyanoacrylate injection.

  15. Esophageal Stent for Refractory Variceal Bleeding: A Systemic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Xiao-Dong Shao

    2016-01-01

    Full Text Available Background. Preliminary studies suggest that covered self-expandable metal stents may be helpful in controlling esophageal variceal bleeding. Aims. To evaluate the effectiveness and safety of esophageal stent in refractory variceal bleeding in a systematic review and meta-analysis. Methods. A comprehensive literature search was conducted on PubMed, EMBASE, and Cochrane Library covering the period from January 1970 to December 2015. Data were selected and abstracted from eligible studies and were pooled using a random-effects model. Heterogeneity was assessed using I2 test. Results. Five studies involving 80 patients were included in the analysis. The age of patients ranged from 18 to 91 years. The mean duration of follow-up was 46.8 d (range, 30–60 d. The success rate of stent deployment was 96.7% (95% CI: 91.6%–99.5% and complete response to esophageal stenting was in 93.9% (95% CI: 82.2%–99.6%. The incidence of rebleeding was 13.2% (95% CI: 1.8%–32.8% and the overall mortality was 34.5% (95% CI: 24.8%–44.8%. Most of patients (87.4% died from hepatic or multiple organ failure, and only 12.6% of patients died from uncontrolled bleeding. There was no stent-related complication reported and the incidence of stent migration was 21.6% (95% CI: 4.7%–46.1%. Conclusion. Esophageal stent may be considered in patients with variceal bleeding refractory to conventional therapy.

  16. Balloon-Occluded Antegrade Transvenous Sclerotherapy to Treat Rectal Varices: A Direct Puncture Approach to the Superior Rectal Vein Through the Greater Sciatic Foramen Under CT Fluoroscopy Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Ono, Yasuyuki, E-mail: onoyasy@hirakata.kmu.ac.jp; Kariya, Shuji, E-mail: kariyas@hirakata.kmu.ac.jp; Nakatani, Miyuki, E-mail: nakatanm@hirakata.kmu.ac.jp; Yoshida, Rie, E-mail: yagir@hirakata.kmu.ac.jp; Kono, Yumiko, E-mail: kohnoy@hirakata.kmu.ac.jp; Kan, Naoki, E-mail: kanna@takii.kmu.ac.jp; Ueno, Yutaka, E-mail: uenoyut@hirakata.kmu.ac.jp; Komemushi, Atsushi, E-mail: komemush@takii.kmu.ac.jp; Tanigawa, Noboru, E-mail: tanigano@hirakata.kmu.ac.jp [Kansai Medical University, Department of Radiology (Japan)

    2015-10-15

    Rectal varices occur in 44.5 % of patients with ectopic varices caused by portal hypertension, and 48.6 % of these patients are untreated and followed by observation. However, bleeding occurs in 38 % and shock leading to death in 5 % of such patients. Two patients, an 80-year-old woman undergoing treatment for primary biliary cirrhosis (Child-Pugh class A) and a 63-year-old man with class C hepatic cirrhosis (Child-Pugh class A), in whom balloon-occluded antegrade transvenous sclerotherapy was performed to treat rectal varices are reported. A catheter was inserted by directly puncturing the rectal vein percutaneously through the greater sciatic foramen under computed tomographic fluoroscopy guidance. In both cases, the rectal varices were successfully treated without any significant complications, with no bleeding from rectal varices after embolization.

  17. Transcatheter arterial embolization for endoscopically unmanageable non-variceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Lee, Han Hee; Park, Jae Myung; Chun, Ho Jong; Oh, Jung Suk; Ahn, Hyo Jun; Choi, Myung-Gyu

    2015-07-01

    Transcatheter arterial embolization (TAE) is a therapeutic option for endoscopically unmanageable upper gastrointestinal (GI) bleeding. We aimed to assess the efficacy and clinical outcomes of TAE for acute non-variceal upper GI bleeding and to identify predictors of recurrent bleeding within 30 days. Visceral angiography was performed in 66 patients (42 men, 24 women; mean age, 60.3 ± 12.7 years) who experienced acute non-variceal upper GI bleeding that failed to be controlled by endoscopy during a 7-year period. Clinical information was reviewed retrospectively. Outcomes included technical success rates, complications, and 30-day rebleeding and mortality rates. TAE was feasible in 59 patients. The technical success rate was 98%. Rebleeding within 30 days was observed in 47% after an initial TAE and was managed with re-embolization in 8, by endoscopic intervention in 5, by surgery in 2, and by conservative care in 12 patients. The 30-day overall mortality rate was 42.4%. In the case of initial endoscopic hemostasis failure (n = 34), 31 patients underwent angiographic embolization, which was successful in 30 patients (96.8%). Rebleeding occurred in 15 patients (50%), mainly because of malignancy. Two factors were independent predictors of rebleeding within 30 days by multivariate analysis: coagulopathy (odds ratio [OR] = 4.37; 95% confidence interval [CI]: 1.25-15.29; p = 0.021) and embolization in ≥2 territories (OR = 4.93; 95% CI: 1.43-17.04; p = 0.012). Catheterization-related complications included hepatic artery dissection and splenic embolization. TAE controlled acute non-variceal upper GI bleeding effectively. TAE may be considered when endoscopic therapy is unavailable or unsuccessful. Correction of coagulopathy before TAE is recommended.

  18. Self-Expandable Metal Stents for Persisting Esophageal Variceal Bleeding after Band Ligation or Injection-Therapy: A Retrospective Study.

    Directory of Open Access Journals (Sweden)

    Martin Müller

    Full Text Available Despite a pronounced reduction of lethality rates due to upper gastrointestinal bleeding, esophageal variceal bleeding remains a challenge for the endoscopist and still accounts for a mortality rate of up to 40% within the first 6 weeks. A relevant proportion of patients with esophageal variceal bleeding remains refractory to standard therapy, thus making a call for additional tools to achieve hemostasis. Self-expandable metal stents (SEMS incorporate such a tool.We evaluated a total number of 582 patients admitted to our endoscopy unit with the diagnosis "gastrointestinal bleeding" according to our documentation software between 2011 and 2014. 82 patients suffered from esophageal variceal bleeding, out of which 11 cases were refractory to standard therapy leading to SEMS application. Patients with esophageal malignancy, fistula, or stricture and a non-esophageal variceal bleeding source were excluded from the analysis. A retrospective analysis reporting a series of clinically relevant parameters in combination with bleeding control rates and adverse events was performed.The initial bleeding control rate after SEMS application was 100%. Despite this success, we observed a 27% mortality rate within the first 42 days. All of these patients died due to non-directly hemorrhage-associated reasons. The majority of patients exhibited an extensive demand of medical care with prolonged hospital stay. Common complications were hepatic decompensation, pulmonary infection and decline of renal function. Interestingly, we found in 7 out of 11 patients (63.6% stent dislocation at time of control endoscopy 24 h after hemostasis or at time of stent removal. The presence of hiatal hernia did not affect obviously stent dislocation rates. Refractory patients had significantly longer hospitalization times compared to non-refractory patients.Self-expandable metal stents for esophageal variceal bleeding seem to be safe and efficient after failed standard therapy

  19. Treatment of symptomatic pelvic varices by ovarian vein embolization

    International Nuclear Information System (INIS)

    Capasso, Patrizio; Simons, Christine; Trotteur, Genevieve; Dondelinger, Robert F.; Henroteaux, Denis; Gaspard, Ulysse

    1997-01-01

    Purpose. Pelvic congestion syndrome is a common cause of chronic pelvic pain in women and its association with venous congestion has been described in the literature. We evaluated the potential benefits of lumboovarian vein embolization in the treatment of lower abdominal pain in patients presenting with pelvic varicosities. Methods. Nineteen patients were treated. There were 13 unilateral embolizations, 6 initial bilateral treatments and 5 treated recurrences (a total of 30 procedures). All embolizations were performed with either enbucrilate and/or macrocoils, and there was an average clinical and Doppler duplex follow-up of 15.4 months. Results. The initial technical success rate was 96.7%. There were no immediate or long-term complications. Variable symptomatic relief was observed in 73.7% of cases with complete responses in 57.9%. All 8 patients who had partial or no pain relief complained of dyspareunia. The direct relationship between varices and chronic pelvic pain was difficult to ascertain in a significant number of clinical failures. Conclusion. Transcatheter embolization of lumboovarian varices is a safe technique offering symptomatic relief of pelvic pain in the majority of cases. The presence of dyspareunia seemed to be a poor prognostic factor, indicating that other causes of pelvic pain may coexist with pelvic varicosities

  20. A combined model based on spleen stiffness measurement and Baveno VI criteria to rule out high risk varices in advanced chronic liver disease.

    Science.gov (United States)

    Colecchia, Antonio; Ravaioli, Federico; Marasco, Giovanni; Colli, Agostino; Dajti, Elton; Biase, Annarita Di; Reggiani, Maria Letizia Bacchi; Berzigotti, Annalisa; Pinzani, Massimo; Festi, Davide

    2018-05-02

    Recently, Baveno VI guidelines suggested that esophagogastroduodenoscopy (EGD) can be avoided in patients with cACLD who have a liver stiffness measurement (LSM) 150,000/mm 3 . We aimed to: assess the performance of spleen stiffness measurement (SSM) in ruling out patients with high-risk varices (HRV); validate Baveno VI criteria in a large population and assess how the sequential use of Baveno VI criteria and SSM could safely avoid the need for endoscopy. We retrospectively analysed 498 cACLD patients who had undergone LSM/SSM by transient elastography (TE) (Fibroscan®), platelet count and EGDs from 2012 to 2016 referred to our tertiary centre. The new combined model was validated internally by a split-validation method, and externally in a prospective multicentre cohort of 115 patients. SSM, LSM, platelet count and Child-Pugh-B were independent predictors of HRV. Applying the newly identified SSM cut-off (≤46 kPa) or Baveno VI criteria, 35.8% and 21.7% of patients in the internal validation cohort could have avoided EGD, with HRV being missed in only 2% in both cases. The combination of SSM with Baveno VI criteria would have led to additionally avoiding 22.5% of EGDs, reaching a final value of 43.8% spared EGDs, with <5% missed HRV. Results were confirmed in the prospective external validation cohort, as the combined Baveno VI/SSM≤46 Model would have safely spared (0 HRV missed) 37.4% of EGDs, compared to 16.5% avoiding Baveno VI Criteria only. A non-invasive prediction model combining SSM with Baveno VI criteria may be useful to rule out HRV and could make it possible to avoid a significantly larger number of unnecessary EGDs compared to Baveno VI criteria only. Spleen stiffness measurement (SSM) assessed by TE, the most widely used electrographic technique, is a non-invasive technique that can help the physician to better stratify the degree of portal hypertension and the risk of oesophageal varices in patients with cACLD. Performing SSM together with LSM

  1. Pre-treatment hemodynamic features involved with long-term survival of cirrhotic patients after embolization of gastric fundal varices

    International Nuclear Information System (INIS)

    Maruyama, Hitoshi; Okugawa, Hidehiro; Kobayashi, Satoshi; Yoshizumi, Hiroaki; Yokosuka, Osamu

    2010-01-01

    Purpose: To clarify the pre-treatment hemodynamic features involved in the long-term survival of cirrhotic patients with gastric fundal varices (FV) after balloon-occluded retrograde transvenous obliteration (B-RTO). Materials and methods: Eighty-one cirrhotic patients with medium- or large-grade FV treated by B-RTO were enrolled in this retrospective study. Pre-treatment flow volume ratio between gastric vein and portal trunk (GP-R) was obtained by Doppler ultrasound. Results: The cumulative survival rate was 90% at 1 year, 74.8% at 3 years, 57.2% at 5 years, and 45.8% at 7 years without recurrence in a median period of 1148.5 days The survival was poorer in patients with HCC (47% at 3 years, 9.4% at 5 years, p < 0.0001) than without (89.2% at 3 years, 81.9% at 5 years, 67.5% at 7 years), in patients with Child B/C (57.7% at 3 years, 42.1% at 5 years, 28.1% at 7 years, p = 0.0016) than with Child A (91.8% at 3 years, 71.5% at 5 years, 62.1% at 7 years), and in patients with GP-R ≥ 1.0 (58.9% at 3 years, p = 0.0485) than with GP-R < 1.0 (76.3% at 3 years, 62% at 5 years, 49.6% at 7 years). Multivariate analysis identified the presence of HCC (hazard ratio, 12.486; 95% CI, 4.08-38.216; p < 0.0001), Child B/C (hazard ratio, 3.41; 95% CI, 1.594-7.15; p = 0.0051) and GP-R ≥ 1.0 (hazard ratio, 2.701; 95% CI, 1.07-6.15; p = 0.0221) as independent factors for poor prognosis. Conclusion: GP-R ≥ 1.0 on Doppler ultrasound before B-RTO may be a predictive indicator for poor prognosis in cirrhotic patients with FV after B-RTO, in addition to the presence of HCC and severe liver damage.

  2. Pre-treatment hemodynamic features involved with long-term survival of cirrhotic patients after embolization of gastric fundal varices

    Energy Technology Data Exchange (ETDEWEB)

    Maruyama, Hitoshi, E-mail: maru-cib@umin.ac.j [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba, 260-8670 (Japan); Okugawa, Hidehiro, E-mail: hideun@yahoo.co.j [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba, 260-8670 (Japan); Kobayashi, Satoshi, E-mail: kobakobakopa@yahoo.co.j [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba, 260-8670 (Japan); Yoshizumi, Hiroaki, E-mail: yossih04@yahoo.co.j [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba, 260-8670 (Japan); Yokosuka, Osamu, E-mail: yokosukao@faculty.chiba-u.j [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba, 260-8670 (Japan)

    2010-08-15

    Purpose: To clarify the pre-treatment hemodynamic features involved in the long-term survival of cirrhotic patients with gastric fundal varices (FV) after balloon-occluded retrograde transvenous obliteration (B-RTO). Materials and methods: Eighty-one cirrhotic patients with medium- or large-grade FV treated by B-RTO were enrolled in this retrospective study. Pre-treatment flow volume ratio between gastric vein and portal trunk (GP-R) was obtained by Doppler ultrasound. Results: The cumulative survival rate was 90% at 1 year, 74.8% at 3 years, 57.2% at 5 years, and 45.8% at 7 years without recurrence in a median period of 1148.5 days The survival was poorer in patients with HCC (47% at 3 years, 9.4% at 5 years, p < 0.0001) than without (89.2% at 3 years, 81.9% at 5 years, 67.5% at 7 years), in patients with Child B/C (57.7% at 3 years, 42.1% at 5 years, 28.1% at 7 years, p = 0.0016) than with Child A (91.8% at 3 years, 71.5% at 5 years, 62.1% at 7 years), and in patients with GP-R {>=} 1.0 (58.9% at 3 years, p = 0.0485) than with GP-R < 1.0 (76.3% at 3 years, 62% at 5 years, 49.6% at 7 years). Multivariate analysis identified the presence of HCC (hazard ratio, 12.486; 95% CI, 4.08-38.216; p < 0.0001), Child B/C (hazard ratio, 3.41; 95% CI, 1.594-7.15; p = 0.0051) and GP-R {>=} 1.0 (hazard ratio, 2.701; 95% CI, 1.07-6.15; p = 0.0221) as independent factors for poor prognosis. Conclusion: GP-R {>=} 1.0 on Doppler ultrasound before B-RTO may be a predictive indicator for poor prognosis in cirrhotic patients with FV after B-RTO, in addition to the presence of HCC and severe liver damage.

  3. Varic acid analogues from fungus as PTP1B inhibitors: Biological evaluation and structure-activity relationships.

    Science.gov (United States)

    Sun, Wenlong; Zhuang, Chunlin; Li, Xia; Zhang, Bowei; Lu, Xinhua; Zheng, Zhihui; Dong, Yuesheng

    2017-08-01

    Protein tyrosine phosphatase 1B (PTP1B) inhibitors as potential therapies for diabetes and obesity have attracted much attention in recent years. Six varic acid analogues were isolated from two strains of fungi and evaluated for PTP1B inhibition activities. The structure-activity relationships were also characterized and predicted by molecular modeling. Further kinetic studies indicated the reversible and competitive inhibition manner of varic acid analogues. Trivaric acid showed insulin-sensitizing effect not only in vitro but also in vivo, representing a promising lead compound for further optimization. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. [Hospital mortality associated with upper gastrointestinal hemorrhage due to ruptured esophageal varices at the Lomé Campus Hospital in Togo].

    Science.gov (United States)

    Bouglouga, O; Bagny, A; Lawson-Ananissoh, L; Djibril, M

    2014-01-01

    To study hospital mortality associated with upper gastrointestinal hemorrhages due to variceal bleeding in the department of hepatology and gastroenterology at the Lome Campus University Hospital. This retrospective cross-sectional and analytic study examined the 55 patients admitted for variceal bleeding on upper endoscopies during the 3-year period from January 1, 2008, through December 31, 2010. These patients accounted for 4.1% of all hospitalizations during the study period in the department. Their average age was 35 years, and their sex-ratio 4. A history of chronic liver disease was found in 65.5%. Liver cirrhosis was the principal cause of the esophageal varices, complicated by hepatocellular carcinoma in 30.9% of them. The mortality rate was 25.5% and was not related to the cause of portal hypertension. All the patients with a recurrence of bleeding died. Mortality was associated with jaundice. Blood transfusion did not significantly improve the prognosis. the mortality rate among patients with upper gastrointestinal hemorrhage linked to variceal bleeding is high in our unit. The prevention of hepatitis virus B is important because it is the main cause of chronic liver disease causing portal hypertension in our department.

  5. 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...

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

    Directory of Open Access Journals (Sweden)

    Justin Cheung

    2006-01-01

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

  7. Evaluation of large esophageal varices in cirrhotic patients by transient elastography: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Tao Li

    Full Text Available Background and purpose: Transient elastography (TE has been shown to be a valuable tool for the prediction of large esophageal varices. However, the conclusions have not been always consistent throughout the different studies. Therefore, we performed a further meta-analysis in order to evaluate the diagnostic accuracy of transient elastography for the prediction of large esophageal varices. Methods: We performed a systematic literature search in PubMed, EMBASE, Web of Science, and CENTRAL in The Cochrane Library without time restriction. The strategy we used was "(fibroscan OR transient elastography OR stiffness AND esophageal varices". Accuracy measures such as pooled sensitivity, specificity, among others, were calculated using Meta-DiSc statistical software. Results: Twenty studies (2,994 patients were included in our meta-analysis. The values of pooled sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratio were as follows: 0.81 (95% CI, 0.79-0.84, 0.71 (95% CI, 0.69-0.73, 2.63 (95% CI, 2.15-3.23, 0.27 (95% CI, 0.22-0.34 and 10.30 (95% CI, 7.33-14.47. The area under the receiver operating characteristics curve was 0.83. The Spearman correlation coefficient was 0.246 with a p-value of 0.296, indicating the absence of any significant threshold effects. In our subgroup analysis, the heterogeneity could be partially explained by the geographical origin of the study or etiology; or it could be partially explained blindingly, through the appropriate interval and cut-off value of the liver stiffness (LS. Conclusions: Transient elastography could be used as a valuable non-invasive screening tool for the prediction of large esophageal varices. However, since LS cut-off values vary throughout the different studies and significant heterogeneity also exists among them, we need more reasonable approaches or flow diagram in order to improve the operability of this technology.

  8. Report from two cases of vesicular varices secondary to thrombosis of the aorta vein, diagnosed by ultrasound Doppler color and pressed

    International Nuclear Information System (INIS)

    Triana R, Gustavo; Romero E, Javier; Prada, Mario; Uribe, Tomas

    1999-01-01

    We report two cases of gallbladder varices diagnosed by ultrasound. The first one is a 71-year-old patient who was diagnosed with liver cirrhosis of unknown etiology. The second patient is a 27-year-old woman who was diagnosed with a hypercoagulability state. Both of them were evaluated with Doppler ultrasound of the esplenoportal circulation, gallbladder varices associated with complete portal vein thrombosis were found

  9. INVASIVE AND NON-INVASIVE TECHNIQUES FOR DETECTING PORTAL HYPERTENSION AND PREDICTING VARICEAL BLEEDING IN CIRRHOSIS: A REVIEW

    Science.gov (United States)

    Zardi, Enrico Maria; Di Matteo, Francesco Maria; Pacella, Claudio Maurizio; Sanyal, Arun J

    2016-01-01

    Portal hypertension is a severe syndrome that may derive from pre-sinusoidal, sinusoidal and post-sinusoidal causes. As a consequence, several complications (i.e., ascites, oesophageal varices) may develop. In sinusoidal portal hypertension, hepatic venous pressure gradient (HVPG) is a reliable method for defining the grade of portal pressure, establishing the effectiveness of the treatment and predicting the occurrence of complications; however, some questions exist regarding its ability to discriminate bleeding from nonbleeding varices in cirrhotic patients. Other imaging techniques (transient elastography, endoscopy, endosonography and duplex Doppler sonography) for assessing causes and complications of portal hypertensive syndrome are available and may be valuable for the management of these patients. In this review, we evaluate invasive and non-invasive techniques currently employed to obtain a clinical prediction of deadly complications, such as variceal bleeding in patients affected by sinusoidal portal hypertension, in order to create a diagnostic algorithm to manage them. Again, HVPG appears to be the reference standard to evaluate portal hypertension and monitor the response to treatment, but its ability to predict several complications and support management decisions might be further improved through the diagnostic combination with other imaging techniques. PMID:24328372

  10. Embolization for non-variceal upper gastrointestinal tract haemorrhage: A systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Mirsadraee, S.; Tirukonda, P.; Nicholson, A. [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom); Everett, S.M. [Department of Gastroenterology, Leeds General Infirmary, Leeds (United Kingdom); McPherson, S.J., E-mail: simon.mcpherson@leedsth.nhs.u [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom)

    2011-06-15

    Aim: To assess the published evidence on the endovascular treatment of non-variceal upper gastrointestinal haemorrhage. Materials and methods: An Ovid Medline search of published literature was performed (1966-2009). Non-English literature, experimental studies, variceal haemorrhage and case series with fewer than five patients were excluded. The search yielded 1888 abstracts. Thirty-five articles were selected for final analysis. Results: The total number of pooled patients was 927. The technical and clinical success of embolization ranged from 52-100% and 44-100%, respectively. The pooled mean technical/clinical success rate in primary upper gastrointestinal tract haemorrhage (PUGITH) only, trans-papillary haemorrhage (TPH) only, and mixed studies were 84%/67%, 93%/89%, and 93%/64%, respectively. Clinical outcome was adversely affected by multi-organ failure, shock, corticosteroids, transfusion, and coagulopathy. The anatomical source of haemorrhage and procedural variables did not affect the outcome. A successful embolization improved survival by 13.3 times. Retrospective comparison with surgery demonstrated equivalent mortality and clinical success, despite embolization being applied to a more elderly population with a higher prevalence of co-morbidities. Conclusions: Embolization is effective in this very difficult cohort of patients with outcomes similar to surgery.

  11. Transjugular Intrahepatic Porto-Systemic Stent-Shunt for Therapy of Bleeding Esophageal Varices Due to Extramedullary Hematopoiesis in Primary Myelofibrosis: A Case Report

    OpenAIRE

    Phillip, Veit;Berger, Hermann;Straub, Melanie;Saugel, Bernd;Treiber, Matthias;Einwächter, Henrik;Schmid, Roland M.;Huber, Wolfgang

    2016-01-01

    Background: Primary myelofibrosis belongs to the group of myeloproliferative syndromes. Extramedullary hematopoiesis in the liver can lead to portal hypertension. Patient and Methods: We report a case of a patient with life-threatening, endoscopically not treatable bleeding from esophageal varices due to extramedullary hematopoiesis of the liver that was successfully treated with placement of a transjugular intrahepatic porto-systemic stent-shunt (TIPS). Results: Therapy of variceal bleeding ...

  12. [Related factors to re-bleeding and mortality in cirrhotic patients with acute variceal bleeding at Hipolito Unanue Hospital, Lima, Peru].

    Science.gov (United States)

    Parra Pérez, Víctor Felipe; Raymundo Cajo, Roxana Magali; Gutiérrez de Aranguren, Constantino Fernando

    2013-01-01

    To determine related factors to 5 days re-bleeding and 6 week-mortality of an episode of variceal bleeding in cirrhotic patients. Observational, descriptive, co relational, retrospective study. In this study were included the cirrhotic patients who entered to Hipolito Unanue Hospital, Lima, Peru, between January 2006 and February 2012 with suspicion of variceal bleeding. Were excluded patients who bled from nonvariceal origin, or that did not have the data in clinical history to calculate the Child Pugh score, the Model for terminal diseases of the liver (MELD), or the endoscopic report detailing the bleeding source and the presence of esophageal and/or gastric varices. We include 63 patients, 35 (55.6%) were men. The median of age was of 64 years. 26 of them (41.3%) were Child Pugh C, where as the median of MELD score was 9. The multivariate analysis found that the Child Pugh score was related to 6 weeks-mortality (p=0,003), where as the presence of active bleeding during endoscopy (p=0.012) and the value of creatinine (p=0.012) were related to 5 days re-bleeding. The Child Pugh score was related to 6 weeks-mortality in cirrhotic patients with variceal bleeding. Active bleeding during endoscopy and the value of creatinine were related to 5 days re-bleeding.

  13. Imaging features of portal biliopathy: Frequency of involvement patterns with emphasis on MRCP

    Energy Technology Data Exchange (ETDEWEB)

    Ozkavukcu, Esra [Ankara University School of Medicine, Department of Radiology (Turkey)], E-mail: eozkavukcu@gmail.com; Erden, Ayse; Erden, Ilhan [Ankara University School of Medicine, Department of Radiology (Turkey)

    2009-07-15

    Purpose: To investigate the imaging features of portal biliopathy with emphasis on MR cholangiopancreatography (MRCP). The ancillary vascular findings of portal biliopathy were also evaluated by accompanying MR portography, dynamic contrast-enhanced (CE) CT, and dynamic CE MRI studies. Materials and methods: Sixteen patients with portal cavernoma were included in the study. Patients had undergone MRCP (n = 16) studies accompanied by MR portography (n = 13), dynamic CE CT (n = 3) or dynamic CE MRI (n = 2) of the liver. Two patients had undergone both dynamic CE CT and dynamic CE MRI. Two radiologists evaluated all the examinations together, retrospectively. MRCP images were analyzed for the presence of biliary stenosis, upstream (prestenotic) dilatation, wavy appearance of the bile ducts, angulation of the common bile duct (CBD), and choledocholithiasis. MR portography, dynamic CE CT and dynamic CE MRI studies were evaluated for the existence of portal cavernomas, and the presence of gall bladder/choledochal varices. Results: All patients had signs of portal biliopathy on MRCP. Frequencies of the biliary findings on MRCP were as follows: biliary stenosis, 93.7%; upstream dilatation, 68.7%; wavy appearance of the biliary tree, 87.5%; angulation of the CBD, 75%. None of the patients had choledocholithiasis. Frequencies of the ancillary vascular findings detected on CE studies were as follows: gall bladder varices, 100%, choledochal varices, 93.7%. Conclusion: MRCP features of portal biliopathy in order to their frequencies were as follows: biliary stenosis, wavy appearance of the bile ducts, angulation of the CBD, and upstream dilatation of the bile ducts.

  14. Efficacy and safety of terlipressin in cirrhotic patients with variceal bleeding or hepatorenal syndrome

    DEFF Research Database (Denmark)

    Krag, Aleksander; Borup, Tine; Møller, Søren

    2008-01-01

    Terlipressin is an analog of the natural hormone arginine-vasopressin. It is used in the treatment of patients with cirrhosis and bleeding esophageal varices (BEV) and in patients with hepatorenal syndrome (HRS): two of the most dramatic and feared complications of cirrhosis. Terlipressin exerts...

  15. Poor endoscopic findings in children with non variceal upper gastrointestinal bleeding: is biopsy necessary?

    OpenAIRE

    Giannakopoulos, A; Logothetis, A; Panayiotou, J; Van-Vliet, K; Orfanou, I; Roma-Giannikou, E

    2010-01-01

    Background: Gastrointestinal bleeding in infants and children is a potentially serious condition in the practice of general pediatrics that requires investigation. The objective of this study is to describe the endoscopic and histopathological findings in children with upper gastrointestinal (UGI) bleeding of non variceal origin.

  16. Guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Fujishiro, Mitsuhiro; Iguchi, Mikitaka; Kakushima, Naomi; Kato, Motohiko; Sakata, Yasuhisa; Hoteya, Shu; Kataoka, Mikinori; Shimaoka, Shunji; Yahagi, Naohisa; Fujimoto, Kazuma

    2016-05-01

    Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding using evidence-based methods. The major cause of non-variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug-related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)-related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first-line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research. © 2016 Japan Gastroenterological Endoscopy Society.

  17. Transjugular intrahepatic porto-systemic stent-shunt for therapy of bleeding esophageal varices due to extramedullary hematopoiesis in primary myelofibrosis: a case report.

    Science.gov (United States)

    Phillip, Veit; Berger, Hermann; Straub, Melanie; Saugel, Bernd; Treiber, Matthias; Einwächter, Henrik; Schmid, Roland M; Huber, Wolfgang

    2012-01-01

    Primary myelofibrosis belongs to the group of myeloproliferative syndromes. Extramedullary hematopoiesis in the liver can lead to portal hypertension. We report a case of a patient with life-threatening, endoscopically not treatable bleeding from esophageal varices due to extramedullary hematopoiesis of the liver that was successfully treated with placement of a transjugular intrahepatic porto-systemic stent-shunt (TIPS). Therapy of variceal bleeding by TIPS insertion was successful. During a 29-month follow-up, no hepatic failure, hepatic encephalopathy, or further variceal bleeding episode occurred. TIPS placement is a well-established procedure for the treatment of complications due to portal hypertension mainly due to liver cirrhosis. This report illustrates that TIPS placement can also be a promising treatment option in patients with primary myelofibrosis and portal hypertension due to extramedullary hematopoiesis. Copyright © 2012 S. Karger AG, Basel.

  18. Correlation study of spleen stiffness measured by FibroTouch with esophageal and gastric varices in patients with liver cirrhosis

    Directory of Open Access Journals (Sweden)

    WEI Yutong

    2015-03-01

    Full Text Available ObjectiveTo explore the correlation of spleen stiffness measured by FibroScan with esophageal and gastric varices in patients with liver cirrhosis. MethodsSpleen and liver stiffness was measured by FibroScan in 72 patients with liver cirrhosis who received gastroscopy in our hospital from December 2012 to December 2013. Categorical data were analyzed by χ2 test, and continuous data were analyzed by t test. Pearson's correlation analysis was used to investigate the correlation between the degree of esophageal varices and spleen stiffness. ResultsWith the increase in the Child-Pugh score in patients, the measurements of liver and spleen stiffness showed a rising trend. Correlation was found between the measurements of spleen and liver stiffness (r=0.367, P<0.05. The differences in measurements of spleen stiffness between patients with Child-Pugh classes A, B, and C were all significant (t=5.149, 7.231, and 6.119, respectively; P=0031, 0.025, and 0.037, respectively. The measurements of spleen and liver stiffness showed marked increases in patients with moderate and severe esophageal and gastric varices. The receiver operating characteristic (ROC curve analysis showed that the area under the ROC curve, sensitivity, and specificity for spleen stiffness were significantly higher than those for liver stiffness and platelet count/spleen thickness. ConclusionThe spleen stiffness measurement by FibroScan shows a good correlation with the esophageal and gastric varices in patients with liver cirrhosis. FibroScan is safe and noninvasive, and especially useful for those who are not suitable for gastroscopy.

  19. Spleen Stiffness Correlates with the Presence of Ascites but Not Esophageal Varices in Chronic Hepatitis C Patients

    Directory of Open Access Journals (Sweden)

    Kazuyo Mori

    2013-01-01

    Full Text Available Although spleen stiffness has recently been identified as potential surrogate marker for portal hypertension, the relationship between spleen stiffness and portal hypertension has not been fully elucidated. We attempted to determine the relationship between the liver or spleen stiffness and the presence of ascites or esophageal varices by acoustic radiation force impulse (ARFI imaging. A total of 33 chronic hepatitis C (CHC patients (median age 68; range 51–84 were enrolled. We evaluated the relationship between the liver or spleen stiffness and indicators of portal hypertension as well as clinical and biochemical parameters. Fourteen healthy volunteers were used for validating the accuracy of AFRI imaging. The liver and spleen stiffness increased significantly with progression of liver disease. A significant positive correlation was observed between the liver and spleen stiffness. However, spleen stiffness, but not liver stiffness, was significantly associated with the presence of ascites (, while there was no significant association between the spleen stiffness and spleen index/presence of esophageal varices in CHC patients. The area under the receiver operating characteristic curve based on the spleen stiffness was 0.80. In conclusion, spleen stiffness significantly correlates with the presence of ascites but not esophageal varices in CHC patients.

  20. Evaluation of portosystemic collaterals by MDCT-MPR imaging for management of hemorrhagic esophageal varices

    International Nuclear Information System (INIS)

    Kodama, Hideaki; Aikata, Hiroshi; Takaki, Shintaro; Azakami, Takahiro; Katamura, Yoshio; Kawaoka, Tomokazu; Hiramatsu, Akira; Waki, Koji; Imamura, Michio; Kawakami, Yoshiiku; Takahashi, Shoichi; Toyota, Naoyuki; Ito, Katsuhide; Chayama, Kazuaki

    2010-01-01

    Objective: To study the correlation between changes in portosystemic collaterals, evaluated by multidetector-row computed tomography imaging using multiplanar reconstruction (MDCT-MPR), and prognosis in patients with hemorrhagic esophageal varices (EV) after endoscopic treatment. Methods: Forty-nine patients with primary hemostasis for variceal bleeding received radical endoscopic treatment: endoscopic injection sclerotherapy (EIS) or endoscopic variceal ligation (EVL). Patients were classified according to the rate of reduction in feeding vessel diameter on MDCT-MPR images, into the narrowing (n = 24) and no-change (n = 25) groups. We evaluated changes in portosystemic collaterals by MDCT-MPR before and after treatment, and determined rebleeding and survival rates. Results: The left gastric and paraesophageal (PEV) veins were recognized as portosystemic collaterals in 100 and 80%, respectively, of patients with EV on MDCT-MPR images. The rebleeding rates at 1, 2, 3, and 5 years after endoscopic treatment were 10, 15, 23, and 23%, respectively, for the narrowing group, and 17, 24, 35, and 67%, respectively, for the no-change group (P = 0.068). Among no-change group, the rebleeding rate in patients with large PEV was significantly lower than that with small PEV (P = 0.027). The rebleeding rate in patients with small PEV of the no-change group was significantly higher than that in the narrowing group (P = 0.018). There was no significant difference in rebleeding rates between the no-change group with a large PEV and narrowing group (P = 0.435). Conclusion: Changes in portosystemic collaterals evaluated by MDCT-MPR imaging correlate with rebleeding rate. Evaluation of portosystemic collaterals in this manner would provide useful information for the management of hemorrhagic EV.

  1. Can transient elastography, Fib-4, Forns Index, and Lok Score predict esophageal varices in HCV-related cirrhotic patients?

    Science.gov (United States)

    Hassan, Eman M; Omran, Dalia A; El Beshlawey, Mohamad L; Abdo, Mahmoud; El Askary, Ahmad

    2014-02-01

    Gastroesophageal varices are present in approximately 50% of patients with liver cirrhosis. The aim of this study was to evaluate liver stiffness measurement (LSM), Fib-4, Forns Index and Lok Score as noninvasive predictors of esophageal varices (EV). This prospective study included 65 patients with HCV-related liver cirrhosis. All patients underwent routine laboratory tests, transient elastograhy (TE) and esophagogastroduodenoscopy. FIB-4, Forns Index and Lok Score were calculated. The diagnostic performances of these methods were assessed using sensitivity, specificity, positive predictive value, negative predictive value, accuracy and receiver operating characteristic curves. All predictors (LSM, FIB-4, Forns Index and Lok Score) demonstrated statistically significant correlation with the presence and the grade of EV. TE could diagnose EV at a cutoff value of 18.2kPa. Fib-4, Forns Index, and Lok Score could diagnose EV at cutoff values of 2.8, 6.61 and 0.63, respectively. For prediction of large varices (grade 2, 3), LSM showed the highest accuracy (80%) with a cutoff of 22.4kPa and AUROC of 0.801. Its sensitivity was 84%, specificity 72%, PPV 84% and NPV 72%. The diagnostic accuracies of FIB-4, Forns Index and Lok Score were 70%, 70% and76%, respectively, at cutoffs of 3.3, 6.9 and 0.7, respectively. For diagnosis of large esophageal varices, adding TE to each of the other diagnostic indices (serum fibrosis scores) increased their sensitivities with little decrease in their specificities. Moreover, this combination decreased the LR- in all tests. Noninvasive predictors can restrict endoscopic screening. This is very important as non invasiveness is now a major goal in hepatology. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

  2. Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding (2015, Nanchang, China).

    Science.gov (United States)

    Bai, Yu; Li, Zhao Shen

    2016-02-01

    Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common medical emergencies in China and worldwide. In 2009, we published the "Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding" for the patients in China; however, during the past years numerous studies on the diagnosis and treatment of ANVUGIB have been conducted, and the management of ANVUGIB needs to be updated. The guidelines were updated after the databases including PubMed, Embase and CNKI were searched to retrieve the clinical trials on the management of ANVUGIB. The clinical trials were evaluated for high-quality evidence, and the advances in definitions, diagnosis, etiology, severity evaluation, treatment and prognosis of ANVUGIB were carefully reviewed, the recommendations were then proposed. After several rounds of discussions and revisions among the national experts of digestive endoscopy, gastroenterology, radiology and intensive care, the 2015 version of "Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding" was successfully developed by the Chinese Journal of Internal Medicine, National Medical Journal of China, Chinese Journal of Digestion and Chinese Journal of Digestive Endoscopy. It shall be noted that although much progress has been made, the clinical management of ANVUGIB still needs further improvement and refinement, and high-quality randomized trials are required in the future. © 2016 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

  3. Gastric Varices with Remarkable Collateral Veins in Valpronic Acid-Induced Chronic Pancreatitis

    Directory of Open Access Journals (Sweden)

    Y. Hattori

    2008-08-01

    Full Text Available Valproic acid (VPA is a commonly prescribed and approved treatment for epilepsy, including Angelman syndrome, throughout the world. However, the long-term administration of drugs like VPA is associated with the possible development of gastric varices and splenic obstruction as a result of chronic pancreatitis. Such cases can be difficult to treat using endoscopy or interventional radiology because of hemodynamic abnormalities; therefore, surgical treatment is often necessary.

  4. Diagnosis of a complication of endoscopic variceal sclerotherapy by combined use of radiology and endoscopy

    International Nuclear Information System (INIS)

    Kulke, H.; Auer, I.O.; Burghardt, W.; Braun, H.

    1982-01-01

    A case is reported of an intramural oesophageal fistula developing after fiberoptic injection sclerotherapy for oesophageal varices in a patient with alcoholic cirrhosis of the liver. Only the combined use of endoscopic application of radiographic contrast medium and detailed radiological investigation allowed the definite diagnosis. (orig.) [de

  5. Embolization with NBCA for the treatment of esophago-fundal varices: its complications and nursing care

    International Nuclear Information System (INIS)

    Liu Lingyun; Li Xiaohui; Qiu Xuanying; Lai Lisha; Zhong Qiuying; Zhu Kangshun

    2009-01-01

    Objective: To discuss the nursing care for patients with portal hypertension after receiving NBCA embolization treatment of esophago-fundal varices. Methods: The clinical data and nursing care effect in 28 patients with portal hypertension after NBCA embolization treatment of esophago-fundal varices were retrospectively analyzed. Results: Successful embolization was achieved in 27 patients, and the bleeding was stopped. Failure of embolization occurred in one patient. Slight pulmonary embolism was found in 4 cases, of which 2 had mild cough. Pain in different degree was seen in 24 cases, and vomiting with mild abdominal pain in 20 cases. Neither puncture site bleeding nor intraperitoneal hemorrhage occurred. Conclusion: In order to increase the success rate and to reduce the occurrence of complications, it is very important for nurses to take the following obligations seriously: to give the patient pertinent psychological nursing care before the procedure, to take a close observation on the patient's condition during and after the surgery and to deal with the complications promptly. (authors)

  6. Comparison of transjugular intrahepatic portosystemic shunt with covered stent and ballon-occluded retrograde transvenous obliteration in managing isolated gastric varices

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seung Kwon; Lee, Kristen A.; Sauk, Steven; Korenblat, Kevin [Washington University St. Louis School of Medicine, St. Louis (United States)

    2017-04-15

    Although a transjugular intrahepatic portosystemic shunt (TIPS) is commonly placed to manage isolated gastric varices, balloon-occluded retrograde transvenous obliteration (BRTO) has also been used. We compare the long-term outcomes from these procedures based on our institutional experience. We conducted a retrospective review of patients with isolated gastric varices who underwent either TIPS with a covered stent or BRTO between January 2000 and July 2013. We identified 52 consecutive patients, 27 who had received TIPS with a covered stent and 25 who had received BRTO. We compared procedural complications, re-bleeding rates, and clinical outcomes between the two groups. There were no significant differences in procedural complications between patients who underwent TIPS (7%) and those who underwent BRTO (12%) (p = 0.57). There were also no statistically significant differences in re-bleeding rates from gastric varices between the two groups (TIPS, 7% [2/27]; BRTO, 8% [2/25]; p = 0.94) or in developing new ascites following either procedure (TIPS, 4%; BRTO, 4%; p = 0.96); significantly more patients who underwent TIPS developed hepatic encephalopathy (22%) than did those who underwent BRTO (0%, p = 0.01). There was no statistically significant difference in mean survival between the two groups (TIPS, 30 months; BRTO, 24 months; p = 0.16); median survival for the patients who received TIPS was 16.6 months, and for those who underwent BRTO, it was 26.6 months. BRTO is an effective method of treating isolated gastric varices with similar outcomes and complication rates to those of TIPS with a covered stent but with a lower rate of hepatic encephalopathy.

  7. Hemodynamic effects of terlipressin in patients with bleeding esophageal varices secondary to cirrhosis of liver

    International Nuclear Information System (INIS)

    Budruddin, A.H.; Rasool, G.; Chaudhry, M.A.

    2006-01-01

    To study the hemodynamics of terlipressin in bleeding esophageal varices due to cirrhosis of the liver. Seventy-eight consecutive patients with bleeding esophageal varices were evaluated. The diagnosis of cirrhosis was based on history, physical examination, laboratory data and abdominal ultrasound. Blood-pressure and pulse rate were monitored. Injection terlipressin 2 mg intravenous bolus was given followed by 2 mg i/v 6 hourly. Intravenous plasma expanders, whole blood, fresh frozen plasma and platelet concentrates were transfused as needed. Upper gastrointestinal endoscopy was performed for evaluation and grading of varices, detection of portal gastropathy, and banding. Descriptive and inferential statistics were applied as applicable. Seventy patients of either gender, aged 18 - 95 years were included in the study. Systolic blood pressure(SP) increased by 7.77 mmHg (mean SP: 108.1 mmHg, SD + 9.84, 95% CI: 105.77 - 110.43 mmHg; p-value: 0.0002); diastolic blood-pressure(DP) by 21.57 mmHg (mean DP: 79.71 mmHg, SD + 7.35, 95% CI: 77.97 - 81.45 mmHg; p-value: 0.001) and mean arterial pressure by 9.42 mmHg(mean MAP: 89.12 mmHg, SD + 6.98, 95% CI: 87.45 - 90.78 mmHg; p-value: 0.0007) within 24 hours of initiating terlipressin in majority of patients. The pulse rate decreased in 34 (48.5%) patients by 6-24 beats/min in 30 min, and by 2-12 beats/min in 24 hours; and increased in 30 (42.85)% patients by 10-15 beats/min at 30 min and by 2-8 beats/min at 24 hours. (author)

  8. Transjugular intrahepatic portosystemic shunt in patients with active variceal bleeding due to portal hypertension and portal vein thrombosis

    International Nuclear Information System (INIS)

    Shin, Hyun Woong; Ryeom, Hun Kyu; Lee, Sang Kwon; Lee, Jong Min; Kim, Young Sun; Suh, Kyung Jin; Kim, Tae Hun; Kim, Yong Joo

    1997-01-01

    To evaluate the feasibility and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in patients with active variceal bleeding due to liver cirrhosis and pre-existing portal vein thrombosis. Of a total of 123 patients who underwent TIPS, 14 patients with intractable variceal bleeding due to portal hypertension and portal vein thrombosis were included in this study. Noncavernomatous portal vein occlusion was seen in eight patients, and complete portal vein occlusion with cavernomatous trans-formation in six. For all patients, the methods used for TIPS placement were the same as those used in patients with patents portal veins. In seven of eight patients with noncavernomatous occlusion, right hepatic vein-right portal vein shunting was performed; in one with knoncavernomatous occlusion, a shunt was created between the right hepatic and left portal vein. In five of six patients with cavernomatous occlusion, the right hepatic and main portal vein were connected via a collateral vein. The procedures were technically successful in all except one patient. Immediate hemostatis was achieved after all technically successful procedures, and no significant complications were encountered. Minor complications were noted in six patients (three biliary tree punctures, one transperitoneal puncture, one splenic vein perforation, one hepatic subcapsular hematoma). TIPS is a technically feasible and hemodynamically effective procedure, even in patients with active variceal bleeding due to cirrhosis and complete portal vein occlusion

  9. Evaluation of some pulmonary functions and pleuropulmonary complications after endoscopic sclerotherapy of gastric fundal varices at Zagazig university hospitals

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    Jihan A. Shawky

    2016-10-01

    Conclusions: NBCA injection of gastric fundal varices was associated with significant, reversible deterioration in some pulmonary functions, atelectasis and minimal pleural effusion with significant rapid improvement if incentive spirometry is used.

  10. Novel Therapeutic Strategies in the Management of Non-Variceal Upper Gastrointestinal Bleeding

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    Ari Garber

    2016-09-01

    Full Text Available Non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitors remain the mainstay of treatment, as they reduce the risk of rebleeding and requirement for recurrent endoscopic evaluation. Tranexamic acid, a derivative of the amino acid lysine, is an antifibrinolytic agent whose role requires further investigation before application. Endoscopically delivered pharmacotherapy, including Hemospray (Cook Medical, EndoClot (EndoClot Plus Inc., and Ankaferd Blood Stopper (Ankaferd Health Products, in addition to standard epinephrine, show promise in this regard, although their mechanisms of action require further investigation. Non-pharmacologic endoscopic techniques use one of the following two methods to achieve hemostasis: ablation or mechanical tamponade, which may involve using endoscopic clips, cautery, argon plasma coagulation, over-the-scope clipping devices, radiofrequency ablation, and cryotherapy. This review aimed to highlight these novel and fundamental hemostatic strategies and the research supporting their efficacy.

  11. 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.

  12. Adrenal pseudomasses due to varices: angiographic-CT-MRI-pathologic correlations

    International Nuclear Information System (INIS)

    Brady, T.M.; Gross, B.H.; Glazer, G.M.; Williams, D.M.

    1985-01-01

    Periadrenal and adrenal portosystemic collaterals are a recently reported cause of adrenal pseudotumor on computed tomography (CT). Nine patients with this left adrenal pseudotumor illustrate its typical position and appearance on CT, angiography, CT-angiography, and magnetic resonance imaging (MRI). The anatomic basis for variceal adrenal pseudotumors is the left inferior phrenic vein, which passes immediately anterior to the left adrenal gland and which serves as a collateral pathway from splenic to left renal vein in portal hypertension. Thus, unlike previously described adrenal pseudotumors, these venous collaterals are not anatomically distinguishable from the adrenal gland on CT. Bolus dynamic CT is usually diagnostic, but in equivocal cases, MRI may prove useful

  13. Adrenal pseudomasses due to varices: angiographic-CT-MRI-pathologic correlations

    Energy Technology Data Exchange (ETDEWEB)

    Brady, T.M.; Gross, B.H.; Glazer, G.M. Williams, D.M.

    1985-08-01

    Periadrenal and adrenal portosystemic collaterals are a recently reported cause of adrenal pseudotumor on computed tomography (CT). Nine patients with this left adrenal pseudotumor illustrate its typical position and appearance on CT, angiography, CT-angiography, and magnetic resonance imaging (MRI). The anatomic basis for variceal adrenal pseudotumors is the left inferior phrenic vein, which passes immediately anterior to the left adrenal gland and which serves as a collateral pathway from splenic to left renal vein in portal hypertension. Thus, unlike previously described adrenal pseudotumors, these venous collaterals are not anatomically distinguishable from the adrenal gland on CT. Bolus dynamic CT is usually diagnostic, but in equivocal cases, MRI may prove useful.

  14. Value of Glasgow-Blatchford score in predicting early prognosis of cirrhotic patients with esophagogastric variceal bleeding

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    CUI Shu

    2017-10-01

    cancer with vascular invasion or metastasis (χ2=14.766, P<0.01, and hepatic encephalopathy (χ2=16.327, P<0.01, albumin (Z=-2.770, P=0.006, bilirubin (Z=-3.191, P=0.001, hemoglobin (Z=-2.484, P=0.013, blood urea nitrogen (Z=-2.407, P=0.016, international normalized ratio (Z=-2.304, P=0.021, systolic pressure (t=2.69, P=0.008, pulse rate (Z=-3.507, P<0.01, CTP classification (χ2=25.851, P<0.01, CTP score (Z=-3.591, P<0.01, MELD score (t=-4.121, P<0.01, and GBS score (Z=-3.54, P<0.01. GBS score (AUC=0.738, 95% confidence interval [CI]: 0.67-0.80 was superior to MELD score (AUC=0.731, 95%CI: 0.66-0.79 and CTP score (AUC=0.728, 95% CI: 066-0.79 in predicting the risk of death at 1 week. MELD score (AUC=0.761, 95%CI: 0.70-0.89 was superior to CTP score (AUC=0.748, 95%CI: 0.69-0.81 and MELD score (AUC=0.726, 95%CI: 0.66-0.79 in predicting the risk of death at 6 weeks. There was a significant difference in the AUC for predicting the death rate at 1 week between GBS score and CTP score (Z=0.079, P=0037, while there was no significant difference in the AUC for predicting the death rate at 6 weeks between the three scoring systems (P>0.05. ConclusionGBS score is superior to MELD score and CTP score in predicting the risk of death at 1 week in cirrhotic patients with esophagogastric variceal bleeding, and MELD and CTP scores are superior to GBS score in predicting the risk of death at 6 weeks.

  15. Management of non variceal upper gastrointestinal bleeding: position statement of the Catalan Society of Gastroenterology.

    Science.gov (United States)

    García-Iglesias, Pilar; Botargues, Josep-Maria; Feu Caballé, Faust; Villanueva Sánchez, Càndid; Calvet Calvo, Xavier; Brullet Benedi, Enric; Cánovas Moreno, Gabriel; Fort Martorell, Esther; Gallach Montero, Marta; Gené Tous, Emili; Hidalgo Rosas, José-Manuel; Lago Macía, Amelia; Nieto Rodríguez, Ana; Papo Berger, Michel; Planella de Rubinat, Montserrat; Saló Rich, Joan; Campo Fernández de Los Ríos, Rafel

    2017-05-01

    In recent years there have been advances in the management of non-variceal upper gastrointestinal bleeding that have helped reduce rebleeding and mortality. This document positioning of the Catalan Society of Digestologia is an update of evidence-based recommendations on management of gastrointestinal bleeding peptic ulcer. Copyright © 2016 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

  16. Antithrombotic drugs and non-variceal bleeding outcomes and risk scoring systems: comparison of Glasgow Blatchford, Rockall and Charlson scores

    Science.gov (United States)

    Taha, Ali S; McCloskey, Caroline; Craigen, Theresa; Angerson, Wilson J

    2016-01-01

    Objectives Antithrombotic drugs (ATDs) cause non-variceal upper gastrointestinal bleeding (NVUGIB). Risk scoring systems have not been validated in ATD users. We compared Blatchford, Rockall and Charlson scores in predicting outcomes of NVUGIB in ATD users and controls. Methods A total of 2071 patients with NVUGIB were grouped into ATD users (n=851) and controls (n=1220) in a single-centre retrospective analysis. Outcomes included duration of hospital admission, the need for blood transfusion, rebleeding requiring surgery and 30-day mortality. Results Duration of admission correlated with all scores in controls, but correlations were significantly weaker in ATD users. Rank correlation coefficients in control versus ATD: 0.45 vs 0.20 for Blatchford; 0.48 vs 0.32 for Rockall and 0.42 vs 0.26 for Charlson (all p<0.001). The need for transfusion was best predicted by Blatchford (p<0.001 vs Rockall and Charlson in both ATD users and controls), but all scores performed less well in ATD users. Area under the receiver operation characteristic curve (AUC) in control versus ATD: 0.90 vs 0.85 for Blatchford; 0.77 vs 0.61 for Rockall and 0.69 vs 0.56 for Charlson (all p<0.005). In predicting surgery, Rockall performed best; while mortality was best predicted by Charlson with lower AUCs in ATD patients than controls (p<0.05). Stratification showed the scores' performance to be age-dependent. Conclusions Blatchford score was the strongest predictor of transfusion, Rockall's had the strongest correlation with duration of admission and with rebleeding requiring surgery and Charlson was best in predicting 30-day mortality. Modifications of these systems should be explored to improve their efficiency in ATD users. PMID:28839866

  17. [Can Glasgow-Blatchford Score and Pre-endoscopic Rockall Score Predict the Occurrence of Hypotension in Initially Normotensive Patients with Non-variceal Upper Gastrointestinal Bleeding?].

    Science.gov (United States)

    Kim, June Sung; Ko, Byuk Sung; Son, Chang Hwan; Ahn, Shin; Seo, Dong Woo; Lee, Yoon Seon; Lee, Jae Ho; Oh, Bum Jin; Lim, Kyoung Soo; Kim, Won Young

    2016-01-25

    The aim of this study was to identify the ability of Glasgow-Blatchford score (GBS) and pre-endoscopic Rockall score (pre-E RS) to predict the occurrence of hypotension in patients with non-variceal upper gastrointestinal bleeding who are initially normotensive at emergency department. Retrospective observational study was conducted at Asan Medical Center emergency department (ED) in patients who presented with non-variceal upper gastrointestinal bleeding from January 1, 2011 to December 31, 2013. Study population was divided according to the development of hypotension, and demographics, comorbidities, and laboratory findings were compared. GBS and pre-E RS were estimated to predict the occurrence of hypotension. A total of 747 patients with non-variceal upper gastrointestinal bleeding were included during the study period, and 120 (16.1%) patients developed hypotension within 24 hours after ED admission. The median values GBS and pre-E RS were statistically different according to the occurrence of hypotension (8.0 vs. 10.0, 2.0 vs. 3.0, respectively; pupper gastrointestinal bleeding. Development of other scoring systems are needed.

  18. Role of Self-Expandable Metal Stents in Acute Variceal Bleeding

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    Fuad Maufa

    2012-01-01

    Full Text Available Acute variceal bleeding continues to be associated with significant mortality. Current standard of care combines hemodynamic stabilization, antibiotic prophylaxis, pharmacological agents, and endoscopic treatment. Rescue therapies using balloon tamponade or transjugular intrahepatic portosystemic shunt are implemented when first-line therapy fails. Rescue therapies have many limitations and are contraindicated in some cases. Placement of fully covered self-expandable metallic stent is a promising therapeutic technique that can be used to control bleeding in cases of refractory esophageal bleeding as an alternative to balloon tamponade. These stents can be left in place for as long as two weeks, allowing for improvement in liver function and institution of a more definitive treatment.

  19. Correlation of adjusted blood requirement index with treatment intervention and outcome in patients presenting with acute variceal bleeding

    International Nuclear Information System (INIS)

    Zaberi, B.F.; Riaz, M.F.; Sultan, B.A.; Gobindram, P.

    2007-01-01

    To determine the correlation of ABRI with treatment intervention and outcome as discharged or expired in patients of acute variceal bleed. Records of all the patients admitted in Medical Unit-IV, Civil Hospital Karachi with acute variceal bleeding during January 2004 to October 2006 were retrieved. Use of vasoactive agents (Terlipressin/Octreotide), endoscopic band ligation (EBL) and outcome (Discharged/Expired) were noted. ABRI was calculated by the following formula. ABRI= Blood Units Transfused/((Final Hematocrit-Initial Hematocrit)+0.01) Mean ABRI were compared by student's 't' test according to vasoactive therapy, EBL and outcome. Correlation of ABRI with the same variables was also studied by plotting Receiver Operative Curves (ROC). Seventy six patients fulfilling inclusion criteria were selected. No statistically significant difference was observed in the mean ABRI scores when compared according to vasoactive drug administration, EBL and outcome. Significant correlation with mortality was seen on ROC plot with significantly larger area under the curve. (author)

  20. Balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding: its feasibility compared with transjugular intrahepatic portosystemic shunt

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Young Ho; Yoon, Chang Jin; Park, Jae Hyung; Chung, Jin Wook; Kwon, Jong Won [Seoul Natioonal University College of Medicine, Seoul (Korea, Republic of); Choi, Guk Myung [Cheju National University College of Medicine, Jeju (Korea, Republic of)

    2003-06-01

    To assess the feasibility of balloon-occluded retrograde transvenous obliteration (BRTO) in active gastric variceal bleeding, and to compare the findings with those of transjugular intrahepatic portosystemic shunt (TIPS). Twenty-one patients with active gastric variceal bleeding due to liver cirrhosis were referred for radiological intervention. In 15 patients, contrast-enhanced CT scans demonstrated gastrorenal shunt, and the remaining six (Group 1) underwent TIPS. Seven of the 15 with gastrorenal shunt (Group 2) were also treated with TIPS, and the other eight (Group 3) underwent BRTO. All patients were followed up for 6 to 21 (mean, 14.4) months. For statistical inter-group comparison of immediate hemostasis, rebleeding and encephalopathy, Fisher's exact test was used. Changes in the Child-Pugh score before and after each procedure in each group were statistically analyzed by means of Wilcoxon's signed rank test. One patient in Group 1 died of sepsis, acute respiratory distress syndrome, and persistent bleeding three days after TIPS, while the remaining 20 survived the procedure with immediate hemostasis. Hepatic encephalopathy developed in four patients (one in Group 1, three in Group 2, and none in Group 3); one, in Group 2, died while in an hepatic coma 19 months after TIPS. Rebleeding occurred in one patient, also in Group 2. Except for transient fever in two Group-3 patients, no procedure-related complication occurred. In terms of immediate hemostasis, rebleeding and encephalopathy, there were no statistically significant differences between the groups (p > 0.05). In Group 3, the Child-Pugh score showed a significant decrease after the procedure (p = 0.02). BRTO can effectively control active gastric variceal bleeding, and because of immediate hemostasis, the absence of rebleeding, and improved liver function, is a good alternative to TIPS in patients in whom such bleeding, accompanied by gastrorenal shunt, occurs.

  1. Balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding: its feasibility compared with transjugular intrahepatic portosystemic shunt

    International Nuclear Information System (INIS)

    Choi, Young Ho; Yoon, Chang Jin; Park, Jae Hyung; Chung, Jin Wook; Kwon, Jong Won; Choi, Guk Myung

    2003-01-01

    To assess the feasibility of balloon-occluded retrograde transvenous obliteration (BRTO) in active gastric variceal bleeding, and to compare the findings with those of transjugular intrahepatic portosystemic shunt (TIPS). Twenty-one patients with active gastric variceal bleeding due to liver cirrhosis were referred for radiological intervention. In 15 patients, contrast-enhanced CT scans demonstrated gastrorenal shunt, and the remaining six (Group 1) underwent TIPS. Seven of the 15 with gastrorenal shunt (Group 2) were also treated with TIPS, and the other eight (Group 3) underwent BRTO. All patients were followed up for 6 to 21 (mean, 14.4) months. For statistical inter-group comparison of immediate hemostasis, rebleeding and encephalopathy, Fisher's exact test was used. Changes in the Child-Pugh score before and after each procedure in each group were statistically analyzed by means of Wilcoxon's signed rank test. One patient in Group 1 died of sepsis, acute respiratory distress syndrome, and persistent bleeding three days after TIPS, while the remaining 20 survived the procedure with immediate hemostasis. Hepatic encephalopathy developed in four patients (one in Group 1, three in Group 2, and none in Group 3); one, in Group 2, died while in an hepatic coma 19 months after TIPS. Rebleeding occurred in one patient, also in Group 2. Except for transient fever in two Group-3 patients, no procedure-related complication occurred. In terms of immediate hemostasis, rebleeding and encephalopathy, there were no statistically significant differences between the groups (p > 0.05). In Group 3, the Child-Pugh score showed a significant decrease after the procedure (p = 0.02). BRTO can effectively control active gastric variceal bleeding, and because of immediate hemostasis, the absence of rebleeding, and improved liver function, is a good alternative to TIPS in patients in whom such bleeding, accompanied by gastrorenal shunt, occurs

  2. Neural Network-Based Coronary Heart Disease Risk Prediction Using Feature Correlation Analysis

    Directory of Open Access Journals (Sweden)

    Jae Kwon Kim

    2017-01-01

    Full Text Available Background. Of the machine learning techniques used in predicting coronary heart disease (CHD, neural network (NN is popularly used to improve performance accuracy. Objective. Even though NN-based systems provide meaningful results based on clinical experiments, medical experts are not satisfied with their predictive performances because NN is trained in a “black-box” style. Method. We sought to devise an NN-based prediction of CHD risk using feature correlation analysis (NN-FCA using two stages. First, the feature selection stage, which makes features acceding to the importance in predicting CHD risk, is ranked, and second, the feature correlation analysis stage, during which one learns about the existence of correlations between feature relations and the data of each NN predictor output, is determined. Result. Of the 4146 individuals in the Korean dataset evaluated, 3031 had low CHD risk and 1115 had CHD high risk. The area under the receiver operating characteristic (ROC curve of the proposed model (0.749 ± 0.010 was larger than the Framingham risk score (FRS (0.393 ± 0.010. Conclusions. The proposed NN-FCA, which utilizes feature correlation analysis, was found to be better than FRS in terms of CHD risk prediction. Furthermore, the proposed model resulted in a larger ROC curve and more accurate predictions of CHD risk in the Korean population than the FRS.

  3. Relationship between recurrence of esophageal varices and changes of portal circulation after endoscopic injection sclerotherapy

    International Nuclear Information System (INIS)

    Azuma, Masayoshi; Kashiwagi, Toru; Ohata, Hiroyuki

    1992-01-01

    The relationship between recurrence of esophageal varices after endoscopic injection sclerotherapy (EIS) and changes of the blood pool of portosystemic collaterals was studied in 36 patients with liver cirrhosis. Examination of the blood pool of portosystemic collaterals was performed by single photon emission CT (SPECT). Seven hundreds and forty MBq of 99m Tc-RBCs, labeled by an in vivo technique, were given intra-venously, and tomographic imaging of the intraabdominal vascular blood pool was performed. Before EIS, the blood pool images of the coronary vein was demonstrated in 34 cases (94.4%). According to changes of SPECT images, the patients were divided into 3 groups, that is, the groups showing a disappearance, decrease, and no changes of the blood pool images of the coronary vein. The recurrence rates of esophageal varices after EIS were 11.1% (1 of 9 patients), 40.0% (6 of 15 patients), and 90.0% (9 of 10 patients) in the disappeared, decreased and unchanged groups respectively. These values were significantly different between the disappeared group and the unchanged group (P<0.01), and between the decreased group and the unchanged group (P<0.05). These results indicate that the abdominal blood pool SPECT is useful for evaluating the therapeutic effectiveness of EIS. (author)

  4. Characteristics of patients with non-variceal upper gastrointestinal bleeding taking antithrombotic agents.

    Science.gov (United States)

    Yamaguchi, Daisuke; Sakata, Yasuhisa; Tsuruoka, Nanae; Shimoda, Ryo; Higuchi, Toru; Sakata, Hiroyuki; Fujimoto, Kazuma; Iwakiri, Ryuichi

    2015-01-01

    The present study aimed to clarify the features and management of non-variceal upper gastrointestinal bleeding (UGIB) in Japanese patients taking antithrombotic agents. We retrospectively investigated the medical records of 560 patients who underwent emergency endoscopy for UGIB from 2002 to 2013. The patients were divided into two groups: group A, antithrombotic agent use; and group NA, no antithrombotic agent use. We compared clinical characteristics, comorbidities, and causes of UGIB between the groups. We also investigated management with antithrombotics. Of 560 patients with UGIB, 27.5% were taking antithrombotics, and this proportion gradually increased during the study period. Mean hemoglobin levels on admission were significantly lower in group A (8.0 ± 1.7 g/dL) than in group NA (8.9 ± 2.9 g/dL) (P bleeding was lower in group A than in group NA (P < 0.001), and the rate of endoscopic hemostasis was significantly higher in group A (98.7%) than in group NA (94.3%) (P = 0.022). After the release of the 2012 Japan Gastroenterological Endoscopy Society guidelines, the antithrombotic agent cessation periods were significantly shortened (P < 0.001). Among patients with UGIB, those taking antithrombotics exhibited more severe clinical signs. However spurting hemorrhage was rare. Antithrombotics may be resumed early after endoscopic hemostasis. © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

  5. EVALUATION OF PRIMARY PROPHYLAXIS WITH PROPRANOLOL AND ELASTIC BAND LIGATION IN VARICEAL BLEEDING IN CIRRHOTIC CHILDREN AND ADOLESCENTS

    Directory of Open Access Journals (Sweden)

    Júlio Rocha PIMENTA

    Full Text Available ABSTRACT Background The efficacy of nonselective β-blocker and endoscopic procedures, such as endoscopic variceal ligation, as primary prophylaxis of variceal hemorrhage in cirrhotic adults was demonstrated by numerous controlled trials, but in pediatric population, few are the number of studies. Objective The objective of this study is to evaluate the primary prophylaxis with β-blocker in cirrhotic children and adolescents with portal hypertension. Methods This is a cohort study encompassing 26 cirrhotic patients. β-blocker prophylaxis was performed with propranolol. When contraindicated the use of β-blocker, or if side effects presents, the patients were referred to endoscopic therapy with band ligation. Patients were evaluated by endoscopy, and those who had varicose veins of medium and large caliber or reddish spots, regardless of the caliber of varices, received primary prophylaxis. Results Of the 26 patients evaluated, 9 (34.6% had contraindications to the use of propranolol and were referred for endoscopic prophylaxis. Six (35.3% of the 17 patients who received β-blocker (propranolol, had bled after a median follow-up time of 1.9 years. β-blockage dosage varied from 1 mg/kg/day to 3.1 mg/kg/day and seven (41.2% patients had the propranolol suspended due to fail of the β-blockage or adverse effects, such as drowsiness, bronchospasm and hypotension. Patients who received endoscopic prophylaxis (elastic bandage had no bleeding during the follow-up period. Conclusion All of the patients that had upper gastroinstestinal bleeding in this study were under propranolol prophylaxis. The use of propranolol showed a high number of contraindications and side effects, requiring referral to endoscopic prophylaxis. The endoscopic prophylaxis was effective in reducing episodes of bleeding.

  6. Efficacy of absolute alcohol injection compared with band ligation in the eradication of esophageal varices Eficácia da injeção de álcool absoluto comparada com ligadura elástica na erradicação de varizes de esôfago

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    Angelo Paulo Ferrari

    2005-06-01

    Full Text Available BACKGROUND: Endoscopic sclerotherapy is an absolute indication for treating esophageal varices. Re-bleeding is common during the treatment period, before all varices become eradicated. AIM: To compare two techniques of endoscopic esophageal varices eradication: sclerotherapy with absolute alcohol and banding ligation. PATIENTS AND METHOD: Forty-six patients with liver cirrhosis and esophageal varices were prospectively randomized into two treatment groups: endoscopic sclerotherapy with absolute alcohol and banding ligation. Patients were included if they had large varices with signs of high bleeding risk. Informed writing consent was obtained from every patient and the Ethics Committee of Federal University of São Paulo, SP, Brazil, approved the study. After eradication, all patients were followed up to 1 year to look for re-bleeding episodes and variceal recurrence. RESULTS: Both groups were similar except that male gender was more common in the sclerotherapy group. There was no statistical difference regarding variceal eradication (78.3% in sclerotherapy group vs 73.9% in the ligation group, recurrence (26.7% vs 42.9%, respectively and death related to any cause (21.7% vs 13.9%. In the sclerotherapy group more sessions were need to obtain complete variceal eradication. In this group we did observe a high re-bleeding rate (34.8% and more ulcers associated with retrosternal pain right after the procedure. There was no difference regarding overall morbidity and mortality. CONCLUSIONS: Banding ligation requires fewer sessions than sclerotherapy with absolute alcohol to eradicate esophageal varices. Both methods are equally efficient regarding variceal eradication and recurrence during a short follow-up period.RACIONAL: Escleroterapia endoscópica tem indicação absoluta no tratamento das varizes de esôfago. Ressangramento é comum durante o período de tratamento, antes que as varizes sejam erradicadas. OBJETIVO: Comparar duas técnicas de

  7. Adherence to guidelines in bleeding oesophageal varices and effects on outcome: comparison between a specialized unit and a community hospital

    DEFF Research Database (Denmark)

    Hobolth, Lise; Krag, Aleksander; Malchow-Møller, Axel

    2010-01-01

    OBJECTIVES: Randomized controlled trials have shown beneficial effects of vasoactive drugs, endoscopic treatment and prophylactic antibiotics on the outcome of bleeding oesophageal varices (BOV). However, translating guidelines based on randomized controlled trials into clinical practice is diffi......OBJECTIVES: Randomized controlled trials have shown beneficial effects of vasoactive drugs, endoscopic treatment and prophylactic antibiotics on the outcome of bleeding oesophageal varices (BOV). However, translating guidelines based on randomized controlled trials into clinical practice...... is difficult. Our aims were to compare adherence to evidence-based guidelines in BOV between a specialized unit and a community hospital, and to investigate whether differences in adherence affected the outcome. METHODS: Two cohorts hospitalized during 2000-2007 with a first episode of BOV were retrospectively...... enrolled, one in a community hospital comprising 66 patients and one in a specialized unit comprising 111 patients. Data on treatment, rebleeding and mortality were collected from medical records according to the Baveno III/IV Criteria. RESULTS: Treatments in the specialized unit versus the community...

  8. Resultados del tratamiento de la hemorragia digestiva alta por varices esofagogástricas

    OpenAIRE

    Ruiz Luna, David; Farran, L.; Ramos, E.; Biondo, Sebastián; Moreno Llorente, Pablo; Bettónica, C.; Jorba, R.; Borobia, F. G.; Jaurrieta Mas, Eduardo

    2001-01-01

    Introducción: el tratamiento de la hemorragia digestiva alta por rotura de varices esofágicas y/o gástricas en pacientes con cirrosis hepática debe estar dirigido al control inicial de la hemorragia sin alterar más una función hepática ya deteriorada , y a la prevención de la recidiva hemorrágica precoz. Métodos endoscópicos, farmacológicos y quirúrgicos forman el conjunto de alternativas terapéuticas. Material y métodos: estudio prospectivo de los resultados obtenidos tras el seguimiento de...

  9. Novel Two-Step Classifier for Torsades de Pointes Risk Stratification from Direct Features

    Directory of Open Access Journals (Sweden)

    Jaimit Parikh

    2017-11-01

    Full Text Available While pre-clinical Torsades de Pointes (TdP risk classifiers had initially been based on drug-induced block of hERG potassium channels, it is now well established that improved risk prediction can be achieved by considering block of non-hERG ion channels. The current multi-channel TdP classifiers can be categorized into two classes. First, the classifiers that take as input the values of drug-induced block of ion channels (direct features. Second, the classifiers that are built on features extracted from output of the drug-induced multi-channel blockage simulations in the in-silico models (derived features. The classifiers built on derived features have thus far not consistently provided increased prediction accuracies, and hence casts doubt on the value of such approaches given the cost of including biophysical detail. Here, we propose a new two-step method for TdP risk classification, referred to as Multi-Channel Blockage at Early After Depolarization (MCB@EAD. In the first step, we classified the compound that produced insufficient hERG block as non-torsadogenic. In the second step, the role of non-hERG channels to modulate TdP risk are considered by constructing classifiers based on direct or derived features at critical hERG block concentrations that generates EADs in the computational cardiac cell models. MCB@EAD provides comparable or superior TdP risk classification of the drugs from the direct features in tests against published methods. TdP risk for the drugs highly correlated to the propensity to generate EADs in the model. However, the derived features of the biophysical models did not improve the predictive capability for TdP risk assessment.

  10. Prediction of Mortality after Emergent Transjugular Intrahepatic Portosystemic Shunt Placement: Use of APACHE II, Child-Pugh and MELD Scores in Asian Patients with Refractory Variceal Hemorrhage

    International Nuclear Information System (INIS)

    Tzeng, Wen Sheng; Wu, Reng Hong; Lin, Ching Yih; Chen, Jyh Jou; Sheu, Ming Juen; Koay, Lok Beng; Lee, Chuan

    2009-01-01

    This study was designed to determine if existing methods of grading liver function that have been developed in non-Asian patients with cirrhosis can be used to predict mortality in Asian patients treated for refractory variceal hemorrhage by the use of the transjugular intrahepatic portosystemic shunt (TIPS) procedure. Data for 107 consecutive patients who underwent an emergency TIPS procedure were retrospectively analyzed. Acute physiology and chronic health evaluation (APACHE II), Child-Pugh and model for end-stage liver disease (MELD) scores were calculated. Survival analyses were performed to evaluate the ability of the various models to predict 30-day, 60-day and 360-day mortality. The ability of stratified APACHE II, Child-Pugh, and MELD scores to predict survival was assessed by the use of Kaplan-Meier analysis with the log-rank test. No patient died during the TIPS procedure, but 82 patients died during the follow-up period. Thirty patients died within 30 days after the TIPS procedure; 37 patients died within 60 days and 53 patients died within 360 days. Univariate analysis indicated that hepatorenal syndrome, use of inotropic agents and mechanical ventilation were associated with elevated 30-day mortality (p 11 or an MELD score > 20 predicted increased risk of death at 30, 60 and 360 days (p 11 or an MELD score > 20 are predictive of mortality in Asian patients with refractory variceal hemorrhage treated with the TIPS procedure. An APACHE II score is not predictive of early mortality in this patient population

  11. Sucralfate and Lidocain: Antacid 50:50 solution in Post Esophageal Variceal Band Ligation Pain.

    Science.gov (United States)

    Hafeez, Muhammad; Kadir, Ehsan; Aijaz, Anjum

    2016-01-01

    To compare the effectiveness of pain relief of Sucralfate and lidocain antacid 50:50 solution in post esophageal variceal band ligation pain. All patients who had under gone Esophageal Variceal Band Ligation (EVBL) were included in the study. Patients un-willing to be included in the study or those who didn't have post EVBL pain were excluded. Patients with post EVBL pains were divided into two groups: one group was given sucralfate and other was given lidocaine: antacid 50:50 solution. Both were inquired about the duration of the pain relief after the medication. The results were analyzed on SPSS 23. Independent samples T-test was performed to find out whether the difference in duration of pain relief was significantly different in the two groups. Out of 110 patients who have EVBL, 66(60.00%) had pain and 44(40.00%) were pain free. In the pain group 46 (69.7%) were given sucralfate and 20 (30.3%) were given lidocain: antacid 50:50 solution. Mean duration of pain relief in two groups was 2.78 (SD ± 2.096) and 2.5 days (SD ±. 0.76) respectively. Independent samples T-test results revealed that there was no statistically significant difference in the duration of pain relief between these two groups with p value 0.426. Both Sucralfate and Lidocain: antacid 50:50 solutions are effective in relieving the post EVBL pain. However, no statistically significant difference in duration of pain relief was detected in separate groups of patients treated with either treatment.

  12. Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study

    DEFF Research Database (Denmark)

    Jepsen, Peter; Ott, Peter; Andersen, Per Kragh

    2010-01-01

    The clinical course of alcoholic cirrhosis, a condition with a high mortality, has not been well described. We examined prevalence, risk, chronology, and mortality associated with three complications of cirrhosis: ascites, variceal bleeding, and hepatic encephalopathy. We followed a population......-risks methods. At diagnosis of alcoholic cirrhosis, 24% of patients had no complications, 55% had ascites alone, 6% had variceal bleeding alone, 4% had ascites and variceal bleeding, and 11% had hepatic encephalopathy. One-year mortality was 17% among patients with no initial complications, 20% following...... variceal bleeding alone, 29% following ascites alone, 49% following ascites and variceal bleeding (from the onset of the later of the two complications), and 64% following hepatic encephalopathy. Five-year mortality ranged from 58% to 85%. The risk of complications was about 25% after 1 year and 50% after...

  13. Frequency and characteristic features of portal hypertensive gastropathy in patients with viral cirrhosis

    International Nuclear Information System (INIS)

    Ahmed, S.; Mumtaz, K.; Ahmed, S.U.; Hamid, S.; Jafri, W.

    2010-01-01

    To determine the frequency and specific characteristic features of portal hypertensive gastropathy (PHG) in cirrhosis due to viral etiology. Study Design: Cross-sectional descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from June 2006 till June 2008. Methodology: Patients with hepatitis B and C cirrhosis were included who underwent screening esophago-gastroduodenoscopy (EGD) for varices. Baveno III consensus statement was used for diagnosing PHG on endoscopy and divided them into two subgroups i.e. mild and severe. Data related to platelet/spleen ratio, MELD score and Child Turcotte Pugh (CTP) score indicating severity of cirrhosis were recorded in all patients. Findings were compared by using independent sample t-test. Results: Out of 360 patients who underwent screening EGD, 226 (62.8%) were males. Two hundred and eighty one (78%) had hepatitis C while 79 (22%) suffered from hepatitis B related cirrhosis. Three hundred patients (83.3%) had PHG while 71 (24%) had severe PHG. Higher proportion of esophageal varices (89.7%) was present among those who had PHG (p 8 MELD score > 12 and platelets/spleen ratio 12, CTP score greater than 8 and platelets/spleen ratio < 900 were significant factors of severe PHG. (author)

  14. PROPHYLACTIC ENDOSCOPIC INJECTION SCLEROTHERAPY FOR GASTRIC VARICES : 1. DEVELOPMENT OF A NEW SCLEROTHERAPY TECHNIQUE AND ITS APPLICATION

    OpenAIRE

    Matsumura, Masahiko

    1994-01-01

    The author designed a direct injection method of endoscopic injection sclerotherapy (EIS) for gastric varices with a newly developed technique for controlling bleeding from the punctured site, and subsequently used it for prophylactic treatment in 10 cases. EIS was performed under X-ray monitoring in the absence of a balloon, and 5% ethanolamine oleate containing 49% Iopamidol was used as the sclerosant. A twenty-five gauge needle wearing an outer tube was used for the puncture. After injecti...

  15. Diagnostic Accuracy of APRI, AAR, FIB-4, FI, and King Scores for Diagnosis of Esophageal Varices in Liver Cirrhosis: A Retrospective Study.

    Science.gov (United States)

    Deng, Han; Qi, Xingshun; Peng, Ying; Li, Jing; Li, Hongyu; Zhang, Yongguo; Liu, Xu; Sun, Xiaolin; Guo, Xiaozhong

    2015-12-20

    BACKGROUND Aspartate aminotransferase-to-platelet ratio index (APRI), aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), FIB-4, fibrosis index (FI), and King scores might be alternatives to the use of upper gastrointestinal endoscopy for the diagnosis of esophageal varices (EVs) in liver cirrhosis. This study aimed to evaluate their diagnostic accuracy in predicting the presence and severity of EVs in liver cirrhosis. MATERIAL AND METHODS All patients who were consecutively admitted to our hospital and underwent upper gastrointestinal endoscopy between January 2012 and June 2014 were eligible for this retrospective study. Areas under curve (AUCs) were calculated. Subgroup analyses were performed according to the history of upper gastrointestinal bleeding (UGIB) and splenectomy. RESULTS A total of 650 patients with liver cirrhosis were included, and 81.4% of them had moderate-severe EVs. In the overall analysis, the AUCs of these non-invasive scores for predicting moderate-severe EVs and presence of any EVs were 0.506-0.6 and 0.539-0.612, respectively. In the subgroup analysis of patients without UGIB, their AUCs for predicting moderate-severe varices and presence of any EVs were 0.601-0.664 and 0.596-0.662, respectively. In the subgroup analysis of patients without UGIB or splenectomy, their AUCs for predicting moderate-severe varices and presence of any EVs were 0.627-0.69 and 0.607-0.692, respectively. CONCLUSIONS APRI, AAR, FIB-4, FI, and King scores had modest diagnostic accuracy of EVs in liver cirrhosis. They might not be able to replace the utility of upper gastrointestinal endoscopy for the diagnosis of EVs in liver cirrhosis.

  16. Predictive features of CT for risk stratifications in patients with primary gastrointestinal stromal tumour

    International Nuclear Information System (INIS)

    Zhou, Cuiping; Zhang, Xiang; Duan, Xiaohui; Hu, Huijun; Wang, Dongye; Shen, Jun

    2016-01-01

    To determine the predictive CT imaging features for risk stratifications in patients with primary gastrointestinal stromal tumours (GISTs). One hundred and twenty-nine patients with histologically confirmed primary GISTs (diameter >2 cm) were enrolled. CT imaging features were reviewed. Tumour risk stratifications were determined according to the 2008 NIH criteria where GISTs were classified into four categories according to the tumour size, location, mitosis count, and tumour rupture. The association between risk stratifications and CT features was analyzed using univariate analysis, followed by multinomial logistic regression and receiver operating characteristic (ROC) curve analysis. CT imaging features including tumour margin, size, shape, tumour growth pattern, direct organ invasion, necrosis, enlarged vessels feeding or draining the mass (EVFDM), lymphadenopathy, and contrast enhancement pattern were associated with the risk stratifications, as determined by univariate analysis (P < 0.05). Only lesion size, growth pattern and EVFDM remained independent risk factors in multinomial logistic regression analysis (OR = 3.480-100.384). ROC curve analysis showed that the area under curve of the obtained multinomial logistic regression model was 0.806 (95 % CI: 0.727-0.885). CT features including lesion size, tumour growth pattern, and EVFDM were predictors of the risk stratifications for GIST. (orig.)

  17. Retrospective Study to Compare Selective Decongestive Devascularization and Gastrosplenic Shunt versus Splenectomy with Pericardial Devascularization for the Treatment of Patients with Esophagogastric Varices Due to Cirrhotic Portal Hypertension.

    Science.gov (United States)

    Bao, Haili; He, Qikuan; Dai, Ninggao; Ye, Ruifan; Zhang, Qiyu

    2017-06-08

    BACKGROUND For patients with esophagogastric varices secondary to portal hypertension due to liver cirrhosis, portosystemic shunts and devascularization have become the most commonly used treatment methods. We have developed a novel surgical approach for the treatment of patients with cirrhotic portal hypertension, selective decongestive devascularization, and shunt of the gastrosplenic region (SDDS-GSR). This aim of this study was to compare the efficacy and safety of SDDS-GSR with splenectomy with pericardial devascularization (SPD). MATERIAL AND METHODS A retrospective study was undertaken between 2006 and 2013 and included 110 patients with cirrhotic portal hypertension, 34 of whom underwent SDDS-GSR; 76 patients underwent SPD. Kaplan-Meier analysis was used to evaluate clinical outcomes, mortality, the incidence of re-bleeding, encephalopathy, and portal venous system thrombosis (PVST). RESULTS Postoperatively portal venous pressure decreased by 20% in both groups. The long-term incidence of re-bleeding and PVST was significantly lower in the SDDS-GSR group compared with the SPD group (P=0.018 and P=0.039, respectively). CONCLUSIONS This preliminary retrospective study has shown that SDDS-GSR was an effective treatment for patients with esophagogastric varices secondary to portal hypertension that may be used as a first-line treatment to prevent variceal bleeding and lower the incidence of PVST.

  18. 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.

  19. The influence of uncertain map features on risk beliefs and perceived ambiguity for maps of modeled cancer risk from air pollution

    Science.gov (United States)

    Myers, Jeffrey D.

    2012-01-01

    Maps are often used to convey information generated by models, for example, modeled cancer risk from air pollution. The concrete nature of images, such as maps, may convey more certainty than warranted for modeled information. Three map features were selected to communicate the uncertainty of modeled cancer risk: (a) map contours appeared in or out of focus, (b) one or three colors were used, and (c) a verbal-relative or numeric risk expression was used in the legend. Study aims were to assess how these features influenced risk beliefs and the ambiguity of risk beliefs at four assigned map locations that varied by risk level. We applied an integrated conceptual framework to conduct this full factorial experiment with 32 maps that varied by the three dichotomous features and four risk levels; 826 university students participated. Data was analyzed using structural equation modeling. Unfocused contours and the verbal-relative risk expression generated more ambiguity than their counterparts. Focused contours generated stronger risk beliefs for higher risk levels and weaker beliefs for lower risk levels. Number of colors had minimal influence. The magnitude of risk level, conveyed using incrementally darker shading, had a substantial dose-response influence on the strength of risk beliefs. Personal characteristics of prior beliefs and numeracy also had substantial influences. Bottom-up and top-down information processing suggest why iconic visual features of incremental shading and contour focus had the strongest visual influences on risk beliefs and ambiguity. Variations in contour focus and risk expression show promise for fostering appropriate levels of ambiguity. PMID:22985196

  20. Gastric Polyp Growth during Endoscopic Surveillance for Esophageal Varices or Barrett's Esophagus.

    Science.gov (United States)

    Livovsky, Dan M; Pappo, Orit; Skarzhinsky, Galina; Peretz, Asaf; Turvall, Elliot; Ackerman, Zvi

    2016-05-01

    We recently observed patients with chronic liver disease (CLD) or chronic reflux symptoms (CRS) who developed gastric polyps (GPs) while undergoing surveillance gastroscopies for the detection of esophageal varices or Barrett's esophagus, respectively. To identify risk factors for GP growth and estimate its growth rate. GP growth rate was defined as the number of days since the first gastroscopy (without polyps) in the surveillance program, until the gastroscopy when a GP was discovered. Gastric polyp growth rates in CLD and CRS patients were similar. However, hyperplastic gastric polyps (HGPs) were detected more often (87.5% vs. 60.5%, P = 0.051) and at a higher number (2.57 ± 1.33 vs. 1.65 ± 0.93, P = 0.021) in the CLD patients. Subgroup analysis revealed the following findings only in CLD patients with HGPs: (i) a positive correlation between the GP growth rate and the patient's age; the older the patient, the higher the GP growth rate (r = 0.7, P = 0.004). (ii) A negative correlation between the patient's age and the Ki-67 proliferation index value; the older the patient, the lower the Ki-67 value (r = -0.64, P = 0.02). No correlation was detected between Ki-67 values of HGPs in CLD patients and the presence of portal hypertension, infection with Helicobacter pylori, or proton pump inhibitor use. In comparison with CRS patients, CLD patients developed HGPs more often and at a greater number. Young CLD patients may have a tendency to develop HGPs at a faster rate than elderly CLD patients.

  1. Relation of borderline personality features to preincarceration HIV risk behaviors of jail inmates: Evidence for gender differences?

    Science.gov (United States)

    Adams, Leah M; Stuewig, Jeffrey B; Tangney, June P

    2016-01-01

    The present study explored the relationship between borderline personality disorder (BPD) features and preincarceration HIV risk behaviors in a sample of 499 (70% male) jail inmates, as well as gender differences in these associations. Elevated levels of BPD symptomatology were present among male and female participants, though there was considerable variance observed in participants' BPD symptoms and HIV risk behaviors. In the full sample, BPD features were positively associated with a variety of HIV risk behaviors, including injection drug use and frequency of unprotected sex with high risk partners and under high risk circumstances. Gender moderated only 2 relationships between BPD features and HIV risk behaviors, with a stronger association between BPD features and number of sexual partners, and BPD features and frequency of unprotected sex while under the influence of alcohol or drugs for women, relative to men. Taken together, these findings suggest that programs targeting HIV risk within correctional populations may benefit from considering the role of BPD features, particularly emotion regulation difficulties and impulsivity, in influencing HIV risk behaviors among both women and men. (c) 2016 APA, all rights reserved).

  2. Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial.

    Science.gov (United States)

    Hou, Ming-Chih; Lin, Han-Chieh; Liu, Tsu-Te; Kuo, Benjamin Ing-Tieu; Lee, Fa-Yauh; Chang, Full-Young; Lee, Shou-Dong

    2004-03-01

    Bacterial infection may adversely affect the hemostasis of patients with gastroesophageal variceal bleeding (GEVB). Antibiotic prophylaxis can prevent bacterial infection in such patients, but its role in preventing rebleeding is unclear. Over a 25-month period, patients with acute GEVB but without evidence of bacterial infection were randomized to receive prophylactic antibiotics (ofloxacin 200 mg i.v. q12h for 2 days followed by oral ofloxacin 200 mg q12h for 5 days) or receive antibiotics only when infection became evident (on-demand group). Endoscopic therapy for the GEVB was performed immediately after infection work-up and randomization. Fifty-nine patients in the prophylactic group and 61 patients in the on-demand group were analyzed. Clinical and endoscopic characteristics of the gastroesophageal varices, time to endoscopic treatment, and period of follow-up were not different between the two groups. Antibiotic prophylaxis decreased infections (2/59 vs. 16/61; P actuarial probability of rebleeding was higher in patients without prophylactic antibiotics (P =.0029). The difference of rebleeding was mostly due to early rebleeding within 7 days (4/12 vs. 21/27, P =.0221). The relative hazard of rebleeding within 7 days was 5.078 (95% CI: 1.854-13.908, P <.0001). The multivariate Cox regression indicated bacterial infection (relative hazard: 3.85, 95% CI: 1.85-13.90) and association with hepatocellular carcinoma (relative hazard: 2.46, 95% CI: 1.30-4.63) as independent factors predictive of rebleeding. Blood transfusion for rebleeding was also reduced in the prophylactic group (1.40 +/- 0.89 vs. 2.81 +/- 2.29 units, P <.05). There was no difference in survival between the two groups. In conclusion, antibiotic prophylaxis can prevent infection and rebleeding as well as decrease the amount of blood transfused for patients with acute GEVB following endoscopic treatment.

  3. Prediction of Mortality after Emergent Transjugular Intrahepatic Portosystemic Shunt Placement: Use of APACHE II, Child-Pugh and MELD Scores in Asian Patients with Refractory Variceal Hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Tzeng, Wen Sheng; Wu, Reng Hong; Lin, Ching Yih; Chen, Jyh Jou; Sheu, Ming Juen; Koay, Lok Beng; Lee, Chuan [Chi-Mei Foundation Medical Center, Tainan (China)

    2009-10-15

    This study was designed to determine if existing methods of grading liver function that have been developed in non-Asian patients with cirrhosis can be used to predict mortality in Asian patients treated for refractory variceal hemorrhage by the use of the transjugular intrahepatic portosystemic shunt (TIPS) procedure. Data for 107 consecutive patients who underwent an emergency TIPS procedure were retrospectively analyzed. Acute physiology and chronic health evaluation (APACHE II), Child-Pugh and model for end-stage liver disease (MELD) scores were calculated. Survival analyses were performed to evaluate the ability of the various models to predict 30-day, 60-day and 360-day mortality. The ability of stratified APACHE II, Child-Pugh, and MELD scores to predict survival was assessed by the use of Kaplan-Meier analysis with the log-rank test. No patient died during the TIPS procedure, but 82 patients died during the follow-up period. Thirty patients died within 30 days after the TIPS procedure; 37 patients died within 60 days and 53 patients died within 360 days. Univariate analysis indicated that hepatorenal syndrome, use of inotropic agents and mechanical ventilation were associated with elevated 30-day mortality (p < 0.05). Multivariate analysis showed that a Child-Pugh score > 11 or an MELD score > 20 predicted increased risk of death at 30, 60 and 360 days (p < 0.05). APACHE II scores could only predict mortality at 360 days (p < 0.05). A Child-Pugh score > 11 or an MELD score > 20 are predictive of mortality in Asian patients with refractory variceal hemorrhage treated with the TIPS procedure. An APACHE II score is not predictive of early mortality in this patient population.

  4. Effectiveness of the polysaccharide hemostatic powder in non-variceal upper gastrointestinal bleeding: Using propensity score matching.

    Science.gov (United States)

    Park, Jun Chul; Kim, Yeong Jin; Kim, Eun Hye; Lee, Jinae; Yang, Hyun Su; Kim, Eun Hwa; Hahn, Kyu Yeon; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan

    2018-02-07

    Recently, the application of hemostatic powder to the bleeding site has been used to treat active upper gastrointestinal bleeding (UGIB). We aimed to assess the effectiveness of the polysaccharide hemostatic powder (PHP) in patients with non-variceal UGIB. We reviewed prospectively collected 40 patients with UGIB treated with PHP therapy between April 2016 and January 2017 (PHP group) and 303 patients with UGIB treated with conventional therapy between April 2012 and October 2014 (conventional therapy group). We compared the rate of successful hemostasis and the rebleeding between the two groups after as well as before propensity score matching using the Glasgow-Blatchford score and Forrest classification. Thirty patients treated with the PHP and 60 patients treated with conventional therapy were included in the matched groups. Baseline patient characteristics including comorbidities, vital signs, and bleeding scores were similar in the matched groups. The rate of immediate hemostasis and 7-day and 30-day rebleeding were also similar in the two groups before and after matching. In the subgroup analysis, no significant differences in immediate hemostasis or rebleeding rate were noted between PHP in monotherapy and PHP combined with a conventional hemostatic method. At 30 days after the therapy, there were no significant PHP-related complications or mortality. Given its safety, the PHP proved feasible for endoscopic treatment of UGIB, having similar effectiveness as that of conventional therapy. The PHP may become a promising hemostatic method for non-variceal UGIB. © 2018 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  5. A Rare Case of Retrogastric Abscess Occurring Six Months after N-Butyl-2-Cyanoacrylate Injection into Gastric Varices

    Directory of Open Access Journals (Sweden)

    Ikram Hussain

    2018-01-01

    Full Text Available Background. Injection with N-butyl-2-cyanoacrylate is a proven and successful therapeutic modality for treatment of patients with bleeding gastric varices. However, a variety of complications have also been associated with its use. Here, we report a rare case of retrogastric abscess which occurred almost six months after this therapy. This abscess was attributed to the hampered microbial clearance caused by the venous obliterations from N-butyl-2-cyanoacrylate. The abscess was successfully treated with 3 months of antibiotics.

  6. Prediction of esophageal variceal bleeding in B-viral liver cirrhosis using the P2/MS noninvasive index based on complete blood counts.

    Science.gov (United States)

    Kim, Beom Kyung; Ahn, Sang Hoon; Han, Kwang-Hyub; Park, Jun Yong; Han, Min Seok; Jo, Jung Hyun; Kim, Ja Kyung; Lee, Kwan Sik; Chon, Chae Yoon; Kim, Do Young

    2012-01-01

    Periodic endoscopy for esophageal varices (EVs) and prophylactic treatment of high-risk EVs, i.e., medium/large EVs, small EVs with the red-color sign or decompensation, are recommended in cirrhotic patients. We assessed the cumulative risks for future EV bleeding using the following simple P2/MS index: (platelet count)2/[monocyte fraction (%) × segmented neutrophil fraction (%)]. We enrolled 475 consecutive B-viral cirrhosis patients for 4 years, none of whom experienced EV bleeding. All underwent laboratory work-ups, endoscopy and ultrasonography. Those with EV bleeding took a nonselective β-blocker as prophylaxis. The major endpoint was the first occurrence of EV bleeding, analyzed using the Kaplan-Meier and Cox regression methods. Among patients with EV bleeding (n = 131), 25 experienced their first EV bleeding during follow-up. To differentiate the risk for EV bleeding, we divided them into two subgroups according to their P2/MS value (subgroup 1: P2/MS ≥9 and subgroup 2: P2/MS P2/MS (p = 0.040) remained a significant predictor for EV bleeding along with large varix size (p = 0.015), red-color sign (p = 0.041) and Child-Pugh classification B/C (p = 0.001). In subgroup 1, the risk for EV bleeding was similar to that of patients with low-risk EVs (p = 0.164). The P2/MS is a reliable predictor for the risk of EV bleeding among patients with EV bleeding. According to risk stratification, different prophylactic treatments should be considered for the subgroup with a P2/MS <9. Copyright © 2012 S. Karger AG, Basel.

  7. Estudio coste-efectividad sobre la medición del gradiente de presión venosa hepática en la profilaxis secundaria de la hemorragia digestiva varicosa A cost-effectiveness study of hepatic venous pressure gradient measurement in the secondary prevention of variceal bleeding

    Directory of Open Access Journals (Sweden)

    A. Amorós

    2008-07-01

    Full Text Available Objetivo: la hemorragia digestiva es una complicación frecuente en pacientes con cirrosis hepática. La tasa de recidiva tras un primer episodio oscila en torno al 60%, motivo por el cual la profilaxis está recomendada. Esta puede realizarse mediante fármacos (betabloqueantes y nitratos combinados o no con ligadura endoscópica con bandas. El objetivo de este estudio es valorar el coste-efectividad de la medición del gradiente de presión venosa hepática (GPVH previo a la elección de la profilaxis secundaria. Métodos: creamos un árbol de decisión para calcular el coste-efectividad de dos estrategias: grupo 1: pacientes a los que se les determinó el GPVH; cuando tras la administración de propranolol hubo una disminución del gradiente ≥ al 20% respecto al inicial o disminuyó por debajo de 12 mmHg, los pacientes fueron tratados con propranolol. Si no hubo tal variación del GPVH, se realizó ligadura endoscópica de las varices. Grupo 2: en este grupo no se monitorizó el GPVH. Los pacientes con varices grado I recibieron tratamiento con betabloqueantes más nitratos y los que presentaban varices grandes (II, III, IV fueron tratados con betabloqueantes y LEB. Resultados: en el grupo del estudio hemodinámico respondió un 36%, estos recibieron tratamiento betabloqueante, la tasa de resangrado fue del 0%. En los no respondedores la tasa de resangrado fue de un 17%. En el grupo sin estudio se trató con propranolol más nitratos al 28,42% y resangraron un 25%; la tasa de resangrado en el grupo que recibió tratamiento con betabloqueantes más ligadura endoscópica fue de un 13%. El coste total en el grupo al que se realizó el estudio hemodinámico fue de 14.100,49 euros y de 14.677,16 euros para el grupo sin estudio hemodinámico. Conclusiones: la realización del estudio hemodinámico es una herramienta coste-efectiva en la profilaxis de la hemorragia digestiva varicosa en pacientes cirróticos y mantiene una relación coste efectiva

  8. Association of mammographic image feature change and an increasing risk trend of developing breast cancer: an assessment

    Science.gov (United States)

    Tan, Maxine; Leader, Joseph K.; Liu, Hong; Zheng, Bin

    2015-03-01

    We recently investigated a new mammographic image feature based risk factor to predict near-term breast cancer risk after a woman has a negative mammographic screening. We hypothesized that unlike the conventional epidemiology-based long-term (or lifetime) risk factors, the mammographic image feature based risk factor value will increase as the time lag between the negative and positive mammography screening decreases. The purpose of this study is to test this hypothesis. From a large and diverse full-field digital mammography (FFDM) image database with 1278 cases, we collected all available sequential FFDM examinations for each case including the "current" and 1 to 3 most recently "prior" examinations. All "prior" examinations were interpreted negative, and "current" ones were either malignant or recalled negative/benign. We computed 92 global mammographic texture and density based features, and included three clinical risk factors (woman's age, family history and subjective breast density BIRADS ratings). On this initial feature set, we applied a fast and accurate Sequential Forward Floating Selection (SFFS) feature selection algorithm to reduce feature dimensionality. The features computed on both mammographic views were individually/ separately trained using two artificial neural network (ANN) classifiers. The classification scores of the two ANNs were then merged with a sequential ANN. The results show that the maximum adjusted odds ratios were 5.59, 7.98, and 15.77 for using the 3rd, 2nd, and 1st "prior" FFDM examinations, respectively, which demonstrates a higher association of mammographic image feature change and an increasing risk trend of developing breast cancer in the near-term after a negative screening.

  9. Relationship of child abuse with personality features and high risk behaviors in adolescents

    Directory of Open Access Journals (Sweden)

    Mehdi Ghezelseflo

    2015-05-01

    Full Text Available Background: Children are one of the most vulnerable groups of the society and are constantly threatened by different people in their family or society. The aim of this study was investigating the correlation of child abuse with personality features and high risk behavior in high school students of Islamshahr, Iran. Methods: This study cross-sectional analytical was conducted on the high school girls and boys of Islamshahr in spring 2014.528 students were selected by cluster random sampling among 4 high schools (two female and two male high schools. Childhood trauma questionnaire, NEO-Five Factor Inventory and Youth Risk-Taking Scale were used for data collection. Data were analyzed by independence t-test, Pearson's correlation coefficient and multiple linear regression. Results: The results of independence t-test indicated significant differences between girls and boys in terms of child abuse and high risk experience (t=-2.16,p=0.03 and t=-5.03, P=0.001, respectively. Also, the results demonstrated a significant relationship between child abuse and personality characteristics, high risk behavior and all its subscales (P<0.05. The findings of multiple linear regressionindicated that child abuse could explain 14% total risk-taking, 25% neurotic personality feature , 14% extroversion, 10% agreeableness, 1% flexibility and 13% conscientiousness (P<0.05. Conclusion: According to the research findings, appropriate behavior with children is of great importance. Therefore, child abuse would form inappropriate personality features and increase risk behaviors among children.

  10. [Application of degree of portal systemic shunting in assessing upper gastrointestinal bleeding in patients with schistosomiasis cirrhosis].

    Science.gov (United States)

    Shuai, Ju; Ying, Li; Chang-Xue, Ji; Biao, Zhang

    2017-03-27

    To discuss the application of the degree of portal systemic shunting in assessing the upper gastrointestinal bleeding in patients with hepatic schistosomiasis. Thirty-three patients with upper gastrointestinal bleeding caused by hepatic schistosomiasis (a bleeding group) and 29 schistosomiasis cirrhosis patients without bleeding (a non-bleeding group) were enrolled as investigation subjects in Jinshan Hospital. The subjects were scanned by the 128 abdominal slice spiral CT. The portal systemic shunting vessels were reconstructed by using thin slab maximum intensity projection (TSMIP) and multiplanar reconstruction (MPR). The degrees of the shunting vessels of the subjects were evaluated and compared, and the relationship between upper gastrointestinal bleeding and the degree of the shunting was analyzed. In the bleeding group, the occurrence rates of the shunting vessels were found as follows: 86.4% in left gastric varices, 68.2% in short gastric varices, 50.0% in esophageal varices, 50.0% in para-esophageal varices, 37.9% in gastric varices, 69.7% in gastric-renal varices, 51.5% in spleen-renal varices, 25.8% in abdominal wall varices, 15.2% in omentum varices, 63.6% in para-splenic varices, 34.8% in umbilical varices, 40.9% in retroperitoneal-paravertebral varices, and 36.4% in mesenteric varices. In the bleeding group, the occurrence rates and the degree of shunt were significantly higher than those in the non-bleeding group in esophageal varices, esophageal vein, left gastric vein and gastric varices (all P upper gastrointestinal bleeding in patients with hepatic schistosomiasis. The patents with higher degree of the shunting vessels have a higher risk of gastrointestinal bleeding.

  11. Blood flow parameters in the short gastric vein and splenic vein on Doppler ultrasound reflect gastric variceal bleeding

    International Nuclear Information System (INIS)

    Maruyama, Hitoshi; Ishihara, Takeshi; Ishii, Hiroshi; Tsuyuguchi, Toshio; Yoshikawa, Masaharu; Matsutani, Shoichi; Yokosuka, Osamu

    2010-01-01

    Purpose: Hemodynamic features associated with the bleeding from gastric fundal varices (FV) have not been fully examined. The purpose of this study was to elucidate hemodynamics in the short gastric vein (SGV) which is a major inflow route for FV and flow direction of the splenic vein (SV) in relation to bleeding FV. Materials and Methods: The subject of this retrospective study was 54 cirrhotic patients who had medium- or large-sized FV (20 bleeders, 34 non-bleeders) on endoscopy with SGV on both angiogram and sonogram. Diameter, flow velocity, flow volume of SGV and flow direction in the SV were evaluated by Doppler ultrasound. Results: Diameter, flow velocity and flow volume of SGV were significantly greater in bleeders (9.6 ± 3.1 mm, 11.4 ± 5.2 cm/s, 499 ± 250.1 ml/min) than non-bleeders (6.5 ± 2.2 mm, p = 0.0141; 7.9 ± 3.3 cm/s, p = 0.022; 205 ± 129.1 ml/min, p = 0.0031). SV showed forward flow in 37 (68.5%), to and fro in 3 (5.6%) and reversed flow in 14 patients (25.9%). The frequency of FV bleeding was significantly higher in case with reversed or 'to and fro' SV flow (11/17) than forward SV flow (9/37, p = 0.0043). The cumulative bleeding rate at 3 and 5 years was significantly higher in patients without forward SV flow (38.8% at 3 years, 59.2% at 5 years) than in patients with forward SV flow (18.7% at 3 years, 32.2% at 5 years, p = 0.0199). Conclusion: Advanced SGV blood flow and reversed SV flow direction may be a hemodynamic features closely related to the FV bleeding.

  12. Temporal assessment of radiomic features on clinical mammography in a high-risk population

    Science.gov (United States)

    Mendel, Kayla R.; Li, Hui; Lan, Li; Chan, Chun-Wai; King, Lauren M.; Tayob, Nabihah; Whitman, Gary; El-Zein, Randa; Bedrosian, Isabelle; Giger, Maryellen L.

    2018-02-01

    Extraction of high-dimensional quantitative data from medical images has become necessary in disease risk assessment, diagnostics and prognostics. Radiomic workflows for mammography typically involve a single medical image for each patient although medical images may exist for multiple imaging exams, especially in screening protocols. Our study takes advantage of the availability of mammograms acquired over multiple years for the prediction of cancer onset. This study included 841 images from 328 patients who developed subsequent mammographic abnormalities, which were confirmed as either cancer (n=173) or non-cancer (n=155) through diagnostic core needle biopsy. Quantitative radiomic analysis was conducted on antecedent FFDMs acquired a year or more prior to diagnostic biopsy. Analysis was limited to the breast contralateral to that in which the abnormality arose. Novel metrics were used to identify robust radiomic features. The most robust features were evaluated in the task of predicting future malignancies on a subset of 72 subjects (23 cancer cases and 49 non-cancer controls) with mammograms over multiple years. Using linear discriminant analysis, the robust radiomic features were merged into predictive signatures by: (i) using features from only the most recent contralateral mammogram, (ii) change in feature values between mammograms, and (iii) ratio of feature values over time, yielding AUCs of 0.57 (SE=0.07), 0.63 (SE=0.06), and 0.66 (SE=0.06), respectively. The AUCs for temporal radiomics (ratio) statistically differed from chance, suggesting that changes in radiomics over time may be critical for risk assessment. Overall, we found that our two-stage process of robustness assessment followed by performance evaluation served well in our investigation on the role of temporal radiomics in risk assessment.

  13. The Features of Introduction of Risk Management in Ukrainian Enterprises

    Directory of Open Access Journals (Sweden)

    Chaikina Alina O.

    2017-11-01

    Full Text Available The article defines key features of introduction of risk-management at the Ukrainian enterprises taking into consideration personal characteristics of managers and identifying the main risks that impact entrepreneurial activity. It has been proved that the essence of entrepreneurial activity is reduced to adequate perception of risk by the entrepreneur and to the ability to prevent its occurrence. The authors suggest their own approach to definition of the essence of entrepreneurial risk. In the article, risk management is considered as a system of enterprise management, providing for timely detection (proactive action and adequate response to the occurrence of risks in the entrepreneurial activity (protective action, the purpose of which is to ensure the seamless operation of the enterprise and its continuous development. The algorithm of implementation of risk-management at enterprise has been developed. The «Top-10 risks of 2017» has been analyzed and it has been concluded that for the Ukrainian enterprises the most significant for today are: changes in the legislation; raising the level of taxes, fees and costs of communal payments; unskilled personnel; loss of the consumer as result of actions of competitors; raider attacks; ATO.

  14. Melancholic features and hostility are associated with suicidality risk in Asian patients with major depressive disorder.

    Science.gov (United States)

    Jeon, Hong Jin; Peng, Daihui; Chua, Hong Choon; Srisurapanont, Manit; Fava, Maurizio; Bae, Jae-Nam; Man Chang, Sung; Hong, Jin Pyo

    2013-06-01

    Suicide rates are higher in East-Asians than other populations, and especially high in Koreans. However, little is known about suicidality risk and melancholic features in Asian patients with major depressive disorder (MDD). Drug-free MDD outpatients were included from 13 centers across five ethnicities consisting of Chinese (n=290), Korean (n=101), Thai (n=102), Indian (n=27), and Malay (n=27). All were interviewed using the Mini-International Neuropsychiatric Interview (M.I.N.I.), the Montgomery-Åsberg Depression Rating Scale (MADRS), and the Symptoms Checklist 90-Revised (SCL-90-R). Of 547 subjects, 177 MDD patients showed melancholic features (32.4%). These melancholic MDD patients revealed significantly higher suicidality risk (pdepression (pdifference in higher hostility. Adjusted odds ratios of melancholic features and hostility for moderate to high suicidality risk were 1.79 (95% CI=1.15-2.79) and 2.45 (95% CI=1.37-4.38), after adjusting for age, sex, education years, and depression severity. Post-hoc analyses showed that suicidality risk was higher in Korean and Chinese than that of Thai, Indian and Malay in MDD subjects with melancholic features, although depression severity showed no significant differences among the ethnicities. Suicidality risk is associated with both melancholic features and hostility and it shows cross-ethnic differences in Asian MDD patients, independent of depression severity. Copyright © 2013 Elsevier B.V. All rights reserved.

  15. Laparoscopic RFA with splenectomy for hepatocellular carcinoma.

    Science.gov (United States)

    Hu, Kunpeng; Lei, Purun; Yao, Zhicheng; Wang, Chenhu; Wang, Qingliang; Xu, Shilei; Xiong, Zhiyong; Huang, He; Xu, Ruiyun; Deng, Meihai; Liu, Bo

    2016-07-27

    The treatment of hepatocellular carcinoma (HCC) is complicated and challenging because of the frequent presence of cirrhosis. Therefore, we propose a novel surgical approach to minimize the invasiveness and risk in patients with HCC, hypersplenism, and esophagogastric varices. This was a retrospective study carried out in 25 patients with HCC and hypersplenism and who underwent simultaneous laparoscopic-guided radio-frequency ablation and laparoscopic splenectomy with endoscopic variceal ligation. Tumor size was restricted to a single nodule of splenectomy. Laparoscopic-guided radio-frequency ablation with laparoscopic splenectomy and endoscopic variceal ligation could be an available technique for patients with HCC <3 cm, hypersplenism, and esophagogastric varices. This approach may help to minimize the surgical risks and results in a fast increase in platelet counts with an acceptable rate of complications.

  16. External validation of scoring systems in risk stratification of upper gastrointestinal bleeding.

    Science.gov (United States)

    Anchu, Anna Cherian; Mohsina, Subair; Sureshkumar, Sathasivam; Mahalakshmy, T; Kate, Vikram

    2017-03-01

    The aim of this study was to externally validate the four commonly used scoring systems in the risk stratification of patients with upper gastrointestinal bleed (UGIB). Patients of UGIB who underwent endoscopy within 24 h of presentation were stratified prospectively using the pre-endoscopy Rockall score (PRS) >0, complete Rockall score (CRS) >2, Glasgow Blatchford bleeding scores (GBS) >3, and modified GBS (m-GBS) >3 scores. Patients were followed up to 30 days. Prognostic accuracy of the scores was done by comparing areas under curve (AUC) in terms of overall risk stratification, re-bleeding, mortality, need for intervention, and length of hospitalization. One hundred and seventy-five patients were studied. All four scores performed better in the overall risk stratification on AUC [PRS = 0.566 (CI: 0.481-0.651; p-0.043)/CRS = 0.712 (CI: 0.634-0.790); p0.001); m-GBS = 0.802 (CI: 0.734-0.871; pbleed [AUC-0.679 (CI: 0.579-0.780; p = 0.003)]. All the scoring systems except PRS were found to be significantly better in detecting 30-day mortality with a high AUC (CRS = 0.798; p-0.042)/GBS = 0.833; p-0.023); m-GBS = 0.816; p-0.031). All four scores demonstrated significant accuracy in the risk stratification of non-variceal patients; however, only GBS and m-GBS were significant in variceal etiology. Higher cutoff scores achieved better sensitivity/specificity [RS > 0 (50/60.8), CRS > 1 (87.5/50.6), GBS > 7 (88.5/63.3), m-GBS > 7(82.3/72.6)] in the risk stratification. GBS and m-GBS appear to be more valid in risk stratification of UGIB patients in this region. Higher cutoff values achieved better predictive accuracy.

  17. Breast varices: imaging findings of an unusual presentation of collateral pathways in superior vena caval syndrome

    International Nuclear Information System (INIS)

    Oezdemir, Ayseguel; Ilgit, Erhan T.; Konus, Oeznur L.; Cetin, Meltem; Oezsunar, Yelda

    2000-01-01

    Imaging findings are presented of an unusual pathway of collateral circulation consisting of bilateral and diffuse dilated breast veins from a patient with long standing superior vena caval syndrome. The main importance of this case is the extent of the collateral development through the breast veins, serving as the major pathway of collateral circulation. Identification of this unusual collateral development, which resembles breast varices, was performed with contrast-enhanced chest CT scans, digital subtraction venography, color Doppler ultrasonography, and mammographic studies. Collateral development was secondary to a long segment idiopathic venous occlusion involving bilateral subclavian and brachiocephalic veins as well as vena cava superior. We conclude that dilated breast veins when detected on any imaging modality should raise the suspicion of central venous obstruction

  18. Hemodynamic evaluation of portal blood flow with transrectal scintigraphy using sup 123 I-iodoamphetamine with special reference to esophageal varices and bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Shirasaki, Keiji; Ishii, Kohdoh; Kokubu, Shigehiro; Shibata, Hisao; Ishii, Katsumi (Kitasato Univ., Sagamihara, Kanagawa (Japan). School of Medicine)

    1990-12-01

    Portosystemic shunting was evaluated by portal scintigraphy with transrectally admininistered {sup 123}I-iodoamphetamine (IMP) in 21 patients with liver diseases. IMP was injected in an amount of 111 MBq (3 mCi) into the upper part of the rectum through the catheter. Images of the liver and lungs were monitores for up to 60 minutes with scintillation camera. The subjects were divided into three groups according to the images of the organs: the tracer was accumulated predominantly in the lungs (group A); almost equally accumulated in the both organs (group B); accumulated predominantly in the liver (group C). Advanced liver cirrhosis and IPH with esophageal varices were almost exclusively seen in group A, whereas early stage of liver cirrhosis and other mild hepatic lesions without esophageal varix remainded in group C. Patients of group A showed worse laboratory data than those of group C, including platelet count, serum levels of ch-E and {gamma}-globulin. It is noteworthy that in patients with esophageal bleeding, clear lung images appeared shortly after IMP administration in contrast with extremely delayed visualization of the liver. On the contrary, liver images was demonstrated early in cirrhotic patients without esophageal bleeding. It was coucluded that portal scintigraphy with IMP is useful for the evaluation of portosystemic shunting, especially in esophageal varices. (author).

  19. Identifying Trajectories of Borderline Personality Features in Adolescence: Antecedent and Interactive Risk Factors.

    Science.gov (United States)

    Haltigan, John D; Vaillancourt, Tracy

    2016-03-01

    To examine trajectories of adolescent borderline personality (BP) features in a normative-risk cohort (n = 566) of Canadian children assessed at ages 13, 14, 15, and 16 and childhood predictors of trajectory group membership assessed at ages 8, 10, 11, and 12. Data were drawn from the McMaster Teen Study, an on-going study examining relations among bullying, mental health, and academic achievement. Participants and their parents completed a battery of mental health and peer relations questionnaires at each wave of the study. Academic competence was assessed at age 8 (Grade 3). Latent class growth analysis, analysis of variance, and logistic regression were used to analyze the data. Three distinct BP features trajectory groups were identified: elevated or rising, intermediate or stable, and low or stable. Parent- and child-reported mental health symptoms, peer relations risk factors, and intra-individual risk factors were significant predictors of elevated or rising and intermediate or stable trajectory groups. Child-reported attention-deficit hyperactivity disorder (ADHD) and somatization symptoms uniquely predicted elevated or rising trajectory group membership, whereas parent-reported anxiety and child-reported ADHD symptoms uniquely predicted intermediate or stable trajectory group membership. Child-reported somatization symptoms was the only predictor to differentiate the intermediate or stable and elevated or rising trajectory groups (OR 1.15, 95% CI 1.04 to 1.28). Associations between child-reported reactive temperament and elevated BP features trajectory group membership were 10.23 times higher among children who were bullied, supporting a diathesis-stress pathway in the development of BP features for these youth. Findings demonstrate the heterogeneous course of BP features in early adolescence and shed light on the potential prodromal course of later borderline personality disorder. © The Author(s) 2015.

  20. THEORETICAL QUESTIONS OF INVESTMENT RISK RESEARCH, ITS MAIN FEATURES AND CLASSIFICATION

    Directory of Open Access Journals (Sweden)

    I. A. Kadyrbaev

    2016-01-01

    Full Text Available The article examines framework methodology of investment risk. The subject of the study are the basic theoretical positions directly related to the economic category of "investment risk". The purpose of this writing is the improvement of the methodology of the study of investment risk in the investment activity. This objective is to define the tasks, which consist in the formulation of the concept of "investment risk", the development of investment risk classification to provide investors with effective protection against such risks. The implementation  of the tasks will create conditions for the growth of investments in Russia. Currently, effective investment strategy for such an increase, is among the priority directions of development of the Russian economy.The article deals with logically interrelated study of basic economic categories, influencing directly on the investment risk. Author provided classification of investments in accordance with the level of risk. Examine the matter of the financial-economic category of the concept of "investment risk" and the classification of investment risks. Specified main features of the investment risk, which allowed to reveal specifics, which consists in the redistribution of capital in various types of assets in order to maximize profits or to obtain significant social effect.

  1. An evaluation of risk methods for prioritizing fire protection features: a procedure for fire barrier penetration seals

    International Nuclear Information System (INIS)

    Dey, M.K.

    2004-01-01

    This paper generally evaluates risk methods available for prioritizing fire protection features. Risk methods involving both the use of qualitative insights, and quantitative results from a fire probabilistic risk analysis are reviewed. The applicability of these methods to develop a prioritized list of fire barrier penetration seals in a plant based on risk significance is presented as a procedure to illustrate the benefits of the methods. The paper concludes that current fire risk assessment methods can be confidently used to prioritize plant fire protection features, specifically fire barrier penetration seals. Simple prioritization schemes, using qualitative assessments and insights from fire PRA methodology may be implemented without the need for quantitative results. More elaborate prioritization schemes that allow further refinements to the categorization process may be implemented using the quantitative results of the screening processes in good fire PRAs. The use of the quantitative results from good fire PRAs provide several benefits for risk prioritization of fire protection features at plants, mainly from the plant systems analyses conducted for a fire PRA

  2. Migration to the pulmonary artery of nine metallic coils placed in the internal iliac vein for treatment of giant rectal varices

    Directory of Open Access Journals (Sweden)

    Wataru Yamasaki

    2012-07-01

    Full Text Available Transcatheter venous embolization with metallic coils is a safe and reliable method for the treatment of pelvic congestion syndrome and pelvic varicocele. While rare, coil migration to the pulmonary arteries is potentially fatal. We report the migration to the pulmonary artery of a cluster of nine metallic microcoils placed in the internal iliac vein to obliterate giant rectal varices. Our patient suffered no severe sequelae. To avoid coil migration to the pulmonary arteries, the coils chosen for placement must take into consideration the characteristics of the target vessels, particularly of larger veins.

  3. Current status and future expectation concerning probabilistic risk assessment of NPPs. 1. Features and issues of probabilistic risk assessment methodology

    International Nuclear Information System (INIS)

    Yamashita, Masahiro

    2012-01-01

    Probabilistic risk assessment (PRA) of Nuclear Power Plants (NPPs) could play an important role in assuring safety of NPPs. However PRA had not always effectively used, which was indicated in Japanese government's report on Fukushima Daiichi NPP accident. At the Risk Technical Committee (RTC) of Standards Committee of Atomic Energy Society of Japan, preparation of standards (implementing criteria) focusing on PRA methodology and investigation on basic philosophy for use of PRA had been in progress. Based on activities of RTC, a serial in three articles including this described current status and future expectation concerning probabilistic risk assessment of NPPs. This article introduced features and issues of PRA methodology related to the use of PRA. Features of PRA methodology could be shown as (1) systematic and comprehensive understanding of risk, (2) support of grading approach, (3) identification of effective safety upgrade measures and (4) quantitative understanding of effects of uncertainty. Issues of PRA methodology were (1) extension of PRA application area, (2) upgrade of PRA methodology, (3) quality assurance of PRA, (4) treatment of uncertainty and (5) quantitative evaluation criteria. (T. Tanaka)

  4. Depression with melancholic features is associated with higher long-term risk for dementia.

    Science.gov (United States)

    Simões do Couto, Frederico; Lunet, Nuno; Ginó, Sandra; Chester, Catarina; Freitas, Vanda; Maruta, Carolina; Figueira, Maria Luísa; de Mendonça, Alexandre

    2016-09-15

    Depression has been reported to increase the risk of subsequently developing dementia, but the nature of this relation remains to be elucidated. Depression can be a prodrome/manifestation of dementia or an early risk factor, and the effect may differ according to depression subtypes. Our aim was to study the association between early-onset depression and different depression subtypes, and the later occurrence of dementia. We conducted a cohort study including 322 subjects with depression, recruited between 1977 and 1984. A comparison cohort (non-exposed) was recruited retrospectively, to include 322 subjects admitted at the same hospital for routine surgery (appendicectomy or cholecystectomy), at the same period as the depressed cohort. Subjects were contacted again between 2009 and 2014, to assess their dementia status. We computed the risk for dementia in subjects with early onset depression and quantified the association between different depression subtypes (namely melancholic, anxious, and psychotic) and dementia. The odds of dementia were increased by 2.90 times (95% C.I. 1.61-5.21; pdepressed cohort when compared to the surgical cohort. When the analysis was restricted to patients younger than 45 years old at baseline, the odds for dementia in the depressed cohort were also significantly higher when compared to the surgical cohort (8.53; 95% C.I. 2.40-30.16). In the multivariate Cox analysis, subjects having depression with melancholic features had an increased risk for developing dementia compared to those without melancholic features (HR=3.64; 95% C.I. 1.78-11.26; p=0.025). About 59% of the participants with depression and 53% of those non-exposed were lost during follow up. The inclusion of biological biomarkers would strengthen the results. The sample included a low number of bipolar patients. These results support depression as an early risk factor for dementia. Depression with melancholic features was found as an important risk factor for dementia

  5. [Evaluation and treatment of portal hypertension].

    Science.gov (United States)

    Brůha, Radan; Petrtýl, Jaromír

    Liver cirrhosis is a serious disease shortening the life expectancy. Unavoidable consequence of cirrhosis is portal hypertension, which usually limits the prognosis by its complications. Portal hypertension is a prognostic factor for cirrhosis decompensation, variceal bleeding and even the mortality in cirrhotic patients. In the evaluation of portal hypertension hepatic venous pressure gradient (HVPG) measurement is used.Measurement of HVPG is used in clinical praxis in these situations: diagnosis of portal hypertension, evaluation of prognosis of patients with cirrhosis, monitoring the treatment efficacy in the prevention of variceal bleeding, management of acute variceal bleeding. Decrease of HVPG below 12 mmHg or at least for more than 20% of initial value in the treatment by beta-blockers is associated with the lower risk of bleeding from varices or other complications. HVPG above 20 mm Hg is associated with the high risk of early rebleeding from varices and can discriminate those patients profiting from early TIPS.HVPG measurement is an invasive, but simple, reproducible and safe catheterization technique with minimal complication rate. The most frequent complication could be incorrect assessment of obtained values. HVPG measurement should be a routine technique in centers specialized to liver diseases.

  6. An Educational System to Help Students Assess Website Features and Identify High-Risk Websites

    Science.gov (United States)

    Kajiyama, Tomoko; Echizen, Isao

    2015-01-01

    Purpose: The purpose of this paper is to propose an effective educational system to help students assess Web site risk by providing an environment in which students can better understand a Web site's features and determine the risks of accessing the Web site for themselves. Design/methodology/approach: The authors have enhanced a prototype…

  7. Association between traditional clinical high-risk features and gene expression profile classification in uveal melanoma.

    Science.gov (United States)

    Nguyen, Brandon T; Kim, Ryan S; Bretana, Maria E; Kegley, Eric; Schefler, Amy C

    2018-02-01

    To evaluate the association between traditional clinical high-risk features of uveal melanoma patients and gene expression profile (GEP). This was a retrospective, single-center, case series of patients with uveal melanoma. Eighty-three patients met inclusion criteria for the study. Patients were examined for the following clinical risk factors: drusen/retinal pigment epithelium (RPE) changes, vascularity on B-scan, internal reflectivity on A-scan, subretinal fluid (SRF), orange pigment, apical tumor height/thickness, and largest basal dimensions (LBD). A novel point system was created to grade the high-risk clinical features of each tumor. Further analyses were performed to assess the degree of association between GEP and each individual risk factor, total clinical risk score, vascularity, internal reflectivity, American Joint Committee on Cancer (AJCC) tumor stage classification, apical tumor height/thickness, and LBD. Of the 83 total patients, 41 were classified as GEP class 1A, 17 as class 1B, and 25 as class 2. The presence of orange pigment, SRF, low internal reflectivity and vascularity on ultrasound, and apical tumor height/thickness ≥ 2 mm were not statistically significantly associated with GEP class. Lack of drusen/RPE changes demonstrated a trend toward statistical association with GEP class 2 compared to class 1A/1B. LBD and advancing AJCC stage was statistically associated with higher GEP class. In this cohort, AJCC stage classification and LBD were the only clinical features statistically associated with GEP class. Clinicians should use caution when inferring the growth potential of melanocytic lesions solely from traditional funduscopic and ultrasonographic risk factors without GEP data.

  8. Fifty-three years' experience with randomized clinical trials of emergency portacaval shunt for bleeding esophageal varices in Cirrhosis: 1958-2011.

    Science.gov (United States)

    Orloff, Marshall J

    2014-02-01

    Emergency treatment of bleeding esophageal varices (BEV) consists mainly of endoscopic and pharmacologic measures, with transjugular intrahepatic portal-systemic shunt (TIPS) performed when bleeding is not controlled. Surgical shunt has been relegated to salvage. At the University of California, San Diego, Medical Center, our group has conducted 10 studies of emergency portacaval shunt (EPCS) during 46 years. To describe 2 randomized clinical trials (RCTs) conducted from 1988 to 2011 in unselected consecutive patients who received emergency treatment for BEV. In RCT No. 1, a total of 211 unselected consecutive patients with cirrhosis and acute BEV were randomized to emergency endoscopic sclerotherapy (EEST) (n=106) or EPCS (n=105). In RCT No. 2, a total of 154 unselected consecutive patients with cirrhosis and acute BEV were randomized to TIPS (n=78) or EPCS (n=76). Diagnostic workup was completed within 6 hours of initial contact, and primary treatment was initiated within 8 to 12 hours. Regular follow-up for up to 10 years was accomplished in 100% of the patients. In RCT No. 1, EEST or EPCS; in RCT No. 2, TIPS or EPCS. The 2 groups were compared with regard to survival, control of bleeding, portal-systemic encephalopathy, and direct cost of care. RESULTS Distribution in Child risk classes was almost identical. One-third of patients were in Child class C. Permanent control of bleeding was achieved by EEST in only 20% of the patients and by TIPS in only 22%. In contrast, EPCS permanently controlled bleeding in 97% and 100% of the patients in RCT No. 2 and RCT No. 1, respectively (Pcases. Recurrent portal-systemic encephalopathy developed in 35% of the patients who underwent EEST and 61% of those who received TIPS. In contrast, portal-systemic encephalopathy occurred in 15% of the patients who received EPCS in RCT No. 1 and 21% of those in RCT No. 2. Direct costs of care were 5 to 7 times greater in the EEST ($168100) and TIPS ($264800) groups than in the EPCS

  9. Perinatal stroke in Saudi children: clinical features and risk factors

    International Nuclear Information System (INIS)

    Salih, Mustafa A.; Al-Jarallah, Ahmed A.; Kentab, Anal Y.; Al-Nasser, Mohammad N.; Abdel-Gader, Abdel-Galil M.; Alorainy, Ibrahim A.; Hassan, Hamdy H.

    2006-01-01

    To describe the clinical features and presentations of perinatal stroke in a prospective and retrospective cohort of Saudi children and ascertain the risk factors. Patients with perinatal stroke were identified from within a cohort of 104 Saudi children who were evaluated at the Division of Pediatric Neurology at King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia from July 1992 to February 2001 (retrospective study) and February 2001 to March 2003 (prospective study). Neuroimaging for suspected cases of stroke consisted of cranial CT, MRI, or both. During the study period, 23 (22%) of 104 children (aged one months to 12 years) were diagnosed to have had perinatal stroke. The male: female ratio was 1.6:1. Ten (67%) of the 15 children who had unilateral ischemic involvement had their lesion in the left hemisphere. The presentation of the ischemic result was within 24-72 hours of life in 13 (57%) patients, and in 6 children (26%), motor impairment was recognized at or after the age of 4 months. Nine children (39%) had seizures at presentation. Pregnancy, labor, and delivery risk factors were ascertained in 18 (78%) cases. The most common of these included emergency cesarean section in 5 cases, and instrumental delivery in other 5. Screening for prothrombotic risk factors detected abnormalities in 6 (26%) patients on at least one test carried out between 2 months and 9 years of age. Four children (17%) had low protein C, which was associated low protein S and raised anticardiolipin antibodies (ACA) in one patient, and low antithrombin III in another. Low proteins S was detected in a 42-month-old boy. The abnormality in the sixth child was confined to raised ACA. The present study highlights the non-specific features by which stroke presents during the neonatal period. The data are in keeping with the potential role for inherited and acquired thrombophilia as being the underlying cause. However, the high prevalence of

  10. The predictive capacity of the Glasgow-Blatchford score for the risk stratification of upper gastrointestinal bleeding in an emergency department

    Directory of Open Access Journals (Sweden)

    José Manuel Recio-Ramírez

    2015-05-01

    Full Text Available Objectives: To assess the ability of the Glasgow Blatchford Score (GBS system to identify the need for urgent upper gastrointestinal endoscopy (UGIE in patients with upper gastrointestinal bleeding (UGIB. Methods: An observational, retrospective study was carried out in all patients attended at the ER for suspected UGIB in one year. Patients were split into two categories -high-risk (>2 and low-risk (≤2- by means of the GBS system. Results: A total of 60 patients were included. Of these, 46 were classified as "high-risk" (> 2 and 14 as "low-risk" (≤ 2 subjects. The characteristics of patients in the low-risk group included: Mean age: 46.6 ± 13.7 (18-88 years. Males/females: 7/7. Urgent endoscopy revealed: normal (50%; n = 7; esophagitis (21.4%; n = 3; gastritis (14.2%; n = 2; Mallory-Weiss syndrome (7.1%; n = 1; non-bleeding varices (7.1%; n = 1. The characteristics of patients in the high-risk group included: Mean age: 68.7 ± 19.8 (31-91 years. Males/females: 30/16. Digestive endoscopy revealed: Gastric/duodenal ulcer (56.52%; n = 26; normal (17.39%; n = 8; esophagitis (8.69%; n = 4; gastritis (8.69%; n = 4; angioectasia (4.34%; n = 2; bleeding varices (4.34%; n = 2. Low-risk patients exhibited no lesions requiring urgent management during endoscopy, and the sensitivity of the GBS scale for high-risk UGIB detection was found to be 100% (95% CI: 86.27%, 99.71%, with a specificity of 48.28% (95% CI: 29.89, 67.1%. Conclusions: The GBS scale seems to accurately identify patients with low-risk UGIB, who may be managed on an outpatient basis and undergo delayed upper GI endoscopy at the outpatient clinic.

  11. Frequency of portal hypertensive gastropathy and its relationship with biochemical, haematological and endoscopic features in cirrhosis

    International Nuclear Information System (INIS)

    Abbasi, A.; Bhutto, A.R.; Butt, N.; Munir, S.M.; Dhilo, A.K.

    2011-01-01

    Objective: To determine the frequency of portal hypertensive gastropathy (PHG) and its relation with biochemical, haematological and endoscopic findings in cirrhotic patients. Study Design: Cross-sectional analytical study. Place and Duration of Study: Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, Ward-7, from June 2009 to December 2010. Methodology: Patients with diagnosis of cirrhosis and either undergoing screening upper gastrointestinal (GI) endoscopy or presented with acute upper GI bleeding were included in the study. Portal hypertensive gastropathy and oesophageal varices were classified using Baveno scoring system. The severity of cirrhosis was classified according to the Child-Pugh criteria. Hypersplenism was assessed by the reduction of haemoglobin, leucocytes and platelets. Results: Out of 217 patients, 148 were males (68.2%) and 69 were females (31.8%) with ages ranging from 15-85 years, (mean 48.06 years). There were 144 HCV +ve patients (66.4%), 36 HBV +ve patients (16.6%), 15 HCV/HBV co-infected patients (6.9%) and only 1 (0.5%) had co-infection of HBV/HDV. Twenty-one patients (9.7%) were classified as having cryptogenic cirrhosis. Out of 172 patients (79.27%), 56 patients (25.8%) had mild and 116 patients (53.5%) were suffering from severe PHG. Significant positive correlation was found between esophageal variceal grade and PHG (r=0.46, p < 0.001) but not with etiology (r=0.05, p=0.41) or hypersplenism (r=0.08, p=0.22). Conclusion: The frequency of PHG was 79.27% in the studied group. The grade of oesophageal varices had significant relation with PHG that is the severity of PHG increased with the grade of oesophageal varices, suggesting common pathophysiology of both entities. (author)

  12. The Short-Term Effects of Balloon-Occluded Retrograde Transvenous Obliteration, for Treating Gastric Variceal Bleeding, on Portal Hypertensive Changes: a CT Evaluation

    International Nuclear Information System (INIS)

    Cho, Sung Ki; Shin, Sung Wook; Yoo, Eun Young; Do, Young Soo; Park, Kwang Bo; Choo, Sung Wook; Choo, In Wook; Han, Heon

    2007-01-01

    We wanted to evaluate the short-term effects of balloon-occluded retrograde transvenous obliteration (BRTO) for treating gastric variceal bleeding, in terms of the portal hypertensive changes, by comparing CT scans. We enrolled 27 patients who underwent BRTO for gastric variceal bleeding and they had CT scans performed just before and after BRTO. The pre- and post-procedural CT scans were retrospectively compared by two radiologists working in consensus to evaluate the short-term effects of BRTO on the subsequent portal hypertensive changes, including ascites, splenomegaly, portosystemic collaterals (other than gastrorenal shunt), the gall bladder (GB) edema and the intestinal wall edema. Statistical differences were analyzed using the Wilcoxon signed rank test and the paired t-test. Following BRTO, ascites developed or was aggravated in 22 (82%) of 27 patients and it was improved in two patients; the median spleen volumes increased from 438.2 cm 3 to 580.8 cm 3 , and based on a 15% volume change cutoff value, splenic enlargement occurred in 15 (56%) of the 27 patients. The development of new collaterals or worsening of existing collaterals was not observed in any patient. GB wall edema developed or was aggravated in four of 23 patients and this disappeared or improved in five; intestinal wall edema developed or was aggravated in nine of 27 patients, and this disappeared or improved in five. Statistically, we found significant differences for ascites and the splenic volumes before and after BRTO (p = 0.001 and p < 0.001, respectively). Some portal hypertensive changes, including ascites and splenomegaly, can be aggravated shortly after BRTO

  13. [Surgical treatment of varices at the stage of trophic disorders in chronic venous insufficiency].

    Science.gov (United States)

    Ludin, A; Ammann, J

    1991-01-01

    Most ulcers of the lower limbs are caused by existing chronic venous insufficiency. Later on, true social and professional problems will arise, with serious economic and psychological consequences not only for the patient himself, but for the community as well, such as huge medical costs--hence the importance of prevention and treatment, which must in no case be purely symptomatic. The ligation of the arch and of the perforating veins and stripping of the affected vein are part of the classical management of varices. These procedures can may prove to be virtually impossible in case of chronic venous insufficiency, if the patient also presents with subcutaneous liposclerosis or atrophy in an already pregangrenous skin. This preulcerous stage can be aggravated later on if the requirements for surgical repair are not met. Necrosis can then occur, if too aggressive surgery directly or indirectly injures the microcirculatory system of the damaged skin. Omitted or undesirable acts are dangerous at the stage of trophic disorders and surgery may fail to reach its aim, which of course would be to definitively and quickly eliminate the varicose disease.

  14. Feature extraction and selection for objective gait analysis and fall risk assessment by accelerometry

    Directory of Open Access Journals (Sweden)

    Cremer Gerald

    2011-01-01

    Full Text Available Abstract Background Falls in the elderly is nowadays a major concern because of their consequences on elderly general health and moral states. Moreover, the aging of the population and the increasing life expectancy make the prediction of falls more and more important. The analysis presented in this article makes a first step in this direction providing a way to analyze gait and classify hospitalized elderly fallers and non-faller. This tool, based on an accelerometer network and signal processing, gives objective informations about the gait and does not need any special gait laboratory as optical analysis do. The tool is also simple to use by a non expert and can therefore be widely used on a large set of patients. Method A population of 20 hospitalized elderlies was asked to execute several classical clinical tests evaluating their risk of falling. They were also asked if they experienced any fall in the last 12 months. The accelerations of the limbs were recorded during the clinical tests with an accelerometer network distributed on the body. A total of 67 features were extracted from the accelerometric signal recorded during a simple 25 m walking test at comfort speed. A feature selection algorithm was used to select those able to classify subjects at risk and not at risk for several classification algorithms types. Results The results showed that several classification algorithms were able to discriminate people from the two groups of interest: fallers and non-fallers hospitalized elderlies. The classification performances of the used algorithms were compared. Moreover a subset of the 67 features was considered to be significantly different between the two groups using a t-test. Conclusions This study gives a method to classify a population of hospitalized elderlies in two groups: at risk of falling or not at risk based on accelerometric data. This is a first step to design a risk of falling assessment system that could be used to provide

  15. Natural history of patients with non cirrhotic portal hypertension: Comparison with patients with compensated cirrhosis.

    Science.gov (United States)

    Gioia, Stefania; Nardelli, Silvia; Pasquale, Chiara; Pentassuglio, Ilaria; Nicoletti, Valeria; Aprile, Francesca; Merli, Manuela; Riggio, Oliviero

    2018-01-31

    The knowledge of natural history of patients with portal hypertension (PH) not due to cirrhosis is less well known than that of cirrhotic patients. To describe the clinical presentation and the outcomes of 89 patients with non-cirrhotic PH (25 with non-cirrhotic portal hypertension, INCPH, and 64 with chronic portal vein thrombosis, PVT) in comparison with 77 patients with Child A cirrhosis. The patients were submitted to a standardized clinical, laboratory, ultrasonographic and endoscopic follow-up. Variceal progression, incidence of variceal bleeding, portal vein thrombosis, ascites and survival were recorded. At presentation, the prevalence of varices, variceal bleeding and ascites was similar in the 3 groups. During follow-up, the rate of progression to varices at risk of bleeding (p portal hypertension in these patients and cannot be simply derived by the observation of cirrhotic patients. Copyright © 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  16. Testing Map Features Designed to Convey the Uncertainty of Cancer Risk: Insights Gained From Assessing Judgments of Information Adequacy and Communication Goals.

    Science.gov (United States)

    Severtson, Dolores J

    2015-02-01

    Barriers to communicating the uncertainty of environmental health risks include preferences for certain information and low numeracy. Map features designed to communicate the magnitude and uncertainty of estimated cancer risk from air pollution were tested among 826 participants to assess how map features influenced judgments of adequacy and the intended communication goals. An uncertain versus certain visual feature was judged as less adequate but met both communication goals and addressed numeracy barriers. Expressing relative risk using words communicated uncertainty and addressed numeracy barriers but was judged as highly inadequate. Risk communication and visual cognition concepts were applied to explain findings.

  17. Monometric and scintiscanning evaluation of esophageal function after endoscopic sclerosis of esophageal varices. Controlled prospective study

    International Nuclear Information System (INIS)

    Bastos, J.L.A.

    1990-01-01

    Esophageal function was studied in twenty-one patients with esophageal varices of different etiology submitted to endoscopic sclerosis for the detection of possible alterations in the functional pattern of the organ after this treatment. The endoscopic injection sclerosis (EIS) was performed electively in 14 patients (Group I) and in the presence of bleeding in 07 (Group II). The sclerotizing agent used was a solution of equal parts of ethanolamine oleate (Ethamolin R ) and 50% glucose. The injections were preferentially performed by the perivascular technique at weekly intervals. Esophageal function was studied by manometry, and esophageal transit time by scintillography. Group I patients were evaluated before and two to three months and five to nine months after EIS, and Group II patients were only evaluated six to nine months after EIS. The manometry and scintillography procedures were performed in sequence on the same day. The scintillographic examinations were performed with the patient in the supine and sitting positions. (author)

  18. The Novel Scoring System for 30-Day Mortality in Patients with Non-variceal Upper Gastrointestinal Bleeding.

    Science.gov (United States)

    Hwang, Sejin; Jeon, Seong Woo; Kwon, Joong Goo; Lee, Dong Wook; Ha, Chang Yoon; Cho, Kwang Bum; Jang, ByungIk; Park, Jung Bae; Park, Youn Sun

    2016-07-01

    Although the mortality rates for non-variceal upper gastrointestinal bleeding (NVUGIB) have recently decreased, it remains a significant medical problem. The main aim of this prospective multicenter database study was to construct a clinically useful predictive scoring system by using our predictors and compare its prognostic accuracy with that of the Rockall scoring system. Data were collected from consecutive patients with NVUGIB. Logistic regression analysis was performed to identify the independent predictors of 30-day mortality. Each independent predictor was assigned an integral point proportional to the odds ratio (OR) and we used the area under the curve to compare the discrimination ability between the new predictive model and the Rockall score. The independent predictors of mortality included age >65 years [OR 2.627; 95 % confidence interval (CI) 1.298-5.318], hemodynamic instability (OR 2.217; 95 % CI 1.069-4.597), serum blood urea nitrogen level >40 mg/dL (OR 1.895; 95 % CI 1.029-3.490), active bleeding at endoscopy (OR 2.434; 95 % CI 1.283-4.616), transfusions (OR 3.811; 95 % CI 1.640-8.857), comorbidities (OR 3.481; 95 % CI 1.405-8.624), and rebleeding (OR 10.581; 95 % CI 5.590-20.030). The new predictive model showed a high discrimination capability and was significantly superior to the Rockall score in predicting the risk of death (OR 0.837;95 % CI 0.818-0.855 vs. 0.761; 0.739-0.782; P = 0.0123). The new predictive score was significantly more accurate than the Rockall score in predicting death in NVUGIB patients. We need to prospectively validate the accuracy of this score for predicting mortality in NVUGIB patients.

  19. Two randomized controlled studies comparing the nutritional benefits of branched-chain amino acid (BCAA) granules and a BCAA-enriched nutrient mixture for patients with esophageal varices after endoscopic treatment

    OpenAIRE

    Sakai, Yoshiyuki; Iwata, Yoshinori; Enomoto, Hirayuki; Saito, Masaki; Yoh, Kazunori; Ishii, Akio; Takashima, Tomoyuki; Aizawa, Nobuhiro; Ikeda, Naoto; Tanaka, Hironori; Iijima, Hiroko; Nishiguchi, Shuhei

    2014-01-01

    Background The usefulness of branched-chain amino acid (BCAA) granules and BCAA-enriched nutrient mixtures for patients with liver cirrhosis is often reported. However, no randomized controlled studies have investigated the usefulness of these supplements in the nutritional intervention of cirrhotic patients receiving endoscopic treatment for esophageal varices. Methods Patients without BCAA before endoscopic treatment were divided into study 1, and those who received BCAA were divided into s...

  20. Adherence to guidelines in bleeding oesophageal varices and effects on outcome: comparison between a specialized unit and a community hospital

    DEFF Research Database (Denmark)

    Hobolth, Lise; Krag, Aleksander; Malchow-Møller, Axel

    2010-01-01

    is difficult. Our aims were to compare adherence to evidence-based guidelines in BOV between a specialized unit and a community hospital, and to investigate whether differences in adherence affected the outcome. METHODS: Two cohorts hospitalized during 2000-2007 with a first episode of BOV were retrospectively...... rebleeding were not statistically different. CONCLUSION: Our study shows that patients with BOV are more likely to receive therapy according to guidelines when hospitalized in a specialized unit compared with a community hospital. This however did not affect mortality.......OBJECTIVES: Randomized controlled trials have shown beneficial effects of vasoactive drugs, endoscopic treatment and prophylactic antibiotics on the outcome of bleeding oesophageal varices (BOV). However, translating guidelines based on randomized controlled trials into clinical practice...

  1. Alterações da motilidade esofagiana em pacientes cirróticos com varizes de esôfago não submetidos a tratamento endoscópico Esophageal motor disorders in cirrhotic patients with esophageal varices non-submitted to endoscopic treatment

    Directory of Open Access Journals (Sweden)

    Priscila Pollo Flores

    2005-12-01

    the development of esophageal varices, the possibility of a digestive hemorrhage and worsening of hepatic insufficiency. It is important to identify causal predictive or aggravating factors and if possible to prevent them. In the last years, it has been observed the association of esophageal motor disorders and gastro-esophageal reflux in cirrhotic patients with esophageal varices. AIMS: To study the prevalence of the esophageal motility disorders and among them, the ineffective esophageal motility, in patients with hepatic cirrhosis and esophageal varices, without previous endoscopic therapeutic and the predictives factors. METHODS: Prospectively, it has been evaluate 74 patients suffering from liver cirrhosis and esophagic varices, without previous endoscopic treatment. All of them were submitted to a clinical protocol, esophageal manometry and 55 patients also held the ambulatory esophageal pHmetry. RESULTS: Esophageal motility disorders have been found in 44 patients (60%. The most prevalent was the ineffective esophageal motility, observed in 28%. The abnormal reflux disease was diagnosed through the pHmetry in 35% of the patients. There were no correlation between the manometrical abnormality in general and the ineffective esophageal motility in particular and the esophageal or gastroesophageal reflux disease symptoms, the abnormal reflux, the disease seriousness, the ascites presence and the gauge of the varices. CONCLUSIONS: The majority of cirrhotic patients with non-treated esophageal varices present esophageal motor disorders. No predictive factor was found. The clinical relevance of these findings need more researches in the scope to define the real meaning of theses abnormalities.

  2. Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer

    International Nuclear Information System (INIS)

    Ang, K. Kian; Trotti, Andy; Brown, Barry W.; Garden, Adam S.; Foote, Robert L.; Morrison, William H.; Geara, Fady B.; Klotch, Douglas W.; Goepfert, Helmuth; Peters, Lester J.

    2001-01-01

    Purpose: A multi-institutional, prospective, randomized trial was undertaken in patients with advanced head-and-neck squamous cell carcinoma to address (1) the validity of using pathologic risk features, established from a previous study, to determine the need for, and dose of, postoperative radiotherapy (PORT); (2) the impact of accelerating PORT using a concomitant boost schedule; and (3) the importance of the overall combined treatment duration on the treatment outcome. Methods and Materials: Of 288 consecutive patients with advanced disease registered preoperatively, 213 fulfilled the trial criteria and went on to receive therapy predicated on a set of pathologic risk features: no PORT for the low-risk group (n=31); 57.6 Gy during 6.5 weeks for the intermediate-risk group (n=31); and, by random assignment, 63 Gy during 5 weeks (n=76) or 7 weeks (n=75) for the high-risk group. Patients were irradiated with standard techniques appropriate to the site of disease and likely areas of spread. The study end points were locoregional control (LRC), survival, and morbidity. Results: Patients with low or intermediate risks had significantly higher LRC and survival rates than those with high-risk features (p=0.003 and p=0.0001, respectively), despite receiving no PORT or lower dose PORT, respectively. For high-risk patients, a trend toward higher LRC and survival rates was noted when PORT was delivered in 5 rather than 7 weeks. A prolonged interval between surgery and PORT in the 7-week schedule was associated with significantly lower LRC (p=0.03) and survival (p=0.01) rates. Consequently, the cumulative duration of combined therapy had a significant impact on the LRC (p=0.005) and survival (p=0.03) rates. A 2-week reduction in the PORT duration by using the concomitant boost technique did not increase the late treatment toxicity. Conclusions: This Phase III trial established the power of risk assessment using pathologic features in determining the need for, and dose of

  3. Analysis of clinical features and risk factors for infective endocarditis

    International Nuclear Information System (INIS)

    Wang Li; Zhao Liangping; Xu Weiting; Chen Jianchang; Tong Guangming; Hong Xiaosu

    2012-01-01

    Objective: To analyze the clinical features of infective endocarditis (IE) and explore the risk factors for it's prognosis. Methods: Clinical data of 65 patients with IE were acquired retrospectively, and its causes, clinical characteristics, pathogenic microorganism, clinical outcomes were analyzed. Results: The major occurring heart diseases for IE in all patients were rheumatic heart disease, congenital heart disease, and there was no any previously known heart disease. The major clinical manifestations included fever and anemia. The major pathogenic bacteria is streptococcus, but percentage of other bacteria increased gradually. Thirteen patients were refractory, in hospital. Haematoglobin and seralbumin were significantly lower, and leucocyte, hsCRP, erythrocyte sedimentation were significantly higher in refractory group. Anaemia, lower seralbumin, higher hsCRP were independent predictors for bad prognosis. Conclusion: The proportion of rheumatic heart disease is decreasing as one of the risk factors for IE in recent years. Streptococcus is major pathogen of IE, and the mortality of IE is still very high. Anaemia, lower seralbumin, higher hsCRP are independent predictors for bad prognosis. (authors)

  4. Ectasias and varices of the vocal fold: clearing the striking zone.

    Science.gov (United States)

    Hochman, I; Sataloff, R T; Hillman, R E; Zeitels, S M

    1999-01-01

    Vascular malformations such as ectasias and varices (Es and Vs) are frequently encountered in patients who present with recurrent vocal fold hemorrhage and/or other traumatic vocal fold lesions. This study examined Es and Vs with regard to their anatomic presentation, phonomicrosurgical management, and treatment outcome. Forty-two patients (39 of them singers) were treated for a total of 87 Es and Vs: 67 of 87 (77%) were on the superior surface of the vocal fold and 20 of 87 (23%) were on the medial surface of the vocal fold. Eighty-three percent were located in the middle musculomembranous region (the striking zone), where the greatest aerodynamically induced shearing stresses occur during phonation. Treatment was performed with carbon dioxide laser cauterization (13 patients), or a new technique utilizing cold instrument excision by means of epithelial cordotomies (23 patients), while a combined approach was employed in 6 patients. Comparisons of preoperative and postoperative stroboscopy revealed improvement or no significant change in all patients in whom the cold instrument technique was used, and increased epithelial stiffness was noted in 4 of 19 patients in whom the carbon dioxide laser was used. Clearing the striking zone appears to have halted further hemorrhages by removing the the fragile Es and Vs from this injury-prone region of the vocal fold. Interpretations of stroboscopic examinations were directed at providing new insights into the biomechanical forces of vocal fold vibration that probably contribute to the genesis of Es and Vs in the vocal folds.

  5. Identification of risk factors and demographic features of patients with peri partum cardiomyopathy

    International Nuclear Information System (INIS)

    Sharieff, S.; Khan, Shah-e-Zaman

    2002-01-01

    Objective: To describe and identify the demographic features and risk factors for peri partum cardiomyopathy (PPCM). Design: A prospective study: The study was conducted at the department of Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan from December 1999 to August 2001. Subjects and Methods: A total of 35 consecutive patients diagnosed to have peri partum cardiomyopathy (PPCM) on echocardiogram were enrolled. Proforma containing demographic characteristics and established risk factors for PPCM was established and filled carefully. The data gathered was analyzed statistically. Results: The mean age at the time of diagnosis was 30.8-6.74 years. Urdu speaking (Mohajir) population was found to be more affected ethnic group (42.9%) Majority of the patients was from lower socio-economic group with poor nutritional status (77%) and multiparous (77.14%). 25.7% had past history of PPCM and 71.4% presented during postpartum period. Mortality at six months was 22.8% while 42.9% had persistent disease and only 34.3% recovered completely. Conclusion: Advanced age, lower economic group with poor nutritional status, multi parity and past history of peri partum cardiomyopathy were identified as risk factors for the development of PPCM, especially among Mohajir population. There was no statistically significant difference between the clinical features and outcome of patients presented first time or with recurrent PPCM. We identified advanced age (>30 years), high LVEDD, and low ejection fraction (EF) at initial presentation as poor prognostic factors. (author)

  6. Efficacy of adjuvant therapy with 3.7 GBq radioactive iodine in intermediate-risk patients with 'higher risk features' and predictive value of postoperative nonstimulated thyroglobulin.

    Science.gov (United States)

    Rosario, Pedro W; Mourão, Gabriela F; Calsolari, Maria Regina

    2016-11-01

    This study evaluated the efficacy of adjuvant therapy with 3.7 GBq radioactive iodine (RAI) in patients with papillary thyroid carcinoma (PTC) of intermediate risk with higher risk features and determined the predictive value of postoperative nonstimulated thyroglobulin (Tg). This was a prospective study including 85 patients with PTC of intermediate risk and higher risk features: tumor greater than 1 cm and aggressive histological subtype or vascular invasion; and/or more than three positive lymph node (LN) or LN greater than 1.5 cm or showing macroscopic extracapsular extension; and/or a combination of tumor greater than 4 cm, microscopic extrathyroidal extension, aggressive histology, and LN metastases (cN1). After thyroidectomy, all patients had nonstimulated Tg of at least 0.3 ng/ml and ultrasonography showed no anomalies. When evaluated 12 months after RAI therapy, an excellent response to initial therapy was achieved in 61 patients (71.7%). Structural disease was detected in five patients (5.9%). During follow-up, 6/80 patients (7.5%) without structural disease 1 year after RAI developed relapse. In the last assessment, 80 patients (94.1%) had nonstimulated Tg less than 1 ng/ml and no evidence of structural disease. There was no case of death because of the tumor. Postoperative nonstimulated Tg was a predictive factor of the main outcome (structural disease 1 year after RAI or recurrence) and the best cut-off was 1.8 ng/ml (sensitivity: 72.7%, specificity: 83.4%, negative predictive value: 95.4%). In patients with PTC of intermediate risk with higher risk features treated with 3.7 GBq RAI, postoperative nonstimulated Tg up to 1.8 ng/ml was a predictor of low risk of structural disease 1 year after therapy or recurrence.

  7. Severe gastric variceal haemorrhage due to splenic artery thrombosis and consecutive arterial bypass

    Directory of Open Access Journals (Sweden)

    Wasmuth Hermann E

    2011-06-01

    Full Text Available Abstract Background Upper gastrointestinal haemorrhage is mainly caused by ulcers. Gastric varicosis due to portal hypertension can also be held responsible for upper gastrointestinal bleeding. Portal hypertension causes the development of a collateral circulation from the portal to the caval venous system resulting in development of oesophageal and gastric fundus varices. Those may also be held responsible for upper gastrointestinal haemorrhage. Case presentation In this study, we describe the case of a 69-year-old male with recurrent severe upper gastrointestinal bleeding caused by arterial submucosal collaterals due to idiopathic splenic artery thrombosis. The diagnosis was secured using endoscopic duplex ultrasound and angiography. The patient was successfully treated with a laparoscopic splenectomy and complete dissection of the short gastric arteries, resulting in the collapse of the submucosal arteries in the gastric wall. Follow-up gastroscopy was performed on the 12th postoperative week and showed no signs of bleeding and a significant reduction in the arterial blood flow within the gastric wall. Subsequent follow-up after 6 months also showed no further gastrointestinal bleeding as well as subjective good quality of life for the patient. Conclusion Submucosal arterial collaterals must be excluded by endosonography via endoscopy in case of recurrent upper gastrointestinal bleeding. Laparoscopic splenectomy provides adequate treatment in preventing any recurrent bleeding, if gastric arterial collaterals are caused by splenic artery thrombosis.

  8. The clinical features of alcohol use disorders in biological and step-fathers that predict risk for alcohol use disorders in offspring.

    Science.gov (United States)

    Kendler, Kenneth S; Ohlsson, Henrik; Edwards, Alexis; Sundquist, Jan; Sundquist, Kristina

    2017-12-01

    Given that Alcohol Use Disorder (AUD) is clinically heterogeneous, can we, in a large epidemiological sample using public registries, identify clinical features of AUD cases in biological and step-fathers that index, respectively, genetic and familial-environmental risk for AUD in their offspring? From all father-offspring pairs where the father had AUD and the offspring was born 1960-1990, we identified not-lived-with (NLW) biological fathers (n = 38,376) and step-father pairs (n = 9,711). The relationship between clinical and historical features of the father's AUD and risk for AUD in offspring was assessed by linear hazard regression. Age at first registration for AUD and recurrence of AUD registration were significantly stronger predictors of risk for AUD in the offspring of NLW fathers than in step-fathers. By contrast, number of AUD registrations in NLW fathers and step-fathers were equally predictive of risk for AUD in offspring. However, while the number of step-father AUD registrations that occurred when he was living them with significantly predicted risk for AUD in his step-children, the number of registrations that occurred when not residing with his step-children was unassociated with their AUD risk. In an epidemiological sample, we could meaningfully differentiate between features of AUD in fathers that indexed genetic risk which was transmitted to biological offspring (early age at onset and recurrence) versus indexed environmental risk (registrations while rearing) which increased risk in step-children. © 2017 Wiley Periodicals, Inc.

  9. Management of Bleeding Duodenal Varices with Combined TIPS Decompression and Trans-TIPS Transvenous Obliteration Utilizing 3% Sodium Tetradecyl Sulfate Foam Sclerosis.

    Science.gov (United States)

    Saad, Wael E; Lippert, Allison; Schwaner, Sandra; Al-Osaimi, Abdullah; Sabri, Saher; Saad, Nael

    2014-01-01

    Endoscopic experience in the management of duodenal varices (DVs) is limited and challenging given the anatomic constraints and limited experience. The endovascular management of DVs is not yet established and the controversy of whether to manage them by decompression with a transjugular intrahepatic portosystemic shunt (TIPS) or by transvenous obliteration is unresolved. In the literature, the 6-12 month rebleeding rate of DVs after TIPS is 21-37% and after transvenous obliteration is 13%. The purpose of the study is to evaluate the clinical outcome of combined TIPS decompression and transvenous obliteration/sclerosis. This is a retrospective study (case series) of two institutions, evaluating patients who underwent TIPS and/or transvenous obliteration/sclerosis for bleeding DVs (from January 2009 to June 2013). TIPS was performed according to a standard procedure using covered stents. Transvenous obliteration (variceal sclerosis) from the systemic and/or portal venous circulation was performed utilizing 3% sodium tetradecyl sulfate foam. Transvenous obliteration was commonly augmented with coils and/or vascular plugs. Technical (technical success of establishing TIPS and completely obliterating the DVs) and clinical outcomes (rebleeding rate and survival) were evaluated. Five patients with liver cirrhosis presenting with bleeding DVs were included in the study with all eventually (and coincidentally) receiving TIPS and transvenous obliteration. Two of the five patients underwent concomitant TIPS and transvenous obliteration in the same procedural setting. However, three patients underwent transvenous obliteration due to bleeding despite a patent TIPS that had been previously placed. The average time from TIPS placement to transvenous obliteration was 125 days (range: 3-324 days). After having both procedures, there was no rebleeding in the patients during a mean follow-up period of 22 months (6-50 months). Coils and/or metallic vascular plugs were used to augment

  10. Applying a machine learning model using a locally preserving projection based feature regeneration algorithm to predict breast cancer risk

    Science.gov (United States)

    Heidari, Morteza; Zargari Khuzani, Abolfazl; Danala, Gopichandh; Mirniaharikandehei, Seyedehnafiseh; Qian, Wei; Zheng, Bin

    2018-03-01

    Both conventional and deep machine learning has been used to develop decision-support tools applied in medical imaging informatics. In order to take advantages of both conventional and deep learning approach, this study aims to investigate feasibility of applying a locally preserving projection (LPP) based feature regeneration algorithm to build a new machine learning classifier model to predict short-term breast cancer risk. First, a computer-aided image processing scheme was used to segment and quantify breast fibro-glandular tissue volume. Next, initially computed 44 image features related to the bilateral mammographic tissue density asymmetry were extracted. Then, an LLP-based feature combination method was applied to regenerate a new operational feature vector using a maximal variance approach. Last, a k-nearest neighborhood (KNN) algorithm based machine learning classifier using the LPP-generated new feature vectors was developed to predict breast cancer risk. A testing dataset involving negative mammograms acquired from 500 women was used. Among them, 250 were positive and 250 remained negative in the next subsequent mammography screening. Applying to this dataset, LLP-generated feature vector reduced the number of features from 44 to 4. Using a leave-onecase-out validation method, area under ROC curve produced by the KNN classifier significantly increased from 0.62 to 0.68 (p breast cancer detected in the next subsequent mammography screening.

  11. Frequency of breast cancer with hereditary risk features in Spain: Analysis from GEICAM "El Álamo III" retrospective study.

    Science.gov (United States)

    Márquez-Rodas, Iván; Pollán, Marina; Escudero, María José; Ruiz, Amparo; Martín, Miguel; Santaballa, Ana; Martínez Del Prado, Purificación; Batista, Norberto; Andrés, Raquel; Antón, Antonio; Llombart, Antonio; Fernandez Aramburu, Antonio; Adrover, Encarnación; González, Sonia; Seguí, Miguel Angel; Calvo, Lourdes; Lizón, José; Rodríguez Lescure, Álvaro; Ramón Y Cajal, Teresa; Llort, Gemma; Jara, Carlos; Carrasco, Eva; López-Tarruella, Sara

    2017-01-01

    To determine the frequency of breast cancer (BC) patients with hereditary risk features in a wide retrospective cohort of patients in Spain. a retrospective analysis was conducted from 10,638 BC patients diagnosed between 1998 and 2001 in the GEICAM registry "El Álamo III", dividing them into four groups according to modified ESMO and SEOM hereditary cancer risk criteria: Sporadic breast cancer group (R0); Individual risk group (IR); Familial risk group (FR); Individual and familial risk group (IFR) with both individual and familial risk criteria. 7,641 patients were evaluable. Of them, 2,252 patients (29.5%) had at least one hereditary risk criteria, being subclassified in: FR 1.105 (14.5%), IR 970 (12.7%), IFR 177 (2.3%). There was a higher frequency of newly diagnosed metastatic patients in the IR group (5.1% vs 3.2%, p = 0.02). In contrast, in RO were lower proportion of big tumors (> T2) (43.8% vs 47.4%, p = 0.023), nodal involvement (43.4% vs 48.1%, p = 0.004) and lower histological grades (20.9% G3 for the R0 vs 29.8%) when compared to patients with any risk criteria. Almost three out of ten BC patients have at least one hereditary risk cancer feature that would warrant further genetic counseling. Patients with hereditary cancer risk seems to be diagnosed with worse prognosis factors.

  12. Sistema Progetto Nazionale Emorragia Digestiva (PNED) vs. escala de Rockall como predictores de mortalidad en pacientes con hemorragia de tubo digestivo alto no variceal: un estudio multicéntrico prospectivo

    OpenAIRE

    R. Contreras-Omaña; J.A. Alfaro-Reynoso; C.E. Cruz-Chávez; A. Velarde-Ruiz Velasco; D.I. Flores-Ramírez; I. Romero-Hernández; I. Donato-Olguín; X. García-Samper; A. Bautista-Santos; M. Reyes-Bastidas; E. Millán-Marín

    2017-01-01

    Antecedentes: El grupo Progetto Nazionale Emorragia Digestiva (PNED) de Italia publicó su propuesta de escala predictora de riesgo de mortalidad en pacientes con hemorragia digestiva alta no variceal (HTDANV), que desde su publicación no ha sido validada en Latinoamérica. Objetivo: Comparar el sistema PNED contra la escala de Rockall en la predicción de mortalidad de pacientes hospitalizados por HTDANV. Material y métodos: Estudio multicéntrico prospectivo, transversal, analítico, en el...

  13. Tratamento da recidiva hemorrágica por varizes do esôfago em doentes esquistossomóticos operados Treatment of recurrent hemorrhage esophageal varices in schistosomotic patients after surgery

    Directory of Open Access Journals (Sweden)

    José Cesar Assef

    2003-01-01

    ástrica esquerda ocluída e veia gástrica esquerda não-opacificada.OBJECTIVE: To standardize the treatment recurrent hemorrhage esophageal varices in schistosomotic patients after non decompressive surgery. METHODS: We treated 45 patients with schistosomotic portal hypertension who presented recurrent hemorrhage esophageal varices. Performance of abdominal ultra-sonography and arteriographic studies and two groups were defined: Group A: Nineteen patients (42,2% with absence of spleen, occluded splenic artery and patency of left gastric artery and vein, thus characterizing splenectomy at prior operation. Group B: Twenty six patients (57,8% with absence of spleen image, occluded splenic and left gastric artery and non-opacified left gastric vein, showing splenectomy and some type of gastroesophageal devascularization performed before. Patients of Group A were reoperated to carry out the gastroesophageal devascularization and patients of Group B were submitted to a sclerotherapy program. RESULTS: In Group A, one patient (5.3% presented recurrent hemorrhage on the late postoperative period. The esophageal varices decreased in number or diameter in 14 patients (73.7%, disappeared in three (15.8% and remained unchanged in two (10.5%, under final endoscopic evaluation. In Group B, six patients (23.1% presented recurrent bleeding. In four patients the acute hemorrhagic event were controlled. Two patients who underwent mesocaval shunt owing to unsuccess of these methods died postoperatively. Esophageal varices disappeared in 17 patients (65.4%, decreased in number or diameter in seven (26.9% and remained unchanged in two (7.7% after the last endoscopic evaluation. CONCLUSIONS: 1 The gastroesophageal devascularization is appropriated to splenectomized patients, with patency of left gastric artery and vein. 2 A long term of esophageal varices endoscopic sclerotherapy may be an option to splenectomized patients, with occluded left gastric artery and non-opacified left gastric ven.

  14. Perfil evolutivo das varizes esofágicas pós esplenectomia associada à ligadura da veia gástrica esquerda e escleroterapia na hipertensão portal esquistossomótica Evolutional profile of the esophageal varices after splenectomy associated with ligation of the left gastric vein and sclerotherapy in schistosomal portal hypertension

    Directory of Open Access Journals (Sweden)

    João Batista-Neto

    2013-03-01

    Full Text Available RACIONAL: A esquistossomose mansônica afeta 200 milhões de pessoas em 70 países do mundo. Estima-se que 10% dos infectados evoluirão para a forma hepatoesplênica e, destes, 30% progredirão para hipertensão portal e varizes esofagogástricas, cuja expressão será através de hemorragia digestiva com mortalidade relevante no primeiro episódio hemorrágico. Múltiplas técnicas cirúrgicas foram desenvolvidas para prevenir o ressangramento. OBJETIVO: Avaliar o perfil evolutivo das varizes esofágicas após esplenectomia + ligadura da veia gástrica esquerda associada à escleroterapia endoscópica na hipertensão portal esquistossomótica. MÉTODO: Estudo prospectivo, observacional, de pacientes esquistossomóticos com antecedentes de hemorragia digestiva alta, submetidos à esplenectomia + ligadura da veia gástrica esquerda e escleroterapia. As variáveis estudadas foram perfil evolutivo das varizes esofágicas antes e após a operação e índice de recidiva hemorrágica. RESULTADOS: Amostra foi constituída por 30 pacientes distribuídos, quanto ao gênero, em 15 doentes para cada sexo. A idade variou de 19 a 74 anos (mediana=43 anos. Houve redução do grau, calibre e red spots em todos os pacientes (pBACKGROUND: The schistosomiasis affects 200 million people in 70 countries worldwide. It is estimated that 10% of those infected will develop hepatosplenic status and of these, 30% will progress to portal hypertension and esophagogastric varices, whose expression is through gastrointestinal bleeding with significant mortality in the first bleeding episode. Multiple surgical techniques have been developed to prevent re-bleeding. AIM: To evaluate the evolutional profile of esophageal varices after splenectomy + ligation of the left gastric vein associated with endoscopic sclerotherapy in schistosomal portal hypertension. METHODS: Prospective and observational study including schistosomiasis patients with previous history of upper digestive

  15. Assessing the contribution of borderline personality disorder and features to suicide risk in psychiatric inpatients with bipolar disorder, major depression and schizoaffective disorder.

    Science.gov (United States)

    Zeng, Ruifan; Cohen, Lisa J; Tanis, Thachell; Qizilbash, Azra; Lopatyuk, Yana; Yaseen, Zimri S; Galynker, Igor

    2015-03-30

    Suicidal behavior often accompanies both borderline personality disorder (BPD) and severe mood disorders, and comorbidity between the two appears to further increase suicide risk. The current study aims to quantify the risk of suicidality conferred by comorbid BPD diagnosis or features in three affective disorders: major depressive disorder (MDD), bipolar disorder (BP) and schizoaffective disorder. One hundred forty-nine (149) psychiatric inpatients were assessed by SCID I and II, and the Columbia Suicide Severity Rating Scale. Logistic regression analyses investigated the associations between previous suicide attempt and BPD diagnosis or features in patients with MDD, BP, and schizoaffective disorder, as well as a history of manic or major depressive episodes, and psychotic symptoms. Comorbid BPD diagnosis significantly increased suicide risk in the whole sample, and in those with MDD, BP, and history of depressive episode or psychotic symptoms. Each additional borderline feature also increased risk of past suicide attempt in these same groups (excepting BP) and in those with a previous manic episode. Of the BPD criteria, only unstable relationships and impulsivity independently predicted past suicide attempt. Overall, among patients with severe mood disorders, the presence of comorbid BPD features or disorder appears to substantially increase the risk of suicide attempts. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Laparoendoscopic transgastric histoacryl injection of gastric varices: a new surgical approach.

    Science.gov (United States)

    Kassem, Mohamed I; El-Haddad, Hani M; El-Bahrawi, Hassan A

    2013-02-01

    Gastric varices (GVs) are a common finding in Egyptian patients with portal hypertension due to cirrhosis or schistosomal hepatic fibrosis. These patients present with an acute attack or history of hematemesis. Endoscopic histoacryl injection is the standard treatment in Egypt; however, because of technical difficulties it is possible to inject only a little amount of this material, as it may endanger the channels of the flexible endoscope. We thought of a new surgical laparoendoscopic technique to obviate the need for repeated endoscopies and complete obliteration of GVs. This study was conducted on 20 patients with portal hypertension and GVs. After the patient was placed under general anesthesia, a small gastrostomy was done in the anterior gastric wall through which a 10-mm trocar was inserted for the laparoscopic camera. Injection of GVs was done via a spinal needle or a central venous line needle inserted directly. Injection of an adequate amount of histoacryl was done under direct vision. This study was conducted from July 2009 to August 2011 on 20 patients with GVs. The age range was from 22 to 56 years, with a mean age of 39.8±7.85 years. There were 14 men (70%) and 6 women (30%). Fourteen patients (70%) showed complete obliteration of GVs after one session of treatment, whereas 6 patients (30%) had unsatisfactory results and were subjected to another session. GVs were completely obliterated after the second session in 4 patients. Two cases of recurrence of GVs were operated on. This new technique enabled us to inject GVs with a suitable amount of glue material under direct vision without harming the endoscope. Use of this procedure is recommended in patients fit for surgery and those who had failed endoscopic injection sclerotherapy.

  17. Non-variceal upper gastrointestinal bleeding: Rescue treatment with a modified cyanoacrylate.

    Science.gov (United States)

    Grassia, Roberto; Capone, Pietro; Iiritano, Elena; Vjero, Katerina; Cereatti, Fabrizio; Martinotti, Mario; Rozzi, Gabriele; Buffoli, Federico

    2016-12-28

    To evaluate the safety and efficacy of a modified cyanoacrylate [N-butyl-2-cyanoacrylate associated with methacryloxysulfolane (NBCA + MS)] to treat non-variceal upper gastrointestinal bleeding (NV-UGIB). In our retrospective study we took into account 579 out of 1177 patients receiving endoscopic treatment for NV-UGIB admitted to our institution from 2008 to 2015; the remaining 598 patients were treated with other treatments. Initial hemostasis was not achieved in 45 of 579 patients; early rebleeding occurred in 12 of 579 patients. Thirty-three patients were treated with modified cyanoacrylate: 27 patients had duodenal, gastric or anastomotic ulcers, 3 had post-mucosectomy bleeding, 2 had Dieulafoy's lesions, and 1 had duodenal diverticular bleeding. Of the 45 patients treated endoscopically without initial hemostasis or with early rebleeding, 33 (76.7%) were treated with modified cyanoacrylate glue, 16 (37.2%) underwent surgery, and 3 (7.0%) were treated with selective transarterial embolization. The mean age of patients treated with NBCA + MS (23 males and 10 females) was 74.5 years. Modified cyanoacrylate was used in 24 patients during the first endoscopy and in 9 patients experiencing rebleeding. Overall, hemostasis was achieved in 26 of 33 patients (78.8%): 19 out of 24 (79.2%) during the first endoscopy and in 7 out of 9 (77.8%) among early rebleeders. Two patients (22.2%) not responding to cyanoacrylate treatment were treated with surgery or transarterial embolization. One patient had early rebleeding after treatment with cyanoacrylate. No late rebleeding during the follow-up or complications related to the glue injection were recorded. Modified cyanoacrylate solved definitively NV-UGIB after failure of conventional treatment. Some reported life-threatening adverse events with other formulations, advise to use it as last option.

  18. Mammographic features and subsequent risk of breast cancer: a comparison of qualitative and quantitative evaluations in the Guernsey prospective studies.

    Science.gov (United States)

    Torres-Mejía, Gabriela; De Stavola, Bianca; Allen, Diane S; Pérez-Gavilán, Juan J; Ferreira, Jorge M; Fentiman, Ian S; Dos Santos Silva, Isabel

    2005-05-01

    Mammographic features are known to be associated with breast cancer but the magnitude of the effect differs markedly from study to study. Methods to assess mammographic features range from subjective qualitative classifications to computer-automated quantitative measures. We used data from the UK Guernsey prospective studies to examine the relative value of these methods in predicting breast cancer risk. In all, 3,211 women ages > or =35 years who had a mammogram taken in 1986 to 1989 were followed-up to the end of October 2003, with 111 developing breast cancer during this period. Mammograms were classified using the subjective qualitative Wolfe classification and several quantitative mammographic features measured using computer-based techniques. Breast cancer risk was positively associated with high-grade Wolfe classification, percent breast density and area of dense tissue, and negatively associated with area of lucent tissue, fractal dimension, and lacunarity. Inclusion of the quantitative measures in the same model identified area of dense tissue and lacunarity as the best predictors of breast cancer, with risk increasing by 59% [95% confidence interval (95% CI), 29-94%] per SD increase in total area of dense tissue but declining by 39% (95% CI, 53-22%) per SD increase in lacunarity, after adjusting for each other and for other confounders. Comparison of models that included both the qualitative Wolfe classification and these two quantitative measures to models that included either the qualitative or the two quantitative variables showed that they all made significant contributions to prediction of breast cancer risk. These findings indicate that breast cancer risk is affected not only by the amount of mammographic density but also by the degree of heterogeneity of the parenchymal pattern and, presumably, by other features captured by the Wolfe classification.

  19. Endoscopic findings of upper gastrointestinal bleeding in patients with liver cirrhosis

    International Nuclear Information System (INIS)

    Hadayat, R.; Rehman, A.U.; Gandapur, A.

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  1. Clinical features and risk factors for development of urinary tract infections in cats.

    Science.gov (United States)

    Martinez-Ruzafa, Ivan; Kruger, John M; Miller, RoseAnn; Swenson, Cheryl L; Bolin, Carole A; Kaneene, John B

    2012-10-01

    The clinical and diagnostic features of 155 cats with urinary tract infection (UTI) and 186 controls with negative urine culture/s were characterized retrospectively (signalment, clinical signs, urinalysis, urine culture, concurrent diseases, lower urinary tract diagnostic/therapeutic procedures). Multivariable logistic regression was used to identify risk factors associated with UTI. Cats of all ages were affected by UTI with no sex/breed predisposition. Lower urinary tract signs were absent in 35.5% of cats with UTI. Pyuria and bacteriuria had sensitivities of 52.9% and 72.9%, and specificities of 85.5% and 67.7% for detection of UTI, respectively. Risk factors significantly associated with increased odds of UTI were urinary incontinence [odds ratio (OR)=10.78, P=0.0331], transurethral procedures (OR=8.37, Purinary tract anatomic abnormalities improved statistical model performance and contributed to UTI.

  2. Assessment of global and local region-based bilateral mammographic feature asymmetry to predict short-term breast cancer risk

    Science.gov (United States)

    Li, Yane; Fan, Ming; Cheng, Hu; Zhang, Peng; Zheng, Bin; Li, Lihua

    2018-01-01

    This study aims to develop and test a new imaging marker-based short-term breast cancer risk prediction model. An age-matched dataset of 566 screening mammography cases was used. All ‘prior’ images acquired in the two screening series were negative, while in the ‘current’ screening images, 283 cases were positive for cancer and 283 cases remained negative. For each case, two bilateral cranio-caudal view mammograms acquired from the ‘prior’ negative screenings were selected and processed by a computer-aided image processing scheme, which segmented the entire breast area into nine strip-based local regions, extracted the element regions using difference of Gaussian filters, and computed both global- and local-based bilateral asymmetrical image features. An initial feature pool included 190 features related to the spatial distribution and structural similarity of grayscale values, as well as of the magnitude and phase responses of multidirectional Gabor filters. Next, a short-term breast cancer risk prediction model based on a generalized linear model was built using an embedded stepwise regression analysis method to select features and a leave-one-case-out cross-validation method to predict the likelihood of each woman having image-detectable cancer in the next sequential mammography screening. The area under the receiver operating characteristic curve (AUC) values significantly increased from 0.5863  ±  0.0237 to 0.6870  ±  0.0220 when the model trained by the image features extracted from the global regions and by the features extracted from both the global and the matched local regions (p  =  0.0001). The odds ratio values monotonically increased from 1.00-8.11 with a significantly increasing trend in slope (p  =  0.0028) as the model-generated risk score increased. In addition, the AUC values were 0.6555  ±  0.0437, 0.6958  ±  0.0290, and 0.7054  ±  0.0529 for the three age groups of 37

  3. Management of Bleeding Duodenal Varices with Combined TIPS Decompression and Trans-TIPS Transvenous Obliteration Utilizing 3% Sodium Tetradecyl Sulfate Foam Sclerosis

    Directory of Open Access Journals (Sweden)

    Wael E Saad

    2014-01-01

    Full Text Available Objectives: Endoscopic experience in the management of duodenal varices (DVs is limited and challenging given the anatomic constraints and limited experience. The endovascular management of DVs is not yet established and the controversy of whether to manage them by decompression with a transjugular intrahepatic portosystemic shunt (TIPS or by transvenous obliteration is unresolved. In the literature, the 6-12 month rebleeding rate of DVs after TIPS is 21-37% and after transvenous obliteration is 13%. The purpose of the study is to evaluate the clinical outcome of combined TIPS decompression and transvenous obliteration/sclerosis. Materials and Methods: This is a retrospective study (case series of two institutions, evaluating patients who underwent TIPS and/or transvenous obliteration/sclerosis for bleeding DVs (from January 2009 to June 2013. TIPS was performed according to a standard procedure using covered stents. Transvenous obliteration (variceal sclerosis from the systemic and/or portal venous circulation was performed utilizing 3% sodium tetradecyl sulfate foam. Transvenous obliteration was commonly augmented with coils and/or vascular plugs. Technical (technical success of establishing TIPS and completely obliterating the DVs and clinical outcomes (rebleeding rate and survival were evaluated. Results: Five patients with liver cirrhosis presenting with bleeding DVs were included in the study with all eventually (and coincidentally receiving TIPS and transvenous obliteration. Two of the five patients underwent concomitant TIPS and transvenous obliteration in the same procedural setting. However, three patients underwent transvenous obliteration due to bleeding despite a patent TIPS that had been previously placed. The average time from TIPS placement to transvenous obliteration was 125 days (range: 3-324 days. After having both procedures, there was no rebleeding in the patients during a mean follow-up period of 22 months (6-50 months

  4. Two randomized controlled studies comparing the nutritional benefits of branched-chain amino acid (BCAA) granules and a BCAA-enriched nutrient mixture for patients with esophageal varices after endoscopic treatment.

    Science.gov (United States)

    Sakai, Yoshiyuki; Iwata, Yoshinori; Enomoto, Hirayuki; Saito, Masaki; Yoh, Kazunori; Ishii, Akio; Takashima, Tomoyuki; Aizawa, Nobuhiro; Ikeda, Naoto; Tanaka, Hironori; Iijima, Hiroko; Nishiguchi, Shuhei

    2015-01-01

    The usefulness of branched-chain amino acid (BCAA) granules and BCAA-enriched nutrient mixtures for patients with liver cirrhosis is often reported. However, no randomized controlled studies have investigated the usefulness of these supplements in the nutritional intervention of cirrhotic patients receiving endoscopic treatment for esophageal varices. Patients without BCAA before endoscopic treatment were divided into study 1, and those who received BCAA were divided into study 2. In study 1, 44 eligible patients were divided into a control group (n = 13), a general liquid nutrient (snack) group (n = 15), and a BCAA-enriched nutrient mixture (BCAA-EN) group (n = 16). In study 2, 48 eligible patients were divided into a BCAA group (n = 24) and a BCAA-EN group (n = 24). The nutritional status including non-protein respiratory quotient (NPRQ) levels, weight gain, and albumin were evaluated on days 0, 7, and 50. In study 1, the BCAA-EN group showed significant improvement in NPRQ levels on day 7 as compared with the snack group. In study 2, the BCAA-EN group showed significant improvement in NPRQ levels on day 7 and in weight levels on day 50 relative to the BCAA group, while the BCAA group showed improved serum albumin levels on day 7 compared to the BCAA-EN group. The BCAA-enriched nutrient mixture maintained NPRQ and weight in cirrhotic patients. Our findings suggest that supplements including both BCAA and a nutritional energy supplement would be beneficial for cirrhotic patients undergoing endoscopic treatment for esophageal varices.

  5. Insightful monitoring of natural flood risk management features using a low-cost and participatory approach

    Science.gov (United States)

    Starkey, Eleanor; Barnes, Mhari; Quinn, Paul; Large, Andy

    2016-04-01

    Pressures associated with flooding and climate change have significantly increased over recent years. Natural Flood Risk Management (NFRM) is now seen as being a more appropriate and favourable approach in some locations. At the same time, catchment managers are also encouraged to adopt a more integrated, evidence-based and bottom-up approach. This includes engaging with local communities. Although NFRM features are being more readily installed, there is still limited evidence associated with their ability to reduce flood risk and offer multiple benefits. In particular, local communities and land owners are still uncertain about what the features entail and how they will perform, which is a huge barrier affecting widespread uptake. Traditional hydrometric monitoring techniques are well established but they still struggle to successfully monitor and capture NFRM performance spatially and temporally in a visual and more meaningful way for those directly affected on the ground. Two UK-based case studies are presented here where unique NFRM features have been carefully designed and installed in rural headwater catchments. This includes a 1km2 sub-catchment of the Haltwhistle Burn (northern England) and a 2km2 sub-catchment of Eddleston Water (southern Scotland). Both of these pilot sites are subject to prolonged flooding in winter and flash flooding in summer. This exacerbates sediment, debris and water quality issues downstream. Examples of NFRM features include ponds, woody debris and a log feature inspired by the children's game 'Kerplunk'. They have been tested and monitored over the 2015-2016 winter storms using low-cost techniques by both researchers and members of the community ('citizen scientists'). Results show that monitoring techniques such as regular consumer specification time-lapse cameras, photographs, videos and 'kite-cams' are suitable for long-term and low-cost monitoring of a variety of NFRM features. These techniques have been compared against

  6. Current features on risk perception and risk communication of radiation

    International Nuclear Information System (INIS)

    Kusama, Tomoko

    1997-01-01

    Health effects and risks of radiation and radionuclides are being misunderstood by many members of general public. Many peoples have fear and anxieties for radiation. So far, the health effects from radiation at low dose and low dose rate have not been cleared on biological aspects. Then, we have quantitatively estimated health risks of low-dose radiation on the basis of linear dose response relationship without threshold from the viewpoints of radiation protection by using both epidemiological data, such as atomic bomb survivors, and some models and assumptions. It is important for researchers and relevant persons in radiation protection to understand the process of risk estimation of radiation and to communicate an exact knowledge of radiation risks of the public members. (author)

  7. Blood in the gastric lumen increases splanchnic blood flow and portal pressure in portal-hypertensive rats.

    Science.gov (United States)

    Chen, L; Groszmann, R J

    1996-10-01

    In portal-hypertensive humans, portal blood flow and pressure increase after a meal. These hemodynamic changes may increase variceal rupture risk. The aim of this study was to determine whether blood in the stomach lumen increases splanchnic flow and portal pressure (PP) in portal-hypertensive rats. superior mesenteric artery flow and PP were measured in conscious, unrestrained, fasted partial portal vein-ligated rats with chronically implanted Doppler flow probes or portal vein catheters before and after gavage with heparinized, warmed blood from donor rats, air, standard meal, or empty tube. Percentage of changes in flow and pressure from baseline were significantly greater after gavage with blood (an increase of 22.6% +/- 3.5% and an increase of 16.4% +/- 3.1%, respectively) than empty tube (an increase of 3.4% +/- 0.6% and a decrease of 5.4% +/- 3.5%, respectively) (P empty tube (P calories probably contributes to these hemodynamic changes. In patients with variceal hemorrhage, blood in the stomach may increase the risk of persistent variceal bleeding or rebleeding.

  8. Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology Hemorragia digestiva alta varicosa: relatório do 1º Consenso da Sociedade Brasileira de Hepatologia

    Directory of Open Access Journals (Sweden)

    Paulo Lisboa Bittencourt

    2010-06-01

    Full Text Available In the last decades, several improvements in the management of variceal bleeding have resulted in a significant decrease in morbidity and mortality of patients with cirrhosis and bleeding varices. Progress in the multidisciplinary approach to these patients has led to a better management of this disease by critical care physicians, hepatologists, gastroenterologists, endoscopists, radiologists and surgeons. In this respect, the Brazilian Society of Hepatology has, recently, sponsored a consensus meeting in order to draw evidence-based recommendations on the management of these difficult-to-treat subjects. An organizing committee comprised of four people was elected by the Governing Board and was responsible to invite 27 researchers from distinct regions of the country to make a systematic review of the subject and to present topics related to variceal bleeding, including prevention, diagnosis, management and treatment, according to evidence-based medicine. After the meeting, all participants met together for discussion of the topics and the elaboration of the aforementioned recommendations. The organizing committee was responsible for writing the final document. The meeting was held at Salvador, May 6th, 2009 and the present manuscript is the summary of the systematic review that was presented during the meeting, organized in topics, followed by the recommendations of the Brazilian Society of Hepatology.Vários avanços científicos obtidos nas últimas duas décadas foram incorporados no manejo da hemorragia digestiva alta varicosa, levando a uma redução significante da sua morbimortalidade, atribuída à abordagem multidisciplinar do sangramento varicoso por paramédicos, emergencistas, intensivistas, gastroenterologistas, hepatologistas, endoscopistas, radiologistas intervencionistas e cirurgiões. Recentemente, a Sociedade Brasileira de Hepatologia patrocinou uma reunião de consenso, visando o estabelecimento de recomendações nacionais

  9. Callous-Unemotional Features, Behavioral Inhibition, and Parenting: Independent Predictors of Aggression in a High-Risk Preschool Sample

    Science.gov (United States)

    Kimonis, Eva R.; Frick, Paul J.; Boris, Neil W.; Smyke, Anna T.; Cornell, Amy H.; Farrell, Jamie M.; Zeanah, Charles H.

    2006-01-01

    A behaviorally-uninhibited temperament, callous-unemotional (CU) features, and harsh parenting have been associated with specific patterns of aggressive behavior in older children and adolescents. We tested the additive and interactive effects of these factors in predicting different types of aggressive behavior in a high-risk preschool sample.…

  10. Special features of high-risk pregnancies as factors in development of mental distress: a review

    Directory of Open Access Journals (Sweden)

    Paula Borba Rodrigues

    Full Text Available Abstract Introduction: Approximately 22% of all pregnant women are classified as having high-risk pregnancies, which may involve feelings of vulnerability because of having a high-risk pregnancy, resulting in greater exposure to stressful feelings. Objective: To review aspects of high-risk pregnancy that can have a negative impact on the these women's mental health status. Method: Original articles were identified by conducting searches of the PubMed/MEDLINE, LILACS and SciELO databases, followed by a manual search of references to select articles and additional bibliographic material. Articles from the last 22 years were included in the review (1992-2014. Results: Fifteen articles were found that specifically studied high-risk pregnancies and mental health outcomes. Women with high-risk pregnancies exhibited a significantly higher level of stress and reported negative emotions as they dealt with stress and had worse emotional status than women with normal pregnancies. Researchers found that hospitalized pregnant women had higher levels of anxiety than non-hospitalized women. Studies of women going through normal and high-risk pregnancies show that women with normal pregnancies had good self-perceived quality of life. Conclusion: Special features of high-risk pregnancies could be factors in development of mental distress, in addition to psychological and social factors. Therefore, only a biopsychosocial research study would be able to identify the factors that can affect the quality of mental health during high-risk pregnancy.

  11. Budd-Chiari Syndrome: Two Cases with Different Courses

    Directory of Open Access Journals (Sweden)

    Shinjiro Inomata

    2008-08-01

    Full Text Available We report two cases of Budd-Chiari syndrome. Case 1: A 57-year-old man presented with leg edema and esophageal varices. Cavography showed obstruction of the inferior vena cava with antiphospholipid syndrome. Further, the patient showed positive serology for hepatitis C virus and consumed large quantities of alcohol. Percutaneous transluminal angioplasty was performed on this patient and anticoagulants administered; leg edema and esophageal varices were ameliorated although liver biopsy showed cirrhosis without evident congestion. More than 9 months since the diagnosis, restenosis of the inferior vena cava has not occurred. Case 2: A 73-year-old woman presented abdominal pain but no edema or varices. Cavography showed membranous obstruction of the inferior vena cava which required no therapy. Manifestation of portal hypertension was not present and liver function was maintained although liver biopsy showed obvious congestion. These cases showed untypical features against histopathology, and careful observation will be required for emergence of hepatocellular carcinoma.

  12. Non-selective beta-blockers may reduce risk of hepatocellular carcinoma

    DEFF Research Database (Denmark)

    Thiele, Maja; Albillos, Agustín; Abazi, Rozeta

    2015-01-01

    BACKGROUND & AIMS: Non-selective beta-blockers (NSBB) are used in patients with cirrhosis and oesophageal varices. Experimental data suggest that NSBB inhibit angiogenesis and reduce bacterial translocation, which may prevent hepatocellular carcinoma (HCC). We therefore assessed the effect of NSBB...

  13. Features for culturally appropriate avatars for behavior-change promotion in at-risk populations

    Directory of Open Access Journals (Sweden)

    Lisetti C

    2009-09-01

    Full Text Available We explore how avatars can be used as social orthotics defined as therapeutic computer-based social companions aimed at promoting healthy behaviors. We review some of the health interventions deployed in helping at-risk populations along with some of the unique advantages that computer-based interventions can add to face-to-face interventions. We posit that artificial intelligence has rendered possible the creation of culturally appropriate dialog-agents for interventions and we identify specific features for social avatars that are important - if not necessary - when applied to the domain of social orthotic systems for health promotion.

  14. Hypoalbuminemia in the outcome of patients with non-variceal upper gastrointestinal bleeding.

    Science.gov (United States)

    González-González, J A; Vázquez-Elizondo, G; Monreal-Robles, R; García-Compean, D; Borjas-Almaguer, O D; Hernández-Velázquez, B; Maldonado-Garza, H J

    The role of serum albumin level in patients with non-variceal upper gastrointestinal bleeding (NVUGB) has not been extensively studied. Our aim was to evaluate the role of serum albumin on admission in terms of in-hospital mortality in patients with NVUGB. Patients admitted with NVUGB during a 4-year period were prospectively included. Demographic, clinical, and laboratory data were collected. ROC curve analysis was used to determine the cutoff value for serum albumin on admission that made a distinction between deceased patients and survivors with respect to serum albumin on admission, as well as its overall performance compared with the Rockall score. 185 patients with NVUGB were evaluated. Men predominated (56.7%) and a mean age of 59.1±19.9 years was found. Mean serum albumin on admission was 2.9±0.9g/dl with hypoalbuminemia (< 3.5g/dl) detected on admission in 71.4% of cases. The ROC curve found that the best value for predicting hospital mortality was an albumin level of 3.1g/dl (AUROC 0.738). Mortality in patients with albumin ≥ 3.2g/dl was 1.2% compared with 11.2% in patients with albumin<3.2g/dl (P=.009; OR 9.7, 95%CI 1.2-76.5). There was no difference in overall performance between the albumin level (AUORC 0.738) and the Rockall score (AUROC 0.715) for identifying mortality. Patients with hypoalbuminemia presenting with NVUGB have a greater in-hospital mortality rate. The serum albumin level and the Rockall score perform equally in regard to identifying the mortality rate. Copyright © 2016 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  15. Emergency TIPS in a Child-Pugh B patient

    DEFF Research Database (Denmark)

    Trebicka, Jonel

    2017-01-01

    Transjugular intrahepatic portosystemic shunt (TIPS) is used to treat complications of cirrhosis such as variceal bleeding and refractory ascites, but it also bears the risk of liver failure, overt hepatic encephalopathy (HE) and cardiac decompensation. Variceal bleeding may be controlled using...... translocation. Both these processes mediate an impaired immunological and hemodynamic response, thereby facilitating the development of acute-on-chronic liver failure (ACLF) and/or death. Similarly, in patients with refractory ascites, TIPS should be used early in treatment to prevent acute kidney injury (AKI...

  16. Pregnancy with Portal Hypertension

    Science.gov (United States)

    Aggarwal, Neelam; Negi, Neha; Aggarwal, Aakash; Bodh, Vijay; Dhiman, Radha K.

    2014-01-01

    Even though pregnancy is rare with cirrhosis and advanced liver disease, but it may co-exist in the setting of non-cirrhotic portal hypertension as liver function is preserved but whenever encountered together is a complex clinical dilemma. Pregnancy in a patient with portal hypertension presents a special challenge to the obstetrician as so-called physiological hemodynamic changes associated with pregnancy, needed for meeting demands of the growing fetus, worsen the portal hypertension thereby putting mother at risk of potentially life-threatening complications like variceal hemorrhage. Risks of variceal bleed and hepatic decompensation increase many fold during pregnancy. Optimal management revolves round managing the portal hypertension and its complications. Thus management of such cases requires multi-speciality approach involving obstetricians experienced in dealing with high risk cases, hepatologists, anesthetists and neonatologists. With advancement in medical field, pregnancy is not contra-indicated in these women, as was previously believed. This article focuses on the different aspects of pregnancy with portal hypertension with special emphasis on specific cause wise treatment options to decrease the variceal bleed and hepatic decompensation. Based on extensive review of literature, management from pre-conceptional period to postpartum is outlined in order to have optimal maternal and perinatal outcomes. PMID:25755552

  17. Risk factors, pathological and phenotypic features of male breast cancer in Greece.

    Science.gov (United States)

    Tsoukalas, Nikolaos; Moirogiorgou, Evangelia; Tolia, Maria; Pistamaltzian, Nikolaos; Bournakis, Evangelos; Papadimitriou, Konstantinos; Demiri, Stamatina; Panopoulos, Christos; Koumakis, Georgios; Efremidis, Anna

    2014-03-01

    Breast cancer (BC) in males is a rare disease and comprises 0.5-1% of all BC cases. Due to its rarity, there are limited data regarding risk factors, biology and relevant treatment. A prospective observational study of demographic, clinical and histological characteristics of serially-admitted men with breast cancer was carried out from 1999 to 2009. Data were recorded and analyzed from a database including 1,315 cases of BC. Registered data concerned age, initial presentation, family and lifestyle history (risk factors), histological features, phenotypic subtypes and TNM staging. Twenty two men with BC were identified, with a median age of 63 years. The most common initial presentation was a palpable lump in 12 patients, nipple contraction in three and ulceration in three. According to their medical history, nine men were overweight, 10 suffered from hypertension and 12 were smokers. The most prevalent phenotype was luminal-A followed by triple-negative type. BC in none of the cases was HER 2-amplified. The majority of cases were grade II or III and stage II or III. In the present small study, we confirm that BC in males is rare. It is a disease of middle-age and presents at advanced stages. Most of patients had 1-3 risk factors for BC. Expression of hormonal receptors occurs in the majority of BC tumors in males and with rarity in HER 2 amplification.

  18. Platelet count/spleen diameter ratio: analysis of its capacity as a predictor of the existence of esophageal varices Índice contagem de plaquetas/diâmetro do baço: análise de sua capacidade como preditor da existência de varizes esofágicas

    Directory of Open Access Journals (Sweden)

    Ângelo Zambam de Mattos

    2010-09-01

    Full Text Available CONTEXT: Upper gastrointestinal bleeding associated to esophageal varices is the most dramatic complication of cirrhosis. It is recommended screening every cirrhotic for esophageal varices with endoscopy. OBJECTIVES: To evaluate the capacity of the platelet count/spleen diameter ratio in non-invasively predicting esophageal varices in a population of cirrhotics originated in an independent center from the one in which it was developed. METHODS: The study included patients from the ambulatory care clinic of cirrhosis of a Brazilian hospital and studied platelet count, spleen diameter and presence of esophageal varices, as well as Child and MELD scores. It used a cutoff value of 909 for the platelet count/spleen diameter ratio, as previously published. A sample of 139 patients was needed to grant results a 95% confidence level. RESULTS: The study included 164 cirrhotics, 56.7% male, with a mean age of 56.6 ± 11.6 years. In the univariate analysis, platelet count, spleen diameter, presence of ascites, Child and MELD scores and the platelet count/spleen diameter ratio were related to esophageal varices (PCONTEXTO: Hemorragia digestiva por varizes esofágicas é a complicação mais dramática da cirrose. É recomendada triagem de varizes esofágicas em todo o cirrótico. OBJETIVO: Avaliar o índice de contagem de plaquetas/diâmetro do baço como predição de varizes esofágicas em uma população distinta daquela em que ele foi desenvolvido. MÉTODOS: O estudo incluiu pacientes do ambulatório de cirrose de um hospital brasileiro quanto ao número de plaquetas, diâmetro ecográfico do baço, presença de varizes esofágicas, Child e MELD. O ponto de corte do índice foi de 909. Amostra de 139 pacientes foi estimada para conferir nível de confiança de 95%. RESULTADOS: Incluíram-se 164 cirróticos, 56,7% homens e com média de idade de 56,6 anos. Na análise univariada, número de plaquetas, diâmetro do baço, ascite, Child, MELD e o

  19. Long-term outcome following trans-jugular intrahepatic portosystemic shunt for variceal bleeding due to portal hypertension

    International Nuclear Information System (INIS)

    Cui Jinguo; Zhang Shutian; Feng Zitan; Zhou Guifen; Pan Xinyuan; Liang Zhihui

    2002-01-01

    Objective: To study the 6-year outcome following trans-jugular intrahepatic portosystemic shunt (TIPSS) for variceal bleeding due to portal hypertension. Methods: 65 patients, 51 males, 14 females, aged 35-72 years old with averaged 4.5 years, have been undergone TIPSS because of portal hypertension due to cirrhosis or Budd-Chiari syndrome. The portal pressures were measured before and after TIPSS. Follow-up study was done by color Doppler sonography or Barium esophageal radiography for 3 months to 6 years (averaged 18 months). Repeated interventional treatments were done in cases of restenosis of the shunts. Results: There were 0, 2, 10, 5, 0 cases of recurrent bleeding after 3 months, 6 months, 1 year, 2 year and 3-6 year following TIPSS respectively. Stenosis occurred in shunt paths due to thrombosis or smooth muscle cell proliferation or neo-intimal hyperplasia were relieved after thrombolytic therapy and repeated balloon angioplasty or stent plant among most of them. 2 were failed due to serious stenosis. 7 cases died, 2 of massive bleeding, 1 of the other cause and 4 of hepatic cancer. The other patients are getting well. Conclusions: Although there were very high rates of restenosis (34%), but most of them could be treated again with interventional therapy, and in kept patency effectively. TIPSS is a still practical valuable management for massive gastric bleeding

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-08-15

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

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

    International Nuclear Information System (INIS)

    Yoon, Min Jae; Hwang, Cheol Mog; Kim, Ho Jun; Cho, Young Jun; Bae, Seok Hwan; Shin, Byung Seok; Ohm, Joon Young; Kang, Chae Hoon

    2013-01-01

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

  2. DDAH2 mRNA expression is inversely associated with some cardiovascular risk-related features in healthy young adults.

    Science.gov (United States)

    Puchau, Blanca; Hermsdorff, Helen Hermana M; Zulet, M Angeles; Martínez, J Alfredo

    2009-01-01

    The purpose of this study was to evaluate whether the mRNA expression profiles of three genes (PRMT1, DDAH2 and NOS3) are related to ADMA metabolism and signalling, and the potential relationships with anthropometrical, biochemical, lifestyle and inflammatory indicators in healthy young adults. An emphasis on the putative effect of different mRNA expression on cardiovascular risk-related features was paid. Anthropometrical measurements as well as lifestyle features were analyzed in 120 healthy young adults. Fasting blood samples were collected for the measurement of glucose and lipid profiles as well as the concentrations of selected inflammatory markers. Profiles of mRNA expression were assessed for PRMT1, DDAH2 and NOS3 genes from peripheral blood mononuclear cells. Regarding inflammatory biomarkers, DDAH2 was inversely associated with IL-6 and TNF-alpha. Moreover, subjects in the highest quintile of DDAH2 mRNA expression showed a reduced risk to have higher values of waist circumference, and to be more prone to show higher values of HDL-c. Interestingly, DDAH2 gene expression seemed to be related with some anthropometrical, biochemical, lifestyle and inflammatory indicators linked to cardiovascular risk in apparently healthy young adults, emerging as a potential disease marker.

  3. DDAH2 mRNA Expression Is Inversely Associated with Some Cardiovascular Risk-Related Features in Healthy Young Adults

    Directory of Open Access Journals (Sweden)

    Blanca Puchau

    2009-01-01

    Full Text Available The purpose of this study was to evaluate whether the mRNA expression profiles of three genes (PRMT1, DDAH2 and NOS3 are related to ADMA metabolism and signalling, and the potential relationships with anthropometrical, biochemical, lifestyle and inflammatory indicators in healthy young adults. An emphasis on the putative effect of different mRNA expression on cardiovascular risk-related features was paid. Anthropometrical measurements as well as lifestyle features were analyzed in 120 healthy young adults. Fasting blood samples were collected for the measurement of glucose and lipid profiles as well as the concentrations of selected inflammatory markers. Profiles of mRNA expression were assessed for PRMT1, DDAH2 and NOS3 genes from peripheral blood mononuclear cells. Regarding inflammatory biomarkers, DDAH2 was inversely associated with IL-6 and TNF-α. Moreover, subjects in the highest quintile of DDAH2 mRNA expression showed a reduced risk to have higher values of waist circumference, and to be more prone to show higher values of HDL-c. Interestingly, DDAH2 gene expression seemed to be related with some anthropometrical, biochemical, lifestyle and inflammatory indicators linked to cardiovascular risk in apparently healthy young adults, emerging as a potential disease marker.

  4. Spontaneous Arterial Dissection—Risk Factors And Clinical Features: Study Of 70 Cases And Review Of Literature

    Directory of Open Access Journals (Sweden)

    Haniyeh Javanmardi

    2017-02-01

    Full Text Available Dissection refers to a serious condition that begin as a tear or rupture in the inner layers of large vessel wall. Tear allows the blood to surges through the layers, leads to intramural hematoma or an aneurysmal dilatation, either of which can be a source of thromboembolism. Ischemic symptoms in surrounding structures are more often secondary to embolism. Dissections are labeled spontaneous in the absence of major blunt or penetrating trauma. The incidence rates for spontaneous carotid artery dissection have been reported to be 2.5 to 3 per 100,000 population. The average annual incidence for vertebral artery dissection were calculated to be 1 to 1.5 per 100,000. Typical clinical features seen with dissection include unilateral headache, ipsilateral Homer's syndrome, oculosympathetic palsy, prominent neck and facial pain, retinal ischemia, and symptoms of focal brain ischemia due to the site of dissection. The reason of dissection occurrence is still unknown but numerous factors e.g. connective tissue disorders, hyperhomocystinemia, fibromuscular dysplasia, recent infection, etc. may underlie spontaneous or minor trauma dissections. Patients with Spontaneous dissection are more susceptible to developing to stroke and its morbidity and mortality.     In this retrospective study, we evaluate the clinical features, risk factors, treatment and outcome of spontaneous dissection in 70 patients (31 female and 39 male, referred to Namazi hospital between September 2012 and September 2016. The diagnosis of arterial dissection was established by qualified physicians according to radiological and clinical features. Patients with traumatic dissection and a history of major or minor head and neck injury were excluded. Subjects were observed for multiple risk factors such as age dependent risk factors, family history of venous thrombosis, history of trauma, coagulopathies, infectious diseases, systemic disorders, arterio-venous malformations and

  5. The Effect of Radiation Timing on Patients With High-Risk Features of Parameningeal Rhabdomyosarcoma: An Analysis of IRS-IV and D9803

    Energy Technology Data Exchange (ETDEWEB)

    Spalding, Aaron C., E-mail: Aaron.Spalding@nortonhealthcare.org [Kosair Children' s Hospital and Brain Tumor Center, Louisville, Kentucky (United States); Hawkins, Douglas S. [Division of Hematology/Oncology, Seattle Children' s Hospital, and Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington (United States); Donaldson, Sarah S. [Department of Radiation Oncology, Stanford University Medical Center, Stanford, California (United States); Anderson, James R.; Lyden, Elizabeth [University of Nebraska Medical Center, Omaha, Nebraska (United States); Laurie, Fran [Quality Assurance Review Center, Providence, Rhode Island and Seattle, Washington (United States); Wolden, Suzanne L. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Arndt, Carola A.S. [Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota (United States); Michalski, Jeff M. [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States)

    2013-11-01

    Purpose: Radiation therapy remains an essential treatment for patients with parameningeal rhabdomyosarcoma (PMRMS), and early radiation therapy may improve local control for patients with intracranial extension (ICE). Methods and Materials: To address the role of radiation therapy timing in PMRMS in the current era, we reviewed the outcome from 2 recent clinical trials for intermediate-risk RMS: Intergroup Rhabdomyosarcoma Study (IRS)-IV and Children's Oncology Group (COG) D9803. The PMRMS patients on IRS-IV with any high-risk features (cranial nerve palsy [CNP], cranial base bony erosion [CBBE], or ICE) were treated immediately at day 0, and PMRMS patients without any of these 3 features received week 6-9 radiation therapy. The D9803 PMRMS patients with ICE received day 0 X-Ray Therapy (XRT) as well; however, those with either CNP or CBBE had XRT at week 12. Results: Compared with the 198 PMRMS patients from IRS-IV, the 192 PMRMS patients from D9803 had no difference (P<.05) in 5-year local failure (19% vs 19%), failure-free-survival (70% vs 67%), or overall survival (75% vs 73%) in aggregate. The 5-year local failure rates by subset did not differ when patients were classified as having no risk features (None, 15% vs 19%, P=.25), cranial nerve palsy/cranial base of skull erosion (CNP/CBBE, 15% vs 28%, P=.22), or intracranial extension (ICE, 21% vs 15%, P=.27). The D9083 patients were more likely to have received initial staging by magnetic resonance imaging (71% vs 53%). Conclusions: These data support that a delay in radiation therapy for high-risk PMRMS features of CNP/CBBE does not compromise clinical outcomes.

  6. Systemic connective tissue features in women with fibromuscular dysplasia.

    Science.gov (United States)

    O'Connor, Sarah; Kim, Esther Sh; Brinza, Ellen; Moran, Rocio; Fendrikova-Mahlay, Natalia; Wolski, Kathy; Gornik, Heather L

    2015-10-01

    Fibromuscular dysplasia (FMD) is a non-atherosclerotic disease associated with hypertension, headache, dissection, stroke, and aneurysm. The etiology is unknown but hypothesized to involve genetic and environmental components. Previous studies suggest a possible overlap of FMD with other connective tissue diseases that present with dissections and aneurysms. The aim of this study was to investigate the prevalence of connective tissue physical features in FMD. A total of 142 FMD patients were consecutively enrolled at a single referral center (97.9% female, 92.1% of whom had multifocal FMD). Data are reported for 139 female patients. Moderately severe myopia (29.1%), high palate (33.1%), dental crowding (29.7%), and early-onset arthritis (15.6%) were prevalent features. Classic connective features such as hypertelorism, cleft palate, and hypermobility were uncommon. The frequency of systemic connective tissue features was compared between FMD patients with a high vascular risk profile (having had ⩾1 dissection and/or ⩾2 aneurysms) and those with a standard vascular risk profile. A history of spontaneous pneumothorax (5.9% high risk vs 0% standard risk) and atrophic scarring (17.6% high risk vs 6.8% standard risk) were significantly more prevalent in the high risk group, pconnective tissue features such as high palate and pneumothorax were more prominent among FMD patients with a high vascular risk profile. © The Author(s) 2015.

  7. Risk assessment of safety data link and network communication in digital safety feature control system of nuclear power plant

    International Nuclear Information System (INIS)

    Lee, Sang Hun; Son, Kwang Seop; Jung, Wondea; Kang, Hyun Gook

    2017-01-01

    Highlights: • Safety data communication risk assessment framework and quantitative scheme were proposed. • Fault-tree model of ESFAS unavailability due to safety data communication failure was developed. • Safety data link and network risk were assessed based on various ESF-CCS design specifications. • The effect of fault-tolerant algorithm reliability of safety data network on ESFAS unavailability was assessed. - Abstract: As one of the safety-critical systems in nuclear power plants (NPPs), the Engineered Safety Feature-Component Control System (ESF-CCS) employs safety data link and network communication for the transmission of safety component actuation signals from the group controllers to loop controllers to effectively accommodate various safety-critical field controllers. Since data communication failure risk in the ESF-CCS has yet to be fully quantified, the ESF-CCS employing data communication systems have not been applied in NPPs. This study therefore developed a fault tree model to assess the data link and data network failure-induced unavailability of a system function used to generate an automated control signal for accident mitigation equipment. The current aim is to provide risk information regarding data communication failure in a digital safety feature control system in consideration of interconnection between controllers and the fault-tolerant algorithm implemented in the target system. Based on the developed fault tree model, case studies were performed to quantitatively assess the unavailability of ESF-CCS signal generation due to data link and network failure and its risk effect on safety signal generation failure. This study is expected to provide insight into the risk assessment of safety-critical data communication in a digitalized NPP instrumentation and control system.

  8. Long-term effects of interventional devascularization in treating cirrhosis patients with portal hypertension

    International Nuclear Information System (INIS)

    Hu Yubin; Feng Gansheng; Liang Huimin; Zhou Guofeng; Xia Xiangwen; Zheng Chuansheng; Xiong Bin

    2009-01-01

    Objective: To analyze long-term cumulative survival and re-bleeding rate of cirrhosis patients with portal hypertension after interventional devascularization and to evaluate long-term efficacy and importance of interventional devascularization. Methods: Sixty-one cirrhosis patients with portal hypertension were retrospectively studied after interventional devascularization. The number of patients in Child A, B and C was respectively 25, 25 and 11, while that of mild, moderate and severe gastro- esophageal varices was 10, 31 and 20 respectively. Forty-seven patients had gastrointestinal bleeding history. Kaplan-Meier was used to analyze the long-term survival and re-bleeding rates, Log rank test was applied to measure differences in survival among the patients with different degree of hepatic function or gastro-esophageal varices, and Cox regression was used for multivariate analysis of survival, which had statistical significance with P 2 =14.1993, P=0.0002) and Child B patients (χ 2 =9.7887, P=0.0022), but there was no significant difference between the latter two groups (χ 2 =0.8664, P=0.352). The cumulative survival at 1-, 3-, 5-, 8-year for mild gastro-esophageal varices patients was 100.0%, 100.0%, 100.0%, 80.0%, and for moderate varices patients was 93.2%, 78.5%, 61.0%, 27.2%, while at 1-, 3-, 5-year for severe varices patients was 95.0%, 67.1%, 53.8%, respectively. The cumulative survival rate of patients with mild gastro-esophageal varices were significantly higher than those of patients with moderate (χ 2 =4.5425, P=0.033) and severe gastro-esophageal varices (χ 2 =5.448, P=0.0196), but there was no significant difference between the latter two groups (χ 2 = 0.3772, P=0.5391). Cox analysis of preoperative risk factors found Child MELD scores≥12(OR=5.119, P=0.0029), gastro-esophageal varices (OR=3.291, P=0.0391) and the last bleeding volume > 800 ml (OR=11.024, P=0.0003) before therapy were independent predictors of poor long-term survival

  9. [Regional features of food standards and health risks associated with chemical contamination of food].

    Science.gov (United States)

    Klepikov, O V; Khatuaev, R O; Istomin, A V; Rumyantseva, L A

    In the article there are presented results of a study of the balance of food consumption by the population of the Voronezh region, the assessment of the level of contamination of food products and both carcinogenic and non-carcinogenic and public health risk caused by this contamination. There was evaluated the level of nutrition-dependent diseases. A special feature of this study is a comparative analysis of data obtained during the two five-year periods of 1995-1999 and 2010-2014, that permitted to reveal changes in food consumption, the dynamics of morbidity rate associated with the nutritional factor.

  10. Comparison of spin-echo echoplanar imaging and gradient recalled echo-based MR elastography at 3 Tesla with and without gadoxetic acid administration

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yong Seek [Chonbuk National University Medical School and Hospital, Department of Radiology, Jeonju, Chonbuk (Korea, Republic of); Song, Ji Soo [Chonbuk National University Medical School and Hospital, Department of Radiology, Jeonju, Chonbuk (Korea, Republic of); Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Chonbuk (Korea, Republic of); Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Chonbuk (Korea, Republic of); Kannengiesser, Stephan [Siemens Healthcare, MR Applications Development, Erlangen (Germany); Seo, Seung Young [Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Chonbuk (Korea, Republic of); Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Chonbuk (Korea, Republic of); Chonbuk National University Medical School and Hospital, Department of Internal Medicine, Jeonju (Korea, Republic of)

    2017-10-15

    To compare spin-echo echoplanar imaging (SE-EPI) and gradient recalled echo (GRE) MR elastography (MRE) at 3 T with and without gadoxetic acid administration. We included 84 patients who underwent MRE before and after gadoxetic acid administration, each time using SE-EPI and GRE sequences. Diagnostic performance for predicting clinical liver cirrhosis and high-risk oesophageal varices was assessed using the area under the receiver-operating characteristic curve (AUC). The relationships between T2* and success of MRE, and correlations of liver stiffness (LS) values between the two sequences or before and after gadoxetic acid administration, were investigated. SE-EPI-MRE resulted in a significantly lower failure rate than GRE-MRE (1.19% vs. 10.71%, P = 0.018). Increased T2* was related to higher probability of successful LS measurement (odds ratio, 1.426; P = 0.004). The AUC of SE-EPI-MRE was comparable to that of GRE-MRE for the detection of clinical liver cirrhosis (0.938 vs. 0.948, P = 0.235) and high-risk oesophageal varices (0.839 vs. 0.752, P = 0.354). LS values were not significantly different before and after gadoxetic acid administration. SE-EPI-MRE can substitute for GRE-MRE for the detection of clinical liver cirrhosis and high-risk oesophageal varices. SE-EPI-MRE is particularly useful in patients with iron deposition, with lower failure rates than GRE-MRE. (orig.)

  11. Greek results of the “ENERGIB” European study on non-variceal upper gastrointestinal bleeding

    Science.gov (United States)

    Papatheodoridis, George; Akriviadis, Evangelos; Evgenidis, Nikolaos; Kapetanakis, Anargyros; Karamanolis, Demetrios; Kountouras, Jannis; Mantzaris, Gerassimos; Potamianos, Spyros; Triantafyllou, Konstantinos; Tzathas, Charalambos

    2012-01-01

    Background Non-variceal upper gastro-intestinal bleeding (NVUGIB) is a common and challenging emergency situation. We aimed to describe the characteristics and clinical outcomes of patients with NVUGIB in Greece. Methods ENERGIB (NCT00797641) was an epidemiological survey conducted in 7 European countries including Greece. It included adult patients with overt NVUGIB from 10 tertiary hospitals across Greece. Data for each patient were collected on admission and up to 30 days thereafter. Results 201 patients were enrolled. A previous history of NVUGIB was reported by 14% of patients, while 61% had ≥ 1 co-morbidities. At presentation, 59% were on therapy that could harm the gastrointestinal mucosa, 14% on anticoagulant(s) and 42% had sign(s) of hemodynamic instability. 54% of patients showed stigmata of recent hemorrhage. Therapeutic endoscopy was performed in 25% and blood product(s) transfusions were required in 86% of cases. Proton pump inhibitors were administered before and after endoscopy in 70% and 95% of patients, respectively. Uncontrolled bleeding or rebleeding was observed in 11% being more common in elderly, hospitalized patients and patients with ≥1 co-morbidities. Second-look endoscopy was performed in 20%, angiographic intervention in 1.5% and surgical intervention in 4% of patients. Only 5/201 (2.5%) patients died during hospitalization and none died during the 30-day post-hospitalization period. Conclusions The majority of patients with NVUGIB in tertiary Greek hospitals are elderly, with co-morbidities, hemodynamic instability and required transfusion(s), while one fourth undergoes therapeutic endoscopic interventions. However, NVUGIB is associated with moderate degrees of continued bleeding/re-bleeding, low surgical rates and, most importantly, low mortality. PMID:24714268

  12. Narrow-band imaging can increase the visibility of fibrin caps after bleeding of esophageal varices: a case with extensive esophageal candidiasis.

    Science.gov (United States)

    Furuichi, Yoshihiro; Kasai, Yoshitaka; Takeuchi, Hirohito; Yoshimasu, Yuu; Kawai, Takashi; Sugimoto, Katsutoshi; Kobayashi, Yoshiyuki; Nakamura, Ikuo; Itoi, Takao

    2017-08-01

    A 58-year-old man with hepatitis B cirrhosis noticed black stools and underwent an endoscopy at a community hospital. The presence of esophageal varices (EVs) was confirmed, but the bleeding point was not found. He was referred to our institution and underwent a second endoscopy. Extensive white patches of esophageal candidiasis were visible on endoscopy by white-light imaging (WLI), but it was difficult to find the fibrin cap of the EVs. This was easier under narrow-band imaging (NBI), however, as the color turned red from absorption by hemoglobin adhered to it. We retrospectively measured the color differences (CD) between the fibrin cap and the surrounding mucosa 10 times using the CIE (L*a*b*) color space method. The median value of CD increased after NBI (13.9 → 43.0, p candidiasis, but the increased visibility of the fibrin cap by NBI enabled it to be found more easily. This is the first report of a case in which NBI was helpful in locating a fibrin cap of EVs.

  13. Single-stage definitive surgical treatment for portal biliopathy

    African Journals Online (AJOL)

    typical cholangiographic features of PB include indentations and irregularities in the wall ... Results. Follow-up. Chaudhary et al.[15]. 9. Proximal splenorenal shunt .... Tighe M, Jacobson I. Bleeding from bile duct varices: An unexpected hazard during ... cirrhotic portal hypertension: Does the type of surgery affect outcome?

  14. Effect of endoscopic injection of cyanoacrylate in treatment of acute esophageal and gastric variceal bleeding in children

    Directory of Open Access Journals (Sweden)

    ZHANG Xiaoxing

    2016-05-01

    Full Text Available ObjectiveTo investigate the effect and safety of endoscopic injection of cyanoacrylate in the treatment of esophageal and gastric variceal bleeding (EGVB in children. MethodsThe clinical data of 35 children with acute EGVB who were treated with endoscopic injection of cyanoacrylate in Children′s Hospital of Baoji Maternal and Child Health Care Hospital from August 2010 to August 2015 were analyzed retrospectively. The emergency response rate, rebleeding rate, and incidence of complications after the treatment were analyzed statistically. ResultsThirty-five patients received 46 times of endoscopic injection of cyanoacrylate in total. The response rate to the initial injection was 95.6% (44/46. The volume of cyanoacrylate injected was 0.2-0.6 ml, with a mean volume of 0.4±0.2 ml. The emergency hemostasis rate was 93.4% (43/46, the rebleeding rate was 11.4% (4/35, and the cycle for 4 patients with the recurrence of bleeding to be cured was 1.2-23.0 months (mean 121±10.9 months. One patient experienced abdominal pain, and no patients experienced ectopic embolism. Two patients died after injection. ConclusionFrequent, small-volume endoscopic injection of cyanoacrylate is an effective and convenient therapeutic method for EGVB in children, has few complications, and holds promise for clinical application.

  15. Clinical predictors of conversion to bipolar disorder in a prospective longitudinal familial high-risk sample: focus on depressive features.

    Science.gov (United States)

    Frankland, Andrew; Roberts, Gloria; Holmes-Preston, Ellen; Perich, Tania; Levy, Florence; Lenroot, Rhoshel; Hadzi-Pavlovic, Dusan; Breakspear, Michael; Mitchell, Philip B

    2017-11-07

    Identifying clinical features that predict conversion to bipolar disorder (BD) in those at high familial risk (HR) would assist in identifying a more focused population for early intervention. In total 287 participants aged 12-30 (163 HR with a first-degree relative with BD and 124 controls (CONs)) were followed annually for a median of 5 years. We used the baseline presence of DSM-IV depressive, anxiety, behavioural and substance use disorders, as well as a constellation of specific depressive symptoms (as identified by the Probabilistic Approach to Bipolar Depression) to predict the subsequent development of hypo/manic episodes. At baseline, HR participants were significantly more likely to report ⩾4 Probabilistic features (40.4%) when depressed than CONs (6.7%; p conversion' to threshold BD (hazard ratio = 6.9, p conversion were psychomotor retardation and ⩾5 MDEs. Behavioural disorders only predicted conversion to subthreshold BD (hazard ratio = 5.23, p disorders did not predict either threshold or subthreshold hypo/mania. This study suggests that specific depressive characteristics substantially increase the risk of young people at familial risk of BD going on to develop future hypo/manic episodes and may identify a more targeted HR population for the development of early intervention programs.

  16. [Clinical features and risk factors of biloma formation after transcatheter arterial chemoembolization].

    Science.gov (United States)

    Zhaolin, Zeng; Xuelian, Liu; Wensou, Huang; Mingyue, Cai; Haofan, Wang; Ming'an, Li; Hong, Shan; Zhu, Kangshun

    2015-04-07

    To explore the risk factors, treatment and outcomes of biloma after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). A total of 481 patients with a diagnosis of HCC underwent TACE at our hospital from January 2011 to December 2013. Biloma was tracked by the follow-ups of computed tomography or magnetic resonance imaging (CT/ MRI) . Retrospective analyses were conducted for their clinical features, treatments and prognosis. The statistically significant factors for univariate analysis were introduced into Logistic regression models for multivariate analysis to obtain the risk factors of biloma post-TACE. There were 43 cases of complicated biloma after TACE. And 38 patients (88.4% ) developed biloma at 0.5-3 months post-TACE while another 5 (9.7%) did so at 3-5 months. The multivariate analysis showed that bile duct dilation, a history of hepatectomy prior to TACE, use of polyvinyl alcohol (PVA) particles and nonsuperselective embolization were the risk factors of biloma formation after TACE. Among 9 symptomatics, there were jaundice (n =2) and fever (n =7). The diameter of bilomas was (8.07 ± 3.53) cm for 9 symptomatics and (2.81 ± 1.26) cm for 35 asymptomatics. And the difference was statistically significant (P <0. 01). Nine symptomatic patients underwent percutaneous drainage with tube and biloma diminished (n = 7) and even vanished (n = 2). Only conservative treatment was offered for 35 asymptomatics. During the follow-ups, it showed no change (n = 24) , diminishing (n = 8) and disappearance (n = 2). One case died from a greatly enlarged biloma due to hepatic failure and septic shock via a rupture into abdominal cavity and choleperitonitis. The risk factors of biloma formation after TACE for HCC are bile duct dilation, a history of hepatectomy before TACE, use of PVA particles and nonsuperselective embolization. For symptomatics, drainage must be performed timely and the prognosis is fair. For asymptomatics, regular imaging

  17. Acute upper gastrointestinal bleeding (UGIB) - initial evaluation and management.

    Science.gov (United States)

    Khamaysi, Iyad; Gralnek, Ian M

    2013-10-01

    Acute upper gastrointestinal bleeding (UGIB) is the most common reason that the 'on-call' gastroenterologist is consulted. Despite the diagnostic and therapeutic capabilities of upper endoscopy, there is still significant associated morbidity and mortality in patients experiencing acute UGIB, thus this is a true GI emergency. Acute UGIB is divided into non-variceal and variceal causes. The most common type of acute UGIB is 'non-variceal' and includes diagnoses such as peptic ulcer (gastric and duodenal), gastroduodenal erosions, Mallory-Weiss tears, erosive oesophagitis, arterio-venous malformations, Dieulafoy's lesion, and upper GI tract tumours and malignancies. This article focuses exclusively on initial management strategies for acute upper GI bleeding. We discuss up to date and evidence-based strategies for patient risk stratification, initial patient management prior to endoscopy, potential causes of UGIB, role of proton pump inhibitors, prokinetic agents, prophylactic antibiotics, vasoactive pharmacotherapies, and timing of endoscopy. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Framing medical tourism: an analysis of persuasive appeals, risks and benefits, and new media features of medical tourism broker websites.

    Science.gov (United States)

    Lee, Hyunmin; Wright, Kevin B; O'Connor, Michaela; Wombacher, Kevin

    2014-01-01

    This study explores the benefits and risks featured in medical tourism broker websites, as well as the types of persuasive appeals that these websites use to attract potential customers, from a framing theory perspective. In addition, it examines relationships among types of appeals and specific types of health-related services offered by medical facilities abroad and the role of new media modalities within medical tourism broker sites. A content analysis of 91 medical tourism broker websites was conducted. The results indicate that the websites highly emphasized benefits while downplaying the risks. Specifically, despite offering consumers complicated and risky medical procedures, the websites failed to report any procedural, postoperative, or legal concerns associated with them. Moreover, the results indicated that the websites relied on heavy use of new media features to enhance the appeal of the medical services that were offered. The implications of these findings, future directions for research, and limitations of the study are discussed.

  19. Clinical features of and risk factors for major depression with history of postpartum episodes in Han Chinese women: A retrospective study.

    Science.gov (United States)

    Yang, Fuzhong; Gardner, Charles O; Bigdeli, Tim; Gao, Jingfang; Zhang, Zhen; Tao, Ming; Liu, Ying; Li, Youhui; Wang, Gang; Shi, Jianguo; Gao, Chengge; Zhang, Kerang; Li, Kan; Wang, Xumei; Liu, Lanfen; Sun, Jing; Du, Bo; Shi, Shenxun; Zhang, Jingbei; Wu, Wenyuan; Wang, Xueyi; Shen, Jianhua; Liu, Tiebang; Gu, Danhua; Liang, Wei; Deng, Hong; Pan, Jiyang; Yang, Lijun; Jian, Hu; Jiang, Guoqin; Meng, Huaqing; Miao, Guodong; Li, Yi; Hu, Chunmei; Huang, Guoping; Zhang, Yutang; Chen, Yunchun; Ha, Baowei; Gao, Shu; Fang, Xiang; Mei, Qiyi; Hong, Xiaohong; Yang, Donglin; Liu, Tieqiao; Fengyu, Yu; Zhong, Hui; Sang, Hong; Chen, Guibing; Cai, Min; Song, Yan; Dong, Jicheng; Shen, Zhenmin; Zhang, Wei; Wang, Xiaoping; Pan, Runde; Liu, Xiaojuan; Li, Yi; Liu, Zhengrong; Zhang, Qiwen; Li, Gongying; Flint, Jonathan; Kendler, Kenneth S

    2015-09-01

    We sought to investigate the clinical features of and risk factors for recurrent major depression (MD) with history of postpartum episodes (PPD) in Han Chinese women and the differences between first-onset postpartum MD (MD that has its first lifetime depressive episode in the postpartum period) and first-onset non-postpartum MD (MD with history of PPD and has its first lifetime depressive episode in a period other than postpartum). Data were derived from the China, Oxford and Virginia Commonwealth University Experimental Research on Genetic Epidemiology (CONVERGE) study (N=6017 cases) and analyzed in two steps. We first examined the clinical features of and risk factors for MD patients with (N=981) or without (N=4410) a history of PPD. We then compared the differences between first-onset postpartum MD (N=583) and first-onset non-postpartum MD (N=398) in those with a history of PPD. Linear, logistic and multinomial logistic models were employed to measure the associations. A history of PPD was associated with more guilt feelings, greater psychiatric comorbidity, higher neuroticism, earlier onset and more chronicity (OR 0.2-2.8). Severe premenstrual symptoms (PMS) and more childbirths increased the risk of PPD, as did a family history of MD, childhood sexual abuse, stressful life events and lack of social support (OR 1.1-1.3). In the MD with history of PPD subsample, first-onset postpartum MD was associated with fewer recurrent major depressive episodes, less psychiatric comorbidity, lower neuroticism, less severe PMS and fewer disagreements with their husbands (OR 0.5-0.8), but more childbirths (OR 1.2). Data were obtained retrospectively through interview and recall bias may have affected the results. MD with history of PPD in Han Chinese women is typically chronic and severe, with particular risk factors including severe PMS and more childbirths. First-onset postpartum MD and first-onset non-postpartum MD can be partly differentiated by their clinical features

  20. Acute Variceal Bleeding: Does Octreotide Improve Outcomes in Patients with Different Functional Hepatic Reserve?

    Science.gov (United States)

    Monreal-Robles, Roberto; Cortez-Hernández, Carlos A; González-González, José A; Abraldes, Juan G; Bosques-Padilla, Francisco J; Silva-Ramos, Héctor N; García-Flores, Jorge A; Maldonado-Garza, Héctor J

    2018-01-01

    Current guidelines do not differentiate in the utilization of vasoactive drugs in patients with cirrhosis and acute variceal bleeding (AVB) depending on liver disease severity. In this retrospective study, clinical outcomes in 100 patients receiving octreotide plus endoscopic therapy (ET) and 216 patients with ET alone were compared in terms of failure to control bleeding, in-hospital mortality, and transfusion requirements stratifying the results according to liver disease severity by Child-Pugh (CP) score and MELD. In patients with CP-A or those with MELD < 10 octreotide was not associated with a better outcome compared to ET alone in terms of hospital mortality (CP-A: 0.0 vs. 0.0%; MELD < 10: 0.0 vs. 2.9%, p = 1.00), failure to control bleeding (CP-A: 8.7 vs. 3.7%, p = 0.58; MELD < 10: 5.3 vs. 4.3%, p = 1.00) and need for transfusion (CP-A: 39.1 vs. 61.1%, p = 0.09; MELD < 10: 63.2 vs. 62.9%, p = 1.00). Those with severe liver dysfunction in the octreotide group showed better outcomes compared to the non-octreotide group in terms of hospital mortality (CP-B/C: 3.9 vs. 13.0%, p = 0.04; MELD ≥ 10: 3.9 vs. 13.3%, p = 0.03) and need for transfusion (CP-B/C: 58.4 vs. 71.6%, p = 0.05; MELD ≥ 10: 50.6 vs. 72.7%, p < 0.01). In multivariate analysis, octreotide was independently associated with in-hospital mortality (p = 0.028) and need for transfusion (p = 0.008) only in patients with severe liver dysfunction (CP-B/C or MELD ≥ 10). Patients with cirrhosis and AVB categorized as CP-A or MELD < 10 had similar clinical outcomes during hospitalization whether or not they received octreotide.

  1. Decompensated cirrhosis-related admissions in a large urban ...

    African Journals Online (AJOL)

    EB

    Background: Cirrhosis-related complications are a major cause of morbidity and mortality in areas where its risk factors are endemic. ... prevalence of risk factors. .... Collateral veins. 39 (45.9%). Splenomegaly. 37 (43.5%). Variceal bleeding. 31 (36.5%). Encephalopathy. Grade 1 and 2. 15 (17.6%). Grade 3 and 4. 5 (5.9%).

  2. [Study on risk factors and behavior features related to chronic diseases among adults in Shanghai].

    Science.gov (United States)

    Xu, Ji-ying; Li, Xin-jian; Yao, Hai-hong; Yan, Qing-hua; Lu, Wei; Zhong, Wei-jian

    2013-09-01

    To investigate the risk factors and behavior features related to chronic diseases among adults in Shanghai. A total of 15 516 subjects aged over 18 years old were selected from the investigation project on chronic diseases and relevant risk factors in Shanghai in 2010. Questionnaire were used to investigate the general information of the subjects, such as behavior features as smoking, drinking, diet, physical activity as well as the prevalence and control of chronic diseases as hypertension and diabetes. The physical examination included height, weight, waist circumference, blood pressure, blood glucose and blood lipids. Being preprocessed by complex weighting method, the data showed that the overweight rate of Shanghai adults aged above 18 was 32.4% (5288), separately 32.2% (2506) and 32.5% (2782) (χ(2) = 0.10, P = 0.844) in urban and rural areas; the obesity rate was 8.8% (1538), separately 8.7% (738) and 8.8% (800) (χ(2) = 0.06, P = 0.901) in urban and rural areas. The overweight rate was separately 36.0% (2888) in males and 28.6% (2400) in females (χ(2) = 96.61, P smoking rate was 25.0% (3813), separately 48.4% (3722) and 1.2% (91) in males and females (χ(2) = 4572.06, P smoking rate was 22.1% (3402). The rate of having the habit of drinking at least once a month in males was 39.5% (3102), separately 35.1% (1262) and 42.7% (1840) in urban and rural areas (χ(2) = 45.98, P = 0.012). The rate of drinking almost every day was 16.3% (1380), and the percentage of excessive alcohol consumption was 28.9% (2483). The percentage in group of subjects aging between 45-59 years old was 38.5% (1191), which was higher than that in any other groups (22.8% (641) in group aging 18-44 years old and 22.9% (651) in group aging ≥ 60 years old) (χ(2) = 241.38, P excess consumption of sodium (52.0%, 8257) and oil (51.7%, 7884). The risk factors of chronic diseases were highly prevalent in Shanghai. The prevalence of risk factors as overweight or obesity, lack of physical

  3. The severity of Internet addiction risk and its relationship with the severity of borderline personality features, childhood traumas, dissociative experiences, depression and anxiety symptoms among Turkish university students.

    Science.gov (United States)

    Dalbudak, Ercan; Evren, Cuneyt; Aldemir, Secil; Evren, Bilge

    2014-11-30

    The aim of this study was to investigate the relationship of Internet addiction (IA) risk with the severity of borderline personality features, childhood traumas, dissociative experiences, depression and anxiety symptoms among Turkish university students. A total of 271 Turkish university students participated in this study. The students were assessed through the Internet Addiction Scale (IAS), the Borderline Personality Inventory (BPI), the Dissociative Experiences Scale (DES), the Childhood Trauma Questionnaire (CTQ-28), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The rates of students were 19.9% (n=54) in the high IA risk group, 38.7% (n=105) in the mild IA risk group and 41.3% (n=112) in the group without IA risk. Correlation analyses revealed that the severity of IA risk was related with BPI, DES, emotional abuse, CTQ-28, depression and anxiety scores. Univariate covariance analysis (ANCOVA) indicated that the severity of borderline personality features, emotional abuse, depression and anxiety symptoms were the predictors of IAS score, while gender had no effect on IAS score. Among childhood trauma types, emotional abuse seems to be the main predictor of IA risk severity. Borderline personality features predicted the severity of IA risk together with emotional abuse, depression and anxiety symptoms among Turkish university students. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Anatomy and Classification of Gastrorenal and Gastrocaval Shunts

    Science.gov (United States)

    Sabri, Saher S.; Saad, Wael E. A.

    2011-01-01

    The gastric varices communicate with gastrorenal and gastrocaval shunts and are classified according to the pattern of venous inflow into three types, which differ in the number and location of the inflow veins. The gastric varices are also classified according to their venous drainage into four different types, reflecting the size and number of collateral veins communicating with the gastric varices and the gastrorenal/gastrocaval shunt. Lastly, the gastric varices are classified according to their appearance on balloon-occluded retrograde venography into five grades representing the degree of opacification of the gastric varices and the collateral veins. Understanding these anatomic classifications is crucial in planning endovascular obliteration of gastric varices. PMID:22942547

  5. Aplicación del método clínico para el diagnóstico de pacientes con hemorragia digestiva alta no variceal

    Directory of Open Access Journals (Sweden)

    Gabriel González Sosa

    Full Text Available La utilización del método clínico para lograr un diagnóstico preciso de las enfermedades en el ser humano, surge con el nacimiento de la Medicina, en la antigua Grecia y tiene como componentes fundamentales la relación médico-paciente, el interrogatorio, el examen físico y la historia clínica; esta última constituye su herramienta más importante en la recogida de datos. Se reflexiona sobre la importancia de su aplicación correcta para llegar a un diagnóstico preciso en los pacientes con hemorragia digestiva alta no variceal comenzando en la atención primaria de salud donde se puede lograr un diagnóstico precoz de esta entidad y evitar complicaciones que ocurren en estos pacientes cuando el diagnóstico es tardío, por lo que lejos pensar en la muerte del método clínico, su vigencia e importancia en la medicina contemporánea es incuestionable.

  6. Assessment of Canine Mast Cell Tumor Mortality Risk Based on Clinical, Histologic, Immunohistochemical, and Molecular Features.

    Science.gov (United States)

    Horta, Rodrigo S; Lavalle, Gleidice E; Monteiro, Lidianne N; Souza, Mayara C C; Cassali, Geovanni D; Araújo, Roberto B

    2018-03-01

    Mast cell tumor (MCT) is a frequent cutaneous neoplasm in dogs that is heterogeneous in clinical presentation and biological behavior, with a variable potential for recurrence and metastasis. Accurate prediction of clinical outcomes has been challenging. The study objective was to develop a system for classification of canine MCT according to the mortality risk based on individual assessment of clinical, histologic, immunohistochemical, and molecular features. The study included 149 dogs with a histologic diagnosis of cutaneous or subcutaneous MCT. By univariate analysis, MCT metastasis and related death was significantly associated with clinical stage ( P < .0001, r P = -0.610), history of tumor recurrence ( P < .0001, r P = -0.550), Patnaik ( P < .0001, r P = -0.380) and Kiupel grades ( P < .0001, r P = -0.500), predominant organization of neoplastic cells ( P < .0001, r P = -0.452), mitotic count ( P < .0001, r P = -0.325), Ki-67 labeling index ( P < .0001, r P = -0.414), KITr pattern ( P = .02, r P = 0.207), and c-KIT mutational status ( P < .0001, r P = -0.356). By multivariate analysis with Cox proportional hazard model, only 2 features were independent predictors of overall survival: an amendment of the World Health Organization clinical staging system (hazard ratio [95% CI]: 1.824 [1.210-4.481]; P = .01) and a history of tumor recurrence (hazard ratio [95% CI]: 9.250 [2.158-23.268]; P < .001]. From these results, we propose an amendment of the WHO staging system, a method of risk analysis, and a suggested approach to clinical and laboratory evaluation of dogs with cutaneous MCT.

  7. The theory-based influence of map features on risk beliefs: self-reports of what is seen and understood for maps depicting an environmental health hazard.

    Science.gov (United States)

    Severtson, Dolores J; Vatovec, Christine

    2012-08-01

    Theory-based research is needed to understand how maps of environmental health risk information influence risk beliefs and protective behavior. Using theoretical concepts from multiple fields of study including visual cognition, semiotics, health behavior, and learning and memory supports a comprehensive assessment of this influence. The authors report results from 13 cognitive interviews that provide theory-based insights into how visual features influenced what participants saw and the meaning of what they saw as they viewed 3 formats of water test results for private wells (choropleth map, dot map, and a table). The unit of perception, color, proximity to hazards, geographic distribution, and visual salience had substantial influences on what participants saw and their resulting risk beliefs. These influences are explained by theoretical factors that shape what is seen, properties of features that shape cognition (preattentive, symbolic, visual salience), information processing (top-down and bottom-up), and the strength of concrete compared with abstract information. Personal relevance guided top-down attention to proximal and larger hazards that shaped stronger risk beliefs. Meaning was more local for small perceptual units and global for large units. Three aspects of color were important: preattentive "incremental risk" meaning of sequential shading, symbolic safety meaning of stoplight colors, and visual salience that drew attention. The lack of imagery, geographic information, and color diminished interest in table information. Numeracy and prior beliefs influenced comprehension for some participants. Results guided the creation of an integrated conceptual framework for application to future studies. Ethics should guide the selection of map features that support appropriate communication goals.

  8. Transjugular Intrahepatic Portosystemic Shunt Placement During Pregnancy: A Case Series of Five Patients

    International Nuclear Information System (INIS)

    Ingraham, Christopher R.; Padia, Siddharth A.; Johnson, Guy E.; Easterling, Thomas R.; Liou, Iris W.; Kanal, Kalpana M.; Valji, Karim

    2015-01-01

    Background and AimsComplications of portal hypertension, such as variceal hemorrhage and ascites, are associated with significant increases in both mortality and complications during pregnancy. Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established procedure for treating portal hypertension, but the safety of TIPS during pregnancy is largely unknown. In this series, we review five patients who underwent TIPS placement while pregnant and describe their clinical outcomes.MethodsFive pregnant patients with cirrhosis and portal hypertension underwent elective TIPS for complications of portal hypertension (four for secondary prevention of variceal bleeding and one for refractory ascites). Outcomes measured were recurrent bleeding episodes or need for further paracenteses during pregnancy, estimated radiation dose to the fetus and gestational age at delivery. All patients were followed after delivery to evaluate technical and clinical success of the procedure.ResultsAll five patients survived pregnancy and went on to deliver successfully. When TIPS was performed for secondary prevention of variceal bleeding (n = 4), no patients demonstrated variceal bleeding after TIPS placement. When TIPS was performed for refractory ascites (n = 1), no further paracenteses were required. All patients delivered successfully, albeit prematurely. Average radiation dose estimated to the fetus was 16.3 mGy.ConclusionsThis series suggests that TIPS can be performed in selective pregnant patients with portal hypertension, with little added risk to the mother or fetus

  9. Transjugular Intrahepatic Portosystemic Shunt Placement During Pregnancy: A Case Series of Five Patients

    Energy Technology Data Exchange (ETDEWEB)

    Ingraham, Christopher R., E-mail: cringra@uw.edu; Padia, Siddharth A., E-mail: spadia@uw.edu; Johnson, Guy E., E-mail: gej@uw.edu [University of Washington, Department of Interventional Radiology (United States); Easterling, Thomas R., E-mail: easter@uw.edu [University of Washington, Department of Obstetrics and Gynecology (United States); Liou, Iris W., E-mail: irisl@medicine.washington.edu [University of Washington, Department of Medicine (United States); Kanal, Kalpana M., E-mail: kkanal@uw.edu [University of Washington, Physics Section, Department of Radiology (United States); Valji, Karim, E-mail: kvalji@uw.edu [University of Washington, Department of Interventional Radiology (United States)

    2015-10-15

    Background and AimsComplications of portal hypertension, such as variceal hemorrhage and ascites, are associated with significant increases in both mortality and complications during pregnancy. Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established procedure for treating portal hypertension, but the safety of TIPS during pregnancy is largely unknown. In this series, we review five patients who underwent TIPS placement while pregnant and describe their clinical outcomes.MethodsFive pregnant patients with cirrhosis and portal hypertension underwent elective TIPS for complications of portal hypertension (four for secondary prevention of variceal bleeding and one for refractory ascites). Outcomes measured were recurrent bleeding episodes or need for further paracenteses during pregnancy, estimated radiation dose to the fetus and gestational age at delivery. All patients were followed after delivery to evaluate technical and clinical success of the procedure.ResultsAll five patients survived pregnancy and went on to deliver successfully. When TIPS was performed for secondary prevention of variceal bleeding (n = 4), no patients demonstrated variceal bleeding after TIPS placement. When TIPS was performed for refractory ascites (n = 1), no further paracenteses were required. All patients delivered successfully, albeit prematurely. Average radiation dose estimated to the fetus was 16.3 mGy.ConclusionsThis series suggests that TIPS can be performed in selective pregnant patients with portal hypertension, with little added risk to the mother or fetus.

  10. Supersonic shear imaging for the diagnosis of liver fibrosis and portal hypertension in liver diseases: a meta-analysis.

    Science.gov (United States)

    Deng, Han; Qi, Xingshun; Zhang, Tiansong; Qi, Xiaolong; Yoshida, Eric M; Guo, Xiaozhong

    2018-01-01

    The meta-analysis aimed to summarize the technical success rate of supersonic shear imaging (SSI) and to evaluate the diagnostic performance of liver and spleen stiffness measurement (LSM and SSM) with SSI for the detection of liver fibrosis, portal hypertension, and gastroesophageal varices in liver diseases. PubMed, EMBASE, and Cochrane Library databases were searched. Technical success rate of SSI was pooled. Area under curve (AUC), sensitivity, and specificity with corresponding 95% confidence interval (CI) were calculated. Included studies regarding the diagnostic performance of SSI for liver fibrosis, portal hypertension, and esophageal varices numbered 28, 4, and 4 respectively. The pooled technical success rates of LSM and SSM were 95.3% and 75.5%, respectively. The AUC, sensitivity, and specificity of LSM/SSM for different stages of liver fibrosis were 0.85-0.94, 0.7-0.89, and 0.82-0.92, respectively. The AUC, sensitivity, and specificity of LSM were 0.84 (95%CI = 0.8-0.86), 0.79 (95%CI = 0.7-0.85), and 0.82 (95%CI = 0.72-0.88) for clinically significant portal hypertension, 0.85 (95%CI = 0.82-0.88), 0.8 (95%CI = 0.68-0.88), and 0.8 (95%CI = 0.6-0.92) for any varices, and 0.86 (95%CI = 0.83-0.89), 0.86 (95%CI = 0.76-0.92), and 0.61 (95%CI = 0.35-0.83) for high-risk varices, respectively. LSM with SSI had a high diagnostic accuracy for liver fibrosis, but a moderate diagnostic accuracy for portal hypertension and esophageal varices.

  11. Sparse representation of multi parametric DCE-MRI features using K-SVD for classifying gene expression based breast cancer recurrence risk

    Science.gov (United States)

    Mahrooghy, Majid; Ashraf, Ahmed B.; Daye, Dania; Mies, Carolyn; Rosen, Mark; Feldman, Michael; Kontos, Despina

    2014-03-01

    We evaluate the prognostic value of sparse representation-based features by applying the K-SVD algorithm on multiparametric kinetic, textural, and morphologic features in breast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). K-SVD is an iterative dimensionality reduction method that optimally reduces the initial feature space by updating the dictionary columns jointly with the sparse representation coefficients. Therefore, by using K-SVD, we not only provide sparse representation of the features and condense the information in a few coefficients but also we reduce the dimensionality. The extracted K-SVD features are evaluated by a machine learning algorithm including a logistic regression classifier for the task of classifying high versus low breast cancer recurrence risk as determined by a validated gene expression assay. The features are evaluated using ROC curve analysis and leave one-out cross validation for different sparse representation and dimensionality reduction numbers. Optimal sparse representation is obtained when the number of dictionary elements is 4 (K=4) and maximum non-zero coefficients is 2 (L=2). We compare K-SVD with ANOVA based feature selection for the same prognostic features. The ROC results show that the AUC of the K-SVD based (K=4, L=2), the ANOVA based, and the original features (i.e., no dimensionality reduction) are 0.78, 0.71. and 0.68, respectively. From the results, it can be inferred that by using sparse representation of the originally extracted multi-parametric, high-dimensional data, we can condense the information on a few coefficients with the highest predictive value. In addition, the dimensionality reduction introduced by K-SVD can prevent models from over-fitting.

  12. 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

  13. High-risk angina patient: identification by clinical features, hospital course, electrocardiography, and technetium-99m stannous pyrophosphate scintigraphy

    International Nuclear Information System (INIS)

    Olson, H.G.; Lyons, K.P.; Aronow, W.S.; Stinson, P.J.; Kuperus, J.; Waters, H.J.

    1981-01-01

    We evaluated 193 consecutive unstable angina patients by clinical features, hospital course and electrocardiography. All patients were managed medically. Of the 193 patients, 150 (78%) had a technetium-99m pyrophosphate (Tc-PYP) myocardial scintigram after hospitalization. Of these, 49 (33%) had positive scintigrams. At a follow-up of 24.9 +- 10.8 months after hospitalization, 16 of 49 patients (33%) with positive scintigrams died from cardiac causes, compared with six of 101 patients (6%) with negative scintigrams (p < 0.001). Of 49 patients with positive scintigrams, 11 (22%) had had nonfatal myocardial infarction at follow-up, compared with seven of 101 patients (7%) with negative scintigrams (p < 0.01). Age, duration of clinical coronary artery disease, continuing angina during hospitalization, ischemic ECG, cardiomegaly and a history of heart failure also correlated with cardiac death at follow-up. Ischemic ECG and a history of angina with a crescendo pattern also correlated with nonfatal infarction at follow-up. Patients with continuing angina, an ischemic ECG and a positive scintigram constituted a high-risk unstable angina subgroup, with a survival rate of 58% at 6 months, 47% at 12 months and 42% at 24 and 36 months. We conclude that the assessment of clinical features, hospital course, ECG and Tc-PYP scintigraphy may be useful in identifying high-risk unstable angina patients

  14. High-risk angina patient. Identification by clinical features, hospital course, electrocardiography and technetium-99m stannous pyrophosphate scintigraphy

    International Nuclear Information System (INIS)

    Olson, H.G.; Lyons, K.P.; Aronow, W.S.; Stinson, P.J.; Kuperus, J.; Waters, H.J.

    1981-01-01

    We evaluated 193 consecutive unstable angina patients by clinical features, hospital course and electrocardiography. All patients were managed medically. Of the 193 patients, 150 (78%) had a technetium-99m pyrophosphate (Tc-PYP) myocardial scintigram after hospitalization. Of these, 49 (33%) had positive scintigrams. At a follow-up of 24.9 +/- 10.8 months after hospitalization, 16 of 49 patients (33%) with positive scintigrams died from cardiac causes, compared with six of 101 patients (6%) with negative scintigrams (p less than 0.001). Of 49 patients with positive scintigrams, 11 (22%) had had nonfatal myocardial infarction at follow-up, compared with seven of 101 patients (7%) with negative scintigrams (p less than 0.01). Age, duration of clinical coronary artery disease, continuing angina during hospitalization, ischemic ECG, cardiomegaly and a history of heart failure also correlated with cardiac death at follow-up. Ischemic ECG and a history of angina with a crescendo pattern also correlated with nonfatal infarction at follow-up. Patients with continuing angina, an ischemic ECG and a positive scintigram constituted a high-risk unstable angina subgroup with a survival rate of 58% at 6 months, 47% at 12 months and 42% at 24 and 36 months. We conclude that the assessment of clinical features, hospital course, ECG and Tc-PYP scintigraphy may be useful in identifying high-risk unstable angina patients

  15. Radiological score for hemorrhage in the patients with portal hypertension.

    Science.gov (United States)

    Ge, Wei; Wang, Yi; Cao, Ya-Juan; Xie, Min; Ding, Yi-Tao; Zhang, Ming; Yu, De-Cai

    2015-01-01

    To analyze the risk factors from radiological indices for hemorrhage in the patients with portal hypertension and weight risk factors. We retrospectively analyzed all cases of portal hypertension with hepatitis B from June 2008 to June 2014 in Nanjing Drum Tower hospital. Patients with hepatocellular carcinoma, portal vein thrombosis, or portal hypertension with other causes, such as autoimmune hepatitis, pancreatitis, or hematological diseases were excluded. Ninety-eight patients were recruited and divided into hemorrhage and non-hemorrhage groups. There were no statistical differences in clinical indexes such as age, prothrombin time, serum albumin, serum creatinine, serum sodium, hemameba, and blood platelet count. However, the differences were statistically significant in total bilirubin, hemoglobin, and liver function with the p values of 0.023, 0.000, and 0.039 respectively. For radiological indices, hemorrhage was correlated with diameter of inferior mesenteric vein (P=0.0528), posterior gastric vein (P=0.0283), and esophageal varices scores (P=0.0221). Logistic procedure was used to construct the model with stepwise selection and finally inferior mesenteric vein, posterior gastric vein, esophageal varices, and short gastric vein were enrolled into the model. These veins were scored according to the diameters and the rates of hemorrhage were increased with the score. We then validated the model with 26 patents from July 2014 to December 2014. The AUC value was 0.8849 in ROC curves for this radiological model. A risk model was constructed including inferior mesenteric vein, esophageal varices, posterior gastric vein, and short gastric vein. This radiological scoring model may be a valuable indicator for hemorrhage of portal hypertension.

  16. Landscape features influence postrelease predation on endangered black-footed ferrets

    Science.gov (United States)

    Poessel, S.A.; Breck, S.W.; Biggins, D.E.; Livieri, T.M.; Crooks, K.R.; Angeloni, L.

    2011-01-01

    Predation can be a critical factor influencing recovery of endangered species. In most recovery efforts lethal and nonlethal influences of predators are not sufficiently understood to allow prediction of predation risk, despite its importance. We investigated whether landscape features could be used to model predation risk from coyotes (Canis latrans) and great horned owls (Bubo virginianus) on the endangered black-footed ferret (Mustela nigripes). We used location data of reintroduced ferrets from 3 sites in South Dakota to determine whether exposure to landscape features typically associated with predators affected survival of ferrets, and whether ferrets considered predation risk when choosing habitat near perches potentially used by owls or near linear features predicted to be used by coyotes. Exposure to areas near likely owl perches reduced ferret survival, but landscape features potentially associated with coyote movements had no appreciable effect on survival. Ferrets were located within 90 m of perches more than expected in 2 study sites that also had higher ferret mortality due to owl predation. Densities of potential coyote travel routes near ferret locations were no different than expected in all 3 sites. Repatriated ferrets might have selected resources based on factors other than predator avoidance. Considering an easily quantified landscape feature (i.e., owl perches) can enhance success of reintroduction efforts for ferrets. Nonetheless, development of predictive models of predation risk and management strategies to mitigate that risk is not necessarily straightforward for more generalist predators such as coyotes. ?? 2011 American Society of Mammalogists.

  17. Clinical usefulness of Tc-99M pertechnetate per-rectal portal scintigraphy in evaluation the severity of portal hypertension in cirrhotic patients

    International Nuclear Information System (INIS)

    Namwongprom, S.; Ekmahachai, M.; Boonyaprapa, S.; Vilasdechanon, N.; Taya, P.; Chankaew, N.; Chitapanarux, T.

    2004-01-01

    Objectives: Variceal hemorrhage is a potentially life-threatening complication in cirrhotic patients. Identification of patients at high risk for bleeding is particularly important. The aim of this study was to determine the clinical usefulness of per-rectal portal scintigraphy in evaluation the severity of portal hypertension in cirrhotic patients in terms of correlation between cirrhosis and classic indicators of hepatic functional reserve and identifying the difference of the portal shunt index (PSI) of the bleeding esophageal varices group and non-bleeding esophageal varices group. Material and methods: Portal circulations in 15 healthy volunteer's and in 67 patients with cirrhosis were evaluated by Tc-99m pertechnetate per-rectal p. ortal scintigraphy. Tc-99m pertechnetate (550 MBq) was instilled into the upper rectum, and dynamic images were taken. Radioactivity curves of the liver and the heart were generated sequentially. Through the analysis of these curves, the PSI was determined by calculating the ratio of counts of the liver to counts of the heart integrated for 24 seconds immediately after the appearance of the liver time-activity curve. Results: The results, expressed as PSI were: 13.63 +/- 6.28 % in healthy subjects and 66.32+/-22.80 % in cirrhotic patients. Of these, the PSIs were 56036 +/- 27.14 % in 31 cirrhotic patients without esophageal varices, and 74.89 +/- 13.62 % in 36 cirrhotic patients with esophageal varices. The PSI was significantly lower in cirrhotic patients without bleeding esophageal vances (BEV) than those with BEV (p=0.001). The PSI calculated with this method was correlated with the serum albumin, the serum bilirubin and the Child-Pugh's score. Conclusion: The Tc-99m pertechnetate per-rectal portal scintigraphy has clinical usefulness as a relatively non-invasive method of choice for quantitative evaluating the severity of portal hypertension in cirrhotic patients. (authors)

  18. Effects of Helicobacter pylori infection on common lethal factors for hepatitis B virus-related cirrhosis

    Directory of Open Access Journals (Sweden)

    LI Yuling

    2015-09-01

    .01. ConclusionThe infection rateof H. pylori is high in patients with HBC. The H. pylori infection is likely to increase the severity of esophagogastric varices and PHG, as well as the blood ammonia level, which further increases the risk of upper gastrointestinal bleeding and hepatic encephalopathy that are the main lethal factors for HBC.

  19. Dysphonic Voice Pattern Analysis of Patients in Parkinson’s Disease Using Minimum Interclass Probability Risk Feature Selection and Bagging Ensemble Learning Methods

    Directory of Open Access Journals (Sweden)

    Yunfeng Wu

    2017-01-01

    Full Text Available Analysis of quantified voice patterns is useful in the detection and assessment of dysphonia and related phonation disorders. In this paper, we first study the linear correlations between 22 voice parameters of fundamental frequency variability, amplitude variations, and nonlinear measures. The highly correlated vocal parameters are combined by using the linear discriminant analysis method. Based on the probability density functions estimated by the Parzen-window technique, we propose an interclass probability risk (ICPR method to select the vocal parameters with small ICPR values as dominant features and compare with the modified Kullback-Leibler divergence (MKLD feature selection approach. The experimental results show that the generalized logistic regression analysis (GLRA, support vector machine (SVM, and Bagging ensemble algorithm input with the ICPR features can provide better classification results than the same classifiers with the MKLD selected features. The SVM is much better at distinguishing normal vocal patterns with a specificity of 0.8542. Among the three classification methods, the Bagging ensemble algorithm with ICPR features can identify 90.77% vocal patterns, with the highest sensitivity of 0.9796 and largest area value of 0.9558 under the receiver operating characteristic curve. The classification results demonstrate the effectiveness of our feature selection and pattern analysis methods for dysphonic voice detection and measurement.

  20. The Theory-based Influence of Map Features on Risk Beliefs: Self-reports of What is Seen and Understood for Maps Depicting an Environmental Health Hazard

    OpenAIRE

    Severtson, Dolores J.; Vatovec, Christine

    2012-01-01

    Theory-based research is needed to understand how maps of environmental health risk information influence risk beliefs and protective behavior. Using theoretical concepts from multiple fields of study including visual cognition, semiotics, health behavior, and learning and memory supports a comprehensive assessment of this influence. We report results from thirteen cognitive interviews that provide theory-based insights into how visual features influenced what participants saw ...

  1. Higher Growth Rate of Branch Duct Intraductal Papillary Mucinous Neoplasms Associates With Worrisome Features.

    Science.gov (United States)

    Kolb, Jennifer M; Argiriadi, Pamela; Lee, Karen; Liu, Xiaoyu; Bagiella, Emilia; Lucas, Aimee L; Kim, Michelle Kang; Kumta, Nikhil A; Nagula, Satish; Sarpel, Umut; DiMaio, Christopher J

    2018-03-11

    For patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMNs, cysts), it is a challenge to identify those at high risk for malignant lesions. We sought to identify factors associated with development of pancreatic cancer, focusing on neoplasm growth rate. We performed a retrospective study of 189 patients with BD-IPMNs who underwent at least 2 contrast-enhanced cross-sectional imaging studies, 1 year or more apart, at a tertiary referral center from January 2003 through 2013. Patients with cysts that had Fukuoka worrisome or high-risk features were excluded. Two radiologists reviewed all images. Cyst size was recorded at the initial and final imaging studies and growth rate was calculated. We collected patient demographic data, cyst characteristics, and clinical outcomes; univariate logistic regression models were used to determine the odds of developing worrisome features. The primary outcomes were to determine growth rate of low-risk BD-IPMNs and to assess whether cyst growth rate correlates high-risk features of IPMNs. Based on image analyses, cysts were initially a median 11 mm (range, 3-31 mm) and their final size was 12.5 mm (range, 3-42 mm). After a median follow-up time of 56 months (range, 12-163 months), the median cyst growth rate was 0.29 mm/year. Twelve patients developed worrisome features, no patients developed high-risk features, 4 patients had surgical resection, and no cancers developed. The rate of BD-IPMN growth was greater in patients who developed worrisome features than those who did not (2.84 mm/year vs 0.23 mm/year; P < .001). The odds of developing worrisome features increased for each unit (mm) increase in cyst size (odds ratio, 1.149; 95% CI, 1.035-1.276, P = .009). In a retrospective analysis of images from patients with BD-IPMN, we found low-risk BD-IPMNs to grow at an extremely low rate (less than 0.3 mm/year). BD-IPMNs in only about 6% of patients developed worrisome features, and none developed high-risk features

  2. Bleeding ectopic duodenal varix: use of a new microvascular plug (MVP) device along with transjugular intrahepatic portosystemic shunt (TIPSS).

    Science.gov (United States)

    Bhardwaj, Richa; Bhardwaj, Gaurav; Bee, Erik; Karagozian, Raffi

    2017-08-16

    Ectopic varices (ECV) occur along the gastrointestinal (GI) tract outside the common variceal sites and represent 2%-5% of all GI variceal bleeds with mortality rates up to 40%. Management is challenging because of inaccessibility and increased risk of rebleeding. We report what is to our knowledge the first clinical use of a new microvascular plug (MVP) with transjugular intrahepatic portosystemic shunt (TIPSS) for a bleeding duodenal varix (DV). A 68-year-old man presented with melena. Endoscopy demonstrated a grade II varix in the second part of the duodenum with red wale sign. TIPSS was performed and portogram revealed a single DV. Poststent placement venogram revealed a persistent varix and hence a 5-7 mm MVP was deployed. Subsequent imaging showed cessation of blood through the DV. The patient had no further bleeding. TIPSS with embolisation is an effective treatment for ECV. This MVP offers advantages due to its size and compatibility and can be redeployed in case of suboptimal placement. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. The Clinical Features, Risk Factors, and Surgical Treatment of Cervicogenic Headache in Patients With Cervical Spine Disorders Requiring Surgery.

    Science.gov (United States)

    Shimohata, Keiko; Hasegawa, Kazuhiro; Onodera, Osamu; Nishizawa, Masatoyo; Shimohata, Takayoshi

    2017-07-01

    To clarify the clinical features and risk factors of cervicogenic headache (CEH; as diagnosed according to the International Classification of Headache Disorders-Third Edition beta) in patients with cervical spine disorders requiring surgery. CEH is caused by cervical spine disorders. The pathogenic mechanism of CEH is hypothesized to involve a convergence of the upper cervical afferents from the C1, C2, and C3 spinal nerves and the trigeminal afferents in the trigeminocervical nucleus of the upper cervical cord. According to this hypothesis, functional convergence of the upper cervical and trigeminal sensory pathways allows the bidirectional (afferent and efferent) referral of pain to the occipital, frontal, temporal, and/or orbital regions. Previous prospective studies have reported an 86-88% prevalence of headache in patients with cervical myelopathy or radiculopathy requiring anterior cervical surgery; however, these studies did not diagnose headache according to the International Classification of Headache Disorders criteria. Therefore, a better understanding of the prevalence rate, clinical features, risk factors, and treatment responsiveness of CEH in patients with cervical spine disorders requiring surgery is necessary. We performed a single hospital-based prospective cross-sectional study and enrolled 70 consecutive patients with cervical spine disorders such as cervical spondylotic myelopathy, ossification of the posterior longitudinal ligament, cervical spondylotic radiculopathy, and cervical spondylotic myeloradiculopathy who had been scheduled to undergo anterior cervical fusion or dorsal cervical laminoplasty between June 2014 and December 2015. Headache was diagnosed preoperatively according to the International Classification of Headache Disorders-Third Edition beta. The Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, Neck Disability Index, and a 0-100 mm visual analog scale (VAS) were used to evaluate clinical

  4. Influence of Feature Encoding and Choice of Classifier on Disease Risk Prediction in Genome-Wide Association Studies.

    Directory of Open Access Journals (Sweden)

    Florian Mittag

    Full Text Available Various attempts have been made to predict the individual disease risk based on genotype data from genome-wide association studies (GWAS. However, most studies only investigated one or two classification algorithms and feature encoding schemes. In this study, we applied seven different classification algorithms on GWAS case-control data sets for seven different diseases to create models for disease risk prediction. Further, we used three different encoding schemes for the genotypes of single nucleotide polymorphisms (SNPs and investigated their influence on the predictive performance of these models. Our study suggests that an additive encoding of the SNP data should be the preferred encoding scheme, as it proved to yield the best predictive performances for all algorithms and data sets. Furthermore, our results showed that the differences between most state-of-the-art classification algorithms are not statistically significant. Consequently, we recommend to prefer algorithms with simple models like the linear support vector machine (SVM as they allow for better subsequent interpretation without significant loss of accuracy.

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

    Directory of Open Access Journals (Sweden)

    L. Sempere

    2009-04-01

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

  6. Prognostic indicators in alcoholic cirrhotic men

    DEFF Research Database (Denmark)

    Gluud, C; Henriksen, Jens Henrik Sahl; Nielsen, G

    1988-01-01

    as wedged minus free hepatic vein pressure, and median pressure was 14 mm Hg (range = 3 to 26 mm Hg). Fourteen of 31 patients (45%) had esophageal varices at upper gastrointestinal endoscopy (the size being considered large in nine patients). During follow-up (median = 31 months; range = 2 to 51 months), 12...... patients (21%) developed variceal hemorrhage. Applying Cox's regression analysis, information about previous variceal bleeding (p = 0.0046), large varices at endoscopy (p = 0.012), hepatic vein pressure gradient (p = 0.0056) and indocyanine green clearance (p = 0.038) all contained significant prognostic...

  7. Predictors of mortality in patients with acute upper gastrointestinal ...

    African Journals Online (AJOL)

    Background: Variceal hemorrhage (VH) is a major complication of chronic liver disease. Several factors have been validated for the prediction of the outcome of an acute VH. The clinical risk characteristics reported in developed countries may be different from developing countries. Aim: The aim of this study was to ...

  8. Discrete features of sedentary behavior impact cardiometabolic risk factors.

    Science.gov (United States)

    Lyden, Kate; Keadle, Sarah Kozey; Staudenmayer, John; Braun, Barry; Freedson, Patty S

    2015-05-01

    Sedentary behavior is linked to numerous poor health outcomes. This study aims to determine the effects of 7 d of increased sitting on markers of cardiometabolic risk among free-living individuals. Ten recreationally active participants (>150 min of moderate-intensity physical activity per week; mean ± SD age, 25.2 ± 5.7 yr; mean ± SD body mass index, 24.9 ± 4.3 kg·m(-2)) completed a 7-d baseline period and a 7-d sedentary condition in their free-living environment. At baseline, participants maintained normal activity. After baseline, participants completed a 7-d sedentary condition. Participants were instructed to sit as much as possible, to limit standing and walking, and to refrain from structured exercise and leisure time physical activity. ActivPAL monitor was used to assess sedentary behavior and physical activity. Fasting lipids, glucose, and insulin were measured, and oral glucose tolerance test was performed after baseline and sedentary condition. In comparison to baseline, total sedentary time (mean Δ, 14.9%; 95% CI, 10.2-19.6) and time in prolonged/uninterrupted sedentary bouts significantly increased, whereas the rate of breaks from sedentary time was significantly reduced (mean Δ, 21.4%; 95% CI, 6.9-35.9). For oral glucose tolerance test, 2-h plasma insulin (mean Δ, 38.8 μU·mL(-1); 95% CI, 10.9-66.8) and area under the insulin curve (mean Δ, 3074.1 μU·mL(-1) per 120 min; 95% CI, 526.0-5622.3) were significantly elevated after the sedentary condition. Lipid concentrations did not change. Change in 2-h insulin was negatively associated with change in light-intensity activity (r = -0.62) and positively associated with change in time in sitting bouts longer than 30 min (r = 0.82) and 60 min (r = 0.83). Increased free-living sitting negatively impacts markers of cardiometabolic health, and specific features of sedentary behavior (e.g., time in prolonged sitting bouts) may be particularly important.

  9. [Clinical features and risk factors of co-morbid tic disorder in children with attention deficit hyperactivity disorder].

    Science.gov (United States)

    Zhou, Ke-Ying; Xiao, Zhi-Hui; Chen, Yan-Zhao; Zhang, Zhao-Xia; Liu, Zhi-Ping; Yang, Chun-He; Gao, Mei-Hao

    2014-09-01

    To study the clinical features and risk factors of co-morbid tic disorder (TD) in children with attention deficit hyperactivity disorder (ADHD). A total of 312 children with ADHD were involved in this study. Subtypes of co-morbid TD, incidences of TD in different subtypes of ADHD (ADHD-I, ADHD-HI and ADHD-C) were observed. Thirteen potential factors influencing the comorbidity rate of TD in ADHD were evaluated by univariate analysis and multiple logistic regression analysis. Forty-two of 312 children with ADHD suffered from co-morbid TD (13.5%). Comorbidity rate of TD in children with ADHD-C (24.1%) was significantly higher than in those with ADHD-HI (10.9%) and ADHD-I (8.8%) (P<0.05). There were 21 cases (50.0%) of transient TD, 12 cases (28.6%) of chronic TD, and 9 cases (21.4%) of Tourette syndrome. The univariate analysis revealed 6 factors associated with comorbidity: addiction to mobile phone or computer games, poor eating habits, infection, improper family education, poor relationship between parents and poor relationship with schoolmates. Multiple logistic analysis revealed two independent risk factors for comorbidity: improper family education (OR=7.000, P<0.05) and infection (OR=2.564, P<0.05). The incidence of co-morbid TD in children with ADHD is influenced by many factors, and early interventions should be performed based on the main risk factors.

  10. Usefulness of Noninvasive Predictors of Oesophageal Varices in Black African Cirrhotic Patients in Côte d'Ivoire (West Africa

    Directory of Open Access Journals (Sweden)

    Alassan Kouamé Mahassadi

    2012-01-01

    Full Text Available Aims. To determine the usefulness of platelet count (PC, spleen diameter (SD and platelet count/spleen diameter ratio (PC/SD ratio for the prediction of oesophageal varices (OV and large OV in black African patients with cirrhosis in Côte d’Ivoire. Materials and Methods. Study was conducted in a training sample (111 patients and in a validation sample (91 patients. Results. Factors predicting OV were sex: (OR=0.08, P=0.0003, PC (OR = 12.4, P=0.0003, SD (OR = 1.04, P=0.002 in the training sample. The AUROCs (±SE of the model (cutoff ≥ 0.6, PC (cutoff 140 and PC/SD ratio (cutoff ≤ 868 were, respectively; 0.879 ± 0.04, 0.768 ± 0.06, 0.679 ± 0.06, 0.793 ± 0.06. For the prediction of large OV, the model’s AUROC (0.850 ± 0.05 was superior to that of PC (0.688 ± 0.06, SD (0.732 ± 0.05 and PC/SD ratio (0.752 ± 0.06. In the validation sample, with PC, PC/SD ratio and the model, upper digestive endoscopy could be obviated respectively in 45.1, 45.1, and 44% of cirrhotic patients. Prophylactic treatment with beta blockers could be started undoubtedly respectively in 36.3, 41.8 and 28.6% of them as having large OV. Conclusion. Non-invasive means could be used to monitor cirrhotic patients and consider treatment in African regions lacking endoscopic facilities.

  11. Analysis of hepatoportal hemodynamics by hepatic radionuclide angiography on patients with portal hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Mitarai, Y; Yoshida, T; Yoshimura, T; Nagamine, K; Kanashima, R; Kobayashi, M; Nakashima, A; Kato, Y; Maeda, H

    1987-04-01

    Hepatoportal circulation was measured using radionuclide angiography with /sup 99m/Tc-fibrinogen in 40 patients with or without portal hypertension ; 20 cirrhotics with esophageal varices(LC with varices), 5 cirrhotics without esophageal varices(LC without varices), 5 patients with idiopathic portal hypertension(IPH) and 10 controls. In 8 cases among LC with varices, the hemodynamics was determined before and after left gastric vena caval shunt(LGCS). The radioactivity count and PA ratio(blood flow proportion of the portal vein to the hepatic artery) at the hepatic hilus were lower in the patients with liver cirrhosis(LC with and without varices) than those of the cases without liver cirrhosis(IPH and control). The comparison of hemodynamics before and during 6 weeks after LGCS demonstrated the radioactivity count well-preserved but on the contrary the PA ratio reduced at the hepatic hilus after surgery. The present results could indicate that the total hepatic inflow was maintained following LGCS, by compensatory increase of hepatic arterial flow in response to reduced portal flow. The implication of hepatic radionuclide angiography is discussed on patients with portal hypertension.

  12. Analysis of hepatoportal hemodynamics by hepatic radionuclide angiography on patients with portal hypertension

    International Nuclear Information System (INIS)

    Mitarai, Yoshinobu; Yoshida, Takanori; Yoshimura, Takahisa; Nagamine, Kenji; Kanashima, Ryoichi; Kobayashi, Michio; Nakashima, Akihisa; Kato, Yukio; Maeda, Hirofumi

    1987-01-01

    Hepatoportal circulation was measured using radionuclide angiography with 99m Tc-fibrinogen in 40 patients with or without portal hypertension ; 20 cirrhotics with esophageal varices(LC with varices), 5 cirrhotics without esophageal varices(LC without varices), 5 patients with idiopathic portal hypertension(IPH) and 10 controls. In 8 cases among LC with varices, the hemodynamics was determined before and after left gastric vena caval shunt(LGCS). The radioactivity count and PA ratio(blood flow proportion of the portal vein to the hepatic artery) at the hepatic hilus were lower in the patients with liver cirrhosis(LC with and without varices) than those of the cases without liver cirrhosis(IPH and control). The comparison of hemodynamics before and during 6 weeks after LGCS demonstrated the radioactivity count well-preserved but on the contrary the PA ratio reduced at the hepatic hilus after surgery. The present results could indicate that the total hepatic inflow was maintained following LGCS, by compensatory increase of hepatic arterial flow in response to reduced portal flow. The implication of hepatic radionuclide angiography is discussed on patients with portal hypertension. (author)

  13. Features of risks assessment from the position of the behavioral economy

    Directory of Open Access Journals (Sweden)

    I. А. Kiseleva

    2018-01-01

    Full Text Available Subject. The article is devoted to the actual topic of modernity – risk management in terms of behavioral economics. Since the domestic theory of risk management is under development, the problem of a clear comprehensive definition of "risk" becomes now of particular relevance. Goals. The study of the mechanism of risk management in the economy from the perspective of psychology. Tasks. Review the main concepts of risk management; to study its components in business; reflect the system and principles of risk management. Methodology. Methods of cognition, retrospective and documentary analysis, as well as synthesis, generalization, systematization were used as methods for performing the work. Results. The cognitive and psychophysical factors that determine the value of choice under risk conditions, proposed by Israeli scientists Daniel Kahneman and Amos Tversky, which contributed to a fundamental breakthrough in the understanding of human behavior under uncertainty and created an economic theory of prospects, were studied. Application area. Risk management from the perspective of economic psychology. Conclusions. The psychological foundations of decision-making in risky situations play a fundamental role. In the risk there is always a certain subjective value, depending on the individual subjective assessment of probability. It is established that in most cases individuals are not prone to risk, and as a rule, an equal change in benefits and losses has unequal value for the subject, so losses, other things being equal, are experienced by the person making the decision, with great emotional costs. There is a direct relationship between the dynamics of the level of risk and the dynamics of profitability, namely: the higher the average profitability of a particular operation, the higher the risk associated with it. The level of threats in the market today is higher than the level of potential profit.

  14. Paresthesia and sensory disturbances associated with 2009 pandemic vaccine receipt: Clinical features and risk factors.

    Science.gov (United States)

    De Serres, Gaston; Rouleau, Isabelle; Skowronski, Danuta M; Ouakki, Manale; Lacroix, Kevin; Bédard, Fernand; Toth, Eveline; Landry, Monique; Dupré, Nicolas

    2015-08-26

    Paresthesia was the third-most-common adverse event following immunization (AEFI) with 2009 monovalent AS03-adjuvanted A(H1N1)pdm09 vaccine in Quebec, Canada and was also frequently reported in Europe. This study assessed clinical features and risk factors associated with this unexpected AEFI. Reports to the passive surveillance system were summarized. A case-control study was conducted to assess risk factors and additional investigations were undertaken among cases with symptoms persisting ≥12 months. There were 328 reports of paresthesia affecting the vaccinated arm (58%), but also face (45%), lower limbs (40%) and back/thorax (23%) with numbness but also muscle weakness (61%), motor impairment (61%), generalized myalgia (37%), visual (14%) and/or speech effects (15%). Reporting rate was highest in women of reproductive age, peaking at 30-39 years-old (28/100,000 doses administered) and exceeding that of men of the same age (7/100,000 doses) by 4-fold. Median time to onset was 2h. Symptoms subsided within one week in 37% but lasted ≥6 months in 26%. No consistent or objective neurological findings were identified. Risk was increased with allergy history, respiratory illness the day of vaccination, depressive symptoms and family history of pulmonary disease, but decreased with physical activity the day of vaccination, and regular weekly alcohol consumption. Paresthesia following 2009 pandemic vaccine receipt lasted several weeks and included other motor-sensory disturbances in an important subset of patients. Although it does not correspond with known neurological disease, and causality remains uncertain, further investigation is warranted to understand the nature and frequency of paresthesia as a possible AEFI with influenza vaccines. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Clinical features and risk factors for post-partum depression in a large cohort of Chinese women with recurrent major depressive disorder.

    Science.gov (United States)

    Tian, Tian; Li, Yihan; Xie, Dong; Shen, Yifeng; Ren, Jianer; Wu, Wenyuan; Guan, Chengbin; Zhang, Zhen; Zhang, Danning; Gao, Chengge; Zhang, Xiaoming; Wu, Jinbo; Deng, Hong; Wang, Gang; Zhang, Yunshu; Shao, Yun; Rong, Han; Gan, Zhaoyu; Sun, Yan; Hu, Bin; Pan, Jiyang; Li, Yi; Sun, Shufan; Song, Libo; Fan, Xuesheng; Li, Yi; Zhao, Xiaochuan; Yang, Bin; Lv, Luxian; Chen, Yunchun; Wang, Xiaoli; Ning, Yuping; Shi, Shenxun; Chen, Yiping; Kendler, Kenneth S; Flint, Jonathan; Tian, Hongjun

    2012-02-01

    Post partum depression (PPD) is relatively common in China but its clinical characteristics and risk factors have not been studied. We set out to investigate whether known risk factors for PPD could be found in Chinese women. A case control design was used to determine the impact of known risk factors for PPD in a cohort of 1970 Chinese women with recurrent DSM-IV major depressive disorder (MDD). In a within-case design we examined the risk factors for PPD in patients with recurrent MDD. We compared the clinical features of MDD in cases with PPD to those without MDD. Odds ratios were calculated using logistic and ordinal regression. Lower occupational and educational statuses increased the risk of PPD, as did a history of pre-menstrual symptoms, stressful life events and elevated levels of the personality trait of neuroticism. Patients with PPD and MDD were more likely to experience a comorbid anxiety disorder, had a younger age of onset of MDD, have higher levels of neuroticism and dysthymia. Results obtained in this clinical sample may not be applicable to PPD within the community. Data were obtained retrospectively and we do not know whether the correlations we observe have the same causes as those operating in other populations. Our results are consistent with the hypothesis that the despite cultural differences between Chinese and Western women, the phenomenology and risk factors for PPD are very similar. Copyright © 2011 Elsevier B.V. All rights reserved.

  16. Integrated risk management in South Africa: between technological features and organisational reality

    CSIR Research Space (South Africa)

    Simonis, I

    2009-01-01

    Full Text Available cost interoperable information and communication technology (ICT) solutions to effectively mitigate disaster risk by addressing all phases of disaster risk management from risk assessment to recovery; paving the way to improved risk governance...

  17. Successful Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Varix Mainly Draining into the Pericardiophrenic Vein

    International Nuclear Information System (INIS)

    Kageyama, Ken; Nishida, N.; Matsui, H.; Yamamoto, A.; Nakamura, K.; Miki, Y.

    2012-01-01

    Two cases of gastric varices were treated by balloon-occluded retrograde transvenous obliteration via the pericardiophrenic vein at our hospital, and both were successful. One case developed left hydrothorax. Gastric varices did not bled and esophageal varices were not aggravated in both cases for 24–30 months thereafter. These outcomes indicate the feasibility of balloon-occluded retrograde transvenous obliteration via the pericardiophrenic vein.

  18. Online feature selection with streaming features.

    Science.gov (United States)

    Wu, Xindong; Yu, Kui; Ding, Wei; Wang, Hao; Zhu, Xingquan

    2013-05-01

    We propose a new online feature selection framework for applications with streaming features where the knowledge of the full feature space is unknown in advance. We define streaming features as features that flow in one by one over time whereas the number of training examples remains fixed. This is in contrast with traditional online learning methods that only deal with sequentially added observations, with little attention being paid to streaming features. The critical challenges for Online Streaming Feature Selection (OSFS) include 1) the continuous growth of feature volumes over time, 2) a large feature space, possibly of unknown or infinite size, and 3) the unavailability of the entire feature set before learning starts. In the paper, we present a novel Online Streaming Feature Selection method to select strongly relevant and nonredundant features on the fly. An efficient Fast-OSFS algorithm is proposed to improve feature selection performance. The proposed algorithms are evaluated extensively on high-dimensional datasets and also with a real-world case study on impact crater detection. Experimental results demonstrate that the algorithms achieve better compactness and higher prediction accuracy than existing streaming feature selection algorithms.

  19. Understanding Legacy Features with Featureous

    DEFF Research Database (Denmark)

    Olszak, Andrzej; Jørgensen, Bo Nørregaard

    2011-01-01

    Java programs called Featureous that addresses this issue. Featureous allows a programmer to easily establish feature-code traceability links and to analyze their characteristics using a number of visualizations. Featureous is an extension to the NetBeans IDE, and can itself be extended by third...

  20. Squamous Cell Carcinoma: Clinical and Pathological Features and Associated Risk Factors in an Observational Study of 118 Patients.

    Science.gov (United States)

    Díaz-Corpas, T; Morales-Suárez-Varela, M; Rausell Fontestad, N; Fuertes Prósper, A; Marquina-Vila, A; Jordá-Cuevas, E

    2015-12-01

    In the latest edition of its cancer staging manual, the American Joint Committee on Cancer (AJCC) revised the criteria for staging squamous cell carcinoma (SCC) by introducing high-risk tumor features to define tumor stage (T) and help to identify tumors with a higher risk of metastasis. The aim of this study was to investigate the characteristics associated with SCC meeting the high-risk criteria defined by the AJCC for T2 lesions. We performed a case-case observational study in which patients with SCC were included over a period of 18 months. We collected clinical, anthropometric, and tumor data, and analyzed these using PASW Statistics (SPSS) version 18. One-hundred eighteen patients, the majority of whom were men, were included. Mean age was 77 years. Over 70% of the tumors were located in the head region and a majority of tumors measured 2 cm or less. The prevalence of SCC T2 was 61.9%. The risk factors significantly associated with SCC T2 were an age of over 85 years (odds ratio [OR], 4.48), location in the head and neck region (OR, 3.38), presence of solar elastosis in the peritumoral tissue (OR, 2.08), a higher tumor growth rate (>1.5 mm·wk(-1); OR, 5.73), and higher cumulative exposure to smoking (>20 pack-years, OR, 3.63). Advanced age, location in the head and neck region, presence of solar elastosis, high tumor growth rate, and high cumulative smoking exposure were all significantly associated with the presence of SCC T2. Copyright © 2015 Elsevier España, S.L.U. and AEDV. All rights reserved.

  1. Advances in the management of childhood portal hypertension.

    Science.gov (United States)

    McKiernan, Patrick; Abdel-Hady, Mona

    2015-05-01

    Portal hypertension is one of the most serious complications of childhood liver disease, and variceal bleeding is the most feared complication. Most portal hypertension results from cirrhosis but extra hepatic portal vein obstruction is the single commonest cause. Upper gastrointestinal endoscopy endoscopy remains necessary to diagnose gastro-esophageal varices. Families of children with portal hypertension should be provided with written instructions in case of gastrointestinal bleeding. Children with large varices should be considered for primary prophylaxis on a case-by-case basis. The preferred method is variceal band ligation. Children with acute bleeding should be admitted to hospital and treated with antibiotics and pharmacotherapy before urgent therapeutic endoscopy. All children who have bled should then receive secondary prophylaxis. The preferred method is variceal band ligation and as yet there is little evidence to support the use of β-blockers. Children with extrahepatic portal vein obstruction should be assessed for suitability of mesoportal bypass.

  2. The White Nipple Sign: Please Do Not Disturb

    Directory of Open Access Journals (Sweden)

    Naser M. Khan

    2011-07-01

    Full Text Available Blood spurting or oozing from a varix confirms the diagnosis of variceal hemorrhage. In most cases of variceal hemorrhage, however, the bleeding has ceased by the time endoscopy is performed. Endoscopists rely on identification of stigmata of recent hemorrhage to determine whether varices are the cause of bleeding and to predict the likelihood of rebleeding. Most of the attention has focused on red color signs, such as red wale markings, described by Beppu et al. [Gastrointest Endosc 1981;27:213–218] and well known to endoscopists. Here we describe our experience with a less recognized stigma of variceal hemorrhage known as the ‘white nipple sign’, which resulted in active hemorrhage when manipulated.

  3. Prognostic impact of demographic factors and clinical features on the mode of death in high-risk patients after myocardial infarction--a combined analysis from multicenter trials

    DEFF Research Database (Denmark)

    Yap, Yee Guan; Duong, Trinh; Bland, J Martin

    2005-01-01

    mortality, whereas diabetes was only predictive of all-cause mortality. Smoking habit and atrial fibrillation had no prognostic value. Similar parameters were also predictive of short-term mortality, but not identical. CONCLUSIONS: Our study has shown that in high-risk patients post MI, who have been...... preselected using LVEF or frequent ventricular premature beats, demographic and clinical features are powerful predictors of mortality in the thrombolytic era. We propose that demographic and clinical factors should be considered when designing risk stratification or survival studies, or when identifying high...

  4. Changes in computed tomography features following preoperative chemotherapy for nephroblastoma: relation to histopathological classification

    International Nuclear Information System (INIS)

    Olsen, Oeystein E.; Jeanes, Annmarie C.; Roebuck, Derek J.; Owens, Catherine M.; Sebire, Neil J.; Risdon, Rupert A.; Michalski, Anthony J.

    2004-01-01

    The objective of this study is to assess computed tomography (CT) changes, both volume estimates and subjective features, following preoperative chemotherapy for nephroblastoma (Wilms' tumour) in patients treated on the United Kingdom Children's Cancer Study Group Wilms' Tumour Study-3 (UKW-3) protocol and to compare CT changes and histopathological classification. Twenty-one nephroblastomas in 15 patients treated on UKW-3 were included. All patients were examined by CT before and after preoperative chemotherapy treatment. CT images were reviewed (estimated volume change and subjectively assessed features). CT changes were compared to histopathological classification. Of the 21 tumours, all five high-risk tumours decreased in volume following chemotherapy (median -79%; range -37 to -91%). The sole low-risk tumour decreased in volume by 98%. Ten intermediate-risk tumours decreased in volume (median -72%; range -6 to -98%) and five intermediate-risk tumours increased (median +110%; range +11 to +164%). None of the five high-risk tumours, compared to 15/16 intermediate or low-risk tumours, became less dense and/or more homogeneous, or virtually disappeared, following chemotherapy. Volume change following chemotherapy did not relate to histopathological risk group. Changes in subjectively assessed qualitative CT features were more strongly related to histopathological risk group. (orig.)

  5. Interventional Radiologic Treatment for Idiopathic Portal Hypertension

    International Nuclear Information System (INIS)

    Hirota, Shozo; Ichikawa, Satoshi; Matsumoto, Shinichi; Motohara, Tomofumi; Fukuda, Tetsuya; Yoshikawa, Takeshi

    1999-01-01

    Purpose: To evaluate the usefulness of interventional radiological treatment for idiopathic portal hypertension. Methods: Between 1995 and 1998, we performed an interventional radiological treatment in five patients with idiopathic portal hypertension, four of whom had refused surgery and one of whom had undergone surgery. Three patients with gastroesophageal varices (GEV) were treated by partial splenic embolization (PSE), one patient with esophageal varices (EV) and massive ascites by transjugular intrahepatic portosytemic shunt (TIPS) and PSE, and one patient with GEV by percutaneous transhepatic obliteration (PTO). Midterm results were analyzed in terms of the effect on esophageal and/or gastric varices. Results: In one woman with severe GEV who underwent three sessions of PSE, there was endoscopic confirmation that the GEV had disappeared. In one man his EV shrunk markedly after two sessions of PSE. In two patients slight reduction of the EV was obtained with one application of PSE combined with endoscopic variceal ligation therapy. PTO for GV in one patient resulted in good control of the varices. All patients have survived for 16-42 months since the first interventional treatment, and varices are well controlled. Conclusion: Interventional radiological treatment is effective for patients with idiopathic portal hypertension, whether or not they have undergone surgery

  6. [Clinical features of suicide occurring in schizophrenia (I). Risk-factors identification].

    Science.gov (United States)

    Besnier, N; Gavaudan, G; Navez, A; Adida, M; Jollant, F; Courtet, P; Lançon, C

    2009-04-01

    Suicide is the leading cause of premature death in schizophrenia. Approximately 10 to 13% of deaths in schizophrenia are explained by suicide, despite widespread availability of generally effective antipsychotic treatments and suicide attempts have been reported among 20 to 50% of patients. This relatively low ratio of attempts/suicide is consistent with greater lethality of means - more violent - and intents - less ambivalence - in this population. Many studies have focused on risk factors and clinical characteristics for completed and/or attempted suicide. Commonly, sociodemographic risk factors for suicide are male sex, younger age and, among women, being unmarried, divorced or widowed. Previous suicidal behaviour is a strong risk factor for suicide and contrary to the common view, schizophrenic patients often communicate their suicidal intents shortly before death. Moreover, family history of suicide is associated with a heightened risk of suicide and is independent of the diagnosis, according to the growing literature that shows that vulnerability to suicidal behaviour is independent of psychiatric diagnosis. Suicide can occur throughout the entire course of schizophrenia. This is particularly true in those high-risk periods: early phase of the disease, active illness phase, period of relapse or during a depressive episode. The role of insight and positive symptoms remains unclear and probably needs further studies. Although not specifically for people with schizophrenia, hopelessness is a major risk factor and tragic loss is often presented as a trigger for suicide. It has been suggested that treatment side-effects, such as akathisia are associated with suicidal behaviour. A better knowledge of risk and protective factors is necessary to prevent suicide and suicidality.

  7. Integrated project risk management of nuclear power projects

    International Nuclear Information System (INIS)

    Wang Xiaohui; Xu Yuanhui

    2001-01-01

    The concept and the features of risks in nuclear power projects are introduced, and in terms of nuclear power projects' own features, the Nuclear Power Project Integrated Risk Management Model is presented. The identification, estimation, evaluation, response plan development, control of risks and the theoretical basis of risk management are discussed. The model has feedback and control functions in order to control and manage the risks dynamically

  8. [Late complications of liver cirrhosis - management of gastrointestinal bleeding in the presence of portal hypertension].

    Science.gov (United States)

    Hejda, Václav

    Cirrhosis is the end stage of progressive development of different liver diseases and is associated with significant morbidity and mortality rates. Cirrhosis is associated with a number of potential complications, in particular with development of portal hypertension. Portal hypertension with the production of ascites, hepatic and gastric varices bleeding in the upper part of the gastrointestinal tract, presents the breakpoint in the natural course of cirrhosis, and it is associated with a considerably worse prognosis of patients, with a dramatically increased risk of mortality. A major progress was reached during the past 10-20 years in diagnosing liver cirrhosis (including non-invasive methods), in primary prevention of the initial episode of upper gastrointestinal bleeding and in the therapy of acute bleeding due to modern pharmacotherapy, with regard to expanding possibilities of therapeutic endoscopy and relatively new options for management of acute bleeding (esophageal stents, TIPS and suchlike). However acute upper gastrointestinal bleeding associated with portal hypertension still presents a considerable risk of premature death (15-20 %). Early diagnosing and causal treatment of numerous liver diseases may lead to slowing or regression of fibrosis and cirrhosis and possibly even of the degree of portal hypertension and thereby also the risk of bleeding.Key words: cirrhosis - esophageal varices - treatment of bleeding - portal hypertension.

  9. Prevalence and Indicators of Portal Hypertension in Patients with Nonalcoholic Fatty Liver Disease

    Science.gov (United States)

    Mendes, Flavia D.; Suzuki, Ayako; Sanderson, Schuyler O.; Lindor, Keith D.; Angulo, Paul

    2012-01-01

    Background & Aims Little is known about the prevalence and severity of portal hypertension in patients with non-alcoholic fatty liver disease (NAFLD). We investigated the prevalence and non-invasive predictors of portal hypertension in patients with NAFLD. Methods Signs of portal hypertension, including esophageal varices, splenomegaly, portosystemic encephalopathy, and ascites where investigated in 354 patients with NAFLD. Results One-hundred patients had portal hypertension at the time of NAFLD diagnosis (28.2%), 88 of these with septal fibrosis or cirrhosis (88%). Fibrosis stage correlated with presence (r=0.41, Pportal hypertension. Of the 204 patients with no or mild fibrosis (stages 0–2), 12 had portal hypertension (6%); they had a significantly higher grade of steatosis, based on biopsy analysis, compared to the 192 patients without portal hypertension (94%). Thrombocytopenia, hyperbilirubinemia, cirrhosis, and obesity were independently associated with portal hypertension. Esophageal varices were found in 57 of the 128 patients undergoing endoscopic screening (44.5%) and independently associated with thrombocytopenia, type 2 diabetes, and splenomegaly. Conclusions Signs of portal hypertension are present in 25% of patients at the time of diagnosis of NAFLD; most had advanced fibrosis or cirrhosis. Portal hypertension can occur in a small proportion of patients with mild or no fibrosis and is associated with the extent of steatosis. Features of advanced liver disease and insulin resistance might identify patients with NAFLD and portal hypertension, and those expected to derive the most benefit from endoscopic screening for esophageal varices. PMID:22610002

  10. Assessment of severe accident prevention and mitigation features: PWR, large dry containment design

    International Nuclear Information System (INIS)

    Perkins, K.R.; Hsu, C.J.; Lehner, J.R.; Luckas, W.J.; Cho, N.; Fitzpatrick, R.G.; Pratt, W.T.; Eltawila, F.; Maly, J.A.

    1988-07-01

    Plant features and operator actions which have been found to be important in either preventing or mitigating severe accidents in PWRs with large dry containments have been identified. These features and actions were developed from insights derived from reviews of risk assessments performed specifically for the Zion plant and from assessments of other relevant studies. Accident sequences that dominate the core-damage frequency and those accident sequences that are of potentially high consequence were identified. Vulnerabilities of the large dry containment to severe accident containment loads were also identified. In addition, those features of a PWR with a large dry containment, which are important for preventing core damage and are available for mitigating fission-product release to the environment were identified. The report is issued to provide focus to the analyst examining an individual plant. The report calls attention to plant features and operator actions and provides a list of deterministic tributes for assessing those features and actions found to be helpful in reducing the overall risk for Zion and other PWRs with large dry containments. Thus, the guidance is offered as a resource in examining the subject plant to determine if the same, or similar, plant features and operator actions will be of value in reducing overall plant risk. This report is intended to serve solely as guidance

  11. Assessment of severe accident prevention and mitigation features: PWR, ice-condenser containment design

    International Nuclear Information System (INIS)

    Hsu, C.J.; Perkins, K.R.; Luckas, W.J.; Fitzpatrick, R.G.; Cho, N.; Lehner, J.R.; Pratt, W.T.; Eltawila, F.; Maly, J.A.

    1988-07-01

    Plant features and operator actions which have been found to be important in either preventing and mitigating severe accidents in PWRs with ice-condenser containments have been identified. Thus features and actions were developed from insights derived from reviews of risk assessments performed specifically for the Sequoyah plant and from assessments of other relevant studies. Accident sequences that dominate the core-damage frequency and those accident sequences that are of potentially high consequence were identified. Vulnerabilities of the ice-condenser containment to sever accident containment loads were also identified. In addition, those features of a PWR with an ice-condenser containment, which are important for preventing core damage and are available for mitigating fission-product release to the environment were identified. This report is issued to provide focus to an analyst examining an individual plant. The report calls attention to plant features and operator actions and provides a list of deterministic attributes for assessing those features and actions found to be helpful in reducing the overall risk for Sequoyah and other PWRs with ice-condenser containments. Thus, the guidance is offered as a resource in examining the subject plant to determine if the same, or similar, plant features and operator actions will be of value in reducing overall plant risk. This report is intended to serve solely as guidance. 14 tabs

  12. Assessment of severe accident prevention and mitigation features: BWR, Mark II containment design

    International Nuclear Information System (INIS)

    Lehner, J.R.; Hsu, C.J.; Eltawila, F.; Perkins, K.R.; Luckas, W.J.; Fitzpatrick, R.G.; Pratt, W.T.

    1988-07-01

    Plant features and operator actions, which have been found to be important in either preventing or mitigating severe accidents in BWRs with Mark II containments (BWR Mark II's) have been identified. These features and actions were developed from insights derived from reviews of in-depth risk assessments performed specifically for the Limerick and Shoreham plants and from other relevant studies. Accident sequences that dominate the core-damage frequency and those accident sequences that are of potentially high consequence were identified. Vulnerabilities of the BWR Mark II to severe-accident containment loads were also noted. In addition, those features of a BWR Mark II, which are important for preventing core damage and are available for mitigating fission-product release to the environment were also identified. This report is issued to provide focus to an analyst examining an individual plant. This report calls attention to plant features and operator actions and provides a list of deterministic attributes for assessing those features and actions found to be helpful in reducing the overall risk for Mark II plants. Thus, the guidance is offered as a resource in examining the subject plant to determine if the same, or similar, plant features and operator actions will be of value in reducing overall plant risk. This report is intended to serve solely as guidance

  13. Risk and safety perception on urban and rural roads: Effects of environmental features, driver age and risk sensitivity.

    Science.gov (United States)

    Cox, Jolene A; Beanland, Vanessa; Filtness, Ashleigh J

    2017-10-03

    The ability to detect changing visual information is a vital component of safe driving. In addition to detecting changing visual information, drivers must also interpret its relevance to safety. Environmental changes considered to have high safety relevance will likely demand greater attention and more timely responses than those considered to have lower safety relevance. The aim of this study was to explore factors that are likely to influence perceptions of risk and safety regarding changing visual information in the driving environment. Factors explored were the environment in which the change occurs (i.e., urban vs. rural), the type of object that changes, and the driver's age, experience, and risk sensitivity. Sixty-three licensed drivers aged 18-70 years completed a hazard rating task, which required them to rate the perceived hazardousness of changing specific elements within urban and rural driving environments. Three attributes of potential hazards were systematically manipulated: the environment (urban, rural); the type of object changed (road sign, car, motorcycle, pedestrian, traffic light, animal, tree); and its inherent safety risk (low risk, high risk). Inherent safety risk was manipulated by either varying the object's placement, on/near or away from the road, or altering an infrastructure element that would require a change to driver behavior. Participants also completed two driving-related risk perception tasks, rating their relative crash risk and perceived risk of aberrant driving behaviors. Driver age was not significantly associated with hazard ratings, but individual differences in perceived risk of aberrant driving behaviors predicted hazard ratings, suggesting that general driving-related risk sensitivity plays a strong role in safety perception. In both urban and rural scenes, there were significant associations between hazard ratings and inherent safety risk, with low-risk changes perceived as consistently less hazardous than high-risk

  14. Introduction to insurance mathematics technical and financial features of risk transfers

    CERN Document Server

    Olivieri, Annamaria

    2015-01-01

    This second edition expands the first chapters, which focus on the approach to risk management issues discussed in the first edition, to offer readers a better understanding of the risk management process and the relevant quantitative phases. In the following chapters the book examines life insurance, non-life insurance and pension plans, presenting the technical and financial aspects of risk transfers and insurance without the use of complex mathematical tools.   The book is written in a comprehensible style making it easily accessible to advanced undergraduate and graduate students in Economics, Business and Finance, as well as undergraduate students in Mathematics who intend starting on an actuarial qualification path. With the systematic inclusion of practical topics, professionals will find this text useful when working in insurance and pension related areas, where investments, risk analysis and financial reporting play a major role.

  15. Risk factors and features of recurrent bacterial complications of upper respiratory tract viral infections in children

    Directory of Open Access Journals (Sweden)

    Karpenko A.V.

    2017-10-01

    Full Text Available The aim of the study was to determine risk factors for recurrent bacterial complications of the upper respiratory tract viral infection (URTI in children, as well as the clinical and immunological features of the course of such complications. We enrolled 214 children aged 3-18 years with URTIs complicated with acute otitis media or acute bacterial rhinosinusitis. Frequency of bacterial complications of URI in 128 children was low (group I and in 86 children it met the criteria of recurrent course (group II. In addition to the standard examination, lysozyme levels in the oropharyngeal secretion were determined three times during the disease. It was found that children of group II were characterized by an early debut of respiratory morbidity (at the age of 6.00 (4.00, 12.00 months against 13.00 (4.50, 16.00 months in children of group I (p<0,0001, as well as a longer duration of catarrhal and intoxication syndromes in similar forms of the disease. The most significant risk factors for the formation of the recurring complication pattern were maternal smoking (OR=2.73, 95% CI [1.34, 5.48], along with gastroenterological pathology and frequent URTI in the mother and a shortened period of breastfeeding. In children with recurrent bacterial complications of URTI, there was an impaired local resistance of the upper respiratory tract mucous membranes (as a decrease in the concentrations of lysozyme in all periods of the disease, which persisted after recovery.

  16. Desired features of smartphone applications promoting physical activity.

    Science.gov (United States)

    Rabin, Carolyn; Bock, Beth

    2011-12-01

    Approximately one-third of adults in the United States are physically inactive. This is a significant public health concern as physical activity (PA) can influence the risk of cardiovascular disease, diabetes, and certain forms of cancer. To minimize these health risks, effective PA interventions must be developed and disseminated to the vast number of individuals who remain sedentary. Smartphone technology presents an exciting opportunity for delivering PA interventions remotely. Although a number of PA applications are currently available for smartphones, these "apps" are not based on established theories of health behavior change and most do not include evidence-based features (e.g., reinforcement and goal setting). Our aim was to collect formative data to develop a smartphone PA app that is empirically and theoretically-based and incorporates user preferences. We recruited 15 sedentary adults to test three currently available PA smartphone apps and provide qualitative and quantitative feedback. Findings indicate that users have a number of specific preferences with regard to PA app features, including that apps provide automatic tracking of PA (e.g., steps taken and calories burned), track progress toward PA goals, and integrate a music feature. Participants also preferred that PA apps be flexible enough to be used with several types of PA, and have well-documented features and user-friendly interfaces (e.g., a one-click main page). When queried by the researcher, most participants endorsed including goal-setting and problem-solving features. These findings provide a blue print for developing a smartphone PA app that incorporates evidence-based components and user preferences.

  17. Predictive features for histology of gastric subepithelial lesions

    Directory of Open Access Journals (Sweden)

    Ricardo Teles SCHULZ

    Full Text Available ABSTRACT BACKGROUND Gastric subepithelial lesion is a relatively common diagnosis after routine upper endoscopy. The diagnostic workup of an undetermined gastric subepithelial lesion should take into consideration clinical and endoscopic features. OBJECTIVE We aimed to investigate the association between patients' characteristics, endoscopic and echographic features with the histologic diagnosis of the gastric subepithelial lesions. METHODS This is a retrospective study with 55 patients, who were consecutively diagnosed with gastric subepithelial lesions, from October 2008 to August 2011. Patients' characteristics, endoscopic and echografic features of each gastric subepithelial lesion were analysed. Histologic diagnosis provided by EUS-guided fine needle aspiration or endoscopic/surgical resection was used as gold standard. RESULTS The probability of gastrointestinal stromal tumors to be located in the cardia was low (4.5%, while for leiomyoma it was high (>95%. In addition, there was a higher risk of gastrointestinal stromal tumors in patients older than 57 years (OR 8.9; 95% CI, with lesions ≥21 mm (OR 7.15; 95% CI, located at 4th layer (OR 18.8; 95% CI, with positive Doppler sign (OR 9; 95% CI, and irregular outer border (OR 7.75; 95% CI. CONCLUSION The location of gastric subepithelial lesions in the gastric cardia lowers the risk of gastrointestinal stromal tumors. While gastric subepithelial lesions occurring in elderly patients, located in the gastric body, with positive Doppler signal and irregular outer border increase the risk of gastrointestinal stromal tumors.

  18. Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study.

    Science.gov (United States)

    Lerman, Joseph B; Joshi, Aditya A; Chaturvedi, Abhishek; Aberra, Tsion M; Dey, Amit K; Rodante, Justin A; Salahuddin, Taufiq; Chung, Jonathan H; Rana, Anshuma; Teague, Heather L; Wu, Jashin J; Playford, Martin P; Lockshin, Benjamin A; Chen, Marcus Y; Sandfort, Veit; Bluemke, David A; Mehta, Nehal N

    2017-07-18

    Psoriasis, a chronic inflammatory disease associated with an accelerated risk of myocardial infarction, provides an ideal human model to study inflammatory atherogenesis in vivo. We hypothesized that the increased cardiovascular risk observed in psoriasis would be partially attributable to an elevated subclinical coronary artery disease burden composed of noncalcified plaques with high-risk features. However, inadequate efforts have been made to directly measure coronary artery disease in this vulnerable population. As such, we sought to compare total coronary plaque burden and noncalcified coronary plaque burden (NCB) and high-risk plaque (HRP) prevalence between patients with psoriasis (n=105), patients with hyperlipidemia eligible for statin therapy under National Cholesterol Education Program-Adult Treatment Panel III guidelines (n=100) who were ≈10 years older, and healthy volunteers without psoriasis (n=25). Patients underwent coronary computed-tomography angiography for total coronary plaque burden and NCB quantification and HRP identification, defined as low attenuation (1.10), and spotty calcification. A consecutive sample of the first 50 patients with psoriasis was scanned again 1 year after therapy. Despite being younger and at lower traditional risk than patients with hyperlipidemia, patients with psoriasis had increased NCB (mean±SD: 1.18±0.33 versus 1.11±0.32, P =0.02) and similar HRP prevalence ( P =0.58). Furthermore, compared to healthy volunteers, patients with psoriasis had increased total coronary plaque burden (1.22±0.31 versus 1.04±0.22, P =0.001), NCB (1.18±0.33 versus 1.03±0.21, P =0.004), and HRP prevalence beyond traditional risk (odds ratio, 6.0; 95% confidence interval, 1.1-31.7; P =0.03). Last, among patients with psoriasis followed for 1 year, improvement in psoriasis severity was associated with improvement in total coronary plaque burden (β=0.45, 0.23-0.67; P psoriasis had greater NCB and increased HRP prevalence than

  19. Pulmonary nodule characterization, including computer analysis and quantitative features.

    Science.gov (United States)

    Bartholmai, Brian J; Koo, Chi Wan; Johnson, Geoffrey B; White, Darin B; Raghunath, Sushravya M; Rajagopalan, Srinivasan; Moynagh, Michael R; Lindell, Rebecca M; Hartman, Thomas E

    2015-03-01

    Pulmonary nodules are commonly detected in computed tomography (CT) chest screening of a high-risk population. The specific visual or quantitative features on CT or other modalities can be used to characterize the likelihood that a nodule is benign or malignant. Visual features on CT such as size, attenuation, location, morphology, edge characteristics, and other distinctive "signs" can be highly suggestive of a specific diagnosis and, in general, be used to determine the probability that a specific nodule is benign or malignant. Change in size, attenuation, and morphology on serial follow-up CT, or features on other modalities such as nuclear medicine studies or MRI, can also contribute to the characterization of lung nodules. Imaging analytics can objectively and reproducibly quantify nodule features on CT, nuclear medicine, and magnetic resonance imaging. Some quantitative techniques show great promise in helping to differentiate benign from malignant lesions or to stratify the risk of aggressive versus indolent neoplasm. In this article, we (1) summarize the visual characteristics, descriptors, and signs that may be helpful in management of nodules identified on screening CT, (2) discuss current quantitative and multimodality techniques that aid in the differentiation of nodules, and (3) highlight the power, pitfalls, and limitations of these various techniques.

  20. The detection of gastro-oesophageal reflux in varicose changes of the oesophagus using scintigraphy. Szintigraphischer Nachweis des gastro-oesophagealen Refluxes bei Patienten mit Oesophagusvarizen

    Energy Technology Data Exchange (ETDEWEB)

    Kielmann, U.

    1984-08-27

    Comparative studies carried out in 22 bearers of oesophageal varices and 13 asymptomatic healthy volunteers on the basis of gastric reflux scintigraphy revealed findings to prove the occurrence of physiological reflux for the control group and, by contrast with this observation, markedly prolonged reflux episodes in the patient group. The occurrence of reflux was seen to be linked to the size of the varices found in the terminal oesophagus (negative correlation). A positive and significant correlation could be established between the size of a patient's varices and the frequency of haemorrhages. Bleedings and reflux episodes, however, were observed to be quite unrelated events. The results obtained strongly suggested that gastro-oesophageal reflux cannot be regarded as having a key role in haemorrhages from oesophageal varices. Nor was it possible to find statistical support for the effects of sclerotherapy on the frequency of haemorrhages. This was evidence in confirmation of the fact that obliteration is the obvious method in the treatment of haemorrhaging varices of the oesophagus. (TRV).

  1. Design Features of Modern Mechanical Ventilators.

    Science.gov (United States)

    MacIntyre, Neil

    2016-12-01

    A positive-pressure breath ideally should provide a V T that is adequate for gas exchange and appropriate muscle unloading while minimizing any risk for injury or discomfort. The latest generation of ventilators uses sophisticated feedback systems to sculpt positive-pressure breaths according to patient effort and respiratory system mechanics. Currently, however, these new control strategies are not totally closed-loop systems. This is because the automatic input variables remain limited, some clinician settings are still required, and the specific features of the perfect breath design still are not entirely clear. Despite these limitations, there are some rationale for many of these newer feedback features. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Efficacy and safety of balloon-occluded retrograde transvenous obliteration with sodium tetradecyl sulfate liquid sclerotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Il Soo; Park, Sang Woo; Kwon, So Young; Cheo, Won Hyeok; Cheon, Young Koog; Shim, Chan Sup; Lee, Tae Yoon; Kim, Jeong Han [Digestive Disease Center, Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2016-04-15

    To evaluate the efficacy and safety of balloon-occluded retrograde transvenous obliteration (BRTO) with sodium tetradecyl sulfate (STS) liquid sclerotherapy of gastric varices. Between February 2012 and August 2014, STS liquid sclerotherapy was performed in 17 consecutive patients (male:female = 8:9; mean age 58.6 years, range 44-86 years) with gastric varices. Retrograde venography was performed after occlusion of the gastrorenal shunt using a balloon catheter and embolization of collateral draining veins using coils or gelfoam pledgets, to evaluate the anatomy of the gastric varices. We prepared 2% liquid STS by mixing 3% STS and contrast media in a ratio of 2:1. A 2% STS solution was injected into the gastric varices until minimal filling of the afferent portal vein branch was observed (mean 19.9 mL, range 6-33 mL). Patients were followed up using computed tomography (CT) or endoscopy. Technical success was achieved in 16 of 17 patients (94.1%). The procedure failed in one patient because the shunt could not be occluded due to the large diameter of gastrorenal shunt. Complete obliteration of gastric varices was observed in 15 of 16 patients (93.8%) with follow-up CT or endoscopy. There was no rebleeding after the procedure. There was no procedure-related mortality. BRTO using STS liquid can be a safe and useful treatment option in patients with gastric varices.

  3. Contamination features and health risk of soil heavy metals in China

    International Nuclear Information System (INIS)

    Chen, Haiyang; Teng, Yanguo; Lu, Sijin; Wang, Yeyao; Wang, Jinsheng

    2015-01-01

    China faces a big challenge of environmental deterioration amid its rapid economic development. To comprehensively identify the contamination characteristics of heavy metals in Chinese soils on a national scale, data set of the first national soil pollution survey was employed to evaluate the pollution levels using several pollution indicators (pollution index, geoaccumulation index and enrichment factor) and to quantify their exposure risks posed to human health with the risk assessment model recommended by the US Environmental Protection Agency. The results showed that, due to the drastically increased industrial operations and fast urban expansion, Chinese soils were contaminated by heavy metals in varying degrees. As a whole, the exposure risk levels of soil metals in China were tolerable or close to acceptable. Comparatively speaking, children and adult females were the relatively vulnerable populations for the non-carcinogenic and carcinogenic risks, respectively. Cadmium and mercury have been identified as the priority control metals due to their higher concentrations in soils or higher health risks posed to the public, as well as, arsenic, lead, chromium and nickel. Spatial distribution pattern analysis implied that the soil metal pollutions in southern provinces of China were relatively higher than that in other provinces, which would be related to the higher geochemical background in southwest regions and the increasing human activities in southeast areas. Meanwhile, it should be noticed that Beijing, the capital of China, also has been labeled as the priority control province for its higher mercury concentration. These results will provide basic information for the improvement of soil environment management and heavy metal pollution prevention and control in China. - Highlights: • Soil contamination with heavy metals in China was systematically studied. • Spatial distribution patterns of heavy metals in Chinese soils were identified. • Monte

  4. Contamination features and health risk of soil heavy metals in China

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Haiyang [Engineering Research Center of Groundwater Pollution Control and Remediation, Ministry of Education, Beijing 100875 (China); College of Water Sciences, Beijing Normal University, Beijing 100875 (China); Teng, Yanguo, E-mail: Teng1974@163.com [Engineering Research Center of Groundwater Pollution Control and Remediation, Ministry of Education, Beijing 100875 (China); College of Water Sciences, Beijing Normal University, Beijing 100875 (China); Lu, Sijin; Wang, Yeyao [China National Environmental Monitoring Center, Beijing 100012 (China); Wang, Jinsheng [Engineering Research Center of Groundwater Pollution Control and Remediation, Ministry of Education, Beijing 100875 (China); College of Water Sciences, Beijing Normal University, Beijing 100875 (China)

    2015-04-15

    China faces a big challenge of environmental deterioration amid its rapid economic development. To comprehensively identify the contamination characteristics of heavy metals in Chinese soils on a national scale, data set of the first national soil pollution survey was employed to evaluate the pollution levels using several pollution indicators (pollution index, geoaccumulation index and enrichment factor) and to quantify their exposure risks posed to human health with the risk assessment model recommended by the US Environmental Protection Agency. The results showed that, due to the drastically increased industrial operations and fast urban expansion, Chinese soils were contaminated by heavy metals in varying degrees. As a whole, the exposure risk levels of soil metals in China were tolerable or close to acceptable. Comparatively speaking, children and adult females were the relatively vulnerable populations for the non-carcinogenic and carcinogenic risks, respectively. Cadmium and mercury have been identified as the priority control metals due to their higher concentrations in soils or higher health risks posed to the public, as well as, arsenic, lead, chromium and nickel. Spatial distribution pattern analysis implied that the soil metal pollutions in southern provinces of China were relatively higher than that in other provinces, which would be related to the higher geochemical background in southwest regions and the increasing human activities in southeast areas. Meanwhile, it should be noticed that Beijing, the capital of China, also has been labeled as the priority control province for its higher mercury concentration. These results will provide basic information for the improvement of soil environment management and heavy metal pollution prevention and control in China. - Highlights: • Soil contamination with heavy metals in China was systematically studied. • Spatial distribution patterns of heavy metals in Chinese soils were identified. • Monte

  5. Risk indicators as a tool for risk control

    International Nuclear Information System (INIS)

    Oien, K.

    2001-01-01

    This paper presents a general methodology for the establishment of risk indicators that can be used as a tool for risk control during operation of offshore petroleum installations. The risk indicators established are based on the platform specific quantitative risk analysis (QRA). The general methodology is evaluated against comparable approaches both in offshore and nuclear industry. There are two distinct features of this methodology. The first is that it is truly risk-based with the intention of covering the total risk picture. The second is that the identification of the risk factors contributing most to the total risk is based on realistic changes of each factor assessed by the platform personnel, not a theoretically assumed change. The set of risk indicators for one specific installation is presented along with test results

  6. Management of decompensated cirrhosis.

    Science.gov (United States)

    Mansour, Dina; McPherson, Stuart

    2018-04-01

    Decompensated cirrhosis is a common reason for admission to the acute medical unit, and such patients typically have complex medical needs and are at high risk of in-hospital death. It is therefore vital that these patients receive appropriate investigations and management as early as possible in their patient journey. Typical presenting clinical features include jaundice, ascites, hepatic encephalopathy, hepato-renal syndrome or variceal haemorrhage. A careful history, examination and investigations can help identify the precipitating cause (infections, gastrointestinal bleeding, high alcohol intake / alcohol-related hepatitis or drug-induced liver injury), so appropriate treatment can be given. A 'care bundle' that has been endorsed by the British Society of Gastroenterology is available to help guide the management of patients with decompensated cirrhosis for the first 24 hours and ensure all aspects are addressed. Specific management of complications, such as infections, gastrointestinal bleeding, hepatic encephalopathy and hepatorenal syndrome, are discussed. © Royal College of Physicians 2018. All rights reserved.

  7. Portaltrykket skal måles ved mistanke om portal hypertension

    DEFF Research Database (Denmark)

    Møller, Søren; Bendtsen, Flemming

    2010-01-01

    Portal hypertension leads to serious complications such as oesophageal varices, ascites, and in some patients hepatocellular carcinoma (HCC). The importance of measurement of the hepatic venous pressure gradient (HVPG) has recently been substantiated as it independently predicts survival and deve......Portal hypertension leads to serious complications such as oesophageal varices, ascites, and in some patients hepatocellular carcinoma (HCC). The importance of measurement of the hepatic venous pressure gradient (HVPG) has recently been substantiated as it independently predicts survival...... and development in connection with ascites, HCC and variceal bleeding. Measurement of HVPG is a simple and safe method and it can, moreover, be used to guide pharmacotherapy for primary and secondary prophylaxis of variceal bleeding. Assessment of HVPG should be available in larger centres that manage portal...... hypertensive patients....

  8. Usefulness of computed tomography (CT) in the diagnosis of portosystemic collaterals in liver cirrhosis

    International Nuclear Information System (INIS)

    Tsukune, Yoshihiko

    1984-01-01

    This study assesses the usefulness of computed tomography (CT) in the diagnosis of portosystemic collaterals in liver cirrhosis. Seventy-eight patients with liver cirrhosis underwent both CT and angiography. Comparison was made between CT and angiography on eleven types of collaterals, and many of them were demonstrated on CT scans better than angio. Especially, esophageal varices, paraesophageal varices, umbilical pathway and caput medusa were diagnostic on CT scans. Gastrorenal collaterals, splenorenal collaterals, retroperitoneal pathway are also well demonstrated. Dilatation of azygos systems and small veins in the liver surface are only observed on CT scans. However, coronary varices and short gastric varices are well diagnostic in angiography. But considering all types of collaterals, it was stressed that angiography can be eliminated by CT in evaluation of collaterals in liver cirrhosis. (author)

  9. Societal perspectives on risk awareness and risk competence.

    Science.gov (United States)

    Koller, Michael; Hoffrage, Ulrich

    2015-01-01

    Medical risks can be assessed by objectifiable therapeutic features; however, these risks are also characterised to a considerable degree by individual and social values. People tend to strive towards both freedom as well as safety; in a medical context, these two aims are taken into account by shared decision-making models and by stricter regulations in the pharmaceutical sector. Media reports on medical risks are caught between providing information and economic interests, and this conflict particularly complicates rational discussions about unexpected risks (for instance, in the field of natural medicine). Thus, it is necessary to create the type of information culture which allows differentiating between real and less pronounced risks.

  10. Risk Factors, Clinical Features and Management Of Children With ...

    African Journals Online (AJOL)

    In spite of the diarrhoeal disease control Programme of WHO and campaign efforts of the Nigerian government in the prevention and management ofdiarrhoea, the disease still remains a major causes of death among children under 5 years in Nigerian. Hence this study was aimed at assessing the risk factors, clinical ...

  11. [Clinical features of invasive candidiasis and risk factors for Candida bloodstream infection in children: a multicenter study in Urumqi, China].

    Science.gov (United States)

    Ai Er Ken, Ai Bi Bai; Ma, Zhi-Hua; Xiong, Dai-Qin; Xu, Pei-Ru

    2017-04-01

    To investigate the clinical features of invasive candidiasis in children and the risk factors for Candida bloodstream infection. A retrospective study was performed on 134 children with invasive candidiasis and hospitalized in 5 tertiary hospitals in Urumqi, China, between January 2010 and December 2015. The Candida species distribution was investigated. The clinical data were compared between the patients with and without Candida bloodstream infection. The risk factors for Candida bloodstream infection were investigated using multivariate logistic regression analysis. A total of 134 Candida strains were isolated from 134 children with invasive candidiasis, and non-albicans Candida (NAC) accounted for 53.0%. The incidence of invasive candidiasis in the PICU and other pediatric wards were 41.8% and 48.5% respectively. Sixty-eight patients (50.7%) had Candida bloodstream infection, and 45 patients (33.6%) had Candida urinary tract infection. There were significant differences in age, rate of use of broad-spectrum antibiotics, and incidence rates of chronic renal insufficiency, heart failure, urinary catheterization, and NAC infection between the patients with and without Candida bloodstream infection (Pcandidiasis is similar between the PICU and other pediatric wards. NAC is the most common species of invasive candidiasis. Candida bloodstream infection is the most common invasive infection. Younger age (1-24 months) and NAC infection are the risk factors for Candida bloodstream infection.

  12. The concept of ignorance in a risk assessment and risk management context

    International Nuclear Information System (INIS)

    Aven, T.; Steen, R.

    2010-01-01

    There are many definitions of ignorance in the context of risk assessment and risk management. Most refer to situations in which there are lack of knowledge, poor basis for probability assignments and possible outcomes not (fully) known. The purpose of this paper is to discuss the ignorance concept in this setting. Based on a set of risk and uncertainty features, we establish conceptual structures characterising the level of ignorance. These features include the definition of chances (relative frequency-interpreted probabilities) and the existence of scientific uncertainties. Based on these structures, we suggest a definition of ignorance linked to scientific uncertainties, i.e. the lack of understanding of how consequences of the activity are influenced by the underlying factors. In this way, ignorance can be viewed as a condition for applying the precautionary principle. The discussion is also linked to the use and boundaries of risk assessments in the case of large uncertainties, and the methods for classifying risk and uncertainty problems.

  13. Noninvasive assessment of oesophageal varices presence and size in patients with liver cirrhosis using right liver lobe/serum albumin concentration

    Directory of Open Access Journals (Sweden)

    Alempijević Tamara

    2007-01-01

    Full Text Available Background/Aim. Liver cirrhosis is a chronic, progressive disease and it is usually accompanied by portal hypertension. The development of oesophageal varices (OV is one of the major complications of portal hypertension. Cirrhotic patients should be screened for the presence of OV when portal hypertension is diagnosed. In order to reduce the increasing burden that endoscopy units have to bear, some studies have attempted to identify parameters for noninvasive prediction of OV presence. The aim of our study was to evaluate the value of biochemical and ultrasonography parameters for prediction of OV presence. Methods. This study included 58 cirrhotic patients who underwent a complete biochemical workup, ultrasonography examination and upper digestive endoscopy. Right liver lobe diameter/albumin ratio was calculated and its correlation to the presence and degree of OV, and Child-Pugh score of liver cirrhosis explored. Results. The mean age of the patients included in the study was 53.07±13.09 years; 40 were males and 18 females. In the Child-Pugh class A were 53.4% patients, class B 39.7%, whereas 6.9% were in the class C. In 24.1% of the patients no OV were identified by upper digestive endoscopy, 19% had OV grade I, 34.5% grade II, 20.7% grade III, and 1.7% OV grade IV. The mean value of the right liver lobe diameter/ albumin ratio was 5.43±1.79 (range of 2.76−11.44. Statistically significant correlation (p < 0.01 was confirm by Spearman's test between OV grade and calculated index (ρ = 0.441. Conclusion. The right liver lobe diameter/albumin ratio is a noninvasive parameter which provides an accurate information pertinent to the determination of OV presence and their grading in patients with liver cirrhosis. .

  14. Upper Gastrointestinal Bleeding in Japanese Patients Prescribed Antithrombotic Drugs: Differences in Trends over Time.

    Science.gov (United States)

    Yamaguchi, Daisuke; Sakata, Yasuhisa; Tsuruoka, Nanae; Shimoda, Ryo; Higuchi, Toru; Sakata, Hiroyuki; Fujimoto, Kazuma; Iwakiri, Ryuichi

    2014-06-01

    We studied the features of upper gastrointestinal bleeding (UGIB) in patients taking antithrombotic drugs. The records of 430 patients taking antithrombotic drugs who underwent emergency endoscopy for UGIB in Saga Medical School Hospital between 2002 and 2011 were studied. We also compared the characteristics of our cohort of 11,919 patients prescribed antithrombotic drugs in our hospital between 2002 and 2011. UBGI patients of variceal bleeding were not included in this study. 186 patients presented with UGIB in the first period (2002-2006) and 244 in the second period (2007-2011). The proportion of patients infected with Helicobacter pylori was lower in the second period, while the proportion taking antithrombotic drugs rose significantly. Peptic ulcer disease was responsible for the majority of bleeding episodes; however, bleeding from other sources is increasing. In the whole cohort, the risk of UGIB was 1.08%; however, of the 31.8% who also took an acid-secretion inhibitor only 18 (0.28%) developed bleeding. In contrast, 102 (1.87%) of those not taking an acid-secretion inhibitor developed UGIB, a statistically significant difference. Risk of UGIB in Japanese patients taking antithrombotics was 1.01% and the incidence is increasing. Acid-secretion inhibitors reduced the risk of antithrombotic drug-related UGIB.

  15. CONSIDERATIONS ABOUT THE ESSENTIAL FEATURES OF INNOVATION

    Directory of Open Access Journals (Sweden)

    Geanina S. BANU

    2014-11-01

    Full Text Available Defining and classifying innovation represents a complex approach both theoretical and practical. While comprising various views, the innovation concept is permanently redefined according to various criteria. Nevertheless, approaching innovation generic features should be always considered as defining the core of innovation as a concept. The aim of the present paper is to perform a literature review identifying the essential features of innovation with the aim of providing a comprehensive and holistic view of the concept. Furthermore, the present article aims at delivering a theoretical guide on innovation. To this end, the review comprises definition of concept, classification, risk factors, innovation systems and measuring indicators.

  16. Associations Between PET Textural Features and GLUT1 Expression, and the Prognostic Significance of Textural Features in Lung Adenocarcinoma.

    Science.gov (United States)

    Koh, Young Wha; Park, Seong Yong; Hyun, Seung Hyup; Lee, Su Jin

    2018-02-01

    We evaluated the association between positron emission tomography (PET) textural features and glucose transporter 1 (GLUT1) expression level and further investigated the prognostic significance of textural features in lung adenocarcinoma. We evaluated 105 adenocarcinoma patients. We extracted texture-based PET parameters of primary tumors. Conventional PET parameters were also measured. The relationships between PET parameters and GLUT1 expression levels were evaluated. The association between PET parameters and overall survival (OS) was assessed using Cox's proportional hazard regression models. In terms of PET textural features, tumors expressing high levels of GLUT1 exhibited significantly lower coarseness, contrast, complexity, and strength, but significantly higher busyness. On univariate analysis, the metabolic tumor volume, total lesion glycolysis, contrast, busyness, complexity, and strength were significant predictors of OS. Multivariate analysis showed that lower complexity (HR=2.017, 95%CI=1.032-3.942, p=0.040) was independently associated with poorer survival. PET textural features may aid risk stratification in lung adenocarcinoma patients. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  17. Relevance of surgery in patients with non-variceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Dango, S; Beißbarth, T; Weiss, E; Seif Amir Hosseini, A; Raddatz, D; Ellenrieder, V; Lotz, J; Ghadimi, B M; Beham, A

    2017-05-01

    Upper GI bleeding remains one of the most common emergencies with a substantial overall mortality rate of up to 30%. In severe ill patients, death does not occur due to failure of hemostasis, either medical or surgical, but mainly from comorbidities, treatment complications, and decreased tolerated blood loss. Management strategies have changed dramatically over the last two decades and include primarily endoscopic intervention in combination with acid-suppressive therapy and decrease in surgical intervention. Herein, we present one of the largest patient-based analysis assessing clinical parameters and outcome in patients undergoing endoscopy with an upper GI bleeding. Data were further analyzed to identify potential new risk factors and to investigate the role of surgery. In this retrospective study, we aimed to analyze outcome of patients with an UGIB and data were analyzed to identify potential new risk factors and the role of surgery. Data collection included demographic data, laboratory results, endoscopy reports, and details of management including blood administration, and surgery was carried out. Patient events were grouped and defined as "overall" events and "operated," "non-operated," and "operated and death" as well as "non-operated and death" where appropriate. Blatchford, clinical as well as complete Rockall-score analysis, risk stratification, and disease-related mortality rate were calculated for each group for comparison. Overall, 253 patients were eligible for analysis: endoscopy was carried out in 96% of all patients, 17% needed surgical intervention after endoscopic failure of bleeding control due to persistent bleeding, and the remaining 4% of patients were subjected directly to surgery. The median length of stay to discharge was 26 days. Overall mortality was 22%; out of them, almost 5% were operated and died. Anticoagulation was associated with a high in-hospital mortality risk (23%) and was increased once patients were taken to surgery (43

  18. Childhood maltreatment and its link to borderline personality disorder features in children: A systematic review approach.

    Science.gov (United States)

    Ibrahim, Jeyda; Cosgrave, Nicola; Woolgar, Matthew

    2018-01-01

    Borderline personality disorder has repeatedly been associated with a history of maltreatment in childhood; however, research on maltreatment and its link to borderline features in children is limited. The aim of this review is to synthesise the existing data on the association between maltreatment and borderline features in childhood. In total, 10 studies were included in this systematic review. Studies indicated that children with borderline features were more likely to have a history of maltreatment, and that children who had been maltreated were more likely to present with borderline features. Other risk factors such as cognitive and executive functioning deficits, parental dysfunction and genetic vulnerability were also identified across studies. This review adds to the literature by highlighting maltreatment as a risk factor for borderline features in childhood. Longitudinal research is required to establish the link between childhood borderline features and adult borderline features. Implications for early identification, prevention and intervention services are discussed.

  19. Credit risk transfer

    OpenAIRE

    Bank for International Settlements

    2003-01-01

    Executive summary Techniques for transferring credit risk, such as financial guarantees and credit insurance, have been a long-standing feature of financial markets. In the past few years, however, the range of credit risk transfer (CRT) instruments and the circumstances in which they are used have widened considerably. A number of factors have contributed to this growth, including: greater focus by banks and other financial institutions on risk management; a more rigorous approach to risk/re...

  20. Case series

    African Journals Online (AJOL)

    ebutamanya

    2015-02-17

    Feb 17, 2015 ... Therefore, the present study has been undertaken to determine ... variceal bleeding is a severe complication occurring in up to 30% of patients ... of large esophageal varices is an upper gastrointestinal endoscopy. It is now ...

  1. Splenic Arterial Embolization in the Treatment of Severe Portal Hypertension Due to Pancreatic Diseases: The Primary Experience in 14 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Qi, E-mail: wqtjmu@gmail.com; Xiong, Bin, E-mail: herrxiong@126.com; Zheng, ChuanSheng, E-mail: hqzcsxh@sina.com; Liang, Ming, E-mail: whliangming@163.com; Han, Ping, E-mail: cjr.hanping@vip.163.com [Huazhong University of Science and Technology, Department of Radiology, Union Hospital, Tongji Medical College (China)

    2016-03-15

    ObjectiveThis retrospective study reports our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding.MethodsFrom August 2009 to May 2012, 14 patients with SPH due to pancreatic disease were diagnosed and treated with splenic arterial embolization. Two different embolization strategies were applied; either combined distal splenic bed particle embolization and proximal splenic artery coil embolization in the same procedure for acute hemorrhage (1-step) or interval staged distal embolization and proximal embolization in the stable patient (2-step). The patients were clinically followed.ResultsIn 14 patients, splenic arterial embolization was successful. The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization. The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only. The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up.ConclusionsSplenic arterial embolization, particularly the two-step method, proved feasible and effective for the treatment of SPH patients with gastric varices or gastric variceal bleeding.

  2. Portal Hypertension Complications Are Frequently the First Presentation of NAFLD in Patients Undergoing Liver Transplantation Evaluation.

    Science.gov (United States)

    Nagpal, Sajan Jiv Singh; Kabbany, Mohammad Nasser; Mohamad, Bashar; Lopez, Rocio; Zein, Nizar N; Alkhouri, Naim

    2016-07-01

    Nonalcoholic fatty liver disease (NAFLD) is likely to replace Hepatitis C as the leading cause of cirrhosis resulting in liver transplantation (LT) within a few years. Unfortunately, due to the lack of established guidelines for the screening of NAFLD in high-risk populations, many patients present with portal hypertension complications as their first manifestation of NAFLD require a LT evaluation. We aimed to investigate what proportion of patients who underwent LT for NAFLD-cirrhosis had knowledge of their liver disease prior to presenting with portal hypertension complications and to identify differences in clinical parameters between those with and without knowledge of preexisting NAFLD. Consecutive patients who underwent LT for NAFLD-cirrhosis at a tertiary referral center were included in the study. Demographic and clinical data at the time of the first LT evaluation visit were collected, and patient knowledge of previous NAFLD was documented. Ascites, variceal bleeding, hepatic encephalopathy, and thrombocytopenia leading to diagnosis of underlying cirrhosis were considered as the presenting symptoms of portal hypertension. A p portal hypertension. The presenting symptoms were new-onset ascites in 61 %, hepatic encephalopathy in 25 %, variceal bleeding in 18 %, thrombocytopenia in 9 %, and other in 9 % (non-exclusive). Patients with no prior knowledge of NAFLD were less likely to have a diagnosis of hypercholesterolemia (30 vs. 50 %, p = 0.035) and had a trend toward having higher MELD scores at the time of the first LT evaluation visit (15 vs. 13.5, p = 0.05) and presenting with encephalopathy (25 vs. 10 %, p = 0.06) compared to those with previous knowledge of NAFLD diagnosis. The majority of patients undergoing liver transplant evaluation for NAFLD-cirrhosis are not aware of underlying NAFLD until they present with features of portal hypertension. New guidelines should consider screening for NAFLD in certain high-risk groups as more

  3. Personality features in ultra-high risk for psychosis: a comparative study with schizophrenia and control subjects using the Temperament and Character Inventory-Revised (TCI-R).

    Science.gov (United States)

    Fresán, Ana; León-Ortiz, Pablo; Robles-García, Rebeca; Azcárraga, Mariana; Guizar, Diana; Reyes-Madrigal, Francisco; Tovilla-Zárate, Carlos Alfonso; de la Fuente-Sandoval, Camilo

    2015-02-01

    Several variables have been identified as risk factors for conversion to overt psychosis in ultra-high risk for psychosis (UHR) individuals. Although almost two-thirds of them do not experience a transition to psychosis, they still exhibit functional disabilities. Other subjective developmental features may be useful for a more precise identification of individuals at UHR. Avoidant behaviors are consistently reported in schizophrenia and in UHR individuals and may be the reflection of a pattern of personality. Thus, personality features in UHR individuals deserves further research. The objective of the present study was to compare temperament and character dimensions between UHR individuals, patients with schizophrenia and healthy controls. One hundred participants (25 UHR individuals, 25 schizophrenia patients and 50 control subjects) where evaluated with the Temperament and Character Inventory-Revised (TCI-R). Univariate ANOVAs followed by Bonferroni tests were used. UHR individuals and schizophrenia patients exhibited higher levels of Harm Avoidance (HA) when compared to control subjects. For HA1 Anticipatory worry vs Uninhibited optimism and HA4 Fatigability & asthenia, UHR and schizophrenia groups showed similar scores and both groups were higher compared to control subjects. With respect to Cooperativeness (CO), UHR and schizophrenia reported lower scores than control subjects, in particular CO2 Empathy vs Social disinterest and CO3 Helpfulness vs unhelpfulness. This study replicates and extends the consideration of HA as a psychopathological related endophenotype and gives us further information of the possible role of personality features in the expression of some of the social dysfunctions observed both in prodromal subjects and schizophrenia patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Renal phlebographic findings in painless macrohematuria

    International Nuclear Information System (INIS)

    Seidel, K.; Federschmidt, K.

    1982-01-01

    After extensive review of literature concerning renal varices including suburothelial phlebectasia three cases of painless macrohematuria are recommended with unusual phlebographic findings: 1. a large renoiliac anastomosis combined with associated varices of the ureter, 2. a wide renohemazygal anastomosis draining nearly totally left renal venous blood into the vena cava superior, simultaneous existing varices of renal pelvis and ureter and 3. a persisting circumaortal ring. It is discussed whether phlebographic revealed renal varicosity is origin of bleeding in any case or bleeding may be caused eventually by associated suburothelial phlebectasia. (orig.) [de

  5. Pharmacologic manipulation of lower esophageal sphincter pressure

    Energy Technology Data Exchange (ETDEWEB)

    Owman, T; Lunderquist, A

    1983-03-01

    Ten patients with portal hypertension and esophageal varices had percutaneous transhepatic portography with selective catheterization of the short gastric or left gastric vein. The effect was studied on variceal blood flow after injection of various drugs. Vasopressin had no effect on variceal flow; pentagastrin gave a total occlusion of flow in five of nine patients; somatostatin interrupted the flow in one of four patients; domperidone obstructed flow completely in one patient, while another receiving the same dose was unaffected; methylcholine did not affect the flow in three patient examined.

  6. Portaltrykket skal måles ved mistanke om portal hypertension

    DEFF Research Database (Denmark)

    Møller, Søren; Bendtsen, Flemming

    2010-01-01

    Portal hypertension leads to serious complications such as oesophageal varices, ascites, and in some patients hepatocellular carcinoma (HCC). The importance of measurement of the hepatic venous pressure gradient (HVPG) has recently been substantiated as it independently predicts survival...... and development in connection with ascites, HCC and variceal bleeding. Measurement of HVPG is a simple and safe method and it can, moreover, be used to guide pharmacotherapy for primary and secondary prophylaxis of variceal bleeding. Assessment of HVPG should be available in larger centres that manage portal...... hypertensive patients....

  7. Borderline personality features in childhood: the role of subtype, developmental timing, and chronicity of child maltreatment.

    Science.gov (United States)

    Hecht, Kathryn F; Cicchetti, Dante; Rogosch, Fred A; Crick, Nicki R

    2014-08-01

    Child maltreatment has been established as a risk factor for borderline personality disorder (BPD), yet few studies consider how maltreatment influences the development of BPD features through childhood and adolescence. Subtype, developmental timing, and chronicity of child maltreatment were examined as factors in the development of borderline personality features in childhood. Children (M age = 11.30, SD = 0.94), including 314 maltreated and 285 nonmaltreated children from comparable low socioeconomic backgrounds, provided self-reports of developmentally salient borderline personality traits. Maltreated children had higher overall borderline feature scores, had higher scores on each individual subscale, and were more likely to be identified as at high risk for development of BPD through raised scores on all four subscales. Chronicity of maltreatment predicted higher overall borderline feature scores, and patterns of onset and recency of maltreatment significantly predicted whether a participant would meet criteria for the high-risk group. Implications of findings and recommendations for intervention are discussed.

  8. Borderline Personality Features in Childhood: The Role of Subtype, Developmental Timing and Chronicity of Child Maltreatment

    Science.gov (United States)

    Hecht, Kathryn F.; Cicchetti, Dante; Rogosch, Fred A.; Crick, Nicki

    2014-01-01

    Child maltreatment has been established as a risk factor for borderline personality disorder (BPD), yet few studies consider how maltreatment influences the development of BPD features through childhood and adolescence. Subtype, developmental timing and chronicity of child maltreatment were examined as factors in the development of borderline personality features in childhood. Children (M age = 11.30, SD = 0.94), including 314 maltreated and 285 nonmaltreated children from comparable low socioeconomic backgrounds, provided self-reports of developmentally salient borderline personality traits. Maltreated children had higher overall borderline feature scores, higher scores on each individual subscale and were more likely to be identified as at high risk for development of BPD through raised scores on all 4 subscales. Chronicity of maltreatment predicted higher overall borderline feature scores and patterns of onset and recency of maltreatment significantly predicted whether a participant would meet criteria for the high-risk group. Implications of findings and recommendations for intervention are discussed. PMID:25047300

  9. Meta-analysis of early nonmotor features and risk factors for Parkinson disease.

    Science.gov (United States)

    Noyce, Alastair J; Bestwick, Jonathan P; Silveira-Moriyama, Laura; Hawkes, Christopher H; Giovannoni, Gavin; Lees, Andrew J; Schrag, Anette

    2012-12-01

    To evaluate the association between diagnosis of Parkinson disease (PD) and risk factors or early symptoms amenable to population-based screening. A systematic review and meta-analysis of risk factors for PD. The strongest associations with later diagnosis of PD were found for having a first-degree or any relative with PD (odds ratio [OR], 3.23; 95% confidence interval [CI], 2.65-3.93 and OR, 4.45; 95% CI, 3.39-5.83) or any relative with tremor (OR, 2.74; 95% CI, 2.10-3.57), constipation (relative risk [RR], 2.34; 95% CI, 1.55-3.53), or lack of smoking history (current vs never: RR, 0.44; 95% CI, 0.39-0.50), each at least doubling the risk of PD. Further positive significant associations were found for history of anxiety or depression, pesticide exposure, head injury, rural living, beta-blockers, farming occupation, and well-water drinking, and negative significant associations were found for coffee drinking, hypertension, nonsteroidal anti-inflammatory drugs, calcium channel blockers, and alcohol, but not for diabetes mellitus, cancer, oral contraceptive pill use, surgical menopause, hormone replacement therapy, statins, acetaminophen/paracetamol, aspirin, tea drinking, history of general anesthesia, or gastric ulcers. In the systematic review, additional associations included negative associations with raised serum urate, and single studies or studies with conflicting results. The strongest risk factors associated with later PD diagnosis are having a family history of PD or tremor, a history of constipation, and lack of smoking history. Further factors also but less strongly contribute to risk of PD diagnosis or, as some premotor symptoms, require further standardized studies to demonstrate the magnitude of risk associated with them. Copyright © 2012 American Neurological Association.

  10. Prognostic variables in patients with cirrhosis and oesophageal varices without prior bleeding

    DEFF Research Database (Denmark)

    Møller, S; Bendtsen, F; Christensen, E

    1994-01-01

    serum bilirubin (p 10 (p associated with a higher risk. In conclusion, the results support the prognostic value of metabolic variables as described earlier...... a significant relation with an increased risk of bleeding or death: high plasma volume (p 10 (p .... The prognostic significance of central circulation time stresses the importance of the hyperdynamic systemic circulation in assessing the increased risk of bleeding or death.(ABSTRACT TRUNCATED AT 250 WORDS)...

  11. Risk premia in general equilibrium

    DEFF Research Database (Denmark)

    Posch, Olaf

    This paper shows that non-linearities can generate time-varying and asymmetric risk premia over the business cycle. These (empirical) key features become relevant and asset market implications improve substantially when we allow for non-normalities in the form of rare disasters. We employ explici......'s effective risk aversion.......This paper shows that non-linearities can generate time-varying and asymmetric risk premia over the business cycle. These (empirical) key features become relevant and asset market implications improve substantially when we allow for non-normalities in the form of rare disasters. We employ explicit...... solutions of dynamic stochastic general equilibrium models, including a novel solution with endogenous labor supply, to obtain closed-form expressions for the risk premium in production economies. We find that the curvature of the policy functions affects the risk premium through controlling the individual...

  12. Liquidity Risk meets Economic Capital and RAROC. A framework for measuring liquidity risk in banks.

    NARCIS (Netherlands)

    Loebnitz, K.

    2011-01-01

    Liquidity risk is a crucial and inherent feature of the business model of banks. While banks and regulators use sophisticated mathematical methods to measure a bank's solvency risk, they use relatively simple tools for a bank's liquidity risk such as coverage ratios, sensitivity analyses, and

  13. Feature: Post Traumatic Stres Disorder PTSD: NIH Research to Results

    Science.gov (United States)

    ... Navigation Bar Home Current Issue Past Issues Feature PTSD NIH Research to Results Past Issues / Winter 2009 ... be a key to a better understanding of PTSD and early identification of those at risk. Early ...

  14. Prognosis in patients with cirrhosis and mild portal hypertension

    DEFF Research Database (Denmark)

    Ytting, Henriette; Møller, Søren; Henriksen, Jens Henrik

    2006-01-01

    HVPG has been sparse. In this study, long-term survival and the risk of complications in mild portal hypertension were analysed. MATERIAL AND METHODS: Sixty-one patients with cirrhosis and HVPG below 10 mmHg were included in the study. Data were collected from medical files and National Patient...... with that in the background population. CONCLUSIONS: The frequency of complications in patients with mild portal hypertension is considerable, and guidelines for follow-up or medical prophylaxis are warranted. The risk of bleeding from oesophageal varices is low and bleeding-related deaths rare....

  15. Predictive Risk Factors for Upper Gastrointestinal Bleeding with Simultaneous Myocardial Injury

    Directory of Open Access Journals (Sweden)

    I-Chen Wu

    2007-01-01

    Full Text Available The aims of this study were to: (1 evaluate the epidemiology of simultaneous upper gastrointestinal bleeding (UGIB and myocardial injury using parameters including troponin I (TnI; and (2 investigate the predictive risk factors of this syndrome. One hundred and fifty-five patients (101 men, 54 women; mean age, 64.7 ± 10.4 years; range, 38–94 years at the emergency department (ED with the major diagnosis of UGIB were included. They underwent serial electrocardiography (ECG and cardiac enzyme follow-up. Emergent gastroendoscopy was performed within 24 hours in most patients except for those who refused or were contraindicated. Mild myocardial injury was defined as the presence of any of the following: typical ST-T change on ECG, elevated creatine kinase-MB (CK-MB > 12U/L, or TnI > 0.2ng/dL. Moderate myocardial injury was defined as the presence of any two of the previously mentioned conditions. In total, 51 (32.9% and 12 (7.74% patients developed mild and moderate myocardial injuries, respectively. Myocardial injury was more common among patients with variceal bleeding (20/25 = 80.0% than those with ulcer bleeding (23/112 = 20.5%. It could partially be attributed to a higher baseline TnI level in cirrhotic patients. After adjusting for significant risk factors revealed by the univariate analysis, UGIB patients with a history of liver cirrhosis and more than three cardiac risk factors comprised a high-risk group for simultaneously developing myocardial injury. Other factors including age, gender, the color of nasogastric tube irrigation fluid, history of nonsteroidal anti-inflammatory drug use, vasopressin or terlipressin administration, vital signs, and creatinine recorded at the ED were not significant predictors. Those who developed myocardial injury had a longer hospital stay (mean duration, 8.73 ± 6.94 vs. 6.34 ± 2.66 days; p = 0.03 and required transfusion of more units of packed erythrocytes.

  16. Risks of Leveraged Products

    NARCIS (Netherlands)

    A. Di Cesare (Antonio)

    2012-01-01

    textabstractLeveraged investments have become a fundamental feature of modern economies. The new financial products allow people to take greater-than-usual exposures to risk factors. This thesis analyzes several different aspects of the risks involved by some frequently used leveraged products:

  17. Built spaces and features associated with user satisfaction in maternity waiting homes in Malawi.

    Science.gov (United States)

    McIntosh, Nathalie; Gruits, Patricia; Oppel, Eva; Shao, Amie

    2018-07-01

    To assess satisfaction with maternity waiting home built spaces and features in women who are at risk for underutilizing maternity waiting homes (i.e. residential facilities that temporarily house near-term pregnant mothers close to healthcare facilities that provide obstetrical care). Specifically we wanted to answer the questions: (1) Are built spaces and features associated with maternity waiting home user satisfaction? (2) Can built spaces and features designed to improve hygiene, comfort, privacy and function improve maternity waiting home user satisfaction? And (3) Which built spaces and features are most important for maternity waiting home user satisfaction? A cross-sectional study comparing satisfaction with standard and non-standard maternity waiting home designs. Between December 2016 and February 2017 we surveyed expectant mothers at two maternity waiting homes that differed in their design of built spaces and features. We used bivariate analyses to assess if built spaces and features were associated with satisfaction. We compared ratings of built spaces and features between the two maternity waiting homes using chi-squares and t-tests to assess if design features to improve hygiene, comfort, privacy and function were associated with higher satisfaction. We used exploratory robust regression analysis to examine the relationship between built spaces and features and maternity waiting home satisfaction. Two maternity waiting homes in Malawi, one that incorporated non-standardized design features to improve hygiene, comfort, privacy, and function (Kasungu maternity waiting home) and the other that had a standard maternity waiting home design (Dowa maternity waiting home). 322 expectant mothers at risk for underutilizing maternity waiting homes (i.e. first-time mothers and those with no pregnancy risk factors) who had stayed at the Kasungu or Dowa maternity waiting homes. There were significant differences in ratings of built spaces and features between the

  18. Evaluation of advanced containment features proposed to Korean SNPP

    International Nuclear Information System (INIS)

    Jin, Y.; Park, S.Y.; Kim, S.D.; Kim, D.H.

    1997-01-01

    Korean Standard Nuclear Power Plant (KSNP) has adopted many advanced design features to enhance its containment performance during severe accidents as well as to reduce changes of core damage. Robust design of containment and hydrogen mixing capability reduced containment failure probability significantly. In addition to these features, new systems are proposed for KSNP: advanced design of cavity geometry, reactor cavity flooding system, hydrogen igniter, and containment filtered venting system. Before these proposals are adopted to the KSNP, their effectiveness on containment performance has been assessed systematically. Containment event tree and sensitivity analysis are used to quantify the effectiveness of these design features. The overall results indicate that these new features do not improve the containment performance significantly except the containment filtered venting system. But adoption of the containment filtered venting system should be examined carefully because accidental failure of this system may result in undue risk to public. (author)

  19. Sexual dimorphism in medulloblastoma features.

    Science.gov (United States)

    Zannoni, Gian Franco; Ciucci, Alessandra; Marucci, Gianluca; Travaglia, Daniele; Stigliano, Egidio; Foschini, Maria Pia; Scambia, Giovanni; Gallo, Daniela

    2016-03-01

    Male sex is a risk factor for medulloblastoma (MB), and is also a negative predictor for clinical outcome. The aim of this study was to assess sex differences in tumour biological features and hormone receptor profiles in a cohort of MB patients. Sixty-four MBs and five normal cerebella were included in the study. Cell proliferation (Ki67), apoptosis (cleaved caspase-3) and microvessel density (CD31) were evaluated in tumours by immunohistochemistry. Tissues were analysed for oestrogen receptor (ER)α, ERβ1, ERβ2, ERβ5 and androgen receptor (AR) expression. The results demonstrated sex-specific features in MBs, with tumours from females showing a higher apoptosis/proliferation ratio and less tumour vascularization than tumours from males. MBs were negative for ERα and AR, but expressed ERβ isoforms at similar levels between the sexes. Altogether, these findings indicate that signalling mechanisms that control cell turnover and angiogenesis operate more efficiently in females than in males. The lack of sex differences in the hormone receptor profiles suggests that circulating oestrogens could be the major determinants of the sexual dimorphism observed in MB features. Here, we provide molecular support for epidemiological data showing sex differences in MB incidence and outcome, completely defining the hormone receptor profile of the tumours. © 2015 John Wiley & Sons Ltd.

  20. Cigarette Design Features: Effects on Emission Levels, User Perception, and Behavior.

    NARCIS (Netherlands)

    Talhout, Reinskje; Richter, Patricia A; Stepanov, Irina; Watson, Christina V; Watson, Clifford H

    This paper describes the effects of non-tobacco, physical cigarette design features on smoke emissions, product appeal, and smoking behaviors - 3 factors that determine smoker's exposure and related health risks.

  1. MR elastography in primary sclerosing cholangitis: correlating liver stiffness with bile duct strictures and parenchymal changes.

    Science.gov (United States)

    Bookwalter, Candice A; Venkatesh, Sudhakar K; Eaton, John E; Smyrk, Thomas D; Ehman, Richard L

    2018-04-07

    To determine correlation of liver stiffness measured by MR Elastography (MRE) with biliary abnormalities on MR Cholangiopancreatography (MRCP) and MRI parenchymal features in patients with primary sclerosing cholangitis (PSC). Fifty-five patients with PSC who underwent MRI of the liver with MRCP and MRE were retrospectively evaluated. Two board-certified abdominal radiologists in agreement reviewed the MRI, MRCP, and MRE images. The biliary tree was evaluated for stricture, dilatation, wall enhancement, and thickening at segmental duct, right main duct, left main duct, and common bile duct levels. Liver parenchyma features including signal intensity on T2W and DWI, and hyperenhancement in arterial, portal venous, and delayed phase were evaluated in nine Couinaud liver segments. Atrophy or hypertrophy of segments, cirrhotic morphology, varices, and splenomegaly were scored as present or absent. Regions of interest were placed in each of the nine segments on stiffness maps wherever available and liver stiffness (LS) was recorded. Mean segmental LS, right lobar (V-VIII), left lobar (I-III, and IVA, IVB), and global LS (average of all segments) were calculated. Spearman rank correlation analysis was performed for significant correlation. Features with significant correlation were then analyzed for significant differences in mean LS. Multiple regression analysis of MRI and MRCP features was performed for significant correlation with elevated LS. A total of 439/495 segments were evaluated and 56 segments not included in MRE slices were excluded for correlation analysis. Mean segmental LS correlated with the presence of strictures (r = 0.18, p duct strictures. Segments with increased LS show T2 hyperintensity, DWI hyperintensity, and post-contrast hyperenhancement. Global liver stiffness shows a moderate correlation with number of segmental strictures and significantly correlates with spleen stiffness, splenomegaly, and varices.

  2. Clinical features and prognosis of patients with primary biliary cholangitis complicated by hepatitis virus infection

    Directory of Open Access Journals (Sweden)

    ZHAO Dantong

    2017-08-01

    Full Text Available ObjectiveTo investigate the clinical features and prognosis of patients with primary biliary cholangitis(PBC complicated by hepatitis virus infection. MethodsA total of 16 patients who were admitted to Beijing YouAn Hospital from October 2004 to October 2012 and diagnosed with PBC complicated by hepatitis virus infection were enrolled, among whom 7 had chronic hepatitis B virus infection, 3 had hepatitis C, 4 had hepatitis E, 1 had hepatitis B and hepatitis C, and 1 had hepatitis A. A total of 76 hospitalized patients with PBC alone were enrolled as controls. The two groups were compared in terms of clinical features, laboratory markers, and autoantibodies, and follow-up visits were performed to investigate prognostic features. The independent samples t-test was used for comparison of normally distributed continuous data, and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data; the chi-square test or Fisher′s exact test was used for comparison of categorical data. The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used to compare survival rates between groups. ResultsCompared with the control group, the PBC-hepatitis virus infection group had significantly lower proportion of female patients (χ2=12.22, P=0.002, alkaline phosphatase (U=225.00, P<0.001, CHO (U=363.50, P=0.036, and IgG level (t=2.79, P=0.007, and no patients in the PBC-hepatitis virus infection group experienced abdominal wall varices, upper gastrointestinal bleeding, or hepatic encephalopathy. The PBC-hepatitis virus infection group had various autoantibodies including anti-nuclear antibody, smooth muscle antibody, anti-parietal cell antibody (APCA, anti-liver specific protein antibody, and anti-myocardial antibody, as well as a significantly higher APCA positive rate than the control group (25% vs 3.9%, χ2=5.608, P=0.016. The median follow-up time was 49.5 months (2-312 months. The PBC

  3. South African Gastroenterology Review - Vol 2, No 2 (2004)

    African Journals Online (AJOL)

    Variceal recurrence, rebleeding and survival after injection sclerotherapy in 306 alcoholic cirrhotic patients with bleeding oesophageal varices: original · EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. JEJ Krige, UK Kotze, PC Bornman, W Ddamulira, M Klipin, 8-13.

  4. CT portal venography manifestations of portal collateral circulation in patients with portal hypertension due to cirrhosis

    International Nuclear Information System (INIS)

    Ni Ming; Lv Weifu; Deng Kexue

    2009-01-01

    Objective: To analyze CT portal venography (CTPV) manifestations of portal collateral circulation in patients with cirrhosis by using a 16-detector row spiral CT scanner. Methods: CTPV was performed in 36 patients with portal hypertension due to cirrhosis, the diagnosis was proved by clinical data, hepatic function findings and imaging signs. By using post-processing reconstruction technique, 3D images of portal venous system and portal collateral circulation were obtained. Results: CTPV images displayed the portal venous system and its collateral circulation stereoscopically. Of 36 patients, left gastric varices were seen in 29(80.6%), lower esophageal varices in 18(50.0%), short gastric or posterior gastric varices in 15(41.7%), paraesophageal varices in 9(25.0%), gastro-renal or splenorenal shunts in 8(22.2%), spongelike transformation of portal vein in 7(19.4%), paraumbilical and abdominal wall varices in 6(16.7%), congenital cavernous in 6(16.7%) and paravertebral venous shunts in 4(11.1%). Conclusion: CTPV can well display the site, extent and severity of the portal collateral circulation in patients with portal hypertension due to cirrhosis,which is of great clinical importance for judging the patient's condition, for selecting therapeutic protocols and for estimating prognosis. (authors)

  5. Splenic artery embolisation for portal hypertention in children

    Directory of Open Access Journals (Sweden)

    Meisheri Ila

    2010-01-01

    Full Text Available Background: Bleeding from esophageal varices is one of the most common causes of serious gastrointestinal haemorrhage in children. We analysed our experience with the use of splenic artery embolisation and variceal sclerotherapy for bleeding oesophageal varices. Patients and Methods: Records of all patients treated for bleeding oesophageal varices caused by portal hypertension from 1998 to 2004 were retrospectively analysed. Patients were followed up for five years. Results: Out of 25 patients treated, ten belonged to sclerotherapy (group A, eight to combined sclerotherapy and embolisation (group B, and seven to only embolisation (group C. The patients were selected randomly, only two patients who had active bleed recently were directly sclerosed. The splenic artery was embolised at the hilum using steel coils in 15 patients with portal hypertension and hypersplenism. Follow-up findings showed decrease in splenic mass, varices, and hyperdynamic flow. Conclusion: In spite of few patients and a short period of follow-up, our results pointed out that a serious consideration should be given to this procedure, as it slowed the sequel of portal hypertension and the complications associated with it. Patients who were embolised and followed up for five years had lesser rebleeds and complications than sclerotherapy patients.

  6. Partial splenic embolization in patients with idiopathic portal hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Romano, Maurizio E-mail: maurizio.romano@ibb.cnr.it; Giojelli, Angela; Capuano, Gaetano; Pomponi, Domenico; Salvatore, Marco

    2004-03-01

    Purpose: To evaluate the effectiveness of partial splenic embolization (PSE) in patients with idiopathic portal hypertension (IPH) in reducing variceal bleeding episodes, splenomegaly and thrombocytopenia. Materials and methods: Six patients (2M, 4F, mean age 30.3 years) with IPH presenting with splenomegaly, thrombocytopenia and recurrent variceal bleeding were treated with PSE using gelatin sponge (four patients) or Contour particles (two patients) as embolization material. Results: PSE was performed successfully in all cases; 3F coaxial microcatheters were necessary in two patients due to extreme splenic artery tortuosity. The average amount of devascularized parenchyma at CT 1 week after PSE was 71%. Splenomegaly and thrombocytopenia improved in all cases, with a mean platelet count increase of 120000/mm{sup 3} and an average 68% reduction of spleen volume at follow up. Variceal bleeding did not recur after PSE. Esophageal or gastroesophageal varices disappeared (one patient) or significantly reduced (five patients) at endoscopic controls. No significant complications were noted. The follow up was of at least 18 months in all patients; mean follow up was 28.2 months. Conclusion: In patients with IPH PSE can be effective in preventing variceal bleedings, in reducing spleen volume and in significantly increasing platelet count; therapeutic results were durable in our population.

  7. Impact of hepatitis C oral therapy in portal hypertension.

    Science.gov (United States)

    Libânio, Diogo; Marinho, Rui Tato

    2017-07-14

    Chronic hepatitis C is a leading cause of morbidity and mortality, mainly related to fibrosis/cirrhosis and portal hypertension. Direct antiviral agents are highly effective and safe and can now cure > 90% of the patients. Sustained viral response (SVR) after interferon-based regimens has been associated with improvement in liver function, fibrosis and portal hypertension in a significant proportion of patients, although a point of no return seems to exist from which viral elimination is no longer capable of preventing portal hypertension progression and liver decompensation. Indeed, although SVR is associated with improvement of hepatic venous pressure gradients and therefore a decreased risk of de novo esophageal varices, several studies show that viral clearance does not eliminate the risk of variceal progression, liver decompensation and death in patients with pre-established portal hypertension. Although evidence about the effects of direct antiviral agents (DAAs) on clinically significant outcomes is still scarce and with short follow-up, DAAs can decrease the burden of the disease if patients are timely treated before significant fibrosis and portal hypertension develops. Studies with longer follow-up are waited to establish the real magnitude of hepatitis C treatment on portal hypertension. Future studies should also focus on predictors of portal hypertension resolution since it can influence management and avoid unnecessary monitoring.

  8. SAGES Guidelines: Prevention and management of gastro ...

    African Journals Online (AJOL)

    SAGES Guidelines: Prevention and management of gastro-oesophageal varices and variceal haemorrhage in cirrhosis. J F Botha. Abstract. No Abstract South African Gastroenterology Review Vol. 6 (1) 2008: pp. 23-25. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  9. Non-cirrhotic portal hypertension entity in South Africa? A report of 6 ...

    African Journals Online (AJOL)

    Three of these patients also had extrahepatic portal vein occlusion. All patients had varying degrees of portal hypertension and hypersplenism. Three patients underwent splenectomy and the remainder had sclerotherapy to control variceal bleeding. The overall prognosis is excellent if variceal bleeding can be controlled by ...

  10. Design and implementation of an online risk monitor

    International Nuclear Information System (INIS)

    Majdara, A.; Nematollah, M. R.; Haddad, K.; Sepanloo, K.

    2006-01-01

    Probabilistic Safety Assessment is a powerful method for evaluating the safety of nuclear facilities. Probabilistic Safety Assessment models are the basis of online risk monitors, which can be utilized for monitoring the online risk. In this paper a newly developed risk monitor called Safety Assessment Tool is presented, and its main features and capabilities are introduced. Some of these features are: graphical event/fault tree developing interface, a 30-day risk profile, performing importance analysis, different administrative levels, and handling time dependent failure data. Safety Assessment Tool can be utilized in nuclear power plants, research reactors, etc. as an online assistant to manage safety issues and prevent high-risk configurations

  11. Experience in the treatment of some complications of portal hypertension in alcoholic liver cirrhosis

    Directory of Open Access Journals (Sweden)

    Savić Željka

    2011-01-01

    Full Text Available Background/Aim. Portal hypertension (PH is hemodynamical abnormality associated with the most serious complications of alcoholic liver cirrhosis (ALC: ascites, varices and variceal bleeding. The aim of this study was to determine characteristics of portal hypertension, especially of upper gastrointestinal bleedings in patients with alcoholic liver cirrhosis (ALC. Methods. A total of 237 patients with ALC were observed in a 3-year period. Results. A total of 161 patients (68% were hospitalized because of PH elements: 86 (36.3% had upper gastrointestinal bleeding, 75 (31.7% were decompensated. Only 76 (32% of the patients had icterus. General mortality was 85 (36%. According to the source of bleeding, 61 (71% patients bled from varices, and 25 (29% from other sources with existing varices but non-incriminated for bleeding in 16 (64% of those patients. Active bleeding or stigmata of recent bleeding were found in 63 (73% cases. Endoscopic treatment of variceal bleeding along with octreotide applied in 20 (32.78% patients, just octreotide in 32 (52.46%, and octreotid plus balloon tamponade in 9 (14.75%. According to Child-Pugh classification, 25 (29% of the bleeding patients were in class A, score 5.4; 43 (50% in class B, score 7.8; and 18 (21% in class C, score 10.9. Average hemoglobin level was 93 g/L, hematocrit 0.27, AST 71.52 U/L (normal to 37 U/L, ALT 37.74 U/L (normal to 40 U/L. Until this bleeding episode, 41 (47% of the patients already bled. In the decompensated patients 3 (4% were in Child Pugh class A, score 6; 42 (56% in class B, score 8.3; and 30 (40% in class C, score 10.6. Until this decompensation episode, 7 (9.3% patients already bled. Conclusion. Patients with ALC need early detection of varices, primary and secondary profilaxis of variceal bleeding and adequate therapy of ascites. When bleeding occurs, patients need urgent upper endoscopy and intensive treatment.

  12. [Experience in the treatment of some complications of portal hypertension in alcoholic liver cirrhosis].

    Science.gov (United States)

    Savić, Zeljka; Vracarić, Vladimir; Hadnadjev, Ljiljana; Petrović, Zora; Damjanov, Dragomir

    2011-11-01

    Portal hypertension (PH) is hemodynamical abnormality associated with the most serious complications of alcoholic liver cirrhosis (ALC): ascites, varices and variceal bleeding. The aim of this study was to determine characteristics of portal hypertension, especially of upper gastrointestinal bleedings in patients with alcoholic liver cirrhosis (ALC). A total of 237 patients with ALC were observed in a 3-year period. A total of 161 patients (68%) were hospitalized because of PH elements: 86 (36.3%) had upper gastrointestinal bleeding, 75 (31.7%) were decompensated. Only 76 (32%) of the patients had icterus. General mortality was 85 (36%). According to the source of bleeding, 61 (71%) patients bled from varices, and 25 (29%) from other sources with existing varices but non-incriminated for bleeding in 16 (64%) of those patients. Active bleeding or stigmata of recent bleeding were found in 63 (73%) cases. Endoscopic treatment of variceal bleeding along with octreotide applied in 20 (32.78%) patients, just octreotide in 32 (52.46%), and octreotid plus balloon tamponade in 9 (14.75%). According to Child-Pugh classification, 25 (29%) of the bleeding patients were in class A, score 5.4; 43 (50%) in class B, score 7.8; and 18 (21%) in class C, score 10.9. Average hemoglobin level was 93 g/L, hematocrit 0.27, AST 71.52 U/L (normal to 37 U/L), ALT 37.74 U/L (normal to 40 U/L). Until this bleeding episode, 41 (47%) of the patients already bled. In the decompensated patients 3 (4%) were in Child Pugh class A, score 6; 42 (56%) in class B, score 8.3; and 30 (40%) in class C, score 10.6. Until this decompensation episode, 7 (9.3%) patients already bled. Patients with ALC need early detection of varices, primary and secondary profilaxis of variceal bleeding and adequate therapy of ascites. When bleeding occurs, patients need urgent upper endoscopy and intensive treatment.

  13. A prototype feature system for feature retrieval using relationships

    Science.gov (United States)

    Choi, J.; Usery, E.L.

    2009-01-01

    Using a feature data model, geographic phenomena can be represented effectively by integrating space, theme, and time. This paper extends and implements a feature data model that supports query and visualization of geographic features using their non-spatial and temporal relationships. A prototype feature-oriented geographic information system (FOGIS) is then developed and storage of features named Feature Database is designed. Buildings from the U.S. Marine Corps Base, Camp Lejeune, North Carolina and subways in Chicago, Illinois are used to test the developed system. The results of the applications show the strength of the feature data model and the developed system 'FOGIS' when they utilize non-spatial and temporal relationships in order to retrieve and visualize individual features.

  14. Women's Heart Disease: Heart Disease Risk Factors

    Science.gov (United States)

    ... this page please turn JavaScript on. Feature: Women's Heart Disease Heart Disease Risk Factors Past Issues / Winter 2014 Table ... or habits may raise your risk for coronary heart disease (CHD). These conditions are known as risk ...

  15. Risk, Uncertainty, and Entrepreneurship

    DEFF Research Database (Denmark)

    Koudstaal, Martin; Sloof, Randolph; Van Praag, Mirjam

    2016-01-01

    21288). The results indicate that entrepreneurs perceive themselves as less risk averse than managers and employees, in line with common wisdom. However, when using experimental incentivized measures, the differences are subtler. Entrepreneurs are only found to be unique in their lower degree of loss...... aversion, and not in their risk or ambiguity aversion. This combination of results might be explained by our finding that perceived risk attitude is not only correlated to risk aversion but also to loss aversion. Overall, we therefore suggest using a broader definition of risk that captures this unique...... feature of entrepreneurs: their willingness to risk losses....

  16. Weapon carrying and psychopathic-like features in a population-based sample of Finnish adolescents.

    Science.gov (United States)

    Saukkonen, Suvi; Laajasalo, Taina; Jokela, Markus; Kivivuori, Janne; Salmi, Venla; Aronen, Eeva T

    2016-02-01

    We investigated the prevalence of juvenile weapon carrying and psychosocial and personality-related risk factors for carrying different types of weapons in a nationally representative, population-based sample of Finnish adolescents. Specifically, we aimed to investigate psychopathic-like personality features as a risk factor for weapon carrying. The participants were 15-16-year-old adolescents from the Finnish self-report delinquency study (n = 4855). Four different groups were formed based on self-reported weapon carrying: no weapon carrying, carrying knife, gun or other weapon. The associations between psychosocial factors, psychopathic-like features and weapon carrying were examined with multinomial logistic regression analysis. 9% of the participants had carried a weapon in the past 12 months. Adolescents with a history of delinquency, victimization and antisocial friends were more likely to carry weapons in general; however, delinquency and victimization were most strongly related to gun carrying, while perceived peer delinquency (antisocial friends) was most strongly related to carrying a knife. Better academic performance was associated with a reduced likelihood of carrying a gun and knife, while feeling secure correlated with a reduced likelihood of gun carrying only. Psychopathic-like features were related to a higher likelihood of weapon carrying, even after adjusting for other risk factors. The findings of the study suggest that adolescents carrying a weapon have a large cluster of problems in their lives, which may vary based on the type of weapon carried. Furthermore, psychopathic-like features strongly relate to a higher risk of carrying a weapon.

  17. Portosystemic pressure reduction achieved with TIPPS and impact of portosystemic collaterals for the prediction of the portosystemic-pressure gradient in cirrhotic patients

    Energy Technology Data Exchange (ETDEWEB)

    Grözinger, Gerd, E-mail: gerd.groezinger@med.uni-tuebingen.de [Department of Diagnostic Radiology, Department of Radiology, University of Tübingen (Germany); Wiesinger, Benjamin; Schmehl, Jörg; Kramer, Ulrich [Department of Diagnostic Radiology, Department of Radiology, University of Tübingen (Germany); Mehra, Tarun [Department of Dermatology, University of Tübingen (Germany); Grosse, Ulrich; König, Claudius [Department of Diagnostic Radiology, Department of Radiology, University of Tübingen (Germany)

    2013-12-01

    Purpose: The portosystemic pressure gradient is an important factor defining prognosis in hepatic disease. However, noninvasive prediction of the gradient and the possible reduction by establishment of a TIPSS is challenging. A cohort of patients receiving TIPSS was evaluated with regard to imaging features of collaterals in cross-sectional imaging and the achievable reduction of the pressure gradient by establishment of a TIPSS. Methods: In this study 70 consecutive patients with cirrhotic liver disease were retrospectively evaluated. Patients received either CT or MR imaging before invasive pressure measurement during TIPSS procedure. Images were evaluated with regard to esophageal and fundus varices, splenorenal collaterals, short gastric vein and paraumbilical vein. Results were correlated with Child stage, portosystemic pressure gradient and post-TIPSS reduction of the pressure gradient. Results: In 55 of the 70 patients TIPSS reduced the pressure gradient to less than 12 mmHg. The pre-interventional pressure and the pressure reduction were not significantly different between Child stages. Imaging features of varices and portosystemic collaterals did not show significant differences. The only parameter with a significant predictive value for the reduction of the pressure gradient was the pre-TIPSS pressure gradient (r = 0.8, p < 0.001). Conclusions: TIPSS allows a reliable reduction of the pressure gradient even at high pre-interventional pressure levels and a high collateral presence. In patients receiving TIPSS the presence and the characteristics of the collateral vessels seem to be too variable to draw reliable conclusions concerning the portosystemic pressure gradient.

  18. Portosystemic pressure reduction achieved with TIPPS and impact of portosystemic collaterals for the prediction of the portosystemic-pressure gradient in cirrhotic patients

    International Nuclear Information System (INIS)

    Grözinger, Gerd; Wiesinger, Benjamin; Schmehl, Jörg; Kramer, Ulrich; Mehra, Tarun; Grosse, Ulrich; König, Claudius

    2013-01-01

    Purpose: The portosystemic pressure gradient is an important factor defining prognosis in hepatic disease. However, noninvasive prediction of the gradient and the possible reduction by establishment of a TIPSS is challenging. A cohort of patients receiving TIPSS was evaluated with regard to imaging features of collaterals in cross-sectional imaging and the achievable reduction of the pressure gradient by establishment of a TIPSS. Methods: In this study 70 consecutive patients with cirrhotic liver disease were retrospectively evaluated. Patients received either CT or MR imaging before invasive pressure measurement during TIPSS procedure. Images were evaluated with regard to esophageal and fundus varices, splenorenal collaterals, short gastric vein and paraumbilical vein. Results were correlated with Child stage, portosystemic pressure gradient and post-TIPSS reduction of the pressure gradient. Results: In 55 of the 70 patients TIPSS reduced the pressure gradient to less than 12 mmHg. The pre-interventional pressure and the pressure reduction were not significantly different between Child stages. Imaging features of varices and portosystemic collaterals did not show significant differences. The only parameter with a significant predictive value for the reduction of the pressure gradient was the pre-TIPSS pressure gradient (r = 0.8, p < 0.001). Conclusions: TIPSS allows a reliable reduction of the pressure gradient even at high pre-interventional pressure levels and a high collateral presence. In patients receiving TIPSS the presence and the characteristics of the collateral vessels seem to be too variable to draw reliable conclusions concerning the portosystemic pressure gradient

  19. A Feature Analysis of Risk Factors for Stroke in the Middle-Aged Adults

    OpenAIRE

    Haewon Byeon; Hyeung Woo Koh

    2015-01-01

    In order to maintain health during middle age and achieve successful aging, it is important to elucidate and prevent risk factors of middle-age stroke. This study investigated high risk groups of stroke in middle age population of Korea and provides basic material for establishment of stroke prevention policy by analyzing sudden perception of speech/language problems and clusters of multiple risk factors. This study analyzed 2,751 persons (1,191 males and 1,560 females) aged 40–59 who partici...

  20. Basal Cell Carcinoma: Pathogenesis, Epidemiology, Clinical Features, Diagnosis, Histopathology, and Management

    Science.gov (United States)

    Marzuka, Alexander G.; Book, Samuel E.

    2015-01-01

    Basal cell carcinoma (BCC) is the most common malignancy. Exposure to sunlight is the most important risk factor. Most, if not all, cases of BCC demonstrate overactive Hedgehog signaling. A variety of treatment modalities exist and are selected based on recurrence risk, importance of tissue preservation, patient preference, and extent of disease. The pathogenesis, epidemiology, clinical features, diagnosis, histopathology, and management of BCC will be discussed in this review. PMID:26029015

  1. Discourse on risks: The definition of risks as a matter of debate in society

    International Nuclear Information System (INIS)

    Lau, C.

    1989-01-01

    The article deals with a certain aspect of a sociological interpretation of the complex subject of risks to be accepted by a society, i.e. with the problem of the implications and impacts of acceptable risk definition becoming a topic of social conflict. The author assumes that the novel conflicts arising from effects of risks and costs of risks are beginning to superimpose upon the traditional conflict patterns of an industrial society. Characteristic features of conflicts about risks, resulting consequences, and three types of risk are discussed. (DG) [de

  2. Outlook for risk assessment and risk-informed regulations

    International Nuclear Information System (INIS)

    Chakraborty, S.; Breutel, C.; Khatib-Rahbar, M.

    2000-01-01

    The Western nuclear regulatory process has evolved from the initial engineering judgment' framework of the 1960's, the prescriptive deterministic requirements of the 1970s, the transition years of the 1980s, to the present day movement toward risk-informed approaches. In this paper, a short overview of the historic development of safety regulation is provided. The critique of traditional regulatory practice will be summarized and the features of risk-informed regulation will be discussed. The implementation of risk-informed regulation is considered on the basis of general legal principles common to many member states of the NEA and IAEA. In a process to risk-inform regulation, principles such as equal treatment, proportionality of rules and predictability of administrative action are found to be important. (author)

  3. RISKS IN INVESTMENT AND MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Ms. Tatiana A. Ykovleva

    2016-12-01

    Full Text Available The article discusses the features of investment risks and their causes, as well as provides a detailed classification of investment risks. The authors reveal the essence and content of the investment process, risk management, providing material for presentation in the form of a diagram. In conclusion, the article explains the use of the system of specialized institutions as a way to exclude the basic, or primary investment risk.

  4. Managing power risk

    International Nuclear Information System (INIS)

    Rudd, D.C.

    1999-01-01

    Issues regarding the management of financial risks in the electric power market were discussed. The nature of the risk was defined for electricity producers, local utilities, traders/dealers, and brokers, each of which are exposed to different types of risks with the exception of credit risk, which is common to all. The main features of options, swaps, CFDs, bilateral financial contracts, futures contracts and the terms of the NYMEX electricity contract were outlined. Basic derivative strategies, the role of the broker, the elements of emissions trading, and trading strategies for consumers were also explained. 3 fig

  5. Satisfying Product Features of a Fall Prevention Smartphone App and Potential Users’ Willingness to Pay: Web-Based Survey Among Older Adults

    Science.gov (United States)

    Mertens, Alexander; Brandl, Christopher; Liu, Shan; Buecking, Benjamin; Bliemel, Christopher; Horst, Klemens; Weber, Christian David; Lichte, Philipp; Knobe, Matthias

    2018-01-01

    Background Prohibiting falls and fall-related injuries is a major challenge for health care systems worldwide, as a substantial proportion of falls occur in older adults who are previously known to be either frail or at high risk for falls. Hence, preventive measures are needed to educate and minimize the risk for falls rather than just minimize older adults’ fall risk. Health apps have the potential to address this problem, as they enable users to self-assess their individual fall risk. Objective The objective of this study was to identify product features of a fall prevention smartphone app, which increase or decrease users’ satisfaction. In addition, willingness to pay (WTP) was assessed to explore how much revenue such an app could generate. Methods A total of 96 participants completed an open self-selected Web-based survey. Participants answered various questions regarding health status, subjective and objective fall risk, and technical readiness. Seventeen predefined product features of a fall prevention smartphone app were evaluated twice: first, according to a functional (product feature is implemented in the app), and subsequently by a dysfunctional (product feature is not implemented in the app) question. On the basis of the combination of answers from these 2 questions, the product feature was assigned to a certain category (must-be, attractive, one-dimensional, indifferent, or questionable product feature). This method is widely used in user-oriented product development and captures users’ expectations of a product and how their satisfaction is influenced by the availability of individual product features. Results Five product features were identified to increase users’ acceptance, including (1) a checklist of typical tripping hazards, (2) an emergency guideline in case of a fall, (3) description of exercises and integrated workout plans that decrease the risk of falling, (4) inclusion of a continuous workout program, and (5) cost coverage by

  6. Skin Cancer: Biology, Risk Factors & Treatment

    Science.gov (United States)

    ... turn Javascript on. Feature: Skin Cancer Skin Cancer: Biology, Risk Factors & Treatment Past Issues / Summer 2013 Table ... Articles Skin Cancer Can Strike Anyone / Skin Cancer: Biology, Risk Factors & Treatment / Timely Healthcare Checkup Catches Melanoma ...

  7. Indications for portal pressure measurement in chronic liver disease

    DEFF Research Database (Denmark)

    Hobolth, Lise; Bendtsen, Flemming; Møller, Søren

    2012-01-01

    Portal hypertension leads to development of serious complications such as esophageal varices, ascites, renal and cardiovascular dysfunction. The importance of the degree of portal hypertension has been substantiated within recent years. Measurement of the portal pressure is simple and safe...... and the hepatic venous pressure gradient (HVPG) independently predicts survival and development of complications such as ascites, HCC and bleeding from esophageal varices. Moreover, measurements of HVPG can be used to guide pharmacotherapy for primary and secondary prophylaxis for variceal bleeding. Assessment...... of HVPG should therefore be considered as a part of the general characterization of patients with portal hypertension in departments assessing and treating this condition....

  8. Enhancing facial features by using clear facial features

    Science.gov (United States)

    Rofoo, Fanar Fareed Hanna

    2017-09-01

    The similarity of features between individuals of same ethnicity motivated the idea of this project. The idea of this project is to extract features of clear facial image and impose them on blurred facial image of same ethnic origin as an approach to enhance a blurred facial image. A database of clear images containing 30 individuals equally divided to five different ethnicities which were Arab, African, Chines, European and Indian. Software was built to perform pre-processing on images in order to align the features of clear and blurred images. And the idea was to extract features of clear facial image or template built from clear facial images using wavelet transformation to impose them on blurred image by using reverse wavelet. The results of this approach did not come well as all the features did not align together as in most cases the eyes were aligned but the nose or mouth were not aligned. Then we decided in the next approach to deal with features separately but in the result in some cases a blocky effect was present on features due to not having close matching features. In general the available small database did not help to achieve the goal results, because of the number of available individuals. The color information and features similarity could be more investigated to achieve better results by having larger database as well as improving the process of enhancement by the availability of closer matches in each ethnicity.

  9. A novel canine model of portal vein stenosis plus thioacetamide administration-induced cirrhotic portal hypertension with hypersplenism.

    Science.gov (United States)

    Lin, Dexin; Wu, Xianbin; Ji, Xiaoke; Zhang, Qiyu; Lin, YuanWei; Chen, WeiJian; Jin, Wangxun; Deng, Liming; Chen, Yunzhi; Chen, Bicheng; Li, Jianmin

    2012-01-01

    Current large animal models that could closely resemble the typical features of cirrhotic portal hypertension in human have not been well established. Thus, we aimed to develop and describe a reliable and reproducible canine cirrhosis model of portal hypertension. A total of 30 mongrel dogs were randomly divided into four groups: 1 (control; n = 5), 2 (portal vein stenosis [PVS]; n = 5], 3 (thioacetamide [TAA]; n = 5), and 4 (PVS plus TAA; n = 15). After 4-months modeling period, liver and spleen CT perfusion, abdominal CT scans, portal hemodynamics, gastroscopy, hepatic function, blood routine, the bone marrow, liver, and spleen histology were studied. The animals in group 2 (PVS) developed extrahepatic portosystemic collateral circulation, particularly esophageal varices, without hepatic cirrhosis and portal hypertension. Animals from group 3 (TAA) presented mild cirrhosis and portal hypertension without significant symptoms of esophageal varices and hypersplenism. In contrast, animals from group 4 (PVS + TAA) showed well-developed micronodular and macronodular cirrhosis, associated with significant portal hypertension and hypersplenism. The combination of PVS and TAA represents a novel, reliable, and reproducible canine cirrhosis model of portal hypertension, which is associated with the typical characteristics of portal hypertension, including hypersplenism.

  10. Spatial features register: toward standardization of spatial features

    Science.gov (United States)

    Cascio, Janette

    1994-01-01

    As the need to share spatial data increases, more than agreement on a common format is needed to ensure that the data is meaningful to both the importer and the exporter. Effective data transfer also requires common definitions of spatial features. To achieve this, part 2 of the Spatial Data Transfer Standard (SDTS) provides a model for a spatial features data content specification and a glossary of features and attributes that fit this model. The model provides a foundation for standardizing spatial features. The glossary now contains only a limited subset of hydrographic and topographic features. For it to be useful, terms and definitions must be included for other categories, such as base cartographic, bathymetric, cadastral, cultural and demographic, geodetic, geologic, ground transportation, international boundaries, soils, vegetation, water, and wetlands, and the set of hydrographic and topographic features must be expanded. This paper will review the philosophy of the SDTS part 2 and the current plans for creating a national spatial features register as one mechanism for maintaining part 2.

  11. Effect of engineered safety features on the risk of hypothetical LMFBR accidents

    International Nuclear Information System (INIS)

    Cybulskis, P.

    1978-01-01

    The risks of hypothetical core-disruptive accidents in liquid-metal-cooled fast breeder reactors which involve meltthrough of the reactor vessel are compared for two plant designs: one design without specific provisions to accommodate such an accident and the other design with an ex-vessel core catcher and a cvity hot liner. The approach to risk analysis used is that developed in the Reactor Safety Study (WASH-1400). Since the probability of occurrence of such an event has not been evaluated, however, insight into the potential risk is gained only on a relative basis. The principal conclusions of this study are: (1) adding a core catcher--hot liner reduces the probabilty of accidents having major consequences; (2) the degree to which hot liner--core catcher systems can reduce the risk of melt-through accidents is limited by the failure probability of these systems; (3) fractional radioactive releases to the environment in the liquid-metal-cooled fast breeder reactor accidents considered are comparable to those from the light-water reactors evaluated in WASH-1400; (4) since sodium--concrete reactions are a dominant driving force during the accident, the integrity of the cavity liner is as important as the function of the core catcher; (5) there may be other accidents or paths to radioactive releases that are not affected by the addition of a hot liner--core catcher

  12. Evaluation of patients with schistosomal portal hypertension treated in a tertiary hospital Perfil dos pacientes com Esquistossomose Mansoni tratados em hospital terciário

    Directory of Open Access Journals (Sweden)

    Fábio Ferrari Makdissi

    2009-12-01

    Full Text Available BACKGROUND: Schistosomiasis is an important public health issue in more than 70 countries around the world. About 600 million people are at risk to acquire the parasite and there are 200 million infected worldwide. AIM: To evaluate the characteristics of schistosomal portal hypertension individuals who underwent previous esophageal varices bleeding treated in a tertiary hospital. METHODS: The records of 155 patients were evaluated and clinical, laboratorial, endoscopic, epidemiological features and hemorrhagic event severity were analyzed to individualize this population. RESULTS: Mean age was 37.2 years and no clinical signs of hepatic failure were observed. Serum laboratory tests to evaluate liver function were normal or slightly alter. Anemia was present in 70 %, leucopenia in 75 % and thrombocytopenia in 86 % of the patients. At endoscopic evaluation varices were classified as grade III and IV in 91.3 %; red spots were observed in 40.3 % and congestive gastropathy in 13.6 %. Patients presented a mean of 2.8 previous episodes of variceal hemorrhage and, in 75 % with hemodynamic instability. CONCLUSIONS: Patients with schistosomal portal hypertension and history of upper digestive bleeding from esophageal varices are young individuals, without either clinical or laboratorial evidence of liver dysfunction, that present high morbidity due to the severity of the acute event of bleeding.RACIONAL: Esquistossomose é importante doença na saúde pública envolvendo mais de 70 países. Cerca de 600 milhões de pessoas estão em áreas de risco para adquirir a doença e em torno de 200 milhões estão por ela infectados. OBJETIVO: Avaliar as características da hipertensão porta esquistossomótica em indivíduos que se submeteram previamente a tratamento de varizes esofágicas hemorrágicas em hospital terciário. MÉTODOS: Os prontuários de 155 pacientes foram avaliados analisando-se aspectos clínicos, laboratoriais, endoscópicos, epidemiol

  13. FEATURE SELECTION METHODS BASED ON MUTUAL INFORMATION FOR CLASSIFYING HETEROGENEOUS FEATURES

    Directory of Open Access Journals (Sweden)

    Ratri Enggar Pawening

    2016-06-01

    Full Text Available Datasets with heterogeneous features can affect feature selection results that are not appropriate because it is difficult to evaluate heterogeneous features concurrently. Feature transformation (FT is another way to handle heterogeneous features subset selection. The results of transformation from non-numerical into numerical features may produce redundancy to the original numerical features. In this paper, we propose a method to select feature subset based on mutual information (MI for classifying heterogeneous features. We use unsupervised feature transformation (UFT methods and joint mutual information maximation (JMIM methods. UFT methods is used to transform non-numerical features into numerical features. JMIM methods is used to select feature subset with a consideration of the class label. The transformed and the original features are combined entirely, then determine features subset by using JMIM methods, and classify them using support vector machine (SVM algorithm. The classification accuracy are measured for any number of selected feature subset and compared between UFT-JMIM methods and Dummy-JMIM methods. The average classification accuracy for all experiments in this study that can be achieved by UFT-JMIM methods is about 84.47% and Dummy-JMIM methods is about 84.24%. This result shows that UFT-JMIM methods can minimize information loss between transformed and original features, and select feature subset to avoid redundant and irrelevant features.

  14. The Utilization of Imaging Features in the Management of Intraductal Papillary Mucinous Neoplasms

    Directory of Open Access Journals (Sweden)

    Stefano Palmucci

    2014-01-01

    Full Text Available Intraductal papillary mucinous neoplasms (IPMNs represent a group of cystic pancreatic neoplasms with large range of clinical behaviours, ranging from low-grade dysplasia or borderline lesions to invasive carcinomas. They can be grouped into lesions originating from the main pancreatic duct, main duct IPMNs (MD-IPMNs, and lesions which arise from secondary branches of parenchyma, denominated branch-duct IPMNs (BD-IPMNs. Management of these cystic lesions is essentially based on clinical and radiological features. The latter have been very well described in the last fifteen years, with many studies published in literature showing the main radiological features of IPMNs. Currently, the goal of imaging modalities is to identify “high-risk stigmata” or “worrisome feature” in the evaluation of pancreatic cysts. Marked dilatation of the main duct (>1 cm, large size (3–5 cm, and intramural nodules have been associated with increased risk of degeneration. BD-IPMNs could be observed as microcystic or macrocystic in appearance, with or without communication with main duct. Their imaging features are frequently overlapped with cystic neoplasms. The risk of progression for secondary IPMNs is lower, and subsequently an imaging based follow-up is very often proposed for these lesions.

  15. Predictors of in-hospital mortality in a cohort of elderly Egyptian patients with acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Elsebaey, Mohamed A; Elashry, Heba; Elbedewy, Tamer A; Elhadidy, Ahmed A; Esheba, Noha E; Ezat, Sherif; Negm, Manal Saad; Abo-Amer, Yousry Esam-Eldin; Abgeegy, Mohamed El; Elsergany, Heba Fadl; Mansour, Loai; Abd-Elsalam, Sherief

    2018-04-01

    Acute upper gastrointestinal bleeding (UGIB) affects large number of elderly with high rates of morbidity and mortality. Early identification and management of the factors predicting in-hospital mortality might decrease mortality. This study was conducted to identify the causes of acute UGIB and the predictors of in-hospital mortality in elderly Egyptian patients.286 elderly patients with acute UGIB were divided into: bleeding variceal group (161 patients) and bleeding nonvariceal group (125 patients). Patients' monitoring was done during hospitalization to identify the risk factors that might predict in-hospital mortality in elderly.Variceal bleeding was the most common cause of acute UGIB in elderly Egyptian patients. In-hospital mortality rate was 8.74%. Increasing age, hemodynamic instability at presentation, co-morbidities (especially liver cirrhosis associated with other co-morbidity) and failure to control bleeding were the predictors of in-hospital mortality.Increasing age, hemodynamic instability at presentation, co-morbidities (especially liver cirrhosis associated with other co-morbidity) and failure to control bleeding should be considered when triaging those patients for immediate resuscitation, close observation, and early treatment.

  16. Research advances in computed tomography and magnetic resonance imaging findings of cirrhotic portal hypertension

    Directory of Open Access Journals (Sweden)

    YAN Fuhua

    2016-06-01

    Full Text Available Portal hypertension is the most common complication of liver cirrhosis. Noninvasive radiological examinations have important values in evaluating liver parenchyma, collateral circulation, and esophagogastric variceal bleeding in liver cirrhosis. Computed tomography (CT and magnetic resonance imaging (MRI can reflect the changes in liver morphology, the density and signals of liver parenchyma, and hemodynamics and have important values in disease diagnosis and prognostic evaluation. CT and functional MRI, such as perfusion-weighted imaging, MR elastography, and MR diffusion-weighted imaging, can provide quantitative information and can be applied in the diagnosis of hepatic fibrosis and early-stage liver cirrhosis in clinical practice. CT angiography and MR angiography, especially unenhanced MR angiography, can show the condition of the branches of portal vein, which helps to evaluate the risk of esophagogastric variceal bleeding and detect the markers for early warning. A combination of CT and MRI and evaluation of their potential in clinical application can give full play to the role of radiological examinations in the diagnosis, evaluation, and prognostic analysis of cirrhotic portal hypertension.

  17. Study on the P-wave feature time course as early predictors of paroxysmal atrial fibrillation

    International Nuclear Information System (INIS)

    Martínez, Arturo; Alcaraz, Raúl; Rieta, José J

    2012-01-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice, increasing the risk of stroke and all-cause mortality. Its mechanisms are poorly understood, thus leading to different theories and controversial interpretation of its behavior. In this respect, it is unknown why AF is self-terminating in certain individuals, which is called paroxysmal AF (PAF), and not in others. Within the context of biomedical signal analysis, predicting the onset of PAF with a reasonable advance has been a clinical challenge in recent years. By predicting arrhythmia onset, the loss of normal sinus rhythm could be addressed by means of preventive treatments, thus minimizing risks for the patients and improving their quality of life. Traditionally, the study of PAF onset has been undertaken through a variety of features characterizing P-wave spatial diversity from the standard 12-lead electrocardiogram (ECG) or from signal-averaged ECGs. However, the variability of features from the P-wave time course before PAF onset has not been exploited yet. This work introduces a new alternative to assess time diversity of the P-wave features from single-lead ECG recordings. Furthermore, the method is able to assess the risk of arrhythmia 1 h before its onset, which is a relevant advance in order to provide clinically useful PAF risk predictors. Results were in agreement with the electrophysiological changes taking place in the atria. Hence, P-wave features presented an increasing variability as PAF onset approximates, thus suggesting intermittently disturbed conduction in the atrial tissue. In addition, high PAF risk prediction accuracy, greater than 90%, has been reached in the two considered scenarios, i.e. discrimination between healthy individuals and PAF patients and between patients far from PAF and close to PAF onset. Nonetheless, more long-term studies have to be analyzed and validated in future works. (paper)

  18. A SURVEY OF URBAN PEOPLE AWARENESS ABOUT NEW INDIAN CURRENCY SECURITY FEATURES AFTER DEMONETIZATION

    OpenAIRE

    Mr. Rajeev & Mr. Dhirender

    2017-01-01

    Use of currency notes is increasing year by year and so does risk of its holders.It has become need of hour for every country to make its currency difficult to counterfeit.Security features and security printing are the only solution for this problem.Security features not only prevent duplicacyof notes but also save the poor citizens from possible financial loss.This survey work was carried out to understand the awareness level about security features in new currency notes because relevancy o...

  19. Splenic artery ligature associated with endoscopic banding for schistosomal portal hypertension.

    Science.gov (United States)

    Colaneri, Renata Potonyacz; Coelho, Fabrício Ferreira; de Cleva, Roberto; Perini, Marcos Vinícius; Herman, Paulo

    2014-11-28

    To propose a less invasive surgical treatment for schistosomal portal hypertension. Ten consecutive patients with hepatosplenic schistosomiasis and portal hypertension with a history of upper gastrointestinal hemorrhage from esophageal varices rupture were evaluated in this study. Patients were subjected to a small supraumbilical laparotomy with the ligature of the splenic artery and left gastric vein. During the procedure, direct portal vein pressure before and after the ligatures was measured. Upper gastrointestinal endoscopy was performed at the 30(th) postoperative day, when esophageal varices diameter were measured and band ligature performed. During follow-up, other endoscopic procedures were performed according to endoscopy findings. There was no intra-operative mortality and all patients had confirmed histologic diagnoses of schistosomal portal hypertension. During the immediate postoperative period, two of the ten patients had complications, one characterized by a splenic infarction, and the other by an incision hematoma. Mean hospitalization time was 4.1 d (range: 2-7 d). Pre- and post-operative liver function tests did not show any significant changes. During endoscopy thirty days after surgery, a decrease in variceal diameters was observed in seven patients. During the follow-up period (57-72 mo), endoscopic therapy was performed and seven patients had their varices eradicated. Considering the late postoperative evaluation, nine patients had a decrease in variceal diameters. A mean of 3.9 endoscopic banding sessions were performed per patient. Two patients presented bleeding recurrence at the late postoperative period, which was controlled with endoscopic banding in one patient due to variceal rupture and presented as secondary to congestive gastropathy in the other patient. Both bleeding episodes were of minor degree with no hemodynamic consequences or need for blood transfusion. Ligature of the splenic artery and left gastric vein with supraumbilical

  20. Embolia cutis medicamentosa: an unusual adverse reaction to terlipressin

    Science.gov (United States)

    Gatos-Gatopoulos, Polychronis; Kostantoudakis, Stephanos; Panayiotides, Ioannis G.; Dimitriadis, George D.; Triantafyllou, Konstantinos

    2017-01-01

    Terlipressin is a synthetic long-acting analog of vasopressin widely used to control variceal bleeding by lowering portal venous pressure. We report an unusual adverse reaction to terlipressin in a 78-year-old patient with esophageal variceal bleeding who developed skin necrosis soon after treatment initiation. Skin biopsy revealed embolia cutis medicamentosa. PMID:29118569

  1. Satisfying Product Features of a Fall Prevention Smartphone App and Potential Users' Willingness to Pay: Web-Based Survey Among Older Adults.

    Science.gov (United States)

    Rasche, Peter; Mertens, Alexander; Brandl, Christopher; Liu, Shan; Buecking, Benjamin; Bliemel, Christopher; Horst, Klemens; Weber, Christian David; Lichte, Philipp; Knobe, Matthias

    2018-03-27

    Prohibiting falls and fall-related injuries is a major challenge for health care systems worldwide, as a substantial proportion of falls occur in older adults who are previously known to be either frail or at high risk for falls. Hence, preventive measures are needed to educate and minimize the risk for falls rather than just minimize older adults' fall risk. Health apps have the potential to address this problem, as they enable users to self-assess their individual fall risk. The objective of this study was to identify product features of a fall prevention smartphone app, which increase or decrease users' satisfaction. In addition, willingness to pay (WTP) was assessed to explore how much revenue such an app could generate. A total of 96 participants completed an open self-selected Web-based survey. Participants answered various questions regarding health status, subjective and objective fall risk, and technical readiness. Seventeen predefined product features of a fall prevention smartphone app were evaluated twice: first, according to a functional (product feature is implemented in the app), and subsequently by a dysfunctional (product feature is not implemented in the app) question. On the basis of the combination of answers from these 2 questions, the product feature was assigned to a certain category (must-be, attractive, one-dimensional, indifferent, or questionable product feature). This method is widely used in user-oriented product development and captures users' expectations of a product and how their satisfaction is influenced by the availability of individual product features. Five product features were identified to increase users' acceptance, including (1) a checklist of typical tripping hazards, (2) an emergency guideline in case of a fall, (3) description of exercises and integrated workout plans that decrease the risk of falling, (4) inclusion of a continuous workout program, and (5) cost coverage by health insurer. Participants' WTP was assessed

  2. Adaptation and analysis of psychometric features of the Caregiver Risk Screen: a tool for detecting the risk of burden in family caregivers.

    Science.gov (United States)

    Martinez-Rodriguez, Silvia; Ortiz-Marqués, Nuria; Iraurgi, Ioseba; Carrasco, María; Miguel, José J

    2013-05-01

    There are a limited number of scales available in the Spanish language that can be used to detect burden among individuals who care for a dependent family member. The purpose of this work was to adapt and validate the Caregiver Risk Screen (CRS) scale developed by Guberman et al. (2001) (Guberman, N., Keefe, J., Fancey, P., Nahmiash, D. and Barylak, L. (2001). Development of Screening and Assessment Tools for Family Caregivers: Final Report. Montreal, Canada: Health Transition Fund). The sample was made up of 302 informal caregivers of dependent family members (average age 57.3 years, and 78.9% were women). Scale structure was subjected to a confirmatory factor analysis. Concurrent and convergent validity were assessed by correlation with validated questionnaires for measuring burden (Zarit Burden Inventory (ZBI)) and psychological health (SCL-90-R). The results show a high level of internal consistency (Cronbach's alpha = 0.86), suitable fit of the one-dimensional model tested via confirmatory factor analysis (GFI = 0.91; CFI = 0.91; RMSEA = 0.097), and appropriate convergent validity with similar constructs (r = 0.77 with ZBI; and r-values between 0.45 and 0.63 with SCL-90-R dimensions). The findings are promising in terms of their adaptation of the CRS to Spanish, and the results enable us to draw the conclusion that the CRS is a suitable tool for assessing and detecting strain in family caregivers. Nevertheless, new research is required that explores all the psychometric features on the scale.

  3. Partial spleen embolization reduces the risk of portal hypertension-induced upper gastrointestinal bleeding in patients not eligible for TIPS implantation.

    Science.gov (United States)

    Buechter, Matthias; Kahraman, Alisan; Manka, Paul; Gerken, Guido; Dechêne, Alexander; Canbay, Ali; Wetter, Axel; Umutlu, Lale; Theysohn, Jens M

    2017-01-01

    Upper gastrointestinal bleeding (UGIB) is a severe and life-threatening complication among patients with portal hypertension (PH). Covered transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice for patients with refractory or recurrent UGIB despite pharmacological and endoscopic therapy. In some patients, TIPS implantation is not possible due to co-morbidity or vascular disorders. Spleen embolization (SE) may be a promising alternative in this setting. We retrospectively analyzed 9 patients with PH-induced UGIB who underwent partial SE between 2012 and 2016. All patients met the following criteria: (i) upper gastrointestinal hemorrhage with primary or secondary failure of endoscopic interventions and (ii) TIPS implantation not possible. Each patient was followed for at least 6 months after embolization. Five patients (56%) suffered from cirrhotic PH, 4 patients (44%) from non-cirrhotic PH. UGIB occured in terms of refractory hemorrhage from gastric varices (3/9; 33%), hemorrhage from esophageal varices (3/9; 33%), and finally, hemorrhage from portal-hypertensive gastropathy (3/9; 33%). None of the patients treated with partial SE experienced re-bleeding episodes or required blood transfusions during a total follow-up time of 159 months, including both patients with cirrhotic- and non-cirrhotic PH. Partial SE, as a minimally invasive intervention with low procedure-associated complications, may be a valuable alternative for patients with recurrent PH-induced UGIB refractory to standard therapy.

  4. Liquidity Risk meets Economic Capital and RAROC. A framework for measuring liquidity risk in banks.

    OpenAIRE

    Loebnitz, K.

    2011-01-01

    Liquidity risk is a crucial and inherent feature of the business model of banks. While banks and regulators use sophisticated mathematical methods to measure a bank's solvency risk, they use relatively simple tools for a bank's liquidity risk such as coverage ratios, sensitivity analyses, and scenario analyses. In this thesis we present a more rigorous framework that allows us to measure a bank's liquidity risk within the standard economic capital and RAROC setting. In particular, we introduc...

  5. Different clinical features of anaphylaxis according to cause and risk factors for severe reactions.

    Science.gov (United States)

    Kim, Sang-Yoon; Kim, Min-Hye; Cho, Young-Joo

    2018-01-01

    Anaphylaxis is a life-threatening allergic reaction. Several studies reported different anaphylactic reactions according to the causative substances. However, a comparison of anaphylaxis for each cause has not been done. This study was conducted to identify common causes of anaphylaxis, characteristics of anaphylactic reaction for each cause and to analyze the factors related to the severity of the reaction. Medical records of patients who visited the emergency room of Ewha Womans University Mokdong Hospital from March 2003 to April 2016 and diagnosed with anaphylactic shock were retrospectively reviewed. We compared the clinical features of anaphylaxis according to the cause. In addition, the severity of anaphylaxis was analyzed and contributing factors for severe anaphylaxis were reviewed. A total of 199 patients with anaphylaxis were analyzed. Food was the most common cause (49.7%), followed by drug reaction (36.2%), bee venom (10.1%), and unknown cause (4.0%). Cardiovascular symptoms of syncope and hypotension were more common in drug-induced anaphylaxis. The incidence of severe anaphylaxis was the highest in anaphylaxis due to drugs (54.2%). Urticaria and other skin symptoms were significantly more common in food-induced anaphylaxis. Risk factors for severe anaphylaxis included older age, male, and drug-induced one. Epinephrine treatment of anaphylaxis was done for 69.7% and 56.9% of patients with food-induced and drug-induced anaphylaxis, respectively. More severe anaphylaxis developed with drug treatment and in males. Low rate of epinephrine prescription was also observed. Male patients with drug induced anaphylaxis should be paid more attention. Copyright © 2017 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.

  6. Identifying significant environmental features using feature recognition.

    Science.gov (United States)

    2015-10-01

    The Department of Environmental Analysis at the Kentucky Transportation Cabinet has expressed an interest in feature-recognition capability because it may help analysts identify environmentally sensitive features in the landscape, : including those r...

  7. Angio-Architectural Features of High-Grade Intracranial Dural Arteriovenous Fistulas: Correlation With Aggressive Clinical Presentation and Hemorrhagic Risk.

    Science.gov (United States)

    Della Pepa, Giuseppe Maria; Parente, Paolo; D'Argento, Francesco; Pedicelli, Alessandro; Sturiale, Carmelo Lucio; Sabatino, Giovanni; Albanese, Alessio; Puca, Alfredo; Fernandez, Eduardo; Olivi, Alessando; Marchese, Enrico

    2017-08-01

    High-grade dural arteriovenous fistulas (dAVFs) can present shunts with very different angio-architectural characteristics. Specific hemodynamic factors may affect clinical history and determine very different clinical courses. To evaluate the relationship between some venous angio-architectural features in high-grade dAVFs and clinical presentation. Specific indicators of moderate or severe venous hypertension were analyzed, such as altered configurations of the dural sinuses (by a single or a dual thrombosis), or overload of cortical vessels (restrictions of outflow, pseudophlebitic cortical vessels, and venous aneurysms). The institutional series was retrospectively reviewed (49 cases), and the pattern of venous drainage was analyzed in relationship with clinical presentation (benign/aggressive/hemorrhage). Thirty-five of 49 cases displayed cortical reflux (high-grade dAVFs). This subgroup displayed a benign presentation in 31.42% of cases, an aggressive in 31.42%, and hemorrhage in 37.14%. Our data confirm that within high-grade dAVFs, 2 distinct subpopulations exist according to severity of clinical presentation. Some indicators we examined showed correlation with aggressive nonhemorrhagic manifestations (outflow restriction and pseudophlebitic cortical vessels), while other showed a correlation with hemorrhage (dual thrombosis and venous aneurysms). Current classifications appear insufficient to identify a wide range of conditions that ultimately determine the organization of the cortical venous drainage. Intermediate degrees of venous congestion correlate better with the clinical risk than the simple definition of cortical reflux. The angiographic aspects of venous drainage presented in this study may prove useful to assess dAVF hemodynamic characteristics and identify conditions at higher clinical risk. Copyright © 2017 by the Congress of Neurological Surgeons

  8. Risk, Uncertainty and Entrepreneurship

    DEFF Research Database (Denmark)

    Koudstaal, Martin; Sloof, Randolph; Van Praag, Mirjam

    . Entrepreneurs are only found to be unique in their lower degree of loss aversion, and not in their risk or ambiguity aversion. This combination of results might be explained by our finding that perceived risk attitude is not only correlated to risk aversion but also to loss aversion. Overall, we therefore...... entrepreneurs to managers – a suitable comparison group – and employees (n = 2288). The results indicate that entrepreneurs perceive themselves as less risk averse than managers and employees, in line with common wisdom. However, when using experimental incentivized measures, the differences are subtler...... suggest using a broader definition of risk that captures this unique feature of entrepreneurs; their willingness to risk losses....

  9. Bivariate value-at-risk

    Directory of Open Access Journals (Sweden)

    Giuseppe Arbia

    2007-10-01

    Full Text Available In this paper we extend the concept of Value-at-risk (VaR to bivariate return distributions in order to obtain measures of the market risk of an asset taking into account additional features linked to downside risk exposure. We first present a general definition of risk as the probability of an adverse event over a random distribution and we then introduce a measure of market risk (b-VaR that admits the traditional b of an asset in portfolio management as a special case when asset returns are normally distributed. Empirical evidences are provided by using Italian stock market data.

  10. Modeling the risk: innovative approaches to understand and quantify the risk of severe FB injury.

    Science.gov (United States)

    Berchialla, Paola; Bellussi, Luisa; Castella, Annalisa; Snidero, Silvia; Passali, Desiderio; Gregori, Dario

    2012-05-14

    The entry of a small item into the respiratory or digestive tract is still one of the leading causes of injuries in children up to 14 years old. The aim of the paper is to provide a quantitative risk assessment analysis for identifying consumer product features which contribute to increase the risk of sustaining a severe injury. Data on foreign body injuries were collected in 28 European countries and one Pakistani hospital. A total of 7296 cases were classified according to ICD-9CM 931-935. Information about injuries included age and gender of the injured child, circumstances of the accident and foreign body features. A classification tree was set up in order to analyze the impact of the item features like volume shape and rigidity on the severity of the injury. Males are involved in severe injuries more often than females. Most severe injuries when the foreign body is localized in the ears were due to objects with volume lesser than 49 mm(3). Volume cut-off is slightly higher for foreign bodies that have been found in the nose (55 mm(3)). Objects with conforming rigidity pose children to higher risk of severe injury. The presence and supervision of an adult is crucial in reducing the risk for severe injuries both in pharynx and laryhnx and in mouth. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  11. Clinical features and risk factors of acute hepatitis E with severe jaundice.

    Science.gov (United States)

    Xu, Bin; Yu, Hai-Bin; Hui, Wei; He, Jia-Li; Wei, Lin-Lin; Wang, Zheng; Guo, Xin-Hui

    2012-12-28

    To compares the clinical features of patients infected with hepatitis E virus (HEV) with or without severe jaundice. In addition, the risk factors for HEV infection with severe jaundice were investigated. We enrolled 235 patients with HEV into a cross-sectional study using multi-stage sampling to select the study group. Patients with possible acute hepatitis E showing elevated liver enzyme levels were screened for HEV infection using serologic and molecular tools.HEV infection was documented by HEV antibodies and by the detection of HEV-RNA in serum. We used χ(2) analysis, Fisher's exact test, and Student's t test where appropriate in this study. Significant predictors in the univariate analysis were then included in a forward, stepwise multiple logistic regression model. No significant differences in symptoms, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, or hepatitis B virus surface antigen between the two groups were observed. HEV infected patients with severe jaundice had significantly lower peak serum levels of γ-glutamyl-transpeptidase (GGT) (median: 170.31 U/L vs 237.96 U/L, P = 0.007), significantly lower ALB levels (33.84 g/L vs 36.89 g/L, P = 0.000), significantly lower acetylcholine esterase (CHE) levels (4500.93 U/L vs 5815.28 U/L, P = 0.000) and significantly higher total bile acid (TBA) levels (275.56 μmol/L vs 147.03 μmol/L, P = 0.000) than those without severe jaundice. The median of the lowest point time tended to be lower in patients with severe jaundice (81.64% vs 96.12%, P = 0.000). HEV infected patients with severe jaundice had a significantly higher viral load (median: 134 vs 112, P = 0.025) than those without severe jaundice. HEV infected patients with severe jaundice showed a trend toward longer median hospital stay (38.17 d vs 18.36 d, P = 0.073). Multivariate logistic regression indicated that there were significant differences in age, sex, viral load, GGT, albumin, TBA, CHE, prothrombin index, alcohol

  12. On how to understand and acknowledge risk

    International Nuclear Information System (INIS)

    Amundrud, Øystein; Aven, Terje

    2015-01-01

    In Norway two concepts in risk assessment and management – risikoforståelse and risikoerkjennelse – have recently been given much attention, particularly in the oil and gas industry and in societal safety and security contexts. The former concept corresponds quite well to ‘risk understanding’ but the latter does not have an exact counterpart in English – the best term seems to be ‘risk acknowledgement’. The discourse related to these two concepts has given us new general insights concerning the risk concept and its practical use, and the purpose of the present paper is to point to and discuss the main observations made. A main conclusion of the paper is that justified beliefs – what we refer to as knowledge – and the processes of generating these beliefs is an essential feature of both these concepts. - Highlights: • We examine two concepts – ‘risk understanding’ and ‘risk acknowledgement’. • Justified beliefs (knowledge) is an essential feature of both concepts. • Risk assessment is to a large extent about gaining ‘risk understanding’. • ‘Risk acknowledgement’ is of special importance in cases with deep uncertainties

  13. Voice Disorder Classification Based on Multitaper Mel Frequency Cepstral Coefficients Features

    Directory of Open Access Journals (Sweden)

    Ömer Eskidere

    2015-01-01

    Full Text Available The Mel Frequency Cepstral Coefficients (MFCCs are widely used in order to extract essential information from a voice signal and became a popular feature extractor used in audio processing. However, MFCC features are usually calculated from a single window (taper characterized by large variance. This study shows investigations on reducing variance for the classification of two different voice qualities (normal voice and disordered voice using multitaper MFCC features. We also compare their performance by newly proposed windowing techniques and conventional single-taper technique. The results demonstrate that adapted weighted Thomson multitaper method could distinguish between normal voice and disordered voice better than the results done by the conventional single-taper (Hamming window technique and two newly proposed windowing methods. The multitaper MFCC features may be helpful in identifying voices at risk for a real pathology that has to be proven later.

  14. Management of reticular veins and telangiectases.

    Science.gov (United States)

    Smith, Philip Coleridge

    2015-11-01

    To review the literature related to the management of reticular varices and telangiectases of the lower limbs to provide guidance on the treatment of these veins. Very few randomised clinical trials are available in this field. A European Guideline has been published on the treatment of reticular varices and telangiectases, which is largely based on the opinion of experts. Older accounts written by individual phlebologists contain extensive advice from their own practice, which is valuable in identifying effective methods of sclerotherapy. All accounts indicate that a history should be taken combined with a clinical and ultrasound examination to establish the full extent of the venous disease. Sclerotherapy is commenced by injecting the larger veins first of all, usually the reticular varices. Later in the same session or in subsequent sessions, telangiectases can be treated by direct injection. Following treatment, the application of class 2 compression stockings for a period of up to three weeks is beneficial but not used universally by all phlebologists. Further sessions can follow at intervals of 2-8 weeks in which small residual veins are treated. Resistant veins can be managed by ultrasound-guided injection of underlying perforating veins and varices. Other treatments including RF diathermy and laser ablation of telangiectases have very limited efficacy in this condition. Sclerotherapy, when used with the correct technique, is the most effective method for the management of reticular varices and telangiectases. © The Author(s) 2015.

  15. Trashepatic left gastric vein embolization in the treatment of recurrent hemorrhaging in patients with schistosomiasis previously submitted to non-derivative surgery

    Directory of Open Access Journals (Sweden)

    Paulo Fernandes Saad

    2012-12-01

    Full Text Available CONTEXT: Non-derivative surgical techniques are the treatment of choice for the control of upper digestive tract hemorrhages after schistosomotic portal hypertension. However, recurrent hemorrhaging due to gastroesophagic varices is frequent. OBJECTIVE: To evaluate the outcome of treatment based on embolization of the left gastric vein to control the reoccurrence of hemorrhages caused by gastroesophagic varices in patients with schistosomiasis previously submitted to non-derivative surgery. METHODS: Rates of reoccurrence of hemorrhages and the qualitative and quantitative reduction of gastroesophagic varices in patients undergoing transhepatic embolization of the left gastric vein between December 1999 and January 2009 were studied based on medical charts and follow-up reports. RESULTS: Seven patients with a mean age of 39.3 years underwent percutaneous transhepatic embolization of the left gastric vein. The mean time between azigoportal disconnections employed in combination with splenectomy and the percutaneous approach was 8.4 ± 7.3 years, and the number of episodes of digestive hemorrhaging ranged from 1 to 7 years. No episodes of reoccurrence of hemorrhaging were found during a follow-up period which ranged from 6 months to 7 years. Endoscopic postembolization studies revealed reductions in gastroesophagic varices in all patients compared to preembolization endoscopy. CONCLUSIONS: Percutaneous transhepatic embolization of the left gastric vein in patients with schistosomiasis previously submitted to surgery resulted in a decrease in gastroesophagic varices and was shown to be effective in controlling hemorrhage reoccurrence.

  16. Clinical results of the transjugular intrahepatic portosystemic shunt

    Energy Technology Data Exchange (ETDEWEB)

    Park, Auh Whan; Sim, Jae In; Ryeom, Hun Kyu; Kim, Yong Joo [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    1994-04-15

    To evaluate the clinical results of transjugular intrahepatic portosystemic shunt(TIPS) for the control of variceal bleeding. TIPS creation was attempted in 23 patients with endoscopically confirmed variceal bleeding. Most patients had multiple episodes of bleeding in the past and have been treated with multiple endoscopic sclerotherapies. Pre-and post-procedural hepatic and portal vein pressures were measured. After creation of TIPS patients were followed up at regular intervals. TIPS has been successfully accomplished in 22 of 23 patients using Wallstent(n = 21) and Strecker stent(n = 1). Immediate bleeding control was achieved in all patients with shunt creation. No procedure-related complication was noted. Portal vein pressure was reduced from 30.7 {+-} 5.8 mmHg to 20.8 {+-} 4.7 mmHg. The mean pressure gradient of portosystemic shunt dropped from 22.8 {+-} 6.0 prior to TIPS to 12.2 {+-} 4.1 immediately after. During the follow-up period (6-556 days, mean; 10 months), seven patients died; progressive hepatic failure (n 4), variceal rebleeding (n = 2), and respiratory failure(n = 1). Hepatic encephalopathy after TIPS was noted in 7 patients(31.8%). Variceal rebleeding occurred in 3 patients(13.6%). The remaining 15 patients have survived an average of 11 months. This results suggest that TIPS is a safe and effective method for lowering portal pressure and controlling variceal bleeding. Furthermore if these initial results are encouraged by further long-term observation, TIPS could replace endoscopic and risky surgical intervention.

  17. Analytical Features: A Knowledge-Based Approach to Audio Feature Generation

    Directory of Open Access Journals (Sweden)

    Pachet François

    2009-01-01

    Full Text Available We present a feature generation system designed to create audio features for supervised classification tasks. The main contribution to feature generation studies is the notion of analytical features (AFs, a construct designed to support the representation of knowledge about audio signal processing. We describe the most important aspects of AFs, in particular their dimensional type system, on which are based pattern-based random generators, heuristics, and rewriting rules. We show how AFs generalize or improve previous approaches used in feature generation. We report on several projects using AFs for difficult audio classification tasks, demonstrating their advantage over standard audio features. More generally, we propose analytical features as a paradigm to bring raw signals into the world of symbolic computation.

  18. New Hybrid Features Selection Method: A Case Study on Websites Phishing

    Directory of Open Access Journals (Sweden)

    Khairan D. Rajab

    2017-01-01

    Full Text Available Phishing is one of the serious web threats that involves mimicking authenticated websites to deceive users in order to obtain their financial information. Phishing has caused financial damage to the different online stakeholders. It is massive in the magnitude of hundreds of millions; hence it is essential to minimize this risk. Classifying websites into “phishy” and legitimate types is a primary task in data mining that security experts and decision makers are hoping to improve particularly with respect to the detection rate and reliability of the results. One way to ensure the reliability of the results and to enhance performance is to identify a set of related features early on so the data dimensionality reduces and irrelevant features are discarded. To increase reliability of preprocessing, this article proposes a new feature selection method that combines the scores of multiple known methods to minimize discrepancies in feature selection results. The proposed method has been applied to the problem of website phishing classification to show its pros and cons in identifying relevant features. Results against a security dataset reveal that the proposed preprocessing method was able to derive new features datasets which when mined generate high competitive classifiers with reference to detection rate when compared to results obtained from other features selection methods.

  19. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

    DEFF Research Database (Denmark)

    Nicolaides, Andrew N; Kakkos, Stavros K; Kyriacou, Efthyvoulos

    2010-01-01

    The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis.......The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis....

  20. Healthcare-associated Pneumonia: Clinical Features and Retrospective Analysis Over 10 Years.

    Science.gov (United States)

    Qi, Fei; Zhang, Guo-Xin; She, Dan-Yang; Liang, Zhi-Xin; Wang, Ren-Tao; Yang, Zhen; Chen, Liang-An; Cui, Jun-Chang

    2015-10-20

    Healthcare-associated pneumonia (HCAP) is associated with drug-resistant pathogens and high mortality, and there is no clear evidence that this is due to inappropriate antibiotic therapy. This study was to elucidate the clinical features, pathogens, therapy, and outcomes of HCAP, and to clarify the risk factors for drug-resistant pathogens and prognosis. Retrospective observational study among hospitalized patients with HCAP over 10 years. The primary outcome was 30-day all-cause hospital mortality after admission. Demographics (age, gender, clinical features, and comorbidities), dates of admission, discharge and/or death, hospitalization costs, microbiological results, chest imaging studies, and CURB-65 were analyzed. Antibiotics, admission to Intensive Care Unit (ICU), mechanical ventilation, and pneumonia prognosis were recorded. Patients were dichotomized based on CURB-65 (low- vs. high-risk). Among 612 patients (mean age of 70.7 years), 88.4% had at least one comorbidity. Commonly detected pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa, and coagulase-negative staphylococci. Initial monotherapy with β-lactam antibiotics was the most common initial therapy (50%). Mean age, length of stay, hospitalization expenses, ICU admission, mechanical ventilation use, malignancies, and detection rate for P. aeruginosa, and Staphylococcus aureus were higher in the high-risk group compared with the low-risk group. CURB-65 ≥3, malignancies, and mechanical ventilation were associated with an increased mortality. Logistic regression analysis showed that cerebrovascular diseases and being bedridden were independent risk factors for HCAP. Initial treatment of HCAP with broad-spectrum antibiotics could be an appropriate approach. CURB-65 ≥3, malignancies, and mechanical ventilation may result in an increased mortality.