WorldWideScience

Sample records for understanding gi bleeding

  1. Reliability measures in managing GI bleeding.

    Science.gov (United States)

    Sonnenberg, Amnon

    2012-06-01

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

  2. Coffee grounds emesis: not just an upper GI bleed.

    Science.gov (United States)

    Bou-Abdallah, Jad Z; Murthy, Uma K; Mehta, Nilish; Prasad, Heramba N; Kaul, Vivek

    2012-07-01

    Acute upper gastrointestinal (UGI) bleeding manifests as hematemesis, melena, or hematochezia. Initial management is identical, irrespective of nasogastric (NG) aspirate results. Current practice includes early upper endoscopy. Significantly fewer high-risk bleeding lesions are found on endoscopy in patients with coffee grounds vs. bloody NG aspirates. We present a case series to illustrate that patients with coffee grounds emesis (CGE) often have other unsuspected illnesses that may be overlooked due to preoccupation with the GI bleed. A retrospective chart review of a series of 6 patients presenting with CGE and admitted for upper GI bleeding was performed. All 6 patients were hemodynamically stable at admission. NG lavage showed coffee grounds that cleared easily. None of the patients required blood transfusions during their hospital stay. Endoscopy in 3 of 6 patients failed to find any significant UGI lesions or stigmata of recent bleed. Although patients were admitted for UGI bleeding, the more significant associated diagnoses included acute myocardial infarction, urosepsis, small bowel obstruction, bilateral pulmonary emboli, and acute renal failure. Hemodynamically stable patients presenting with coffee grounds NG aspirate and no fall in hemoglobin/hematocrit should be evaluated for other non-GI bleeding-related conditions even as the GI bleed is being managed. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Upper GI bleeding among neonates admitted to Mulago Hospital ...

    African Journals Online (AJOL)

    These conditions are risk factors for upper GI bleeding (UGIB) in sick neonates. UGIB is associated with poor neonatal outcomes such as prolonged hospitalisation and poor weight gain. The magnitude of UGIB and its contribution to neonatal morbidity has not been described in most low income countries. Objective: To ...

  4. Giant gastric lipoma presenting as GI bleed: Enucleation or Resection?

    Directory of Open Access Journals (Sweden)

    Salah Termos

    Full Text Available Introduction: Gastric lipomas are unusual benign lesions and account for less than 1% of all tumours of the stomach and 5% of all gastrointestinal lipomas (Thompson et al.2003; Fernandez et al. 1983 [1,2]. Although predominantly asymptomatic and indolent; they may present with gastric outlet obstruction and upper gastrointestinal (GI bleeding owing to size and ulceration. Only a few cases have been reported, presenting large in size with massive GI bleeding (Alcalde Escribano et al. 1989; Johnson et al. 1981 [3,4]. Presentation of case: We report the case of a 62-year-old gentleman who presented to the emergency department with massive upper GI hemorrhage. He was initially resuscitated and stabilized. Later gastroscopy showed a large submucosal tumour (Fig. 1. Biopsy revealed adipose tissue. Computed tomography (CT scan of the abdomen and pelvis showed a huge well defined oval soft tissue lesion measuring about 16 × 8 × 8 cm. The mass noted a homogenous fat density arising from the posterior wall of stomach with no extramural infiltration (Fig. 2. The tumour was completely enucleated through an explorative gastrotomy incision (Fig. 4. Discussion and conclusion: Massive bleeding secondary to a giant gastric lipoma is a rare finding of a rare disease. The majority of cases in the literature result in major gastric resection. Familiarity with its radiological findings and a high index of suspicion can lead to proper diagnosis in the acute setting. If malignancy is carefully ruled out, stomach preserving surgery is an optimal treatment option. Keywords: Case report, Lipoma, Gastric lipoma, G I bleeding, Enucleation, Gastric resection

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

    Directory of Open Access Journals (Sweden)

    Prashanth Prabakaran

    2013-01-01

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

  6. A case of atrio-esophageal fistula masquerading as upper GI bleed.

    Science.gov (United States)

    Rali, Parth; Rali, Mayur; Malik, Khalid

    2017-01-01

    We represent a fatal case of atrio esophageal fistula that presented as upper GI bleed. The case was complicated by rapidly progressing multi organ dysfunction syndrome and eventual death. This was an iatrogenic complication of an elective procedure.

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

    Directory of Open Access Journals (Sweden)

    Tatiana Bihun, BA

    2017-11-01

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

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

    LENUS (Irish Health Repository)

    Murphy, SF

    2018-02-01

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

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

    Science.gov (United States)

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

    2017-08-01

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

  10. Studies of GI bleeding with scintigraphy and the influence of vasopressin

    International Nuclear Information System (INIS)

    Alavi, A.; McLean, G.K.

    1981-01-01

    The management of patients with gastrointestinal (GI) bleeding depends on accurate localization of the site of hemorrhage. Endoscopy and arteriography, although successful in achieving this goal in the majority of patients, are invasive and have other shortcomings. The introduction of the 99mTc-sulfur colloid technique has greatly simplified the evaluation and management of these patients. This test is useful in detecting and localizing the bleeding site in the lower GI tract. Scintigraphy is now used as the initial study of choice in patients with rectal bleeding. Advances made in angiography and nuclear medicine techniques also have resulted in improved management of patients. Conservative approaches succeed in controlling hemorrhage in most patients. Vasopressin is the most widely tested agent and has been adopted by many as the preferred preparation for this purpose. Before the introduction of the 99mTc-sulfur colloid technique, angiography was used to monitor the effectiveness of this drug, whether administered intravenously or intraarterially. With the use of scintigraphy and intravenous administration of vasopressin, these patients now can be managed noninvasively. Only when the intravenous Pitressin infusion fails to stop hemorrhage, is the intraarterial approach considered. Surgery is used as a last resort when these measures fail to stop the bleeding

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

    International Nuclear Information System (INIS)

    Jaeckle, T.; Stuber, G.; Hoffmann, M.H.K.; Jeltsch, M.; Schmitz, B.L.; Aschoff, A.J.

    2008-01-01

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

  12. In-111-oxine red cells for imaging of intermittent G.I. bleeding sites

    International Nuclear Information System (INIS)

    Marcus, C.S.; Angulo, M.C.; Salk, R.D.; Essex, C.E.

    1985-01-01

    Sequential daily abdominal imaging was performed for up to 7 days in 11 patients with intermittent G.I. bleeding after the intravenous administration of lmCi autologous In-111-oxine labeled RBC's. The bleeding sites were identified in 3 patients. The causes were colon carcinoma, diverticulitis, and eroding distal aortic aneutysm. In addition to the imaging information, the authors have obtained preliminary biodistribution and kinetic data on the In-RBC's. Distribution to liver, spleen, and bone marrow was approximately 40%, 40%, and 20%, respectively. (This does not include the quantity of In-111 in the blood pool, which is very high initially and declines with time.) The survival of circulating In-RBC's is described by the equation: Surviving fraction=0.26e/sup -0.0021t/+0.74e/sup -0.00083t/ The halflives of the fast and slow components (x-bar+-x-bar) are 33.4 +- 1.6 hours and 35.0 +- 1.25 days, respectively. The In-oxine label is less stable than Cr-51 but more stable than Tc-99m. At 24 hours, Cr-RBC/In-RBC survival is 1.11 and Cr-RBC/Tc-RBC survival is 1.23. This imaging procedure is quite useful in selected patients

  13. Endoscopic hemoclipping for upper GI bleeding due to Mallory-Weiss syndrome.

    Science.gov (United States)

    Yamaguchi, Y; Yamato, T; Katsumi, N; Morozumi, K; Abe, T; Ishida, H; Takahashi, S

    2001-04-01

    Endoscopic hemoclipping is known to be highly effective as hemostatic treatment for upper gastrointestinal bleeding. However, the efficacy and safety of hemoclipping for Mallory-Weiss syndrome (MWS) have not been reported. Thus, the aim of the present study was to assess prospectively the usefulness of endoscopic hemoclipping for MWS bleeding. This study was conducted from January 1994 to August 1999. Hemoclipping was performed when active bleeding (spurting, streaming or oozing), visible vessels or fresh adhesive clots were found on endoscopic examination. Patients who did not have any of these findings were conservatively treated. Follow-up endoscopy was performed within 24 hours, after 5 days and between 1 and 2 months after the procedure. MWS was diagnosed in a total of 58 patients during the study. Hemoclipping was performed in 26 patients and was technically successful in all cases. The average number of hemoclips used was 2.8 +/- 1.6 (range 1 to 8). The number of hemoclips required for hemostasis depended on the nature of the bleeding. No complications, recurrent bleeding, or deaths resulted. Follow-up endoscopy showed no evidence of hemoclip-induced tissue injury and no impairment of Mallory-Weiss tears. Endoscopic hemoclipping provided an effective and safe modality for obtaining hemostasis when bleeding is due to MWS.

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

    Directory of Open Access Journals (Sweden)

    Haas I

    2008-01-01

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

  15. Gastrointestinal (GI) Bleeding

    Science.gov (United States)

    ... Kidney Disease Weight Management Liver Disease Urologic Diseases Endocrine Diseases Diet & Nutrition Blood Diseases Diagnostic Tests La información ... Kidney Disease Weight Management Liver Disease Urologic Diseases Endocrine Diseases Diet & Nutrition Blood Diseases Diagnostic Tests La información ...

  16. Is non-Helicobacter pylori, non-NSAID peptic ulcer a common cause of upper GI bleeding? A prospective study of 977 patients.

    Science.gov (United States)

    Chan, H L; Wu, J C; Chan, F K; Choi, C L; Ching, J Y; Lee, Y T; Leung, W K; Lau, J Y; Chung, S C; Sung, J J

    2001-04-01

    Non-Helicobacter pylori, non-NSAID ulcer is relatively common in Western countries. Whether it is a significant problem in the Orient is unclear. The aim of this study was to investigate the incidence of non-H pylori, non-NSAID ulcers presenting with GI bleeding. A prospective study was done of 1675 consecutive patients presenting with upper GI bleeding over a period of 12 months. Upper endoscopy was performed with biopsy specimens taken from the antrum and body of the stomach for a biopsy urease test (BUT) and histology for detection of H pylori. Exposure to nonsteroidal anti-inflammatory drugs (NSAID) or aspirin within 4 weeks of hospitalization was carefully scrutinized. A 6-week course of treatment with an H2-receptor antagonist was prescribed for patients who did not use an NSAID and had a negative BUT result. Follow-up endoscopy was performed to confirm H pylori status with a BUT and histology. Positive histology at either initial or follow-up endoscopy was used as the standard for diagnosing H pylori infection. Among 977 patients who were found to have ulcer bleeding, 434 (44%) had exposure to aspirin or an NSAID. Of the 543 non-NSAID users, 431 (79.4%) had a positive BUT and 112 (20.6%) were BUT negative on initial endoscopy. Eighty-nine of 112 patients who were NSAID negative, BUT negative returned for follow-up endoscopy. Forty-nine of 89 (55.1%) were found to have a positive BUT and positive histology at follow-up endoscopy. Only 40 of 977 (4.1%) patients admitted with ulcer bleeding were confirmed to have non-H pylori, non-NSAID ulcers. Non-H pylori, non-NSAID bleeding ulcer is uncommon. A negative BUT is unreliable for exclusion of H pylori infection during the acute phase of ulcer bleeding.

  17. Bleeding

    Science.gov (United States)

    ... with problems in the joints, or gastrointestinal or urogenital tracts. Symptoms You may have symptoms such as: Blood ... may be internal bleeding or shock. Signs of infection develop, including increased pain, redness, swelling, yellow or ...

  18. Exsanguinating upper GI bleeds due to Unusual Arteriovenous Malformation (AVM of stomach and spleen: a case report

    Directory of Open Access Journals (Sweden)

    Baqai Mohammad

    2009-05-01

    Full Text Available Abstract Background In this paper we are reporting one case of exsanguinating upper gastrointestinal tract (GIT bleed requiring massive blood transfusion and immediate life saving surgery. Case presentation A 30 years old female, 12 weeks pregnant was referred to our hospital from the earth-quake affected area of Kashmir with history of upper abdominal pain, haematemesis and melaena for one week. After stabilizing the patient, upper gastro-intestinal endoscopy was performed. It revealed gastric ulcer just distal to the gastro-esophageal junction on the lesser curvature. Biopsy from the ulcer edge led to profuse spurting of the blood and patient went into state of shock. Immediate resuscitation led to rebleeding and recurrence of post haemorrahagic shock. Conclusion The patient was immediately explored and total gastrectectomy with splenectomy concluded as life saving procedure. A review of literature was conducted to make this report possible.

  19. The lucid interval associated with epidural bleeding: evolving understanding.

    Science.gov (United States)

    Ganz, Jeremy C

    2013-04-01

    The aim of this paper was to elucidate the evolution of our understanding of the term "lucid interval." A number of texts were reviewed to assess their suitability for analysis. The primary requirement was that the text contain detailed descriptions of a series of patients. Details of the clinical course, the findings and timing of surgery, and, when relevant, the time of death and postmortem findings were required. Books written by Henri-François Le Dran, Percival Pott, and James Hill fulfilled these criteria. Surgical findings included the presence and type of fractures, changes in the bone, separation of periosteum, malodorous or purulent material, tense brain, and hematoma. Postmortem findings supplemented and/or complemented the surgical findings. The courses of the patients were then tabulated, and the correlation between different clinical and operative findings was thereby determined. Our understanding of a lucid interval began in the early 18th century with the work of Henri-François Le Dran and Percival Pott in London. They did not, however, demonstrate an interval without symptoms between trauma and deterioration in patients with epidural hematomas (EDHs). The interval they described was longer than usually expected with EDHs and occurred exclusively in patients who had a posttraumatic infection. In 1751, James Hill, from Dumfries, Scotland, described the first hematoma-related lucid interval in a patient with a subdural hematoma. The first case of a lucid interval associated with an EDH was described by John Abernethy. In the 19th century, Jonathan Hutchinson and Walter Jacobson described the interval as it is known today, in cases of EDH. The most recent work on the topic came from studies in Cincinnati and Oslo, where it was demonstrated that bleeding can separate dura mater and that hemorrhage into the epidural space can be shunted out via the veins. This shunting could delay the accumulation of a hematoma and thus the rise in intracranial pressure

  20. [Gastrointestinal bleeding].

    Science.gov (United States)

    Lanas, Ángel

    2015-09-01

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

  1. Gastrointestinal bleeding following NSAID ingestion in children

    African Journals Online (AJOL)

    presented with GI bleeding following ingestion of NSAID. Two female children ... users of NSAIDs [2]. The risk and the magnitude of. NSAID-induced GI injury in children are uncertain. Here, we report two cases of GI bleeding in children following NSAID use. .... Nonsteroidal anti-inflammatory drug induced gastrointestinal ...

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

    Directory of Open Access Journals (Sweden)

    M. Keese

    2007-10-01

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

  3. Current understanding of bleeding with ibrutinib use: a systematic review and meta-analysis.

    Science.gov (United States)

    Caron, François; Leong, Darryl P; Hillis, Christopher; Fraser, Graeme; Siegal, Deborah

    2017-05-09

    Ibrutinib therapy was associated with an increased risk of bleeding in previous trials. In this systematic review and meta-analysis of published trials including patients treated with ibrutinib, the relative risk (95% confidence interval [CI]) of overall bleeding was significantly higher in ibrutinib recipients (2.72 [1.62-6.58]), but major bleeding did not show a significant difference (1.66 [0.96-2.85]). The incidences (95% CI) of major bleeding and any bleeding were 3.0 (2.3-3.7) and 20.8 (19.1-22.1) per 100 patient-years, respectively. This analysis is limited by reporting bias from variable ascertainment of bleeding and lack of allocation concealment in some studies and differing exposures between groups, leading to potential overestimation of event rates in the ibrutinib group.

  4. GI endoscopes.

    Science.gov (United States)

    Varadarajulu, Shyam; Banerjee, Subhas; Barth, Bradley A; Desilets, David J; Kaul, Vivek; Kethu, Sripathi R; Pedrosa, Marcos C; Pfau, Patrick R; Tokar, Jeffrey L; Wang, Amy; Wong Kee Song, Louis-Michel; Rodriguez, Sarah A

    2011-07-01

    The ASGE Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, performing a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the Committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through September 2010 for articles related to endoscopy by using the key words "gastroscope," "colonoscope," "echoendoscope," "duodenoscope," "choledochoscope," "ultraslim endoscope," "variable stiffness colonoscope," and "wide-angle colonoscope." Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment. Copyright © 2011 American Society for Gastrointestinal

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

    International Nuclear Information System (INIS)

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

    2001-01-01

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

  6. Low hemoglobin levels are associated with upper gastrointestinal bleeding.

    Science.gov (United States)

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

    2016-09-01

    Upper gastrointestinal (GI) bleeding can be fatal. Blood test variables were reviewed in search of threshold values to detect the presence of occult upper GI bleeding. The records of 1,023 patients who underwent endoscopy at the National Hospital Organization Shimoshizu Hospital from October 2014, to September 2015, were retrospectively reviewed. Of those, 95 had upper GI bleeding. One-way analysis of variance was applied to blood test variables comparing patients with and without upper GI bleeding. Logistic regression analysis was applied to detect the association of blood test parameters with upper GI bleeding, and receiver-operator characteristics were applied to establish threshold values. White blood cell count (WBC), platelet (Plt) count, and blood urea nitrogen (BUN) levels were higher, and hemoglobin (Hb) and albumin (Alb) levels were lower in patients with upper GI bleeding. Logistic regression analysis showed that low Hb was significantly associated with upper GI bleeding and a Hb value of 10.8 g/dl was established as the threshold for the diagnosis. In patients with upper GI bleeding, WBC, Plt count, and BUN levels were higher and Hb and Alb levels were reduced. Hb at 10.8 g/dl was established as a threshold value to detect upper GI bleeding.

  7. Upper GI Endoscopy

    Science.gov (United States)

    ... Upper GI Series Urinary Tract Imaging Urodynamic Testing Virtual Colonoscopy Upper GI Endoscopy What is upper gastrointestinal ( ... endoscopy, a doctor obtains biopsies by passing an instrument through the endoscope to obtain a small piece ...

  8. Upper Gastrointestinal (GI) Series

    Science.gov (United States)

    ... standard barium upper GI series, which uses only barium a double-contrast upper GI series, which uses both air and ... evenly coat your upper GI tract with the barium. If you are having a double-contrast study, you will swallow gas-forming crystals that ...

  9. Lower GI Series

    Science.gov (United States)

    ... single-contrast lower GI series, which uses only barium during the test • a double-contrast or air-contrast lower GI series, which uses ... to evenly coat the large intestine with the barium • if the health care provider has ordered a double-contrast lower GI series, the radiologist will inject air ...

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

    Science.gov (United States)

    Pingleton, S K; Hadzima, S K

    1983-01-01

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

  11. Building a taxonomy of GI knowledge

    DEFF Research Database (Denmark)

    Arleth, Mette

    2004-01-01

    of this project is to investigate how and how well non-professional users actually understand GI. For that purpose a taxonomy of GI knowledge is built, drawing on Bloom`s taxonomy. The elements of this taxonomy are described after a presentation of the main research question of the study, the applications chosen...

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

    Science.gov (United States)

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

    2005-12-21

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

  13. Scintigraphic demonstration of acute gastrointestinal bleeding caused by gallbladder carcinoma eroding the colon

    Energy Technology Data Exchange (ETDEWEB)

    Czerniak, A.; Zwas, S.T.; Rabau, M.Y.; Avigad, I.; Borag, B.; Wolfstein, I.

    1985-08-01

    Massive lower gastrointestinal (GI) bleeding caused by gallbladder carcinoma eroding into the colonic wall was demonstrated accurately by Tc-99m RBCs. In addition, retrograde bleeding into the gallbladder was also identified while arteriography did not show contrast extravasation. This case supports the use of Tc-99m RBCs over Tc-99m sulfur colloid for more accurate localization of lower GI bleeding.

  14. Vaginal Bleeding

    Science.gov (United States)

    ... Gynecology. ACOG Practice Bulletin No. 128. Diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstetrics and Gynecology. 2012;120:197. Kaunitz AM. Approach to abnormal uterine bleeding in nonpregnant reproductive-age women. http://www.uptodate. ...

  15. Gastrointestinal Bleeding Secondary to Calciphylaxis

    Science.gov (United States)

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

    2015-01-01

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

  16. A long-Segmental Vascular Malformation in the Small Bowel Presenting With Gastrointestinal Bleeding in a Preschool-Aged Child

    International Nuclear Information System (INIS)

    Lee, Yeoun Joo; Hwang, Jae-Yeon; Cho, Yong Hoon; Kim, Yong-Woo; Kim, Tae Un; Shin, Dong Hoon

    2016-01-01

    Gastrointestinal (GI) bleeding in pediatric patients has several causes. Vascular malformation of the small bowel is a rare disease leading to pediatric GI bleeding. To our knowledge, few reports describe ultrasound and computed tomography findings of venous malformations involving the small bowel. We present a case of long-segmental and circumferential vascular malformation that led to GI bleeding in a pre-school aged child, focusing on the radiologic findings. Although vascular malformation including of the GI tract is rare in children, it should be considered when GI bleeding occurs in pediatric patients

  17. Perimenopausal Bleeding and Bleeding After Menopause

    Science.gov (United States)

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

  18. Preface Gi4DM

    NARCIS (Netherlands)

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

    2015-01-01

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

  19. Incidence, predictors, and outcomes of gastrointestinal bleeding in patients on dual antiplatelet therapy with aspirin and clopidogrel.

    Science.gov (United States)

    Alli, Oluseun; Smith, Colin; Hoffman, Micah; Amanullah, Steven; Katz, Philip; Amanullah, Aman M

    2011-01-01

    The benefits of dual antiplatelet therapy are counterbalanced by the increased incidence of gastrointestinal (GI) complications. The aim of this study was to determine the frequency of GI bleeding, identify the predictors associated with the increased bleeding, and determine the short-term and long-term outcomes. This was an observational, case-control cohort study carried out at the Albert Einstein Medical Center. It included all patients who had a drug-eluting stent implanted between May 2003 and April 2007. A total of 1852 patients were identified; of these 50 patients were readmitted for a GI bleed. A control group of 202 patients who did not have any evidence of GI bleeding were compared with the original group. All data were expressed as mean±SD. The baseline clinical characteristics between the 2 groups were compared using the t test and the Fisher exact test. Multivariate analysis was used to determine the predictors of GI bleeding. The rate of GI bleeding was 2.7%. The mean age in the group with GI bleeding was 70.9±12.2 years, whereas in the group without GI bleeding it was 66.5±12.8 years (P<0.05). The majority of the patients presented with melena (40%). Gastritis and gastric ulcers were the most common findings seen in 49% of the patients on endoscopy. On multivariate logistic regression analysis, a history of GI bleeding was the most important independent predictor of future GI bleeding (P<0.001), whereas the use of statins was found to be protective (95% confidence interval, 0.13-0.48; P<0.001) against future GI bleeding. The 30-day mortality rate in the GI bleeding and control groups was 3.7% and 0%, respectively (P<0.01), whereas in the corresponding 1 year the mortality rate was 18.9% and 0%, respectively (P<0.001). The rate of GI bleeding in patients on dual antiplatelet therapy is low. Earlier history of GI bleeding is the most significant multivariate predictor of future GI bleeding whereas statins seemed to be protective. Patients with GI

  20. Rectal Bleeding

    Science.gov (United States)

    ... rectal bleeding and any signs of shock: Rapid, shallow breathing Dizziness or lightheadedness after standing up Blurred ... shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. © 1998-2018 Mayo ...

  1. Lower GI Series (Barium Enema)

    Science.gov (United States)

    ... single-contrast lower GI series, which uses only barium a double-contrast or air-contrast lower GI series, which uses ... to evenly coat the large intestine with the barium. If you are having a double-contrast lower GI series, the radiologist will inject air ...

  2. Octreotide for the Management of Gastrointestinal Bleeding in a Patient with a HeartWare Left Ventricular Assist Device

    Directory of Open Access Journals (Sweden)

    Geetanjali Dang

    2014-01-01

    Full Text Available HeartWare is a third generation left ventricular assist device (LVAD, widely used for the management of advanced heart failure patients. These devices are frequently associated with a significant risk of gastrointestinal (GI bleeding. The data for the management of patients with LVAD presenting with GI bleeding is limited. We describe a 56-year-old lady, recipient of a HeartWare device, who experienced recurrent GI bleeding and was successfully managed with subcutaneous (SC formulations of octreotide.

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

    Science.gov (United States)

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

    2015-12-01

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

  4. [Gastrointestinal lesions and characteristics of acute gastrointestinal bleeding in acenocoumarol-treated patients].

    Science.gov (United States)

    Nantes, Óscar; Zozaya, José Manuel; Montes, Ramón; Hermida, José

    2014-01-01

    In the last few years, the number of anticoagulated patients has significantly increased and, as a consequence, so have hemorrhagic complications due to this therapy. We analyzed gastrointestinal (GI) bleeding because it is the most frequent type of major bleeding in these patients, and we hypothesized that they would have lesions responsible for GI bleeding regardless of the intensity of anticoagulation, although excessively anticoagulated patients would have more serious hemorrhages. To study the characteristics of anticoagulated patients with GI bleeding and the relationship between the degree of anticoagulation and a finding of causative lesions and bleeding severity. We prospectively studied 96 patients, all anticoagulated with acenocoumarol and consecutively admitted to hospital between 01/01/2003 and 09/30/2005 because of acute GI bleeding. We excluded patients with severe liver disease, as well as nine patients with incomplete details. The incidence of GI bleeding requiring hospitalization was 19.6 cases/100,000 inhabitants-year. In 90% of patients, we found a causative (85% of upper GI bleeding and 50% of lower GI bleeding) or potentially causative lesion, and 30% of them required endoscopic treatment, without differences depending on the intensity of anticoagulation. No relationship was found between the type of lesions observed and the degree of anticoagulation in these patients. Patients who received more intense anticoagulation therapy had more severe hemorrhages (23% of patients with an INR ≥4 had a life-threatening bleed versus only 4% of patients with INR <4). We found an incidence of 20 severe GI bleeding episodes in anticoagulated patients per 100,000 inhabitants-year, with no difference in localization or in the frequency of causative lesions depending on the intensity of anticoagulation. Patients receiving more intense anticoagulation had more severe GI bleeding episodes. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights

  5. CT enteroclysis in the diagnosis of obscure gastrointestinal bleeding: initial results

    International Nuclear Information System (INIS)

    Jain, T.P.; Gulati, M.S.; Makharia, G.K.; Bandhu, S.; Garg, P.K.

    2007-01-01

    Aim: To evaluate the usefulness of computed tomography (CT) enteroclysis in patients with obscure gastrointestinal (GI) bleeding. Materials and methods: In a prospective study, CT enteroclysis was performed in 21 patients (median age 50 years; range 13-71 years) with obscure GI bleeding in which the source of the bleeding could not be detected despite the patient having undergone both upper GI endoscopic and colonoscopic examinations. The entire abdomen and pelvis was examined in the arterial and venous phases using multisection CT after distending the small intestine with 2 l of 0.5% methylcellulose as a neutral enteral contrast medium and the administration of 150 ml intravenous contrast medium. Results: Adequate distension of the small intestine was achieved in 20 of the 21 (95.2%) patients. Potential causes of GI bleeding were identified in 10 of the 21 (47.6%) patients using CT enteroclysis. The cause of the bleeding could be detected nine of 14 (64.3%) patients with overt, obscure GI bleeding. However, for patients with occult, obscure GI bleeding, the cause of the bleeding was identified in only one of the seven (14.3%) patients. The lesions identified by CT enteroclysis included small bowel tumours (n = 2), small bowel intussusceptions (n = 2), intestinal tuberculosis (n = 2), and vascular lesions (n = 3). All vascular lesions were seen equally well in both the arterial and venous phases. Conclusions: The success rate in detection of the cause of bleeding using CT enteroclysis was 47.6% in patients with obscure GI bleeding. The diagnostic yield was higher in patients with overt, obscure GI bleeding than in those with occult obscure GI bleeding

  6. CT enteroclysis in the diagnosis of obscure gastrointestinal bleeding: initial results

    Energy Technology Data Exchange (ETDEWEB)

    Jain, T.P. [Department ofRadiodiagnosis, All India Institute of Medical Sciences, New Delhi (India); Gulati, M.S. [Department of Imaging, Queen Elizabeth Hospital NHS Trust, London (United Kingdom); Makharia, G.K. [Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi (India)]. E-mail: govindmakharia@aiims.ac.in; Bandhu, S. [Department ofRadiodiagnosis, All India Institute of Medical Sciences, New Delhi (India); Garg, P.K. [Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi (India)

    2007-07-15

    Aim: To evaluate the usefulness of computed tomography (CT) enteroclysis in patients with obscure gastrointestinal (GI) bleeding. Materials and methods: In a prospective study, CT enteroclysis was performed in 21 patients (median age 50 years; range 13-71 years) with obscure GI bleeding in which the source of the bleeding could not be detected despite the patient having undergone both upper GI endoscopic and colonoscopic examinations. The entire abdomen and pelvis was examined in the arterial and venous phases using multisection CT after distending the small intestine with 2 l of 0.5% methylcellulose as a neutral enteral contrast medium and the administration of 150 ml intravenous contrast medium. Results: Adequate distension of the small intestine was achieved in 20 of the 21 (95.2%) patients. Potential causes of GI bleeding were identified in 10 of the 21 (47.6%) patients using CT enteroclysis. The cause of the bleeding could be detected nine of 14 (64.3%) patients with overt, obscure GI bleeding. However, for patients with occult, obscure GI bleeding, the cause of the bleeding was identified in only one of the seven (14.3%) patients. The lesions identified by CT enteroclysis included small bowel tumours (n = 2), small bowel intussusceptions (n = 2), intestinal tuberculosis (n = 2), and vascular lesions (n = 3). All vascular lesions were seen equally well in both the arterial and venous phases. Conclusions: The success rate in detection of the cause of bleeding using CT enteroclysis was 47.6% in patients with obscure GI bleeding. The diagnostic yield was higher in patients with overt, obscure GI bleeding than in those with occult obscure GI bleeding.

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

    International Nuclear Information System (INIS)

    Kim, Jin Hyoung; Shin, Ji Hoon; Yoon, Hyun Ki; Chae, Eun Young; Myung, Seung Jae; Ko, Gi Young; Gwon, Dong Il; Sung, Kyu Bo

    2009-01-01

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

  8. Bleeding Disorders

    Science.gov (United States)

    ... study of intranasal desmopressin and oral tranexamic acid . British Journal of Haematology; 145(2): 212-220. Bleeding ... Ayisyen Français Polski Português Italiano Deutsch 日本語 فارسی English A federal government website managed by the Office ...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-03-15

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

  10. [Gastrointestinal bleeding, NSAIDs, aspirin and anticoagulants].

    Science.gov (United States)

    Lanas, Ángel

    2014-09-01

    The studies presented at the recent American Congress of Gastroenterology in the field of non-variceal upper gastrointestinal bleeding (associated or not to NSAIDs or ASA use) have not been numerous but interesting. The key findings are: a) rabeprazole, the only PPI that had few studies in this field, is effective in the prevention of gastric ulcers; b) famotidine could also be effective in the prevention of complications by AAS; c) the new competitive inhibitors of the acid potassium pump are effective (as much as PPIs) on the recurrence of peptic ulcers by ASA; d) early endoscop (<8 h) in non-variceal upper gastrointestinal bleeding seems to offer no better results than those made in the first 24 h; e) endoscopic therapy in Forrest 1a ulcers does not obliterate the bleeding artery in 30% of cases and is the cause of bleeding recurrence; f) alternative therapies with glue or clotting products are being increasingly used in endoscopic therapy of gastrointestinal bleeding; g) liberal administration of blood in the GI bleeding is associated with poor prognosis; h) lesions of the small intestine are frequent cause of gastrointestinal bleeding when upper endoscopy shows no positive stigmata; and i) capsule endoscopy studies have high performance in gastrointestinal bleeding of obscure origin, if performed early in the first two days after the beginning of the bleeding episode. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  11. Abnormal uterine bleeding

    Science.gov (United States)

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

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

    Science.gov (United States)

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

    2014-03-06

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

  13. Left ventricular assist devices and gastrointestinal bleeding: a narrative review of case reports and case series.

    Science.gov (United States)

    Islam, Sameer; Cevik, Cihan; Madonna, Rosalinda; Frandah, Wesam; Islam, Ebtesam; Islam, Sherazad; Nugent, Kenneth

    2013-04-01

    The use of left ventricular assist devices (LVADs) has become a state-of-the-art therapy for advanced cardiac heart failure; however, multiple reports in the literature describe an increased risk for gastrointestinal (GI) bleeding in these patients. We characterized this association by reviewing recent studies on this topic. GI bleeding occurs frequently in patients with LVADs, especially with devices with nonpulsatile flow patterns. We performed a comprehensive literature review to identify articles that reported GI bleeding in patients with LVADs. Databases used included PubMed, EMBASE, Scopus, Web of Knowledge, and Ovid. Baseline and outcome data were then ed from these reports. We identified 10 case reports and 22 case series with 1543 patients. The mean age was 54.2 years. Most patients had nonpulsatile LVADs (1316, 85.3%). Three hundred and seventeen patients (20.5%) developed GI bleeding; this occurred more frequently in patients with nonpulsatile LVADs. Multiple procedures were performed without complications but often did not identify a definite bleeding site. Suspect lesions occurred throughout the GI tract but were more frequent in the upper GI tract. Many patients had arteriovenous malformations. All patients received medical therapy. None of the patients had their LVAD replaced. The use of anticoagulation did not appear to predispose these patients to more GI bleeding episodes. Patients with LVADs have frequent GI bleeds, especially from arteriovenous malformations, which can occur throughout the GI tract. Most diagnostic and therapeutic interventions can be used safely in these patients. The pathogenesis of the GI bleeding in these patients may involve the use of anticoagulant medications, the formation of arteriovenous malformations, loss of von Willebrand factor activity, and mucosal ischemia. © 2013 Wiley Periodicals, Inc.

  14. Lower gastrointestinal bleeding: role of 64-row computed tomographic angiography in diagnosis and therapeutic planning.

    Science.gov (United States)

    Ren, Jian-Zhuang; Zhang, Meng-Fan; Rong, Ai-Mei; Fang, Xiang-Jie; Zhang, Kai; Huang, Guo-Hao; Chen, Peng-Fei; Wang, Zhao-Yang; Duan, Xu-Hua; Han, Xin-Wei; Liu, Yan-Jie

    2015-04-07

    To determine the value of computed tomographic angiography (CTA) for diagnosis and therapeutic planning in lower gastrointestinal (GI) bleeding. Sixty-three consecutive patients with acute lower GI bleeding underwent CTA before endovascular or surgical treatment. CTA was used to determine whether the lower GI bleeding was suitable for endovascular treatment, surgical resection, or conservative treatment in each patient. Treatment planning with CTA was compared with actual treatment decisions or endovascular or surgical treatment that had been carried out in each patient based on CTA findings. 64-row CTA detected active extravasation of contrast material in 57 patients and six patients had no demonstrable active bleeding, resulting in an accuracy of 90.5% in the detection of acute GI bleeding (57 of 63). In three of the six patients with no demonstrable active bleeding, active lower GI bleeding recurred within one week after CTA, and angiography revealed acute bleeding. The overall location-based accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the detection of GI bleeding by 64-row CTA were 98.8% (249 of 252), 95.0% (57 of 60), 100% (192 of 192), 100% (57 of 57), and 98.5% (192 of 195), respectively. Treatment planning was correctly established on the basis of 64-row CTA with an accuracy, sensitivity, specificity, PPV and NPV of 98.4% (248 of 252), 93.3% (56 of 60), 100% (192 of 192), 100% (56 of 56), and 97.5% (192 of 196), respectively, in a location-based evaluation. 64-row CTA is safe and effective in making decisions regarding treatment, without performing digital subtraction angiography or surgery, in the majority of patients with lower GI bleeding.

  15. Endoscopic management of bleeding peptic ulcers

    International Nuclear Information System (INIS)

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

    2001-01-01

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

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

    International Nuclear Information System (INIS)

    Alavi, A.

    1988-01-01

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

  17. Small Bowel Bleeding

    Science.gov (United States)

    ... Hepatitis C Inflammatory Bowel Disease Irritable Bowel Syndrome Obesity Digestive Health Topics Abdominal Pain Syndrome Belching, Bloating, and Flatulence Common GI Symptoms Gastroparesis See All Topics (A-Z) GI Procedures ...

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

    Science.gov (United States)

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

    2009-01-01

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

  19. Causes of lower gastrointestinal bleeding on colonoscopy

    International Nuclear Information System (INIS)

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

    2017-01-01

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

  20. A novel approach to assess the spontaneous gastrointestinal bleeding risk of antithrombotic agents using Apc(min/+) mice.

    Science.gov (United States)

    Wei, Huijun; Shang, Jin; Keohane, CarolAnn; Wang, Min; Li, Qiu; Ni, Weihua; O'Neill, Kim; Chintala, Madhu

    2014-06-01

    Assessment of the bleeding risk of antithrombotic agents is usually performed in healthy animals with some form of vascular injury to peripheral organs to induce bleeding. However, bleeding observed in patients with currently marketed antithrombotic drugs is typically spontaneous in nature such as intracranial haemorrhage (ICH) and gastrointestinal (GI) bleeding, which happens most frequently on top of preexisting pathologies such as GI ulcerations and polyps. Apc(min/+) mice are reported to develop multiple adenomas through the entire intestinal tract and display progressive anaemia.In this study, we evaluated the potential utility of Apc(min/+) mice as a model for assessing spontaneous GI bleeding with antithrombotic agents. Apc(min/+) mice exhibited progressive blood loss starting at the age of nine weeks. Despite the increase in bleeding, Apc(min/+) mice were in a hypercoagulable state and displayed an age-dependent increase in thrombin generation and circulating fibrinogen as well as a significant decrease in clotting times. We evaluated the effect of warfarin, dabigatran etexilate, apixaban and clopidogrel in this model by administering them in diet or in the drinking water to mice for 1-4 weeks. All of these marketed drugs significantly increased GI bleeding in Apc(min/+) mice, but not in wild-type mice. Although different exposure profiles of these antithrombotic agents make it challenging to compare the bleeding risk of compounds, our results indicate that the Apc(min/+) mouse may be a sensitive preclinical model for assessing the spontaneous GI bleeding risk of novel antithrombotic agents.

  1. Risk stratification in upper gastrointestinal bleeding; prediction, prevention and prognosis

    NARCIS (Netherlands)

    de Groot, N.L.

    2013-01-01

    In the first part of this thesis we developed a novel prediction score for predicting upper gastrointestinal (GI) bleeding in both NSAID and low-dose aspirin users. Both for NSAIDs and low-dose aspirin use risk scores were developed by identifying the five most dominant predictors. The risk of upper

  2. Endoscopic Evaluation of Upper and Lower Gastro‑Intestinal Bleeding

    African Journals Online (AJOL)

    Injection sclerotherapy was successfully performed in the hemorrhoids and a case of gastric varices. The mortality recorded was 0%. Conclusion: Endoscopy is vital in the diagnosis and treatment of GIB. Gastritis and Haemorrhoid are the most common causes of upper and lower GI bleeding respectively, in our environment.

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

    Directory of Open Access Journals (Sweden)

    Shou-jiang Tang

    2004-01-01

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

  4. Gastrointestinal bleeding and subsequent risk of thromboembolic events during support with a left ventricular assist device.

    Science.gov (United States)

    Stulak, John M; Lee, Dustin; Haft, Jonathon W; Romano, Matthew A; Cowger, Jennifer A; Park, Soon J; Aaronson, Keith D; Pagani, Francis D

    2014-01-01

    Modern left ventricular assist devices (LVAD) require anti-coagulation (AC) with warfarin and anti-platelet therapy to prevent thromboembolic complications in patients. Gastrointestinal bleeding (GI) is a significant adverse event in these patients and treatment typically requires reduction or elimination of AC or anti-platelet therapy. It is not known whether alterations in AC to treat GI bleeding influence subsequent risk of thromboembolic (TE) events during LVAD support. Between July 2003 and September 2011, 389 patients (308 male) underwent implantation of a continuous-flow LVAD at the University of Michigan Health System and the Mayo Clinic. Median age at implant was 60 years (range 18 to 79 years). Outcomes were analyzed for the association of GI bleeding events and subsequent TE events, defined as stroke, transient ischemic attack, hemolysis or suspected or confirmed pump thrombosis. Median survival was 10 months (maximum 7.2 years, total 439 patient-years). TE events occurring within the first 30 days were not counted. Overall survival and freedom from an outcome event were assessed using the Kaplan-Meier method. Associations between GI bleeding and subsequent TE events and survival impact were analyzed as time-dependent covariates. One hundred ninety-nine GI bleeding episodes occurred in 116 of 389 patients (30%) for an event rate of 0.45 GI bleed/patient-year of support. One hundred thirty-eight TE events occurred in 97 of 389 patients (25%) for an event rate of 0.31 TE event/patient-year of support. Median time from LVAD implant to first GI bleed was 5 months (range 1 to 116 months) and to first TE event was 6 months (range 1 to 29 months). For patients who had a TE event after GI bleed, the median interval was 5 months (range 0.5 to 25 months). TE events were 7.4-fold more likely in patients who had a prior GI bleed (range 4.9- to 11.1-fold) (p cause of this relationship is unknown, it suggests that a reduction in anti-coagulation and anti

  5. Primary evaluation of 99mTc-RBC imaging for the diagnosis of lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Zhang Songhai

    1995-01-01

    99m Tc-RBC gastrointestinal (GI) scintigraphy was performed in 10 patients with lower GI bleeding which was confirmed by operation later. The results suggested that 99m Tc-RBC imaging was an effective method for the diagnosis of intestinal hemorrhage, especially the small intestine. However, there was some difficulty in accurately localizing the bleeding site due to the movement of the blood containing labelled RBC from original bleeding site to lower portion during intestinal peristalsis and also displacement of the moving colon. Therefore it is necessary to completely explore the intestine carefully and awareness of the possibility of biliary hemorrhage

  6. A Mysterious Cause of Gastrointestinal Bleeding Disguising Itself as Diverticulosis and Peptic Ulcer Disease: A Review of Diagnostic Modalities for Aortoenteric Fistula

    Directory of Open Access Journals (Sweden)

    Viplove Senadhi

    2010-11-01

    Full Text Available An 81-year-old male with a history of hypertension, hyperlipidemia, smoking, and peptic ulcer disease (PUD presented with 2 episodes of maroon stools for 3 days and was found to be orthostatic. His PUD was thought to have accounted for a previous upper gastrointestinal (GI bleed. A colonoscopy revealed 3 polyps and a few diverticuli throughout the colon that were considered to be the source of the bleeding. Two months later, the patient had massive lower GI bleeding and developed hypovolemic shock with a positive bleeding scan in the splenic flexure; however, angiography was negative. A repeat colonoscopy revealed transverse/descending colon diverticular disease and the patient was scheduled for a left hemicolectomy for presumed diverticular bleeding. Intraoperatively, an aortoenteric (AE fistula secondary to an aorto-bi-iliac bypass graft placed during an abdominal aortic aneurysm (AAA repair 14 years prior was discovered and was found to be the source of the bleeding. The patient had an AE fistula repair and did well postoperatively without further bleeding. AE fistulas can present with either upper GI or lower GI bleeding, and are universally deadly if left untreated. AE fistulas often present with a herald bleed before life-threatening bleeding. A careful history should always be elicited in patients with risk factors of AAAs such as hypertension, hyperlipidemia and a history of smoking. Strong clinical suspicion in the setting of a scrupulous patient history is the most important factor that allows for the diagnosis of an AE fistula. There are numerous diagnostic modalities for AE fistula, but there is not one specific test that universally diagnoses AE fistulas. Nuclear medicine scans and angiography should not be completely relied on for the diagnosis of AE fistulas or other lower GI bleeds for that manner. Although the conventional paradigm for evaluating lower GI bleeds incorporates nuclear medicine scans and angiography, there is

  7. An Unusual Case of Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Kristin N. Fiorino

    2011-01-01

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

  8. An unusual case of gastrointestinal bleeding.

    Science.gov (United States)

    Fiorino, Kristin N; Lestini, Brian; Nichols, Kim E; Anupindi, Sudha A; Maqbool, Asim

    2011-01-01

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

  9. An Unusual Case of Gastrointestinal Bleeding

    Science.gov (United States)

    Fiorino, Kristin N.; Lestini, Brian; Nichols, Kim E.; Anupindi, Sudha A.; Maqbool, Asim

    2011-01-01

    A 10-year-old boy presented with a 3-day history of worsening abdominal pain, fever, emesis and melena. Abdominal ultrasound revealed a right upper quadrant mass that was confirmed by computed tomography angiogram (CTA), which showed an 8 cm well-defined retroperitoneal vascular mass. 123Iodine metaiodobenzylguanidine (123MIBG) scan indicated uptake only in the abdominal mass. Subsequent biopsy revealed a paraganglioma that was treated with chemotherapy. This case represents an unusual presentation of a paraganglioma associated with gastrointestinal (GI) bleeding and highlights the utility of CTA and 123MIBG in evaluation and treatment. PMID:22606522

  10. Detection of small colon bleeding in wireless capsule endoscopy videos.

    Science.gov (United States)

    Usman, Muhammad Arslan; Satrya, G B; Usman, Muhammad Rehan; Shin, Soo Young

    2016-12-01

    In the recent years, wireless capsule endoscopy (WCE) technology has played a very important role in diagnosing diseases within the gastro intestinal (GI) tract of human beings. The WCE device captures images of the GI tract of patient with a certain frame rate. Physicians examine these images in order to find abnormalities in the GI tract. This examination process is very time consuming and hectic for the physician as a WCE device captures around 60,000 images on the average. At present, there are no standards defined for the WCE image classification. Computer aided methods help reducing the burden on the physicians by automatically detecting the abnormalities in the GI tract such as small colon bleeding. In this paper, a pixel based approach to detect bleeding regions in the WCE videos by using a support vector classifier is proposed. Threshold analysis in HSV color space is performed to compute the features for training an optimal support vector machine. The HSV features of the WCE images are fed to the trained support vector classifier for classification. Also, our method includes image enhancement and edge removal in WCE images, which is done prior to classification, for robust results. The method offers high sensitivity, specificity and accuracy in terms of correctly classifying images that contain bleeding regions as compared to another contemporary method. A detailed experimental analysis is also provided for the purpose of method evaluation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Beliefs About GI Medications and Adherence to Pharmacotherapy in Functional GI Disorder Outpatients

    Science.gov (United States)

    Cassell, Benjamin; Gyawali, C. Prakash; Kushnir, Vladimir M.; Gott, Britt M.; Nix, Billy D.; Sayuk, Gregory S.

    2016-01-01

    OBJECTIVES Pharmacotherapy is a mainstay in functional gastrointestinal (GI) disorder (FGID) management, but little is known about patient attitudes toward medication regimens. Understanding patient concerns and adherence to pharmacotherapy is particularly important for off-label medication use (e.g., anti-depressants) in FGID. METHODS Consecutive tertiary GI outpatients completed the Beliefs About Medications questionnaire (BMQ). Subjects were categorized as FGID and structural GI disease (SGID) using clinician diagnoses and Rome criteria; GI-specific medications and doses were recorded, and adherence to medication regimens was determined by patient self-report. BMQ domains (overuse, harm, necessity, and concern) were compared between FGID and SGID, with an interest in how these beliefs affected medication adherence. Psychiatric measures (depression, anxiety, and somatization) were assessed to gauge their influence on medication beliefs. RESULTS A total of 536 subjects (mean age 54.7±0.7 years, range 22–100 years; n=406, 75.7% female) were enrolled over a 5.5-year interval: 341 (63.6%) with FGID (IBS, 64.8%; functional dyspepsia, 51.0%, ≥2 FGIDs, 38.7%) and 142 (26.5%) with SGID (IBD, 28.9%; GERD, 23.2%). PPIs (n=231, 47.8%), tricyclic antidepressants (TCAs) (n=167, 34.6%), and anxiolytics (n=122, 25.3%) were common medications prescribed. FGID and SGID were similar across all BMQ domains (P>0.05 for overuse, harm, necessity, and concern). SGID subjects had higher necessity-concern framework (NCF) scores compared with FGID subjects ( P=0.043). FGID medication adherence correlated negatively with concerns about medication harm (r=−0.24, P<0.001) and overuse (r=−0.15, P=0.001), whereas higher NCF differences predicted medication compliance (P=0.006). Medication concern and overuse scores correlated with psychiatric comorbidity among FGID subjects (P<0.03 for each). FGID patients prescribed TCAs (n=142, 41.6%) expressed a greater medication necessity (17.4

  12. Application of endoscopic hemoclips for nonvariceal bleeding in the upper gastrointestinal tract

    Science.gov (United States)

    Guo, Shi-Bin; Gong, Ai-Xia; Leng, Jing; Ma, Jing; Ge, Lin-Mei

    2009-01-01

    AIM: To investigate acute nonvariceal bleeding in the upper gastrointestinal (GI) tract and evaluate the effects of endoscopic hemoclipping. METHODS: Sixty-eight cases of acute nonvariceal bleeding in the upper GI tract were given endoscopic treatment with hemoclip application. Clinical data, endoscopic findings, and the effects of the therapy were evaluated. RESULTS: The 68 cases (male:female = 42:26, age from 9 to 70 years, average 54.4) presented with hematemesis in 26 cases (38.2%), melena in nine cases (13.3%), and both in 33 cases (48.5%). The causes of the bleeding included gastric ulcer (29 cases), duodenal ulcer (11 cases), Dieulafoy’s lesion (11 cases), Mallory-Weiss syndrome (six cases), post-operative (three cases), post-polypectomy bleeding (five cases), and post-sphincterotomy bleeding (three cases); 42 cases had active bleeding. The mean number of hemoclips applied was four. Permanent hemostasis was obtained by hemoclip application in 59 cases; 6 cases required emergent surgery (three cases had peptic ulcers, one had Dieulafoy’s lesion, and two were caused by sphincterotomy); three patients died (two had Dieulafoy’s lesion and one was caused by sphincterotomy); and one had recurrent bleeding with Dieulafoy’s lesion 10 mo later, but in a different location. CONCLUSION: Endoscopic hemoclip application was an effective and safe method for acute nonvariceal bleeding in the upper GI tract with satisfactory outcomes. PMID:19750577

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

    Science.gov (United States)

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

    2011-01-01

    Background Selective serotonin reuptake inhibitors (SSRIs) have been associated with upper gastrointestinal (GI) bleeding. Given their worldwide use, even small risks account for a large number of cases. This study has been conducted with carefully collected information to further investigate the relationship between SSRIs and upper GI bleeding. Methods We conducted a case-control study in hospitals in Spain and in Italy. Cases were patients aged ≥18 years with a primary diagnosis of acute upper GI bleeding diagnosed by endoscopy; three controls were matched by sex, age, date of admission (within 3 months) and hospital among patients who were admitted for elective surgery for non-painful disorders. Exposures to SSRIs, other antidepressants and other drugs were defined as any use of these drugs in the 7 days before the day on which upper gastrointestinal bleeding started (index day). Results 581 cases of upper GI bleeding and 1358 controls were considered eligible for the study; no differences in age or sex distribution were observed between cases and controls after matching. Overall, 4.0% of the cases and 3.3% of controls used an SSRI antidepressant in the week before the index day. No significant risk of upper GI bleeding was encountered for SSRI antidepressants (adjusted odds ratio, 1.06, 95% CI, 0.57–1.96) or for whichever other grouping of antidepressants. Conclusions The results of this case-control study showed no significant increase in upper GI bleeding with SSRIs and provide good evidence that the magnitude of any increase in risk is not greater than 2. PMID:21625637

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

    Directory of Open Access Journals (Sweden)

    Alfonso Carvajal

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

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

    Science.gov (United States)

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

    2011-01-01

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

  16. Advances in gastrointestinal bleeding.

    Science.gov (United States)

    Lanas, Ángel

    2016-09-01

    The main innovations of the latest meeting of the Gastroenterological Association (2016) concerning upper gastrointestinal bleeding from the clinician's perspective can be summarised as follows: a) The Glasgow-Blatchford scale has the best accuracy in predicting the need for surgical intervention and hospital mortality; b) Prognostic scales for non-variceal upper gastrointestinal bleeding are also useful for lower gastrointestinal bleeding; c) Preliminary data suggest that treatment with hemospray does not seem to be superior to current standard treatment in controlling active peptic ulcer bleeding; d) Either famotidine or a proton pump inhibitor may be effective in preventing haemorrhagic recurrence in patients taking aspirin, but this finding needs to be confirmed in further studies; e) There was confirmation of the need to re-introduce antiplatelet therapy as early as possible in patients with antiplatelet-associated gastrointestinal bleeding in order to prevent cardiovascular mortality; f) Routine clinical practice suggests that gastrointestinal or cardiovascular complications with celecoxib or traditional NSAIDs are very low; g) Dabigatran is associated with an increased incidence of gastrointestinal bleeding compared with apixaban or warfarin. At least half of the episodes are located in the lower gastrointestinal tract; h) Implant devices for external ventricular circulatory support are associated with early gastrointestinal bleeding in up to one third of patients; the bleeding is often secondary to arteriovenous malformations. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  17. Bleeding esophageal varices

    Science.gov (United States)

    ... amount of bleeding, the only symptom may be dark or black streaks in the stools. If larger amounts of bleeding occur, symptoms ... exam which may show: Bloody or black stool (in a rectal exam) Low ... the use of a camera on a flexible tube to examine the esophagus ...

  18. Piroxicam-β-cyclodextrin: a GI safer piroxicam.

    Science.gov (United States)

    Scarpignato, C

    2013-01-01

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

  19. Assessment of Postmenopausal Bleeding

    Directory of Open Access Journals (Sweden)

    Chin-Yuan Hsu

    2008-06-01

    Full Text Available Postmenopausal bleeding is bleeding that occurs 12 or more months after the last menstrual period and accounts for 5% of all gynecologic office visits. While it is not always a symptom of cancer, the exclusion of endometrial hyperplasia and carcinoma is the key issue in the evaluation of patients with postmenopausal bleeding. The primary evaluation of postmenopausal women who present with abnormal uterine bleeding includes a medical history and a pelvic examination. Investigative studies, such as a uterine biopsy, ultrasound, hysteroscopy or dilation and curettage, may be required. Treatment will depend on the cause determined. The most important point is that irregular perimenopausal or postmenopausal bleeding should not be ignored or assumed to be a normal phenomenon.

  20. Wireless capsule endoscopy: perspectives beyond gastrointestinal bleeding.

    Science.gov (United States)

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

    2014-11-14

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

  1. Anesthesia related Complications in Pediatric GI Endoscopy

    Directory of Open Access Journals (Sweden)

    A Sabzevari

    2014-04-01

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

  2. 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)

  3. Usefulness of the blood urea nitrogen/creatinine ratio in gastrointestinal bleeding.

    Science.gov (United States)

    Ernst, A A; Haynes, M L; Nick, T G; Weiss, S J

    1999-01-01

    This study was conducted to evaluate the blood urea nitrogen/creatinine (BUN/Cr) ratio for distinguishing an upper versus lower source of gastrointestinal (GI) bleeding. Charts of patients who presented to the emergency department (ED) with the diagnosis of GI bleeding from August 1995 to August 1996 were retrospectively reviewed for source of bleeding, initial BUN, Cr, BUN/Cr ratio, hematocrit (Hct), and need for transfusion. A total of 124 patients were eligible for inclusion, 71 (57%) of whom were male. A total of 63 (51%) presented with blood in stool and 53 (43%) with bloody emesis; 8 (6%) had blood in both emesis and stool. A total of 31 (25%) patients had a lower GI bleed, 88 (70%) had an upper, and 5 (4%) had both upper and lower bleeding sources. The mean BUN level was 24 mg/dL, the mean Cr level 1.03 mg/dL, and the mean BUN/Cr ratio was 24. The mean hemoglobin (Hb) level was 11.3 g/dL, the mean Hct was 32 g/dL, and 51% required transfusion. Upper GI bleeding was significantly correlated with age younger than 50 (P = .01) and male gender (P = .01; odds ratio, 3.13). Taking into account age and gender, the BUN/Cr ratio correlated significantly with an upper GI source of bleeding (P = .03), with a ratio greater than 36 having a sensitivity of 90% and a specificity of 27%. The area under the receiver operating characteristic curve using age, gender, and BUN/Cr ratio was .73 (95% confidence interval, .62 to .84).

  4. Abnormal Uterine Bleeding

    Science.gov (United States)

    ... uterine cancer isn’t the cause. Women after menopause Hormone replacement therapy is a common cause of uterine bleeding after menopause. Other causes include endometrial and uterine cancer. These ...

  5. Scintigraphic pattern of small bowel bleeding

    International Nuclear Information System (INIS)

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

    2004-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Hang; Kim, Young Hoon; Lee, Kyoung Ho; Lee, Yoon Jin; Park, Ji Hoon [Dept. of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam (Korea, Republic of)

    2015-06-15

    To investigate the diagnostic performance of computed tomography angiography (CTA) in identifying the cause of bleeding and to determine the clinical features associated with a positive test result of CTA in patients visiting emergency department with overt gastrointestinal (GI) bleeding. We included 111 consecutive patients (61 men and 50 women; mean age: 63.4 years; range: 28-89 years) who visited emergency department with overt GI bleeding. They underwent CTA as a first-line diagnostic modality from July through December 2010. Two radiologists retrospectively reviewed the CTA images and determined the presence of any definite or potential bleeding focus by consensus. An independent assessor determined the cause of bleeding based on other diagnostic studies and/or clinical follow-up. The diagnostic performance of CTA and clinical characteristics associated with positive CTA results were analyzed. To identify a definite or potential bleeding focus, the diagnostic yield of CTA was 61.3% (68 of 111). The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value were 84.8% (67 of 79), 96.9% (31 of 32), 98.5% (67 of 68), and 72.1% (31 of 43), respectively. Positive CTA results were associated with the presence of massive bleeding (p = 0.001, odds ratio: 11.506). Computed tomography angiography as a first-line diagnostic modality in patients presenting with overt GI bleeding showed a fairly high accuracy. It could identify definite or potential bleeding focus with a moderate diagnostic yield and a high PPV. CTA is particularly useful in patients with massive bleeding.

  7. Ion channelopathies in functional GI disorders

    OpenAIRE

    Beyder, Arthur; Farrugia, Gianrico

    2016-01-01

    In the gastrointestinal (GI) tract, abnormalities in secretion, absorption, motility, and sensation have been implicated in functional gastrointestinal disorders (FGIDs). Ion channels play important roles in all these GI functions. Disruptions of ion channels' ability to conduct ions can lead to diseases called ion channelopathies. Channelopathies can result from changes in ion channel biophysical function or expression due to mutations, posttranslational modification, and accessory protein m...

  8. Gastrointestinal bleeding detection in wireless capsule endoscopy images using handcrafted and CNN features.

    Science.gov (United States)

    Xiao Jia; Meng, Max Q-H

    2017-07-01

    Gastrointestinal (GI) bleeding detection plays an essential role in wireless capsule endoscopy (WCE) examination. In this paper, we present a new approach for WCE bleeding detection that combines handcrafted (HC) features and convolutional neural network (CNN) features. Compared with our previous work, a smaller-scale CNN architecture is constructed to lower the computational cost. In experiments, we show that the proposed strategy is highly capable when training data is limited, and yields comparable or better results than the latest methods.

  9. Acute pancreatitis associated left-sided portal hypertension with severe gastrointestinal bleeding treated by transcatheter splenic artery embolization: a case report and literature review.

    Science.gov (United States)

    Li, Zhi-yu; Li, Bin; Wu, Yu-lian; Xie, Qiu-ping

    2013-06-01

    Left-sided portal hypertension (LSPH) followed by acute pancreatitis is a rare condition with most patients being asymptomatic. In cases where gastrointestinal (GI) bleeding is present, however, the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment. A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this article. The patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography (CT) scan and CT-angiography. After embolization, the bleeding stopped and stabilized for the entire follow-up period without any severe complications. In conclusion, embolization of the splenic artery is a simple, safe, and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.

  10. 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.

  11. Ion channelopathies in functional GI disorders.

    Science.gov (United States)

    Beyder, Arthur; Farrugia, Gianrico

    2016-10-01

    In the gastrointestinal (GI) tract, abnormalities in secretion, absorption, motility, and sensation have been implicated in functional gastrointestinal disorders (FGIDs). Ion channels play important roles in all these GI functions. Disruptions of ion channels' ability to conduct ions can lead to diseases called ion channelopathies. Channelopathies can result from changes in ion channel biophysical function or expression due to mutations, posttranslational modification, and accessory protein malfunction. Channelopathies are strongly established in the fields of cardiology and neurology, but ion channelopathies are only beginning to be recognized in gastroenterology. In this review, we describe the state of the emerging field of GI ion channelopathies. Several recent discoveries show that channelopathies result in alterations in GI motility, secretion, and sensation. In the epithelium, mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) or CFTR-associating proteins result in channelopathies with constipation or diarrhea as phenotypes. In the muscle, mutations in the SCN5A-encoded voltage-gated sodium channel Na V 1.5 are associated with irritable bowel syndrome. In the sensory nerves, channelopathies of voltage-gated sodium channels Na V 1.7 and Na V 1.9 (encoded by SCN9A, SCN11A, respectively) manifest by either GI hyper- or hyposensation. Recent advances in structural biology and ion channel biophysics, coupled with personalized medicine, have fueled rapid discoveries of novel channelopathies and direct drug targeting of specific channelopathies. In summary, the emerging field of GI ion channelopathies has significant implications for functional GI disease stratification, diagnosis, and treatment. Copyright © 2016 the American Physiological Society.

  12. HYSTEROSCOPY IN POSTMENOPAUSAL BLEEDING.

    Science.gov (United States)

    Vardhan, S; Mohan, S; Ranjan, P

    2001-04-01

    The purpose of the present study was to evaluate the utility of hysteroscopy as a diagnostic tool in cases of postmenopausal bleeding. The study includes 42 cases presenting with postmenopausal bleeding on which hysterscopy was performed using rigid hysteroscope (CIRCON) with glycine 1.5% as the distension medium. In 17 of the 42 cases positive hysteroscopic findings were noted which included 2 cases of endometrial carcinoma, 2 cases of postmenopausal endometritis, 4 cases of endometrial polyp, 5 cases of endometrial hyperplasia, 1 case of submucous myoma and 3 cases of endocervical polyp whereas normal postmenopausal endometrium was noticed in rest of the 25 cases. Endometrial biopsy was done in all these cases so that the hysteroscopic findings could be corroborated with tissue diagnosis. Hysteroscopy along with directed endometrial biopsy proved to be a useful diagnostic aid in cases of postmenopausal bleeding.

  13. GI-conf: A configuration tool for the GI-cat distributed catalog

    Science.gov (United States)

    Papeschi, F.; Boldrini, E.; Bigagli, L.; Mazzetti, P.

    2009-04-01

    In this work we present a configuration tool for the GI-cat. In an Service-Oriented Architecture (SOA) framework, GI-cat implements a distributed catalog service providing advanced capabilities, such as: caching, brokering and mediation functionalities. GI-cat applies a distributed approach, being able to distribute queries to the remote service providers of interest in an asynchronous style, and notifies the status of the queries to the caller implementing an incremental feedback mechanism. Today, GI-cat functionalities are made available through two standard catalog interfaces: the OGC CSW ISO and CSW Core Application Profiles. However, two other interfaces are under testing: the CIM and the EO Extension Packages of the CSW ebRIM Application Profile. GI-cat is able to interface a multiplicity of discovery and access services serving heterogeneous Earth and Space Sciences resources. They include international standards like the OGC Web Services -i.e. OGC CSW, WCS, WFS and WMS, as well as interoperability arrangements (i.e. community standards) such as: UNIDATA THREDDS/OPeNDAP, SeaDataNet CDI (Common Data Index), GBIF (Global Biodiversity Information Facility) services, and SibESS-C infrastructure services. GI-conf implements user-friendly configuration tool for GI-cat. This is a GUI application that employs a visual and very simple approach to configure both the GI-cat publishing and distribution capabilities, in a dynamic way. The tool allows to set one or more GI-cat configurations. Each configuration consists of: a) the catalog standards interfaces published by GI-cat; b) the resources (i.e. services/servers) to be accessed and mediated -i.e. federated. Simple icons are used for interfaces and resources, implementing a user-friendly visual approach. The main GI-conf functionalities are: • Interfaces and federated resources management: user can set which interfaces must be published; besides, she/he can add a new resource, update or remove an already federated

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

    Directory of Open Access Journals (Sweden)

    Mihajlo Gjeorgjievski

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    NARCIS (Netherlands)

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

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

  17. Heavy Menstrual Bleeding

    Science.gov (United States)

    ... option. It also is used to treat endometrial cancer. After the uterus is removed, a woman can no longer get ... to stop or reduce menstrual bleeding. Endometrial Cancer: Cancer of the lining of the uterus. Endometrial Biopsy: A procedure in which a small ...

  18. Bleeding Disorders Treatment Options

    Science.gov (United States)

    ... rare bleeding disorders are usually made from human plasma and are treated to eliminate viruses like HIV and hepatitis B and C. ... concentrate (PCC) This concentrate is made from human plasma and ... (VKCFD). It is treated to eliminate viruses like HIV and hepatitis B and C. ...

  19. Multi-detector CT: review of its use in acute GI haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Anthony, S.; Milburn, S. [Department of Radiology, John Radcliffe Hospital, Oxford (United Kingdom); Uberoi, R. [Department of Radiology, John Radcliffe Hospital, Oxford (United Kingdom)], E-mail: raman.uberoi@orh.nhs.uk

    2007-10-15

    The advent of multi-section computed tomography (CT) technology allows the non-invasive assessment of the arterial tree. Using current software, it is now possible to produce high-quality, angiographic-like images that can be used to plan and guide therapeutic procedures. One such clinical situation is the assessment of patients with acute gastrointestinal (GI) haemorrhage. Multi-section CT has a number of advantages over conventional angiography in this situation. The simplicity and non-invasive nature of the technique compared with conventional angiography make CT angiography possible in situations where conventional angiography is not available. Movement artefact from respiration and peristalsis is a common problem in the interpretation of conventional angiography; this is essentially abolished with rapid acquisition times and the use of multi-planar images to remove overlying bowel loops. Cross-sectional imaging with the ability for multi-planar reconstruction allows the accurate anatomical localization of the bleeding site, as well as an assessment of the underlying pathology: this can be used to plan therapy (embolization or surgery). The aim of this paper is to review the current use of CT in the investigation of patients with GI haemorrhage, illustrated with images from our Institution. For patients in whom GI endoscopy has failed to establish a diagnosis, we propose multi-section CT angiography as the initial imaging investigation in acute GI haemorrhage.

  20. Multi-detector CT: review of its use in acute GI haemorrhage

    International Nuclear Information System (INIS)

    Anthony, S.; Milburn, S.; Uberoi, R.

    2007-01-01

    The advent of multi-section computed tomography (CT) technology allows the non-invasive assessment of the arterial tree. Using current software, it is now possible to produce high-quality, angiographic-like images that can be used to plan and guide therapeutic procedures. One such clinical situation is the assessment of patients with acute gastrointestinal (GI) haemorrhage. Multi-section CT has a number of advantages over conventional angiography in this situation. The simplicity and non-invasive nature of the technique compared with conventional angiography make CT angiography possible in situations where conventional angiography is not available. Movement artefact from respiration and peristalsis is a common problem in the interpretation of conventional angiography; this is essentially abolished with rapid acquisition times and the use of multi-planar images to remove overlying bowel loops. Cross-sectional imaging with the ability for multi-planar reconstruction allows the accurate anatomical localization of the bleeding site, as well as an assessment of the underlying pathology: this can be used to plan therapy (embolization or surgery). The aim of this paper is to review the current use of CT in the investigation of patients with GI haemorrhage, illustrated with images from our Institution. For patients in whom GI endoscopy has failed to establish a diagnosis, we propose multi-section CT angiography as the initial imaging investigation in acute GI haemorrhage

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    , 1068 (36%) presented within 6 hours and 576 (20%) beyond 48 hours. Significant independent factors associated with presentation ≤6 hours versus >6 hours on logistic regression included melena (OR=0.22, 0.18-0.28), hemoglobin ≤80 g/L (OR=0.47, 0.36-0.61), altered mental status (OR=2.06, 1.......55-2.73), albumin ≤30 g/L (OR=1.43, 1.14-1.78), and red-blood emesis (OR=1.29, 1.06-1.59). Patients presenting ≤6 hours versus >6 hours required transfusion less often (286 (27%) versus 791 (42%), difference = -15%, -19% to -12%) due to a smaller proportion with low hemoglobin levels, but were similar in hemostatic...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-05-02

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

  3. Accessibility of GI for Public Participation

    DEFF Research Database (Denmark)

    Arleth, Mette; Campagna, Michele

    2005-01-01

    The paper reports an ongoing comparative study on the accessibility of Geographic Information at public authorities’ websites in Denmark and Italy. The purpose of the study is twofold; to give an idea of the latest development and diffusion of GI on public authorities websites, and to identify...

  4. The normal bacterial flora prevents GI disease

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. The normal bacterial flora prevents GI disease. Inhibits pathogenic enteric bacteria. Decrease luminal pH; Secrete bacteriocidal proteins; Colonization resistance; Block epithelial binding – induce MUC2. Improves epithelial and mucosal barrier integrity. Produce ...

  5. Vaginal or uterine bleeding - overview

    Science.gov (United States)

    ... Metrorrhagia and other menstrual conditions; Abnormal menstrual periods; Abnormal vaginal bleeding ... of regular ovulation (anovulation). Doctors call the problem abnormal uterine bleeding (AUB) . AUB is more common in teenagers and ...

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

    Directory of Open Access Journals (Sweden)

    Zlatko Horvat

    2014-06-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-01-15

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

  8. Management of Acute Bleeding Per Rectum

    Directory of Open Access Journals (Sweden)

    Benita K.T. Tan

    2004-01-01

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

  9. Relationship between gingival bleeding and anaerobic periodontal infection assessed by BANA (N-Benzoyl-DL-Arginine-β-Napthylamide) assay.

    Science.gov (United States)

    Muthukumar, S; Anand, M Vijay; Madhankumar, Seenivasan

    2014-07-01

    Since periodontal diseases are primarily inflammatory in nature, the ability to detect inflammatory lesions in gingival tissue is essential for the diagnosis and monitoring of changes in gingival status. Gingival bleeding has been used as a reliable and objective clinical parameter not only for the evaluation of inflammatory conditions of periodontium, but also in the detection of its activity and progression. The gingival bleeding index (Loe) is based on the presence or absence of gingival bleeding, thereby provides a means of converting observed clinical data into statistical analysis. Periodontitis is widely regarded as a bacterial infection mainly mediated by subgingival plaque. N-benzoyl-DL-arginine β-naphthylamide (BANA) test is a simple chair side test used to detect, the specific enzymatic activity of microorganisms involved in periodontal disease. The objective of this study is to compare the clinical evaluation of the gingival index (GI) with the enzymatic BANA test. A total of 320 sites were selected from 20 patients with generalized chronic periodontitis, based on the presence are absence of gingival bleeding according to GI of Loe. Sub-gingival plaque samples were collected using a sterile curette and the BANA test was performed. The distribution of GI and the intensity of the BANA test for the 320 sites analyzed during the initial examination of patients, with significance determined by the Chi-square test. The results were statistically significant at P ≤ 0.000. There was a direct relationship between positive BANA test results and GI scores, clearly demonstrating the validity of gingival bleeding as a significant diagnostic parameter. The validity of gingival bleeding as a clinical tool not only for the diagnosis of periodontal disease, but also in the detection of its activity and progression could be established by correlating the GI scores (which is based on the presence or absence of bleeding) with the primary etiologic factors (putative

  10. Relationship between gingival bleeding and anaerobic periodontal infection assessed by BANA (N-Benzoyl-DL-Arginine-β-Napthylamide assay

    Directory of Open Access Journals (Sweden)

    S Muthukumar

    2014-01-01

    Full Text Available Background: Since periodontal diseases are primarily inflammatory in nature, the ability to detect inflammatory lesions in gingival tissue is essential for the diagnosis and monitoring of changes in gingival status. Gingival bleeding has been used as a reliable and objective clinical parameter not only for the evaluation of inflammatory conditions of periodontium, but also in the detection of its activity and progression. The gingival bleeding index (Loe is based on the presence or absence of gingival bleeding, thereby provides a means of converting observed clinical data into statistical analysis. Periodontitis is widely regarded as a bacterial infection mainly mediated by subgingival plaque. N-benzoyl-DL-arginine β-naphthylamide (BANA test is a simple chair side test used to detect, the specific enzymatic activity of microorganisms involved in periodontal disease. Objective: The objective of this study is to compare the clinical evaluation of the gingival index (GI with the enzymatic BANA test. Materials and Methods: A total of 320 sites were selected from 20 patients with generalized chronic periodontitis, based on the presence are absence of gingival bleeding according to GI of Loe. Sub-gingival plaque samples were collected using a sterile curette and the BANA test was performed. Results: The distribution of GI and the intensity of the BANA test for the 320 sites analyzed during the initial examination of patients, with significance determined by the Chi-square test. The results were statistically significant at P ≤ 0.000. Conclusion: There was a direct relationship between positive BANA test results and GI scores, clearly demonstrating the validity of gingival bleeding as a significant diagnostic parameter. Clinical Significance: The validity of gingival bleeding as a clinical tool not only for the diagnosis of periodontal disease, but also in the detection of its activity and progression could be established by correlating the GI

  11. Pinworms and postmenopausal bleeding.

    OpenAIRE

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

    1998-01-01

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

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

    OpenAIRE

    Simola, Tuomas

    2017-01-01

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

  13. SnapShot: GI tract development.

    Science.gov (United States)

    McGrath, Patrick S; Wells, James M

    2015-03-26

    The endoderm germ layer contributes to the respiratory and gastrointestinal (GI) lineages during development, giving rise to an array of specialized epithelial cell types lining organs, including the thyroid, thymus, lungs, liver, biliary system, pancreas, and intestines. This SnapShot timelines and summarizes key stages following gastrulation, including endoderm patterning, organ specification, and organogenesis. A lineage tree of the developing endocrine pancreas is outlined to further illustrate this process. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Upper Gastrointestinal (GI) Tract X-Ray (Radiography)

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z X-ray (Radiography) - Upper GI Tract Upper gastrointestinal tract radiography or ... X-ray? What is Upper Gastrointestinal (GI) Tract Radiography? Upper gastrointestinal tract radiography, also called an upper ...

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

    Directory of Open Access Journals (Sweden)

    Shou-Chuan Shih

    2007-03-01

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

  16. Factors related to late GI and GU complications in conformal and conventional radiation treatment of cancer of the prostate

    International Nuclear Information System (INIS)

    Schultheiss, Timothy E.; Lee, W. Robert; Hunt, Margie A.; Hanlon, Alexandra L.; Peter, Ruth S.; Hanks, Gerald E.

    1995-01-01

    Purpose: To assess the factors that predict for late GI and GU morbidity in radiation treatment of the prostate. Materials and Methods: Six hundred sixteen consecutive prostate cancer patients treated between 1985 and 1994 with conformal or conventional techniques were included in the analysis. All patients had at least 3 months followup (median 26 months) and received at least 65 Gy. Late GI morbidity was rectal bleeding (requiring more than 2 procedures) or proctitis. Late GU morbidity was cystitis or stricture. Univariate analysis compared the differences in the incidence of RTOG-EORTC grade 3 and 4 late morbidity by age (<60 versus ≥ 60 years), peracute side effects ≥ grade 1 (during treatment), subacute side effects ≥ grade 1 (0 to 90 days after treatment), irradiated volume parameters, and dose. Multivariate proportional hazards analysis includes these same variables in a model of time to complication. Multivariate logistic regression was used to analyze incidence of peracute and subacute GI and GU side effects by GI and GU comorbidities, performance status, pretreatment procedures (biopsy, TURP, etc.), age, treatment volume parameters, and peracute responses. Results: Peracute GI and GU side effects were noted in 441 and 442 patients, respectively. Subacute GI and GU side effects were noted in 34 and 54 patients, respectively. Subacute GI side effects were highly correlated with subacute GU side effects (p<0.00001). Late morbidities were not correlated with peracute side effects but were correlated with subacute side effects (both GI and GU). Thirteen of the 616 patients expressed grade 3 or 4 GI injuries 3 to 32 months after the end of treatment, with a mean of 13 months. The 6 GU morbidities occurred significantly later (9 - 52 months) with a mean of 33 months. Central axis dose and age less than 60 years were the only independent variables significantly related to the incidence of late GI morbidity on multivariate analysis. Subacute and peracute

  17. Mild bleeding disorders

    OpenAIRE

    PERROUD, V.

    2011-01-01

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

  18. Primary non-variceal upper gastrointestinal bleeding in NSAID and low-dose aspirin users: development and validation of risk scores for either medication in two large Dutch cohorts.

    Science.gov (United States)

    de Groot, Nicolette L; Hagenaars, Matthijs P; Smeets, Hugo M; Steyerberg, Ewout W; Siersema, Peter D; van Oijen, Martijn G H

    2014-02-01

    Non-steroidal anti-inflammatory drugs (NSAIDs) and low-dose acetylsalicylic acid (ASA) have several adverse gastrointestinal (GI) effects, including upper GI bleeding. We aimed to develop a simple risk score to identify high risk NSAID and ASA users for primary upper GI bleeding. Using data from two large anonymized health insurance databases, we defined a development and validation cohort with NSAID and ASA users which were followed-up for the occurrence of a primary upper GI bleeding. Cox regression analyses identified risk factors which were combined into simple risk scores. C-statistics were used to evaluate the discriminative ability of these scores in a validation cohort. In total, 421 cases of upper GI bleeding were identified in the initial cohort of 784,263 NSAID users (incidence rate 54.2 per 10,000 person-years), while 1,295 cases of upper GI bleeding were identified in 235,531 ASA users (incidence rate 37.9 per 10,000 person-years). The risk of upper GI bleeding increased with a higher risk score, which for NSAID users included age, male gender, anemia and concomitant use of ASA or anticoagulants. For ASA users, age, anemia, diabetes and concomitant use of other antiplatelet drugs or anticoagulants were included in the risk score. The C-statistics in the validation cohort were 0.68 and 0.63 or NSAID and ASA users, respectively. Risk factors for primary upper GI bleeding are to a large extent similar for NSAID and ASA users. Using a risk score based on these risk factors, patients at the highest risk can be identified with moderate accuracy.

  19. GiSAO.db: a database for ageing research

    Directory of Open Access Journals (Sweden)

    Grillari Johannes

    2011-05-01

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

  20. A deep convolutional neural network for bleeding detection in Wireless Capsule Endoscopy images.

    Science.gov (United States)

    Xiao Jia; Meng, Max Q-H

    2016-08-01

    Wireless Capsule Endoscopy (WCE) is a standard non-invasive modality for small bowel examination. Recently, the development of computer-aided diagnosis (CAD) systems for gastrointestinal (GI) bleeding detection in WCE image videos has become an active research area with the goal of relieving the workload of physicians. Existing methods based primarily on handcrafted features usually give insufficient accuracy for bleeding detection, due to their limited capability of feature representation. In this paper, we present a new automatic bleeding detection strategy based on a deep convolutional neural network and evaluate our method on an expanded dataset of 10,000 WCE images. Experimental results with an increase of around 2 percentage points in the Fi score demonstrate that our method outperforms the state-of-the-art approaches in WCE bleeding detection. The achieved Fi score is of up to 0.9955.

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

    DEFF Research Database (Denmark)

    Krag, Mette; Perner, Anders; Wetterslev, Jørn

    2015-01-01

    replacement therapy (6.9, 2.7-17.5), co-existing coagulopathy (5.2, 2.3-11.8), acute coagulopathy (4.2, 1.7-10.2), use of acid suppressants (3.6, 1.3-10.2) and higher organ failure score (1.4, 1.2-1.5). In ICU, 73 % (71-76 %) of patients received acid suppressants; most received proton pump inhibitors....... In patients with clinically important GI bleeding, crude and adjusted odds for mortality were 3.7 (1.7-8.0) and 1.7 (0.7-4.3), respectively. CONCLUSIONS: In ICU patients clinically important GI bleeding is rare, and acid suppressants are frequently used. Co-existing diseases, liver failure, coagulopathy......PURPOSE: To describe the prevalence of, risk factors for, and prognostic importance of gastrointestinal (GI) bleeding and use of acid suppressants in acutely ill adult intensive care patients. METHODS: We included adults without GI bleeding who were acutely admitted to the intensive care unit (ICU...

  2. GiA Roots: software for the high throughput analysis of plant root system architecture

    Science.gov (United States)

    2012-01-01

    Background Characterizing root system architecture (RSA) is essential to understanding the development and function of vascular plants. Identifying RSA-associated genes also represents an underexplored opportunity for crop improvement. Software tools are needed to accelerate the pace at which quantitative traits of RSA are estimated from images of root networks. Results We have developed GiA Roots (General Image Analysis of Roots), a semi-automated software tool designed specifically for the high-throughput analysis of root system images. GiA Roots includes user-assisted algorithms to distinguish root from background and a fully automated pipeline that extracts dozens of root system phenotypes. Quantitative information on each phenotype, along with intermediate steps for full reproducibility, is returned to the end-user for downstream analysis. GiA Roots has a GUI front end and a command-line interface for interweaving the software into large-scale workflows. GiA Roots can also be extended to estimate novel phenotypes specified by the end-user. Conclusions We demonstrate the use of GiA Roots on a set of 2393 images of rice roots representing 12 genotypes from the species Oryza sativa. We validate trait measurements against prior analyses of this image set that demonstrated that RSA traits are likely heritable and associated with genotypic differences. Moreover, we demonstrate that GiA Roots is extensible and an end-user can add functionality so that GiA Roots can estimate novel RSA traits. In summary, we show that the software can function as an efficient tool as part of a workflow to move from large numbers of root images to downstream analysis. PMID:22834569

  3. Bleeding in children with cancer

    African Journals Online (AJOL)

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

  4. Treatment of acute variceal bleeding

    DEFF Research Database (Denmark)

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

    2008-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    Christo J. Van Rensburg

    2012-01-01

    Full Text Available Adding proton pump inhibitors (PPIs to endoscopic therapy has become the mainstay of treatment for peptic ulcer bleeding, with current consensus guidelines recommending high-dose intravenous (IV PPI therapy (IV bolus followed by continuous therapy. However, whether or not high-dose PPI therapy is more effective than low-dose PPI therapy is still debated. Furthermore, maintaining pH ≥ 4 appears to prevent mucosal bleeding in patients with acute stress ulcers; thus, stress ulcer prophylaxis with acid-suppressing therapy has been increasingly recommended in intensive care units (ICUs. This review evaluates the evidence for the efficacy of IV pantoprazole, a PPI, in preventing ulcer rebleeding after endoscopic hemostasis, and in controlling gastric pH and protecting against upper gastrointestinal (GI bleeding in high-risk ICU patients. The review concludes that IV pantoprazole provides an effective option in the treatment of upper GI bleeding, the prevention of rebleeding, and for the prophylaxis of acute bleeding stress ulcers.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  7. GI Symptoms in Infants Are a Potential Target for Fermented Infant Milk Formulae: A Review

    Science.gov (United States)

    van de Heijning, Bert J. M.; Berton, Amelie; Bouritius, Hetty; Goulet, Olivier

    2014-01-01

    Besides pre- and pro-biotic-containing infant formulae, fermented infant formulae are commonly used to relieve or prevent symptoms of gastrointestinal (GI) discomfort in young infants. During the fermentation process in cow’s milk-based formulae, the beneficial bacteria modulate the product by forming several beneficial compounds, which contribute to the alleviation of the symptoms observed. This review summarizes the clinical evidence on the impact of fermented infant formulae on common pediatric GI-symptoms. The potential mechanisms involved are discussed: i.e., the lactose and protein (in-) digestibility, effects on gastric emptying and gut transit and modulation of the colonic microbiota. Although initial evidence indicates a beneficial effect of fermented formulae on GI discomfort in newborns, validation and confirmation of the clinical proof obtained so far is warranted, as well as further research to (more fully) understand the mode of action. PMID:25255831

  8. A Promise Deferred: Black Veterans' Access to Higher Education through the GI Bill at the University of Florida, 1944-1962

    Science.gov (United States)

    McCardle, Todd

    2017-01-01

    Examining both the GI Bill and the origins of desegregation of traditionally segregated institutions of higher learning in the South, this historical essay argues that these 2 separate historic markers should not be considered independently. Indeed, to understand the full scope of the GI Bill, we must consider the limited options that Black…

  9. CHOBS: Color Histogram of Block Statistics for Automatic Bleeding Detection in Wireless Capsule Endoscopy Video.

    Science.gov (United States)

    Ghosh, Tonmoy; Fattah, Shaikh Anowarul; Wahid, Khan A

    2018-01-01

    Wireless capsule endoscopy (WCE) is the most advanced technology to visualize whole gastrointestinal (GI) tract in a non-invasive way. But the major disadvantage here, it takes long reviewing time, which is very laborious as continuous manual intervention is necessary. In order to reduce the burden of the clinician, in this paper, an automatic bleeding detection method for WCE video is proposed based on the color histogram of block statistics, namely CHOBS. A single pixel in WCE image may be distorted due to the capsule motion in the GI tract. Instead of considering individual pixel values, a block surrounding to that individual pixel is chosen for extracting local statistical features. By combining local block features of three different color planes of RGB color space, an index value is defined. A color histogram, which is extracted from those index values, provides distinguishable color texture feature. A feature reduction technique utilizing color histogram pattern and principal component analysis is proposed, which can drastically reduce the feature dimension. For bleeding zone detection, blocks are classified using extracted local features that do not incorporate any computational burden for feature extraction. From extensive experimentation on several WCE videos and 2300 images, which are collected from a publicly available database, a very satisfactory bleeding frame and zone detection performance is achieved in comparison to that obtained by some of the existing methods. In the case of bleeding frame detection, the accuracy, sensitivity, and specificity obtained from proposed method are 97.85%, 99.47%, and 99.15%, respectively, and in the case of bleeding zone detection, 95.75% of precision is achieved. The proposed method offers not only low feature dimension but also highly satisfactory bleeding detection performance, which even can effectively detect bleeding frame and zone in a continuous WCE video data.

  10. Side Effects: Bleeding and Bruising

    Science.gov (United States)

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

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

    African Journals Online (AJOL)

    β2-adrenoceptors activated by adrenaline can also couple to both Gs and Gi proteins. The former is associated with an increase in cAMP to illicit the effect of the catecholamine. In the later, β2-AR induces PKA-catalysed phosphorylation of the receptor, which intends couples to Gi, at high concentration. We proposed that ...

  12. Internationally recognised armed forces / Urmas Roosimägi

    Index Scriptorium Estoniae

    Roosimägi, Urmas

    1999-01-01

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

  13. Tranexamic Acid for Lower GI Hemorrhage: A Randomized Placebo-Controlled Clinical Trial.

    Science.gov (United States)

    Smith, Stephen R; Murray, David; Pockney, Peter G; Bendinelli, Cino; Draganic, Brian D; Carroll, Rosemary

    2018-01-01

    Lower GI hemorrhage is a common source of morbidity and mortality. Tranexamic acid is an antifibrinolytic that has been shown to reduce blood loss in a variety of clinical conditions. Information regarding the use of tranexamic acid in treating lower GI hemorrhage is lacking. The aim of this trial was to determine the clinical efficacy of tranexamic acid when used for lower GI hemorrhage. This was a prospective, double-blind, placebo-controlled, randomized clinical trial. The study was conducted at a tertiary referral university hospital in Australia. Consecutive patients aged >18 years with lower GI hemorrhage requiring hospital admission from November 2011 to January 2014 were screened for trial eligibility (N = 265). A total of 100 patients were recruited after exclusions and were randomly assigned 1:1 to either tranexamic acid or placebo. The primary outcome was blood loss as determined by reduction in hemoglobin levels. The secondary outcomes were transfusion rates, transfusion volume, intervention rates for bleeding, length of hospital stay, readmission, and complication rates. There was no difference between groups with respect to hemoglobin drop (11 g/L of tranexamic acid vs 13 g/L of placebo; p = 0.9445). There was no difference with respect to transfusion rates (14/49 tranexamic acid vs 16/47 placebo; p = 0.661), mean transfusion volume (1.27 vs 1.93 units; p = 0.355), intervention rates (7/49 vs 13/47; p = 0.134), length of hospital stay (4.67 vs 4.74 d; p = 0.934), readmission, or complication rates. No complications occurred as a direct result of tranexamic acid use. A larger multicenter trial may be required to determine whether there are more subtle advantages with tranexamic acid use in some of the secondary outcomes. Tranexamic acid does not appear to decrease blood loss or improve clinical outcomes in patients presenting with lower GI hemorrhage in the context of this trial. see Video Abstract at http://links.lww.com/DCR/A453.

  14. A Note on the GI/GI/∞ System with Identical Service and Interarrival-Time Distributions

    NARCIS (Netherlands)

    van Doorn, E.A.; Jagers, A.A.

    2004-01-01

    We study the stationary distribution of the number of busy servers in a GI/GI/∞ system in which the service-time distribution is identical to the interarrival-time distribution, and obtain several representations for the variance. As a result we can verify an expression for the variance, conjectured

  15. Non-steroidal anti-inflammatory drug related upper gastrointestinal bleeding: types of drug use and patient profiles in real clinical practice.

    Science.gov (United States)

    Sostres, Carlos; Carrera-Lasfuentes, Patrica; Lanas, Angel

    2017-10-01

    The best available evidence regarding non-steroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) bleeding comes from randomized controlled trials including patients who use NSAIDs to manage chronic rheumatic diseases; however, patients with varying background profiles commonly take NSAIDs for many other reasons, often without prescription, and such usage has not been well studied. To define the characteristics of patients hospitalized for upper GI bleeding in clinical practice, we conducted a case-control study among patients with endoscopy-proven major upper GI bleeding due to gastroduodenal peptic lesions and control subjects. We used adjusted logistic regression models to estimate bleeding risks. Data analysis was performed using SPSS 22.0. Our analysis included 3785 cases and 6540 controls, including 1270 cases (33.55%) and 834 controls (12.75%) reporting recent use (NSAIDs including high-dose acetylsalicylic acid (ASA). NSAID use was associated with increased risk of upper GI bleeding, with an adjusted relative risk of 4.86 (95% CI, 4.32-5.46). Acute musculoskeletal pain (36.1%), chronic osteoarthritis (13.5%), and headache (13.6%) were the most common reasons for NSAID use. Among cases, only 17.31% took NSAIDs and 6.38% took high dose ASA due to chronic osteoarthritis. Demographic characteristics significantly differed between subjects with chronic vs. acute musculoskeletal pain. Proton pump inhibitor use was significantly higher in patients who used NSAIDs due to chronic osteoarthritis compared to patients with acute musculoskeletal pain. NSAID (65.15%) or high-dose ASA use (65.83%) preceding upper GI bleeding was most often short-term. In over half of cases (63.62%), the upper GI bleeding event was not preceded by dyspeptic warning symptoms. The majority of patients hospitalized due to NSAID-related upper GI bleeding reported short-term NSAID use for reasons other than chronic rheumatic disease. These findings suggest that current prevention

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

    DEFF Research Database (Denmark)

    Russell, Lene; Holst, Lars Broksø; Kjeldsen, Lars

    2017-01-01

    products and risk factors for bleeding in an adult population of ICU patients with haematological malignancies. METHODS: We screened all patients with acute leukaemia and myelodysplastic syndrome admitted to a university hospital ICU during 2008-2012. Bleeding in ICU was scored according to the WHO grading...... lower and upper airways and upper GI tract. Thirty-nine (59%) of the 66 patients had severe or debilitating (WHO grade 3 or 4) bleeding. The median platelet count on the day of grade 3 or 4 bleeding was 23 × 109 per litre (IQR 13-39). Nine patients (8%) died in ICU following a bleeding episode; five...... was the cause of death in four patients. The median platelet count was 20 × 109 per litre (15-48) at the time of thrombosis. The patients received a median of 6 units of red blood cells, 1 unit of fresh frozen plasma and 8 units of platelet concentrates in ICU. CONCLUSIONS: Severe and debilitating bleeding...

  17. Similar Efficacy of Proton-Pump Inhibitors vs H2-Receptor Antagonists in Reducing Risk of Upper Gastrointestinal Bleeding or Ulcers in High-Risk Users of Low-Dose Aspirin.

    Science.gov (United States)

    Chan, Francis K L; Kyaw, Moe; Tanigawa, Tetsuya; Higuchi, Kazuhide; Fujimoto, Kazuma; Cheong, Pui Kuan; Lee, Vivian; Kinoshita, Yoshikazu; Naito, Yuji; Watanabe, Toshio; Ching, Jessica Y L; Lam, Kelvin; Lo, Angeline; Chan, Heyson; Lui, Rashid; Tang, Raymond S Y; Sakata, Yasuhisa; Tse, Yee Kit; Takeuchi, Toshihisa; Handa, Osamu; Nebiki, Hiroko; Wu, Justin C Y; Abe, Takashi; Mishiro, Tsuyoshi; Ng, Siew C; Arakawa, Tetsuo

    2017-01-01

    It is not clear whether H 2 -receptor antagonists (H2RAs) reduce the risk of gastrointestinal (GI) bleeding in aspirin users at high risk. We performed a double-blind randomized trial to compare the effects of a proton pump inhibitor (PPI) vs a H2RA antagonist in preventing recurrent upper GI bleeding and ulcers in high-risk aspirin users. We studied 270 users of low-dose aspirin (≤325 mg/day) with a history of endoscopically confirmed ulcer bleeding at 8 sites in Hong Kong and Japan. After healing of ulcers, subjects with negative results from tests for Helicobacter pylori resumed aspirin (80 mg) daily and were assigned randomly to groups given a once-daily PPI (rabeprazole, 20 mg; n = 138) or H2RA (famotidine, 40 mg; n = 132) for up to 12 months. Subjects were evaluated every 2 months; endoscopy was repeated if they developed symptoms of upper GI bleeding or had a reduction in hemoglobin level greater than 2 g/dL and after 12 months of follow-up evaluation. The adequacy of upper GI protection was assessed by end points of recurrent upper GI bleeding and a composite of recurrent upper GI bleeding or recurrent endoscopic ulcers at month 12. During the 12-month study period, upper GI bleeding recurred in 1 patient receiving rabeprazole (0.7%; 95% confidence interval [CI], 0.1%-5.1%) and in 4 patients receiving famotidine (3.1%; 95% CI, 1.2%-8.1%) (P = .16). The composite end point of recurrent bleeding or endoscopic ulcers at month 12 was reached by 9 patients receiving rabeprazole (7.9%; 95% CI, 4.2%-14.7%) and 13 patients receiving famotidine (12.4%; 95% CI, 7.4%-20.4%) (P = .26). In a randomized controlled trial of users of low-dose aspirin at risk for recurrent GI bleeding, a slightly lower proportion of patients receiving a PPI along with aspirin developed recurrent bleeding or ulcer than of patients receiving an H2RA with the aspirin, although this difference was not statistically significant. ClincialTrials.gov no: NCT01408186. Copyright © 2017 AGA

  18. Mortality from nonulcer bleeding is similar to that of ulcer bleeding in high-risk patients with nonvariceal hemorrhage: a prospective database study in Italy.

    Science.gov (United States)

    Marmo, Riccardo; Del Piano, Mario; Rotondano, Gianluca; Koch, Maurizio; Bianco, Maria Antonia; Zambelli, Alessandro; Di Matteo, Giovanni; Grossi, Enzo; Cipolletta, Livio; Prometeo Investigators

    2012-02-01

    Nonulcer causes of bleeding are often regarded as minor, ie, associated with a lower risk of mortality. To assess the risk of death from nonulcer causes of upper GI bleeding (UGIB). Secondary analysis of prospectively collected data from 3 national databases. Community and teaching hospitals. Consecutive patients admitted for acute nonvariceal UGIB. Early endoscopy, medical and endoscopic treatment as appropriate. Thirty-day mortality, recurrent bleeding, and need for surgery. A total of 3207 patients (65.8% male), mean (standard deviation) age 68.3 (16.4) years, were analyzed. Overall mortality was 4.45% (143 patients). According to the source of bleeding, mortality was 9.8% for neoplasia, 4.8% for Mallory-Weiss tears, 4.8% for vascular lesions, 4.4% for gastroduodenal erosions, 4.4% for duodenal ulcer, and 3.1% for gastric ulcer. Frequency of death was not different among benign endoscopic diagnoses (overall P = .567). Risk of death was significantly higher in patients with neoplasia compared with benign conditions (odds ratio 2.50; 95% CI, 1.32-4.46; P Society of Anesthesiologists score (1-2 vs 3-4, P Society of Anesthesiologists class score in the Prometeo study. Nonulcer causes of nonvariceal UGIB have a risk of death, similar to bleeding peptic ulcers in the clinical context of a high-risk patient. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  19. Hemostatic function to regulate perioperative bleeding in patients undergoing spinal surgery: A prospective observational study.

    Directory of Open Access Journals (Sweden)

    Atsushi Kimura

    Full Text Available Although bleeding is a common complication of surgery, routine laboratory tests have been demonstrated to have a low ability to predict perioperative bleeding. Better understanding of hemostatic function during surgery would lead to identification of high-risk patients for bleeding. Here, we aimed to elucidate hemostatic mechanisms to determine perioperative bleeding. We prospectively enrolled 104 patients undergoing cervical spinal surgery without bleeding diathesis. Blood sampling was performed just before the operation. Volumes of perioperative blood loss were compared with the results of detailed laboratory tests assessing primary hemostasis, secondary hemostasis, and fibrinolysis. Platelet aggregations induced by several agonists correlated with each other, and only two latent factors determined inter-individual difference. Platelet aggregability independently determined perioperative bleeding. We also identified low levels of plasminogen-activator inhibitor-1 (PAI-1 and α2-plasmin inhibitor to be independent risk factors for intraoperative and postoperative bleeding, respectively. Most important independent factor to determine postoperative bleeding was body weight. Of note, obese patients with low levels of PAI-1 became high-risk patients for bleeding during surgery. Our data suggest that bleeding after surgical procedure may be influenced by inter-individual differences of hemostatic function including platelet function and fibrinolysis, even in the patients without bleeding diathesis.

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

    Directory of Open Access Journals (Sweden)

    Jestin N. Carlson

    2015-12-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  2. Coagulation management in massive bleeding.

    Science.gov (United States)

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

    2010-04-01

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

  3. Managing oral bleeding in children with hereditary bleeding disorders

    African Journals Online (AJOL)

    All the patients presented with bleeding gingivae secondary to either physiologic processes of eruption, infective or traumatic dental conditions. The management of the patients was comprehensive with a multidisciplinary approach. The prevention of traumatic and infective dental conditions is an important part of oral health ...

  4. Safety and efficacy of lansoprazole injection in upper gastrointestinal bleeding: a postmarketing surveillance conducted in Indonesia.

    Science.gov (United States)

    Syam, Ari F; Setiawati, Arini

    2013-04-01

    to assess the safety and effectiveness of lansoprazole injection (Prosogan®) in patients with upper gastrointestinal bleeding due to peptic ulcers or erosive gastritis. this study was a multicenter observational postmarketing study of lansoprazole (Prosogan®) injection. Patients with upper gastrointestinal bleeding due to peptic ulcers or erosive gastritis were given intravenous lansoprazole for a maximum of 7 days or until the bleeding stopped and the patients were able to take oral doses of lansoprazole. Primary outcome of the study was cessation of bleeding. Some laboratory parameters were also measured. among a total of 204 patients evaluable for safety, there was no adverse event reported during the study. A total of 200 patients were eligible for efficacy evaluation, 125 patients (62.5%) were males. Among these patients, upper GI bleeding stopped in 20 patients (10.0%) on day 1, in 71 patients (35.5%) on day 2, 75 patients (37.5%) on day 3, 24 patients (12.0%) on day 4, and 7 patients (3.5%) on day 5, making a cumulative of 197 patients (98.5%) on day 5. The hemostatic effect was rated as 'excellent' if the bleeding stopped within 3 days, and 'good' if the bleeding stopped within 5 days. Thus, the results were 'excellent' in 166 patients (83.0%) and 'good' in 31 patients (15.5%). These results were not different between males and females, between age below 60 years and 60 years and above, and between baseline Hb below 10 g/dL and 10 g/dL and above. the results of this observational postmarketing study in 200 patients with upper gastrointestinal bleeding due to peptic ulcers or erosive gastritis demonstrated that intravenous lansoprazole twice a day was well tolerated and highly effective.

  5. Peptic ulcer bleeding: is Helicobacter pylori a risk factor in an endemic area?

    Science.gov (United States)

    Sotoudehmanesh, Rasoul; Asgari, Ali Ali; Fakheri, Hafez Tirgar; Nouraie, Mehdi; Khatibian, Morteza; Shirazian, Nahid

    2005-01-01

    A high prevalence of Helicobacter pylori infection has been reported in Iran. Although the importance of H. pylori in the induction of peptic ulcer disease is clearly defined, only few studies have addressed its role in bleeding from peptic ulcers. We evaluated the role of H. pylori in peptic ulcer bleeding. Patients with acute peptic ulcer bleeding (PUB) and those with peptic ulcer disease without bleeding ('controls') were enrolled. Upper GI endoscopy and rapid urease test were performed in both groups. Histological study for detection of H. pylori was performed in patients with active bleeding, if RUT was negative. Other variables evaluated included sex, age, smoking, previous history of bleeding, non-steroidal anti-inflammatory drugs use, ulcer size, ulcer location, and duration of acid-peptic disease. Multivariate logistic regression analysis was performed to identify independent risk factors. 161 patients with PUB and 287 control patients were enrolled. H. pylori infection was seen more frequently in patients with duodenal ulcer than gastric ulcer (88.9% vs. 60.5%, pulcer located in the stomach and not in the duodenum, and more often had large ulcer (>1 cm). Logistic regression analysis showed that H. pylori infection was protective in PUB after controlling for confounders (OR 0.41, 95% CI 0.21-0.79), when ulcer location was not entered in the model. A second model including ulcer location (to test for a residual effect) showed that H. pylori infection was not a significant risk factor in PUB (OR 0.61, 95% CI 0.30-1.24). H. pylori may not be an independent factor in bleeding from peptic ulcers. The lower frequency of this infection in these patients can be described by the higher frequency of bleeding from gastric ulcers, which are less H. pylori related compared with duodenal ulcer.

  6. Predictors of bleeding during heparin therapy.

    Science.gov (United States)

    Walker, A M; Jick, H

    1980-09-12

    Among 2,656 patients receiving heparin sodium therapy, bleeding was a dose-related phenomenon that occurred most commonly among women, severely ill patients, and patients who received asprin during heparin therapy. Except for dose, factors that predisposed patients to bleeding were more strongly associated with major bleeding than with minor bleeding. Heavy alcohol drinkers were at particularly high risk for major bleeding episodes during heparinization. The seven-day cumulative risk for any bleeding was 9.1%. Risk was greatest on the third day of heparin administration.

  7. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  8. Abnormal uterine bleeding in perimenopause.

    Science.gov (United States)

    Goldstein, S R; Lumsden, M A

    2017-10-01

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

  9. Tõnis Mägi ja Chalice esitavad koolioratooriumi

    Index Scriptorium Estoniae

    2008-01-01

    Tõnis Mägi ja Chalice esitavad Tallinna Filharmoonia uue kontserdisarja "Viva oratorio" raames koolioratooriumi "Tarkus" 30. aug. Paide Kultuurikeskuses, 31. aug. Tartu Jaani kirikus ja 1. sept. Tallinna Jaani kirikus

  10. Spontaneous Bleeding Associated with Ginkgo biloba

    Science.gov (United States)

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

    2005-01-01

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

  11. Endoscopic application of EGF-chitosan hydrogel for precipitated healing of GI peptic ulcers and mucosectomy-induced ulcers.

    Science.gov (United States)

    Maeng, Jin Hee; Bang, Byoung Wook; Lee, Eunhye; Kim, Jungju; Kim, Hyung Gil; Lee, Don Haeng; Yang, Su-Geun

    2014-02-01

    The gastrointestinal (GI) endoscopy has become a standard diagnostic tool for GI ulcers and cancer. In this study we studied endoscopic application of epidermal growth factor-containing chitosan hydrogel (EGF-CS gel) for treatment of GI ulcer. We hypothesized that directional ulcer-coating using EGF-CS gel via endoscope would precipitate ulcer-healing. EGF-CS gel was directly introduced to the ulcer-region after ulceration in acetic acid-induced gastric ulcer (AAU) and mucosal resection-induced gastric ulcer (MRU) rabbit and pig models. The ulcer dimensions and mucosal thicknesses were estimated and compared with those in the control group. Healing efficacy was more closely evaluated by microscopic observation of the ulcer after histological assays. In the AAU model, the normalized ulcer size of the gel-treated group was 2.3 times smaller than that in the non-treated control group on day 3 after ulceration (P < 0.01). In the MRU model, the normalized ulcer size of the gel-treated group was 5.4 times smaller compared to that in the non-treated control group on day 1 after ulceration (P < 0.05). Histological analysis supported the ability of EGF-CS gel to heal ulcers. The present study suggests that EGF-CS gel is a promising candidate for treating gastric bleeding and ulcers.

  12. On the number of observable customers, served during he busy period of GI/GI/infinity queue

    International Nuclear Information System (INIS)

    Dvurechenskij, A.

    1982-01-01

    It is proved that the number of observable customers, served during the busy period of the GI/GI infinity queue with infinitely many servers has a geometric distribution. The parameter of this distribution is determined, too. It is shown that the normalized distributions converge to the exponential distribution. As a particular result is obtained that the distribution of the number of nonabsorbing streamers in a streamer blob has a geometric distribution

  13. Rabbit haemorrhagic disease virus 2 (GI.2) is replacing endemic strains of RHDV in the Australian landscape within 18 months of its arrival.

    Science.gov (United States)

    Mahar, Jackie E; Hall, Robyn N; Peacock, David; Kovaliski, John; Piper, Melissa; Mourant, Roslyn; Huang, Nina; Campbell, Susan; Gu, Xingnian; Read, Andrew; Urakova, Nadya; Cox, Tarnya; Holmes, Edward C; Strive, Tanja

    2017-11-01

    Rabbit haemorrhagic disease virus 2 (RHDV2; Lagovirus GI.2) is a pathogenic calicivirus that affects European rabbits ( Oryctolagus cuniculus ) and various hare ( Lepus ) species. GI.2 was first detected in France in 2010 and subsequently caused epidemics in wild and domestic lagomorph populations throughout Europe. In May 2015 GI.2 was detected in Australia. Within 18 months of its initial detection GI.2 had spread to all Australian states and territories and rapidly became the dominant circulating strain, replacing Rabbit haemorrhagic disease virus (RHDV/GI.1) in mainland Australia. Reconstruction of the evolutionary history of 127 Australian GI.2 isolates revealed that the virus arrived in Australia at least several months before its initial description and likely circulated unnoticed in wild rabbit populations in the east of the continent prior to its detection. GI.2 sequences isolated from five hares clustered with sequences from sympatric rabbit populations sampled contemporaneously, indicating multiple spillover events into hares rather than an adaptation of the Australian GI.2 to a new host. Since the presence of GI.2 in Australia may have wide ranging consequences for rabbit biocontrol, particularly with the release of the novel biocontrol agent GI.1a/RHDVa-K5 in March 2017, ongoing surveillance is critical to understanding the interactions of the various lagoviruses in Australia, and their impact on host populations. IMPORTANCE This study describes the spread and distribution of Rabbit Haemorrhagic Disease virus 2 (GI.2) in Australia since its first detection in May 2015. Within the first 18 months following its detection, RHDV2 spread from east to west across the continent and became the dominant strain in all mainland states of Australia. This has important implications for pest animal management and for owners of pet and farmed rabbits, as there is currently no effective vaccine available in Australia for GI.2. The closely related RHDV (GI.1) is used

  14. Vitamin K deficiency bleeding of the newborn

    Science.gov (United States)

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

  15. Bleeding Risks With Aspirin Use for Primary Prevention in Adults: A Systematic Review for the U.S. Preventive Services Task Force.

    Science.gov (United States)

    Whitlock, Evelyn P; Burda, Brittany U; Williams, Selvi B; Guirguis-Blake, Janelle M; Evans, Corinne V

    2016-06-21

    The balance between potential aspirin-related risks and benefits is critical in primary prevention. To evaluate the risk for serious bleeding with regular aspirin use in cardiovascular disease (CVD) primary prevention. PubMed, MEDLINE, Cochrane Central Register of Controlled Trials (2010 through 6 January 2015), and relevant references from other reviews. Randomized, controlled trials; cohort studies; and meta-analyses comparing aspirin with placebo or no treatment to prevent CVD or cancer in adults. One investigator abstracted data, another checked for accuracy, and 2 assessed study quality. In CVD primary prevention studies, very-low-dose aspirin use (≤100 mg daily or every other day) increased major gastrointestinal (GI) bleeding risk by 58% (odds ratio [OR], 1.58 [95% CI, 1.29 to 1.95]) and hemorrhagic stroke risk by 27% (OR, 1.27 [CI, 0.96 to 1.68]). Projected excess bleeding events with aspirin depend on baseline assumptions. Estimated excess major bleeding events were 1.39 (CI, 0.70 to 2.28) for GI bleeding and 0.32 (CI, -0.05 to 0.82) for hemorrhagic stroke per 1000 person-years of aspirin exposure using baseline bleeding rates from a community-based observational sample. Such events could be greater among older persons, men, and those with CVD risk factors that also increase bleeding risk. Power to detect effects on hemorrhagic stroke was limited. Harms other than serious bleeding were not examined. Consideration of the safety of primary prevention with aspirin requires an individualized assessment of aspirin's effects on bleeding risks and expected benefits because absolute bleeding risk may vary considerably by patient. Agency for Healthcare Research and Quality.

  16. Antifibrinolytics for heavy menstrual bleeding.

    Science.gov (United States)

    Lethaby, A; Farquhar, C; Cooke, I

    2000-01-01

    Heavy menstrual bleeding (HMB) is an important cause of ill health in women. Medical therapy, with the avoidance of possibly unnecessary surgery, is an attractive treatment option. A wide variety of medications are available to reduce heavy menstrual bleeding but there is considerable variation in practice and uncertainty about the most appropriate therapy. Plasminogen activators are a group of enzymes that cause fibrinolysis (the dissolution of clots). An increase in the levels of plasminogen activators has been found in the endometrium of women with heavy menstrual bleeding compared to those with normal menstrual loss. Plasminogen activator inhibitors (antifibrinolytic agents) have therefore been promoted as a treatment for heavy menstrual bleeding. There has been a reluctance to prescribe tranexamic acid due to possible side effects of the drugs such as an increased risk of thrombogenic disease (deep venous thrombosis). Long term studies in Sweden, however, have shown that the rate of incidence of thrombosis in women treated with tranexamic acid is comparable with the spontaneous frequency of thrombosis in women. To determine the effectiveness of antifibrinolytics in achieving a reduction in heavy menstrual bleeding. All studies which might describe randomised controlled trials of antifibrinolytic therapy for the treatment of heavy menstrual bleeding were obtained by electronic searches of MEDLINE 1966-1997, EMBASE 1980-1997 and the Cochrane Library. Companies producing antifibrinolytics and experts within the field were contacted for reference lists and information on unpublished trials. Randomised controlled trials in women of reproductive age treated with antifibrinolytic agents versus placebo, no treatment or any other medical (non-surgical) therapy for regular heavy menstrual bleeding within either the primary, family planning or specialist clinic settings. Women with post menopausal bleeding, intermenstrual bleeding, iatrogenic or pathological causes of

  17. What to do when she's bleeding through: the recognition, evaluation, and management of abnormal uterine bleeding in adolescents.

    Science.gov (United States)

    Bennett, Alyssa R; Gray, Susan H

    2014-08-01

    This article reviews the current understanding and management of abnormal uterine bleeding (AUB) in adolescents. The readers will learn a practical approach to the evaluation and treatment of mild-to-severe uterine bleeding. In 2011, a new classification system was proposed to standardize the terminology used to describe AUB. This system is based on the pattern and etiology of bleeding and has been adopted by other organizations. The term dysfunctional uterine bleeding has been replaced by AUB. The negative effect of AUB on adolescents' quality of life is now well established. The levonorgestrel-releasing intrauterine system is considered a first-line treatment for heavy menstrual bleeding and should be considered, especially in those adolescents who may also need contraception. AUB is a common adolescent complaint that can vary from mild to life-threatening if not recognized and treated promptly. This article reviews the appropriate assessment and management of AUB and proposes a practical algorithm that can be used in an office or hospital setting.

  18. Etiology of Lower Gastrointestinal Bleeding in Children:A Single Center Experience from Southern Iran

    Science.gov (United States)

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

    2012-01-01

    BACKGROUND This study aimed to determine the common etiologies and characteristics of lower gastrointestinal (GI) bleeding in children from Southern Iran. METHODS This five-year prospective cross-sectional study was performed from March 2006 to March 2011 in Nemazee Hospital. All pediatric patients (<18 years of age) who referred to our center with gross lower GI bleeding or two consecutive positive occult blood tests with at least a one-week interval were included in the study. Patients were categorized as neonates, infants, children and adolescents and the findings were reported separately in each group. Each patient underwent a colonoscopy and several mucosal biopsies were taken. Demographic and clinical information as well as colonoscopy and pathology findings were reported. RESULTS Overall, we included 363 pediatric patients with a mean age of 71.9±58.4 months (range: 1-216 months). There were 215 (59.2%) boys and 148 (40.8%) girls. The most common colonoscopy findings were sigmoid colon polyp in 91 (25.1%) patients followed by descending colon petechia in 78 (21.5%) patients, whitish rectal lesions in 45 (12.4%) patients, and sigmoid and rectal ulcers in 37 (10.2%) patients. Biopsy samples were non-specific in 96 (26.4%) patients. The most common pathological findings were juvenile polyp in 84 (23.1%) followed by lymphoid nodular hyperplasia in 55 (15.2%) and solitary rectal ulcers in 25 (6.9%) patients. CONCLUSION We found that lower GI bleeding was more common among 2-10 year-old children and was rarely encountered in neonates. Hematochezia was the most common form of presentation followed by bloody diarrhea and occult blood. The most common colonoscopy finding was sigmoid colon polyp and the most common pathological finding was juvenile polyp. PMID:24829660

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

    Directory of Open Access Journals (Sweden)

    Matheus Cavalcante FRANCO

    2015-12-01

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

  20. Review of GI Science Trends and Grand Challenges (Invited)

    Science.gov (United States)

    Gould, M.; Esri Education Team

    2010-12-01

    Geographic Information Science was defined by Goodchild's keynote presentation at the 1990 Symposium on Spatial Data Handling in Zurich and subsequent paper in the International Journal of Geographic Information Systems. Over the past 20 years it has maintained part of its original base but also has grown to accommodate possibilities afforded by new technologies and new societal concerns. Recent review articles and a special session on GI Science grand challenges held at the 2010 meeting of the Association of American Geographers, have provided perspectives on key trends in GI Science, that this AGU presentation now summarizes. The GIS software industry has responded to some and are pending advances on others of these trends.

  1. Lower Gastrointestinal Bleeding in Children.

    Science.gov (United States)

    Sahn, Benjamin; Bitton, Samuel

    2016-01-01

    This article provides an overview of the evaluation and management of lower gastrointestinal bleeding (LGIB) in children. The common etiologies at different ages are reviewed. Conditions with endoscopic importance for diagnosis or therapy include solitary rectal ulcer syndrome, polyps, vascular lesions, and colonic inflammation and ulceration. Diagnostic modalities for identifying causes of LGIB in children include endoscopy and colonoscopy, cross-sectional and nuclear medicine imaging, video capsule endoscopy, and enteroscopy. Pre-endoscopic preparation and decision-making unique to pediatrics is highlighted. The authors conclude with a summary of current and emerging therapeutic hemostatic techniques that can be used in pediatric patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. [APPROACH TO PATIENTS WITH GASTROINTESTINAL BLEEDING].

    Science.gov (United States)

    Nikolić, M; Hanževački, M; Jurčić, P; Budimir, I; Ljubičić, N

    2015-11-01

    In the developed Western countries, despite the accumulation of knowledge about the causes and treatment of gastrointestinal bleeding, as well as the experience of gastroenterologists-endoscopists using sophisticated endoscopic devices, the number of hospitalizations and mortality rates has not declined as expected. The most likely explanations are the following: aging population, increased prevalence of alcoholic liver cirrhosis, gastroesophageal reflux disease and obesity, Helicobacter pylori antibiotic resistance, using dual anti-aggregation therapy, anticoagulants, and excessive use of nonsteroidal anti-inflammatory drugs. The aim of this paper is to show the incidence and the most common signs and symptoms of gastrointestinal bleeding. The aim is also to present initial clinical evaluation, diagnostic methods, the main causes of gastrointestinal bleeding, endoscopic hemostatic modalities and treatment of bleeding from the upper and lower gastrointestinal tract. Using the MEDLINE and Ovid databases, we searched the meta-analyses and systematic reviews published in English during the 2005-2015 period. Meta-analyses included results of randomized, double-blind studies on adults treated for gastrointestinal bleeding. Included were guidelines of the European and American Society of Gastroenterological Endoscopy, as well as recent expert work. In this review, we bring the state-of-the-art on gastrointestinal bleeding, new classification of gastrointestinal bleeding from the upper, mid and lower gut, controversy of nasogastric tube placement, use of prokinetic agents and inhibitor proton pumps in acute gastrointestinal bleeding from the upper tract, restrictive transfusion strategy, useful clinical stratification of the severity of bleeding, indications for hospitalization and outcome of using the clinical bleeding score, proper use of gastroprotection in patients at a high risk of peptic ulcer, the need of initial endoscopy, variceal assessment in newly diagnosed

  3. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

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

    2012-01-01

    Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved by the D......Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved...... by the Danish Society of Gastroenterology and Hepatology September 4, 2011. Recommendations: Recommendations emphasize the importance of early and efficient resuscitation. Endoscopy should generally be performed within 24 hours, reducing operation rate, rebleeding rate and duration of in-patient stay. When...... in achieving endoscopic hemostasis. Use of endoscopic monotherapy with epinephrine injection is not recommended. Intravenous high-dose proton pump inhibitor (PPI) therapy for 72 hours after successful endoscopic hemostasis is recommended as it decreases both rebleeding rate and mortality in patients with high...

  4. Eesti uued helid / Tristan Priimägi

    Index Scriptorium Estoniae

    Priimägi, Tristan, 1976-

    2009-01-01

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

  5. Empty Promise: Black American Veterans and the New GI Bill

    Science.gov (United States)

    Ottley, Alford H.

    2014-01-01

    The 2008 GI Bill offers college funds for veterans. Yet Black male vets are not taking advantage of these benefits. This chapter examines personal and societal problems that hinder access to higher education for Black vets, and suggests some ways adult educators can advocate for these young men.

  6. Lenz, Eestis unustatud geenius / Riina Mägi

    Index Scriptorium Estoniae

    Mägi, Riina, 1957-

    2001-01-01

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

  7. The food, GI tract functionality and human health cluster

    NARCIS (Netherlands)

    Mattila-Sandholm, T.; Blaut, M.; Daly, C.; Vuyst, de L.; Dore, J.; Gibson, G.; Goossens, H.; Knorr, D.; Lucas, J.; Lahteenmaki, L.; Mercenier, A.M.E.; Saarela, M.; Shanahan, F.; Vos, de W.M.

    2002-01-01

    The Food, GI-tract Functionality and Human Health (PROEUHEALTH) Cluster brings together eight complementary, multicentre interdisciplinary research projects. All have the common aim of improving the health and quality of life of European comsumers. The collaboration involves 64 different research

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

    African Journals Online (AJOL)

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

  9. Gastric ulcer bleeding: diagnosis by computed tomography

    International Nuclear Information System (INIS)

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

    1999-01-01

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

  10. 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.

  11. Serendipity in scintigraphic gastrointestinal bleeding studies

    International Nuclear Information System (INIS)

    Goergen, T.G.

    1983-01-01

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

  12. Serendipity in scintigraphic gastrointestinal bleeding studies

    Energy Technology Data Exchange (ETDEWEB)

    Goergen, T.G.

    1983-09-01

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

  13. In silico predictions of gastrointestinal drug absorption in pharmaceutical product development: application of the mechanistic absorption model GI-Sim.

    Science.gov (United States)

    Sjögren, Erik; Westergren, Jan; Grant, Iain; Hanisch, Gunilla; Lindfors, Lennart; Lennernäs, Hans; Abrahamsson, Bertil; Tannergren, Christer

    2013-07-16

    Oral drug delivery is the predominant administration route for a major part of the pharmaceutical products used worldwide. Further understanding and improvement of gastrointestinal drug absorption predictions is currently a highly prioritized area of research within the pharmaceutical industry. The fraction absorbed (fabs) of an oral dose after administration of a solid dosage form is a key parameter in the estimation of the in vivo performance of an orally administrated drug formulation. This study discloses an evaluation of the predictive performance of the mechanistic physiologically based absorption model GI-Sim. GI-Sim deploys a compartmental gastrointestinal absorption and transit model as well as algorithms describing permeability, dissolution rate, salt effects, partitioning into micelles, particle and micelle drifting in the aqueous boundary layer, particle growth and amorphous or crystalline precipitation. Twelve APIs with reported or expected absorption limitations in humans, due to permeability, dissolution and/or solubility, were investigated. Predictions of the intestinal absorption for different doses and formulations were performed based on physicochemical and biopharmaceutical properties, such as solubility in buffer and simulated intestinal fluid, molecular weight, pK(a), diffusivity and molecule density, measured or estimated human effective permeability and particle size distribution. The performance of GI-Sim was evaluated by comparing predicted plasma concentration-time profiles along with oral pharmacokinetic parameters originating from clinical studies in healthy individuals. The capability of GI-Sim to correctly predict impact of dose and particle size as well as the in vivo performance of nanoformulations was also investigated. The overall predictive performance of GI-Sim was good as >95% of the predicted pharmacokinetic parameters (C(max) and AUC) were within a 2-fold deviation from the clinical observations and the predicted plasma AUC

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    Coagulation in blood is initiated when coagulation factor VII (FVII) binds to exposed TF and is activated to FVIIa, and the TF/ FVIIa complex may therefore provide a marker of vascular injury potentially applicable in diagnostic imaging of acute gastrointestinal (GI) bleeding. Methods: Recombinan...

  15. Locations and Mucosal Lesions Responsible for Major Gastrointestinal Bleeding in Patients on Warfarin or Dabigatran.

    Science.gov (United States)

    Kolb, Jennifer M; Flack, Kathryn Friedman; Chatterjee-Murphy, Prapti; Desai, Jay; Wallentin, Lars C; Ezekowitz, Michael; Connolly, Stuart; Reilly, Paul; Brueckmann, Martina; Ilgenfritz, John; Aisenberg, James

    2018-03-27

    Different oral anticoagulants may be associated with gastrointestinal bleeding (GIB) from different locations or mucosal lesions. We aimed to test this hypothesis. Two blinded gastroenterologists independently analyzed source documents from the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial of dabigatran 150 mg BID (D150), dabigatran 110 mg BID (D110) versus warfarin in non-valvular atrial fibrillation (NVAF). Major GIB events (total n = 546) and life-threatening GIB events (n = 258) were more common with D150 versus warfarin (RR 1.57 [1.28-1.92] and RR 1.62 [1.20-2.18], respectively) and similar for D110 compared to warfarin (RR 1.11 [0.89-1.38] and RR 1.16 [0.84-1.61], respectively). Fatal bleeding was similarly rare across treatment groups. Lower GI major bleeding and life-threatening bleeding were more common with D150 compared to warfarin (RR 2.23 [1.47, 3.38] and RR 2.64 [1.36, 5.13], respectively) and with D110 compared to warfarin (RR 1.78 [1.16, 2.75] and RR 2.00 [1.00, 4.00], respectively). MGIB from colonic angiodysplasia was increased with dabigatran versus warfarin (P < 0.01 for both dose comparisons). Subacute and chronic MGIB events were more common with D150 than with warfarin (RR 1.72 [1.06, 2.78] and RR 1.66 [1.12, 2.45], respectively), as were hematochezia or melena (RR 1.67 [1.18, 2.36] and RR 1.72 [1.20, 2.47], respectively). In a chronic NVAF population, D150 but not D110 is associated with increased major and life-threatening GI bleeding in comparison with warfarin. At both dabigatran doses, increased bleeding from the colorectum, in particular from angiodysplasia, is seen.

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

    African Journals Online (AJOL)

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

  17. Rectal bleeding in children: endoscopic evaluation revisited

    NARCIS (Netherlands)

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

    2007-01-01

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

  18. 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 ...

  19. Duodenal diverticular bleeding: an endoscopic challenge

    Directory of Open Access Journals (Sweden)

    Eduardo Valdivielso-Cortázar

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

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

    Science.gov (United States)

    ... Feelings Expert Answers Q&A Movies & More for Teens Teens site Sitio para adolescentes Body Mind Sexual Health ... English Español Abnormal Uterine Bleeding (AUB) KidsHealth / For Teens / Abnormal Uterine Bleeding (AUB) What's in this article? ...

  1. Massive rectal bleeding from colonic diverticulosis

    African Journals Online (AJOL)

    ABEOLUGBENGAS

    Objectives: This is to describe a case of colonic diverticulosis causing massive rectal bleeding in an elderly Nigerian man. ... also oozing blood. He was worked up, and had surgery for hemicolectomy due to massive blood loss following failure of initial conservative management. .... bleeding patterns observed in fifty cases.

  2. Transarterial embolization of acute intercostal artery bleeding

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-09-15

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

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

    Science.gov (United States)

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

    2014-01-01

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

  4. Understanding extractive bleed : wood extractives: distribution, properties, and classes

    Science.gov (United States)

    Edward Burke; Norm Slavik; Tony Bonura; Dennis Connelly; Tom Faris; Arnie Nebelsick; Brent Stuart; Sam Williams; Alex C. Wiedenhoeft

    2010-01-01

    Color, odor, and natural durability of heartwood are characteristics imparted by a class of chemicals in wood known collectively extractives. Wood is converted by the tree from sapwood to heartwood by the deposition of extractives, typically many years after the growth ring undergoing this change was formed by the tree. Extractives are thus not a part of the wood...

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

    OpenAIRE

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

    2011-01-01

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

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

    Science.gov (United States)

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

    2011-03-08

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

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

    Directory of Open Access Journals (Sweden)

    Atiomo William

    2011-03-01

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

  8. THROMBIN GENERATION AND BLEEDING IN HEMOPHILIA A

    Science.gov (United States)

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

    2012-01-01

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

  9. Compressor bleed cooling fluid feed system

    Science.gov (United States)

    Donahoo, Eric E; Ross, Christopher W

    2014-11-25

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

  10. Animal Models of Hemophilia and Related Bleeding Disorders

    Science.gov (United States)

    Lozier, Jay N.; Nichols, Timothy C.

    2013-01-01

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

  11. 2D/3D ultrasonography for endometrial evaluation in a cohort of 118 postmenopausal women with abnormal uterine bleedings.

    Science.gov (United States)

    Stachowiak, Grzegorz; Zając, Agnieszka; Pertynska-Marczewska, Magdalena; Stetkiewicz, Tomasz

    2016-01-01

    2D/3D transvaginal ultrasonography in evaluation of endometrium in postmenopausal women with abnormal uterine bleedings (AUB). 2D/3D transvaginal ultrasonography (TVU) was performed in 118 menopausal women with AUB. Endometrial volume and thickness, uterine volume and endometrial vascularity were evaluated. Complete histologic evaluation of the endometrium was obtained through dilatation & curettage (D&C) and/or hysteroscopy. Accordingly, patients were divided into 3 groups: controls (no endometrial pathology, n = 49), GI (benign endometrial pathology, n = 37), GII (endometrial carcinoma, n = 32). GII had greater thickness and volume of the endometrium, compared to GI and controls. The presence of arterial vascular flow was identified only in GI and GII (51.35% and 93.75%, respectively). Endometrial volume merged together with uterine volume measurements (TVU-3D) showed a strong, statistical significance between GI and GII, allowing differentiation of begin and malignant endometrial pathologies in postmenopausal women. In TVU diagnostics of postmenopausal women with AUB the following play the most significant role: 1) endometrial thickness (TVU-2D); 2) endometrial volume (TVU-3D); 3) uterine plus endometrial volume (TVU-3D); 4) vascularization within the endometrium, allowing to differentiate between pathological and normal endometrium (TVU-2/3D). Evaluation of the endometrial vascularity, both in TVU-2D and TVU-3D technique, does not allow for reliable differentiation between benign lesions and endometrial cancer.

  12. Peptic ulcers accompanied with gastrointestinal bleeding, pylorus obstruction and cholangitis secondary to choledochoduodenal fistula: A case report.

    Science.gov (United States)

    Xi, Bin; Jia, Jun-Jun; Lin, Bing-Yi; Geng, Lei; Zheng, Shu-Sen

    2016-01-01

    Peptic ulcers are an extremely common condition, usually occurring in the stomach and proximal duodenum. However, cases of peptic ulcers accompanied with multiple complications are extremely rare and hard to treat. The present case reinforces the requirement for the early recognition and correct treatment of peptic ulcers accompanied with multiple complications. A 67-year-old man presented with recurrent abdominal pain, fever and melena. The laboratory results showed anemia (hemoglobin 62 g/l) and hypoproteinemia (23 g/l). Abdominal imaging examinations revealed stones in the gallbladder and right liver, with air in the dilated intrahepatic and extrahepatic bile ducts. Endoscopic retrograde cholangiopancreatography failed due to a deformed pylorus. The patient was finally diagnosed with peptic ulcers accompanied with gastrointestinal (GI) bleeding, pylorus obstruction and cholangitis secondary to a choledochoduodenal fistula during an emergency pancreatoduodenectomy, which was performed due to a massive hemorrhage of the GI tract. The patient recovered well after the surgery.

  13. AL Amyloidosis Complicated by Persistent Oral Bleeding

    Directory of Open Access Journals (Sweden)

    Luiz Antonio Liarte Marconcini

    2015-01-01

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

  14. Gastrointestinal Bleeding: MedlinePlus Health Topic

    Science.gov (United States)

    ... peptic ulcers , tears or inflammation in the esophagus, diverticulosis and diverticulitis , ulcerative colitis and Crohn's disease , colonic ... PubMed (National Library of Medicine) Article: Small intestinal diverticulum with bleeding: Case report and literature review. Article: ...

  15. Fibrinogen concentrate for bleeding - a systematic review

    DEFF Research Database (Denmark)

    Lunde, J; Stensballe, J; Wikkelsø, A

    2014-01-01

    included a control group. Three out of 11 found a reduction in transfusion requirements while mortality was reduced in two and bleeding in one. In the available RCTs, which all have substantial shortcomings, we found a significant reduction in bleeding and transfusions requirements. However, data......Fibrinogen concentrate as part of treatment protocols increasingly draws attention. Fibrinogen substitution in cases of hypofibrinogenaemia has the potential to reduce bleeding, transfusion requirement and subsequently reduce morbidity and mortality. A systematic search for randomised controlled...... determined to be of high risk of bias and none reported a significant effect on mortality. Two RCTs found a significant reduction in bleeding and five RCTs found a significant reduction in transfusion requirements. The 23 non-randomised studies included a total of 2825 patients, but only 11 of 23 studies...

  16. CLSM bleed water reduction test results

    International Nuclear Information System (INIS)

    Langton, C.A.; Rajendran, N.

    1997-01-01

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

  17. Management of patients with ulcer bleeding.

    Science.gov (United States)

    Laine, Loren; Jensen, Dennis M

    2012-03-01

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

  18. Engine bleed air reduction in DC-10

    Science.gov (United States)

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

    1980-01-01

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

  19. Helping mothers survive bleeding after birth

    DEFF Research Database (Denmark)

    Nelissen, Ellen; Ersdal, Hege; Ostergaard, Doris

    2014-01-01

    OBJECTIVE: To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. DESIGN: Educational intervention study. SETTING: Rural referral hospital in Northern Tanzania. POPULATION: Clinicians, nurse-midwives, medical attendants, and ambul......OBJECTIVE: To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. DESIGN: Educational intervention study. SETTING: Rural referral hospital in Northern Tanzania. POPULATION: Clinicians, nurse-midwives, medical attendants...

  20. Transcatheter emboilization therapy of massive colonic bleeding

    International Nuclear Information System (INIS)

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

    1996-01-01

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

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

    Science.gov (United States)

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

    2015-07-01

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

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

    Science.gov (United States)

    Thomas, Megan D.

    2017-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

    Early refeeding after nonvariceal upper gastrointestinal bleeding is safe and reduces hospital stay/costs. The aim of this study was obtaining objective data on refeeding after nonvariceal upper gastrointestinal bleeding. From 1 year span records of nonvariceal upper gastrointestinal bleeding patients that underwent urgent endoscopy: clinical features; rockall score; endoscopic data, including severity of lesions and therapy; feeding related records of seven days: liquid diet prescription, first liquid intake, soft/solid diet prescription, first soft/solid intake. From 133 patients (84 men) Rockall classification was possible in 126: 76 score ≥5, 50 score gastrointestinal bleeding patients must be refed earlier, according to guidelines.

  4. Antifibrinolytics for heavy menstrual bleeding.

    Science.gov (United States)

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

    2018-04-15

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

  5. Prevalence and Outcome of Upper Gastrointestinal Bleeding Post-coronary Artery Bypass Graft.

    Science.gov (United States)

    Aljarallah, Badr; Wong, Winnie; Modry, Dennis; Fedorak, Richard

    2008-01-01

    Upper gastrointestinal bleeding (UGIB), a potentially fatal occurrence, can sometimes follow coronary artery bypass graft (CABG) surgery. However, little has been published about its prevalence, risk factors, and outcomes. This study aimed to determine the rate, etiologies, predisposing factors, and outcomes of UGIB following CABG. The authors conducted a retrospective chart review of all UGIBs which followed CABGs performed at the University of Alberta Hospital from January 1, 1998 to December 31, 2002. During the study period, 4,502 CABGs were performed at the UAH. Eighteen patients (0.4%) had a documented major UGIB (defined as evidence of melena, red or coffee-grounds emesis, blood per NG tube, or a decrease of Hgb by > 20 g/l and requiring a confirmation by endoscopy or radiological study). Two of these 18 patients (11%) had a past history of peptic ulcer disease, and one of these patients had had previous UGIB. Three patients (17%) had been taking proton pump inhibitors (PPI) before the UGIB occurred. At the time of UGIB, PPIs were prescribed for 16 patients (89%), and the PPIs achieved effective hemostasis as a single agent for 10 (62.5%). Of the 18 patients, 16 (89%) underwent upper GI endoscopy. Bleeding was found to be due to duodenal ulceration in 9 (56%), esophagitis in 4 (22%) and gastritis in 6 cases (33%); fifty percent of these patients had multiple sites of bleeding. Endoscopic therapeutic intervention was needed by 6 patients (37.5%), and successful hemostasis was achieved for 5 of these patients (83%). One patient had a recurrence of bleeding and required surgery. One patient underwent surgery as the primary hemostatic therapy after a diagnostic endoscopy. The overall surgical rate was 11.1% for this patient cohort. In this cohort, three patients died, two from multi-organ failure, and the third, a surgically managed patient, had a cardiac arrest 72 hours post-surgery. The number of complication increased as both cardiopulmonary bypass and cross

  6. Surgical treatment of massive upper gastrointestinal bleeding in ...

    African Journals Online (AJOL)

    Acute upper gastrointestinal bleeding is a potentially life-threatening abdominal emergency condition. More immediately life-threatening is massive upper gastrointestinal bleeding resulting in cardiovascular compromise causing dizziness, syncope and shock. The causes of upper gastrointestinal bleeding include bleeding ...

  7. Predicting major bleeding in patients with noncardioembolic stroke on antiplatelets: S2TOP-BLEED.

    Science.gov (United States)

    Hilkens, Nina A; Algra, Ale; Diener, Hans-Christoph; Reitsma, Johannes B; Bath, Philip M; Csiba, Laszlo; Hacke, Werner; Kappelle, L Jaap; Koudstaal, Peter J; Leys, Didier; Mas, Jean-Louis; Sacco, Ralph L; Amarenco, Pierre; Sissani, Leila; Greving, Jacoba P

    2017-08-29

    To develop and externally validate a prediction model for major bleeding in patients with a TIA or ischemic stroke on antiplatelet agents. We combined individual patient data from 6 randomized clinical trials (CAPRIE, ESPS-2, MATCH, CHARISMA, ESPRIT, and PRoFESS) investigating antiplatelet therapy after TIA or ischemic stroke. Cox regression analyses stratified by trial were performed to study the association between predictors and major bleeding. A risk prediction model was derived and validated in the PERFORM trial. Performance was assessed with the c statistic and calibration plots. Major bleeding occurred in 1,530 of the 43,112 patients during 94,833 person-years of follow-up. The observed 3-year risk of major bleeding was 4.6% (95% confidence interval [CI] 4.4%-4.9%). Predictors were male sex, smoking, type of antiplatelet agents (aspirin-clopidogrel), outcome on modified Rankin Scale ≥3, prior stroke, high blood pressure, lower body mass index, elderly, Asian ethnicity, and diabetes (S 2 TOP-BLEED). The S 2 TOP-BLEED score had a c statistic of 0.63 (95% CI 0.60-0.64) and showed good calibration in the development data. Major bleeding risk ranged from 2% in patients aged 45-54 years without additional risk factors to more than 10% in patients aged 75-84 years with multiple risk factors. In external validation, the model had a c statistic of 0.61 (95% CI 0.59-0.63) and slightly underestimated major bleeding risk. The S 2 TOP-BLEED score can be used to estimate 3-year major bleeding risk in patients with a TIA or ischemic stroke who use antiplatelet agents, based on readily available characteristics. The discriminatory performance may be improved by identifying stronger predictors of major bleeding. © 2017 American Academy of Neurology.

  8. Chronic rectal bleeding after high-dose conformal treatment of prostate cancer warrants modification of existing morbidity scales

    International Nuclear Information System (INIS)

    Hanlon, Alexandra L.; Schultheiss, Timothy E.; Hunt, Margie A.; Movsas, Benjamin; Peter, Ruth S.; Hanks, Gerald E.

    1997-01-01

    Purpose: Serious late morbidity (Grade (3(4))) from the conformal treatment of prostate cancer has been reported in <1% to 6% of patients based on existing late gastrointestinal (GI) morbidity scales. None of the existing morbidity scales include our most frequently observed late GI complication, which is chronic rectal bleeding requiring multiple fulgerations. This communication documents the frequency of rectal bleeding requiring multiple fulgerations and illustrates the variation in reported late serious GI complication rates by the selection of morbidity scale. Methods and Materials: Between May 1989 and December 1993, 352 patients with T1-T3 nonmetastatic prostate cancers were treated with our four-field conformal technique without special rectal blocking. This technique includes a 1-cm margin from the clinical target volume (CTV) to the planning target volume (PTV) in all directions. The median follow-up for these patients was 36 months (range 2-76), and the median center of prostate dose was 74 Gy (range 63-81). Three morbidity scales are assessed: the Radiation Therapy Oncology Group (RTOG), the Late Effects Normal Tissue Task Force (LENT), and our modification of the LENT (FC-LENT). This modification registers chronic rectal bleeding requiring at least one blood transfusion and/or more than two coagulations as a Grade 3 event. Estimates for Grade (3(4)) late GI complication rates were determined using Kaplan-Meier methodology. The duration of severe symptoms with chronic rectal bleeding is measured from the first to the last transrectal coagulation. Latency is measured from the end of radiotherapy to surgery, first blood transfusion, or third coagulation procedure. Results: Sixteen patients developed Grade (3(4)) complications by one of the three morbidity scales. Two patients required surgery (colostomy or sigmoid resection), three required multiple blood transfusions, two required one or two blood transfusions, and nine required at least three

  9. Massive Upper Gastrointestinal Bleeding from a Splenic Artery Pseudoaneurysm Caused by a Penetrating Gastric Ulcer: Case Report and Review of Literature

    International Nuclear Information System (INIS)

    Sawicki, Marcin; Marlicz, Wojciech; Czapla, Norbert; Łokaj, Marek; Skoczylas, Michał M.; Donotek, Maciej; Kołaczyk, Katarzyna

    2015-01-01

    Splenic artery aneurysm and pseudoaneurysm are rare pathologies. True aneurysms are usually asymptomatic. Aneurysm rupture occurring in 2–3% of cases results in bleeding into the lesser sack, peritoneal space or adjacent organs typically presenting as abdominal pain and hemodynamic instability. In contrast, pseudoaneurysms are nearly always symptomatic carrying a high risk of rupture of 37–47% and mortality rate of 90% if untreated. Therefore, prompt diagnosis and treatment are essential in the management of patients with splenic artery pseudoaneurysm. Typical causes include pancreatitis and trauma. Rarely, the rupture of a pseudoaneurysm presents as upper gastrointestinal (UGI) bleeding. Among causes, peptic ulcer is the casuistic one. This report describes a very rare case of recurrent UGI bleeding from a splenic artery pseudoaneurysm caused by a penetrating gastric ulcer. After negative results of endoscopy and ultrasound, the diagnosis was established in CT angiography. The successful treatment consisted of surgical ligation of the bleeding vessel and suture of the ulcer with preservation of the spleen and pancreas, which is rarely tried in such situations. The most important factor in identifying a ruptured splenic artery pseudoaneurysm as a source of GI bleeding is considering the diagnosis. UGI hemorrhage from splenic artery pseudoaneurysm can have a relapsing course providing false negative results of endoscopy and ultrasound if performed between episodes of active bleeding. In such cases, immediate CT angiography is useful in establishing diagnosis and in application of proper therapy before possible recurrence

  10. An Automatic Bleeding Frame and Region Detection Scheme for Wireless Capsule Endoscopy Videos Based on Interplane Intensity Variation Profile in Normalized RGB Color Space

    Directory of Open Access Journals (Sweden)

    Amit Kumar Kundu

    2018-01-01

    Full Text Available Wireless capsule endoscopy (WCE is an effective video technology to diagnose gastrointestinal (GI disease, such as bleeding. In order to avoid conventional tedious and risky manual review process of long duration WCE videos, automatic bleeding detection schemes are getting importance. In this paper, to investigate bleeding, the analysis of WCE images is carried out in normalized RGB color space as human perception of bleeding is associated with different shades of red. In the proposed method, at first, from the WCE image frame, an efficient region of interest (ROI is extracted based on interplane intensity variation profile in normalized RGB space. Next, from the extracted ROI, the variation in the normalized green plane is presented with the help of histogram. Features are extracted from the proposed normalized green plane histograms. For classification purpose, the K-nearest neighbors classifier is employed. Moreover, bleeding zones in a bleeding image are extracted utilizing some morphological operations. For performance evaluation, 2300 WCE images obtained from 30 publicly available WCE videos are used in a tenfold cross-validation scheme and the proposed method outperforms the reported four existing methods having an accuracy of 97.86%, a sensitivity of 95.20%, and a specificity of 98.32%.

  11. Interventions for treating post-extraction bleeding.

    Science.gov (United States)

    Kumbargere Nagraj, Sumanth; Prashanti, Eachempati; Aggarwal, Himanshi; Lingappa, Ashok; Muthu, Murugan S; Kiran Kumar Krishanappa, Salian; Hassan, Haszelini

    2018-03-04

    Post-extraction bleeding (PEB) is a recognised, frequently encountered complication in dental practice, which is defined as bleeding that continues beyond 8 to 12 hours after dental extraction. The incidence of post-extraction bleeding varies from 0% to 26%. If post-extraction bleeding is not managed, complications can range from soft tissue haematomas to severe blood loss. Local causes of bleeding include soft tissue and bone bleeding. Systemic causes include platelet problems, coagulation disorders or excessive fibrinolysis, and inherited or acquired problems (medication induced). There is a wide array of techniques suggested for the treatment of post-extraction bleeding, which include interventions aimed at both local and systemic causes. This is an update of a review published in June 2016. To assess the effects of interventions for treating different types of post-extraction bleeding. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 24 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 12), MEDLINE Ovid (1946 to 24 January 2018), Embase Ovid (1 May 2015 to 24 January 2018) and CINAHL EBSCO (1937 to 24 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. We searched the reference lists of relevant systematic reviews. We considered randomised controlled trials (RCTs) that evaluated any intervention for treating PEB, with male or female participants of any age, regardless of type of teeth (anterior or posterior, mandibular or maxillary). Trials could compare one type of intervention with another, with placebo, or with no treatment. Three pairs of review authors independently screened search records. We obtained full papers for potentially relevant trials. If data had been extracted

  12. Secondary electric power generation with minimum engine bleed

    Science.gov (United States)

    Tagge, G. E.

    1983-01-01

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

  13. [Update on non-variceal gastrointestinal bleeding].

    Science.gov (United States)

    Lanas, Ángel

    2013-10-01

    This article summarizes the main studies in the field of non-variceal gastrointestinal bleeding reported in the last American Congress of Gastroenterology (Digestive Disease Week) in 2013. Some of these studies have provided new knowledge and expertise in areas of uncertainty. In this context and among other findings, it has been reported that the administration of a proton pump inhibitor (PPI) prior to endoscopy or the early performance of endoscopy-within 6 hours of admission in patients with upper gastrointestinal bleeding (UGIB) (or colonoscopy within 24 hours in patients with lower gastrointestinal bleeding)-does not improve the prognosis of the event. It has also been reported that oral administration of a PPI after endoscopic hemostasis may produce a similar outcome to that of intravenously administered PPI in patients with upper gastrointestinal bleeding (UGIB). In the field of endoscopic therapy, the use of radiofrequency ablation for antral vascular ectasia is of interest. Regarding UGIB and nonsteroidal antiinflammatory drugs (NSAIDs), new data confirm the risk of cardiovascular events by stopping treatment with acetylsalicylic acid (ASA) after an episode of UGIB, the increased risk of UGIB when associating gastrotoxic drugs, and the need to identify both the gastrointestinal and cardiovascular risks of each NSAID and coxib when prescribing these agents. Finally, there is evidence that both environmental and genetic factors are involved in individual susceptibility to gastrointestinal bleeding. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  14. Comparison of heater probe coagulation and argon plasma coagulation in the management of Mallory-Weiss tears and high-risk ulcer bleeding.

    Science.gov (United States)

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

    2017-03-01

    Upper gastrointestinal (GI) bleeding is a common medical emergency. Endoscopic treatments often lead to better therapeutic outcomes than conventional conservative treatments. This study aimed to investigate and compare the use of heater probe coagulation (HPC) and argon plasma coagulation (APC) together with epinephrine injection for the treatment of Mallory-Weiss tears and high-risk ulcer bleeding. A total of 97 patients (54 in the HPC group and 43 in the APC group) who were diagnosed with upper GI bleeding secondary to a Mallory-Weiss tear or high-risk gastric or duodenal ulcers were included in the study. Lesions were classified according to the Forrest classification. The HPC and APC groups were compared in terms of initial haemostasis, re-bleeding in the early period, need for surgery, average need for transfusion, and duration of hospital stay. There were no significant differences between the HPC and APC groups in terms of ensuring initial haemostasis (98% vs. 97.5%, p>0.05), re-bleeding rates (17% vs. 19%, p>0.05), need for surgery (2% vs. 9%, p>0.05), average need for transfusion (3.7±2.11 vs. 3.4±2.95 units, p>0.05), and average duration of hospital stay (4.6±2.24vs. 5.3±3.23days, p>0.05). There was no difference between HPC and APC when used together with epinephrine injection for the treatment of Mallory-Weiss tear and high-risk ulcer bleeding. Copyright © 2017 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

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

    2014-03-11

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

  16. Polytraumatism and solid organ bleeding syndrome: The role of imaging.

    Science.gov (United States)

    Thony, F; Rodière, M; Frandon, J; Vendrell, A; Jankowski, A; Ghelfi, J; Sengel, C; Arvieux, C; Bouzat, P; Ferretti, G

    2015-01-01

    In multiple injuries, features of bleeding from solid organs mostly involve the liver, spleen and kidneys and may be treated by embolization. The indications and techniques for embolization vary between organs and depend on the pathophysiology of the injuries, type of vascularization (anastomotic or terminal) and type of embolization (curative or preventative). Interventional radiologists should have a full understanding of these indications and techniques and management algorithms should be produced within each facility in order to define the respective place of the different treatment options. Copyright © 2015 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  17. A comparative study of digital GI and CT in diagnosis of gastric carcinoma

    International Nuclear Information System (INIS)

    Wan Xiangrong; Chen Guoqin; Ding Xinmin

    2003-01-01

    Objective: To evaluate the digital GI and CT in the diagnosis of gastric carcinoma. Methods: Total 42 patients with gastric carcinoma received digital GI and CT examination. The digital GI and CT findings were analyzed comparatively. Results: 42 cases of patients with gastric carcinoma were examined with digital GI and CT. Digital GI demonstrated mucosal erosion in 40 cases, narrowed gastric lumen in 12, malignant ulceration in 10, filling defect in 12 and abnormal peristalsis in 36. CT revealed gastric wall thickening in 30 cases, intra-gastric masses in 36, narrowed gastric lumen in 36, regional lymphadenopathy and/or distant metastases in 19 and pyloristenosis in 4. Conclusion: The lesions in stomach could be demonstrated on digital GI, the imaging is clear and precise. CT is valuable for assessing the extra-gastric involvement, lymphadenopathy and distant metastases, which is an important pre-operative examination

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

    Directory of Open Access Journals (Sweden)

    Fransiska Prihatini Sihotang

    2017-08-01

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

  19. 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

  20. Radiotherapy in benign uterine bleeding disorders

    International Nuclear Information System (INIS)

    Ryberg, M.; Pettersson, F.; Lundell, M.

    1989-01-01

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

  1. Somatostatin analogues for acute bleeding oesophageal varices

    DEFF Research Database (Denmark)

    Gøtzsche, Peter C.; Hrobjartsson, A.

    2008-01-01

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

  2. Hemospray application in nonvariceal upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

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

    2013-01-01

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

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

    OpenAIRE

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

    2017-01-01

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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    gastrointestinal cancer is 1/7 as common as colon cancer. Benign gastrointestinal causes of anemia are iron malabsorption (atrophic gastritis, celiac disease, chronic inflammation, and bariatric surgery) and chronic blood loss due to gastrointestinal ulcerations. The following diagnostic strategy is recommended......A general overview is given of the causes of anemia with iron deficiency as well as the pathogenesis of anemia and the para-clinical diagnosis of anemia. Anemia with iron deficiency but without overt GI bleeding is associated with a risk of malignant disease of the gastrointestinal tract; upper...... for unexplained anemia with iron deficiency: conduct serological celiac disease screening with transglutaminase antibody (IgA type) and IgA testing and perform bidirectional endoscopy (gastroscopy and colonoscopy). Bidirectional endoscopy is not required in premenopausal women

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    A general overview is given of the causes of anemia with iron deficiency as well as the pathogenesis of anemia and the para-clinical diagnosis of anemia. Anemia with iron deficiency but without overt GI bleeding is associated with a risk of malignant disease of the gastrointestinal tract; upper...... gastrointestinal cancer is 1/7 as common as colon cancer. Benign gastrointestinal causes of anemia are iron malabsorption (atrophic gastritis, celiac disease, chronic inflammation, and bariatric surgery) and chronic blood loss due to gastrointestinal ulcerations. The following diagnostic strategy is recommended...... for unexplained anemia with iron deficiency: conduct serological celiac disease screening with transglutaminase antibody (IgA type) and IgA testing and perform bidirectional endoscopy (gastroscopy and colonoscopy). Bidirectional endoscopy is not required in premenopausal women

  6. 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.

  7. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

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

    2008-01-01

    . All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean...... follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed...

  8. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

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

    2008-01-01

    follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed...... reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding...

  9. A reduced functionality of Gi proteins as a possible cause of fibromyalgia.

    Science.gov (United States)

    Galeotti, N; Ghelardini, C; Zoppi, M; Bene, E D; Raimondi, L; Beneforti, E; Bartolini, A

    2001-10-01

    The etiopathogenesis of fibromyalgia (FM), a syndrome characterized by widespread pain and hyperalgesia, is still unknown. Since the involvement of Gi proteins in the modulation of pain perception has been widely established, the aim of the present study was to determine whether an altered functionality of the Gi proteins occurred in patients with FM. Patients with FM and other painful diseases such as neuropathic pain, rheumatoid arthritis (RA), and osteoarthritis, used as reference painful pathologies, were included in the study. The functionality, evaluated as capability to inhibit forskolin-stimulated adenylyl cyclase activity, and the level of expression of Gi proteins were investigated in peripheral blood lymphocytes. Patients with FM showed a hypofunctionality of the Gi protein system. In contrast, unaltered Gi protein functionality was observed in patients with neuropathic pain, RA, and osteoarthritis. Patients with FM also showed basal cAMP levels higher than controls. The reduced activity of Gi proteins seems to be unrelated to a reduction of protein levels since only a slight reduction (about 20-30%) of the Gi3alpha subunit was observed. Gi protein hypofunctionality is the first biochemical alteration observed in FM that could be involved in the pathogenesis of this syndrome. In the complete absence of laboratory diagnostic tests, the determination of an increase in cAMP basal levels in lymphocytes, together with the assessment of a Gi protein hypofunctionality after adenylyl cyclase stimulation, may lead to the biochemical identification of patients with FM.

  10. GiRaFFE: An Open-Source General Relativistic Force-Free Electrodynamics Code

    OpenAIRE

    Etienne, Zachariah B.; Wan, Mew-Bing; Babiuc, Maria C.; McWilliams, Sean T.; Choudhary, Ashok

    2017-01-01

    We present GiRaFFE, the first open-source general relativistic force-free electrodynamics (GRFFE) code for dynamical, numerical-relativity generated spacetimes. GiRaFFE adopts the strategy pioneered by McKinney and modified by Paschalidis and Shapiro to convert a GR magnetohydrodynamic (GRMHD) code into a GRFFE code. In short, GiRaFFE exists as a modification of IllinoisGRMHD, a user-friendly, open-source, dynamical-spacetime GRMHD code. Both GiRaFFE and IllinoisGRMHD leverage the Einstein To...

  11. Safety and efficacy of nasogastric intubation for gastrointestinal bleeding after myocardial infarction: an analysis of 125 patients at two tertiary cardiac referral hospitals.

    Science.gov (United States)

    Cappell, Mitchell S

    2005-11-01

    Our purpose was to analyze risks versus benefits of nasogastric (NG) intubation for gastrointestinal (GI) bleeding performed soon after myocardial infarction (MI). While NG intubation and aspiration is relatively safe, clinically beneficial, and routinely performed in the general population for recent GI bleeding, its safety after MI is unstudied and unknown. In addition to the usual complications of NG tubes, patients status post-MI may be particularly susceptible to myocardial ischemia or cardiac arrhythmias from anxiety or discomfort during intubation. We studied NG intubation within 30 days of MI in 125 patients at two hospitals from 1986 through 2001. Indications for NG intubation included melena in 55 patients; fecal occult blood with an acute hematocrit decline, severe anemia, or sudden hypotension in 37; hematemesis in 18; bright red blood per rectum in 8; and dark red blood per rectum in 7. The intubation was performed on average 5.3 +/- 7.2 (SD) days after MI. NG aspiration revealed bright red blood in 38 patients, "coffee grounds"-appearing blood in 45, and clear (or bilious) fluid in 42. Among 114 of the patients undergoing esophagogastroduodenoscopy (EGD), EGD revealed the cause of bleeding in 79 (95%) of 83 patients with a grossly bloody NG aspirate versus 12 (39%) of 31 patients with a clear aspirate (P tube complications (epistaxis during intubation and gastric erosions from NG suctioning) were neither cardiac nor major (requiring blood transfusions). This study suggests that short-term NG intubation is relatively safe and may be beneficial and indicated for acute GI bleeding after recent MI. Aside from improving visualization at EGD, the potential benefits include providing a rational basis for the timing of endoscopy (urgent versus semielective), for prioritizing the order of endoscopy (EGD versus colonoscopy), and for avoiding or deferring endoscopy in low-yield situations (e.g., colonoscopy when the NG aspirate is bloody). These benefits may be

  12. xenoGI: reconstructing the history of genomic island insertions in clades of closely related bacteria.

    Science.gov (United States)

    Bush, Eliot C; Clark, Anne E; DeRanek, Carissa A; Eng, Alexander; Forman, Juliet; Heath, Kevin; Lee, Alexander B; Stoebel, Daniel M; Wang, Zunyan; Wilber, Matthew; Wu, Helen

    2018-02-05

    Genomic islands play an important role in microbial genome evolution, providing a mechanism for strains to adapt to new ecological conditions. A variety of computational methods, both genome-composition based and comparative, have been developed to identify them. Some of these methods are explicitly designed to work in single strains, while others make use of multiple strains. In general, existing methods do not identify islands in the context of the phylogeny in which they evolved. Even multiple strain approaches are best suited to identifying genomic islands that are present in one strain but absent in others. They do not automatically recognize islands which are shared between some strains in the clade or determine the branch on which these islands inserted within the phylogenetic tree. We have developed a software package, xenoGI, that identifies genomic islands and maps their origin within a clade of closely related bacteria, determining which branch they inserted on. It takes as input a set of sequenced genomes and a tree specifying their phylogenetic relationships. Making heavy use of synteny information, the package builds gene families in a species-tree-aware way, and then attempts to combine into islands those families whose members are adjacent and whose most recent common ancestor is shared. The package provides a variety of text-based analysis functions, as well as the ability to export genomic islands into formats suitable for viewing in a genome browser. We demonstrate the capabilities of the package with several examples from enteric bacteria, including an examination of the evolution of the acid fitness island in the genus Escherichia. In addition we use output from simulations and a set of known genomic islands from the literature to show that xenoGI can accurately identify genomic islands and place them on a phylogenetic tree. xenoGI is an effective tool for studying the history of genomic island insertions in a clade of microbes. It identifies

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

    Science.gov (United States)

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

    2018-01-17

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

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

    African Journals Online (AJOL)

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

  15. Dysfunctional uterine bleedings of a climacteric period

    International Nuclear Information System (INIS)

    Prilepskaya, V.N.

    1993-01-01

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

  16. Systemic causes of heavy menstrual bleeding

    NARCIS (Netherlands)

    Verschueren, Sophie

    2017-01-01

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

  17. Thromboembolic and Bleeding Complications among Patients with ...

    African Journals Online (AJOL)

    Objective: This study was conducted to determine the incidence of thromboembolic and bleeding complications among patients with mechanical heart valves operated from 1990 to 2003 attending the Muhimbili National Hospital. Study design: This was a retrospective cohort study conducted at the cardiac, anticoagulation ...

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

    African Journals Online (AJOL)

    RESEARCH. 884 November 2012, Vol. 102, No. 11 SAMJ. Endoscopic injection sclerotherapy for bleeding varices in children with intrahepatic and extrahepatic portal venous ... Progress has been made in developing newer endoscopic techniques ... a sclerosant, usually 0.5 - 0.75 ml per injection, at multiple (up to.

  19. Massive rectal bleeding from colonic diverticulosis

    African Journals Online (AJOL)

    ABEOLUGBENGAS

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

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

    African Journals Online (AJOL)

    Summary. This is an unusual case report of a 60-year-old man who presented with massive rectal bleeding due to angiomatous formation. ' He was also found to be cirrhosis and to have an ectopic left kidney in the ... attribuable a la formation angiomateuse. On a decouvert qu' ... challenging experience to the treating team.

  1. Endometrial biopsy findings in postmenopausal bleeding

    International Nuclear Information System (INIS)

    Sarfraz, T.; Tariq, H.

    2007-01-01

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

  2. Continued bleeding following acute intracerebral hemorrhage

    NARCIS (Netherlands)

    Brouwers, H.B.

    2014-01-01

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

  3. First trimester bleeding and maternal cardiovascular morbidity

    DEFF Research Database (Denmark)

    Lykke, Jacob A; Langhoff-Roos, Jens

    2012-01-01

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

  4. Managing Chemotherapy Side Effects: Bleeding Problems

    Science.gov (United States)

    ... nurse: 1. What problems should I call you about? 2. How long should I wait for the bleeding to stop before I call you or go to the emergency room? 3. Is it okay to drink beer, wine, or other drinks with alcohol? Yes No, don’ ...

  5. Medical treatment for heavy menstrual bleeding

    Directory of Open Access Journals (Sweden)

    Yi-Jen Chen

    2015-10-01

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

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

    Science.gov (United States)

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

    2017-04-01

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

  7. THERMOELECTRIC SEMICONDUCTOR DEVICE FOR CAUTERY OF BLEEDING

    Directory of Open Access Journals (Sweden)

    Denis V. Yevdulov

    2017-01-01

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

  8. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    International Nuclear Information System (INIS)

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

    2008-01-01

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

  9. Nad võitlesid oma isamaa eest / Otto Mägi

    Index Scriptorium Estoniae

    Mägi, Otto

    2001-01-01

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

  10. Postimüügi tõusulaine rahunes / Andres Kärssin

    Index Scriptorium Estoniae

    Kärssin, Andres, 1971-

    2003-01-01

    Eesti Hobby Halli juhataja Riitta Kinnunen ja Anttila tegevjuht Tauno Tuula tunnistavad, et postimüügi osakaalu kasv üldises jaemüügis on seiskunud ning peavad selle peamiseks põhjuseks järelmaksuvõimaluste mitmekülgset arengut Eestis. Diagramm: postimüügi kasv 1998-2003

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

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  12. GI ischemia in patients with portal vein thrombosis: A prospective cohort study

    NARCIS (Netherlands)

    J. Harki (Jihan); E.P.C. Plompen (Elisabeth); D. van Noord (Désirée); J.W. Hoekstra; E.J. Kuipers (Ernst); H.L.A. Janssen (Harry); E.T.T.L. Tjwa (Eric)

    2016-01-01

    textabstractBackground and Aims GI ischemia is a concerning adverse event of portal vein thrombosis (PVT). Minimally invasive techniques, such as visible light spectroscopy (VLS), have greatly improved the ability to diagnose GI ischemia. The aim of this study was to assess the clinical presentation

  13. Kalapüügiõiguse tasu on kalurisõbralik / Robert Aps

    Index Scriptorium Estoniae

    Aps, Robert, 1944-

    1997-01-01

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

  14. Prügi tekkekohas sortimise kavatsus on läbi kukkunud / Anti Ronk

    Index Scriptorium Estoniae

    Ronk, Anti

    2004-01-01

    Korteriühistute ja prügifirmade kogemuste kohaselt ei ole Eesti inimesed harjunud prügi sorteerima ega kasuta vastavaid konteinereid. Kommentaarid Lauka korteriühistu eksjuhilt Nelli Vahemetsalt ja Ragn-Sellsi müügijuhilt Maren Pärnalt. Lisa: Prügi

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

    Indian Academy of Sciences (India)

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

  16. Radiological evaluation of G-I tract diverticulum in Korean

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Ki Jun; Park, Joong Wha; Hong, In Soo; Kim, Myung Soon [Yeonsei University Wonju College of Medicine, Wonju (Korea, Republic of)

    1986-12-15

    We reviewed 887 cases of esophagogram, 8863 cases of UGI series, 174 cases of small bowel series and 1926 cases of double contrast barium enema performed at the department of Radiology, Wonju College of Medicine from Jan. 1982 to Dec. 1984 to analyzed diverticular disease pattern of the GI tract in Korean. The results were as follows: 1. Esophageal diverticular. The incidence was 3.27% and the sex ratio of male to female was 2.22:1 Age distribution was relatively even and most common in 5th decade. Most of them showed single in number, above 6mm sized and common in middle one third of both lateral side of esophagus. 2. Stomach diverticular. The incidence was 0.07% and the sex ratio of male to female was equal. Multiplicity was single in all cases. Most of them were above 11mm sized and common in gastric fundic area of greater curvature site of stomach. 3. Duodenal diverticular. The incidence was 1.51% and relatively even distribution in sex and age and common in after 5th decade. Most of them showed single in number, 11-30mm sized and common in medial margin of 2nd portion of duodenum. 4. Colonic diverticular. The incidence was 2.34% and predominant in male and common in 5th. and 6th. decade. Most of them showed single in number, below 5mm sized and common in right sided colon.

  17. Radiological evaluation of G-I tract diverticulum in Korean

    International Nuclear Information System (INIS)

    Sung, Ki Jun; Park, Joong Wha; Hong, In Soo; Kim, Myung Soon

    1986-01-01

    We reviewed 887 cases of esophagogram, 8863 cases of UGI series, 174 cases of small bowel series and 1926 cases of double contrast barium enema performed at the department of Radiology, Wonju College of Medicine from Jan. 1982 to Dec. 1984 to analyzed diverticular disease pattern of the GI tract in Korean. The results were as follows: 1. Esophageal diverticular. The incidence was 3.27% and the sex ratio of male to female was 2.22:1 Age distribution was relatively even and most common in 5th decade. Most of them showed single in number, above 6mm sized and common in middle one third of both lateral side of esophagus. 2. Stomach diverticular. The incidence was 0.07% and the sex ratio of male to female was equal. Multiplicity was single in all cases. Most of them were above 11mm sized and common in gastric fundic area of greater curvature site of stomach. 3. Duodenal diverticular. The incidence was 1.51% and relatively even distribution in sex and age and common in after 5th decade. Most of them showed single in number, 11-30mm sized and common in medial margin of 2nd portion of duodenum. 4. Colonic diverticular. The incidence was 2.34% and predominant in male and common in 5th. and 6th. decade. Most of them showed single in number, below 5mm sized and common in right sided colon.

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

    Science.gov (United States)

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

    2017-01-01

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

  19. Systematic review: tranexamic acid for upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

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

    2008-01-01

    BACKGROUND: Tranexamic acid may reduce upper gastrointestinal bleeding and stabilize patients before endoscopic treatments. AIM: To review randomized trials on tranexamic acid for upper gastrointestinal bleeding. METHODS: Manual and electronic searches of The Cochrane Library, MEDLINE, EMBASE and...

  20. 14 CFR 23.1109 - Turbocharger bleed air system.

    Science.gov (United States)

    2010-01-01

    ... Induction System § 23.1109 Turbocharger bleed air system. The following applies to turbocharged bleed air... vapors following any probable failure or malfunction of the engine exhaust, hydraulic, fuel, or oil...

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

    Science.gov (United States)

    Johnstone, Candice; Rich, Shayna E

    2017-12-18

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

  2. Breast cancer recurrence after reoperation for surgical bleeding

    DEFF Research Database (Denmark)

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

    2017-01-01

    BACKGROUND: Bleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. This study investigated whether reoperation for postoperative bleeding is associated with breast cancer recurrence. METHODS: Using the Danish Breast Cancer Group d...

  3. Advanced GI Surgery Training-a Roadmap for the Future: the White Paper from the SSAT Task Force on Advanced GI Surgery Training.

    Science.gov (United States)

    Hutter, Matthew M; Behrns, Kevin E; Soper, Nathaniel J; Michelassi, Fabrizio

    2017-04-01

    There is the need for well-trained advanced GI surgeons. The super specialization seen in academic and large community centers may not be applicable for surgeons practicing in other settings. The pendulum that has been swinging toward narrow specialization is swinging the other way, as many trained subspecialists are having a harder time finding positions after fellowship, and if they do find a position, the majority of their practice can actually be advanced GI surgery and not exclusively their area of focused expertise. Many hospitals/practices desire surgeons who are competent and specifically credentialed to perform a variety of advanced GI procedures from the esophagus through the anus. Furthermore, broader exposure in training may provide complementary and overlapping skills that may lead to an even better trained GI surgeon compared to someone whose experience is limited to just the liver and pancreas, or to just the colon and rectum, or to only bariatric and foregut surgery. With work hour restrictions and limitations on autonomy for current trainees in residency, many senior trainees have not developed the skills and knowledge to allow them to be competent and comfortable in the broad range of GI surgery. Such training should reflect the needs of the patients and their diseases, and reflect what many practicing surgeons are currently doing, and what many trainees say they would like to do, if there were such fellowship pathways available to them. The goal is to train advanced GI surgeons who are competent and proficient to operate throughout the GI tract and abdomen with open, laparoscopic, and endoscopic techniques in acute and elective situations in a broad variety of complex GI diseases. The program may be standalone, or prepare a surgeon for additional subspecialty training (transition to fellowship and/or to practice). This group of surgeons should be distinguished from subspecialist surgeons who focus in a narrow area of GI surgery. Advanced GI

  4. TC-325 versus the conventional combined technique for endoscopic treatment of peptic ulcers with high-risk bleeding stigmata: A randomized pilot study.

    Science.gov (United States)

    Kwek, Boon Eu Andrew; Ang, Tiing Leong; Ong, Peng Lan Jeannie; Tan, Yi Lyn Jessica; Ang, Shih Wen Daphne; Law, Ngai Moh; Thurairajah, Prem Harichander; Fock, Kwong Ming

    2017-06-01

    Preliminary studies on a new topical hemostatic agent, TC-325, have shown its safety and effectiveness in treating active upper gastrointestinal (GI) bleeding. However, to date there have been no randomized trials comparing TC-325 with the conventional combined technique (CCT). Our pilot study aimed to compare the efficacy and safety of TC-325 with those of CCT in treating peptic ulcers with active bleeding or high-risk stigmata. This was a comparative randomized study of patients with upper GI bleeding who had Forrest class I, IIA or IIB ulcers. Altogether 20 patients with a mean age of 70 years (range 23-87 years) were recruited, including 16 men, with a mean hemoglobin of 97 g/L. Initial hemostasis was successful in 19 (95.0%) patients, including 90.0% (9/10) in the TC-325 group and 100% (10/10) in the CCT group. TC-325 monotherapy failed to stop bleeding in a patient with Forrest IB posterior duodenal wall ulcer. Rebleeding was seen in 33.3% (3/9) of the patients in the TC-325 group and 10.0% (1/10) in the CCT group. One patient required angio-embolization therapy while three had successful conventional endotherapy. Two patients from the TC-325 group had serious adverse events that were not procedure- or therapy-related. In patients with Forrest IIA or IIB ulcers, five received TC-325 monotherapy; none had rebleeding. Our pilot study showed that TC-325 has a tendency towards a higher rebleeding rate than CCT, when treating actively bleeding ulcers. Larger trials are necessary for definitive results. © 2017 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.

  5. Short-Term Treatment of Bothersome Bleeding for Etonogestrel Implant Users Using a 14-Day Oral Contraceptive Pill Regimen: A Randomized Controlled Trial.

    Science.gov (United States)

    Guiahi, Maryam; McBride, Madeline; Sheeder, Jeanelle; Teal, Stephanie

    2015-09-01

    To understand whether using oral contraceptive pills (OCPs) results in temporary interruption of bleeding for etonogestrel contraceptive implant users during a 14-day course. In this double-blind trial, we randomly assigned etonogestrel implant users reporting 7 consecutive days or more of bothersome bleeding to receive 14 pills of study drug (150 microgram levonorgestrel and 30 microgram ethinyl estradiol combined OCPs) or an identical-appearing placebo. The primary outcome was the proportion of women in each group who stopped bleeding during therapy and continued to report no bleeding at the end of therapy. Prespecified secondary outcomes were number of days until temporary interruption of bleeding occurred, number of days without bleeding during therapy, and number of days to recurrence of bleeding after discontinuation of therapy. We hypothesized that temporary interruption of bleeding would occur in 80% of the treatment group compared with 20% in the control group; using 80% power, we needed a sample size of 26 women. We performed intent-to-treat analysis. From November 2013 through December 2014, 66 women were screened and 32 were randomized: OCPs (n=16) or placebo (n=16). The majority was young, Caucasian women with reported bleeding as extremely or very annoying; groups had similar baseline characteristics. Participants randomized OCPs were more likely (14 of 16 [87.5%±16.2%] compared with six of 16 [37.5%±23.7%]) to have a temporary interruption of bleeding during the study drug period (odds ratio 11.7, 95% confidence interval 1.9-70.2). Of women in the OCP arm who had a temporary interruption, 85.7% had bleeding recurrence within 10 days after treatment. Bothersome bleeding in etonogestrel contraceptive implant users will usually stop with 14-day OCP treatment, but bleeding most often resumes within days of treatment cessation. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01968135. I.

  6. 14 CFR 23.1111 - Turbine engine bleed air system.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Turbine engine bleed air system. 23.1111... Induction System § 23.1111 Turbine engine bleed air system. For turbine engine bleed air systems, the following apply: (a) No hazard may result if duct rupture or failure occurs anywhere between the engine port...

  7. Colonoscopic examination of rectal bleeding in children: A report of ...

    African Journals Online (AJOL)

    Rectal bleeding in children is a frightening and cause of great concern, and of parental anxiety. In this report, we present the value of colonoscopy to unravel the diagnostic conundrum often associated with rectal bleeding in children. Key words: Children, colonoscopy, juvenile polyps, rectal bleeding ...

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

    African Journals Online (AJOL)

    Leech bites are a recognized cause of bleeding from any human orifice upon exposure to water which is infested with leeches. A high level of suspicion is necessary to make the diagnosis and institute cost-effective definitive treatment for leech bite induced bleeding including vaginal bleeding as has been revealed by the ...

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

    NARCIS (Netherlands)

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

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

  10. Small intestinal diverticulum with bleeding: Case report and literature review.

    Science.gov (United States)

    Zhao, Lifang; Lu, Wei; Sun, Yinping; Liang, Junrong; Feng, Shanshan; Shi, Yongquan; Wu, Qiong; Wang, Jianhong; Wu, Kaichun

    2018-03-01

    Small intestinal diverticulum with bleeding is an important reason for obscure gastrointestinal bleeding (OGB) , in addition to tumor and vascular diseases. Small intestinal diverticulum with bleeding is difficult to detect by barium meal and angiographic methods and has been regarded as an important cause of obscure gastrointestinal tract bleeding in adolescents. Because of its complicated etiology and non-specific clinical manifestations, it is relatively difficult to detect small intestinal diverticulum with bleeding, especially in patients with a large amount of bleeding and hemodynamic instability. This retrospective study collects clinical statistics of 19 patients admitted to our hospital from January 2010 to December 2016. Patients who had small intestinal diverticulum patients with bleeding were included in this study. Patients who were taking anticoagulants were excluded DIAGNOSES:: Small intestinal diverticulum patients with bleeding. This retrospective study describes the clinical features of patients with small intestinal diverticulum whose main symptom was gastrointestinal bleeding and analyze the literature on this topic, with particular reference to the clinical characteristics, pathological features, and choice of examination methods. Small intestinal diverticulum with bleeding is a common cause of obscure gastrointestinal bleeding, but it is difficult to detect using normal examination methods. For patients with repeated gastrointestinal bleeding and no positive results found on gastroscopy and colonoscopy, endoscopy of the small intestine and CTE with contrast can be considered as a diagnostic modality.

  11. Helping mothers survive bleeding after birth

    DEFF Research Database (Denmark)

    Nelissen, Ellen; Ersdal, Hege; Ostergaard, Doris

    2014-01-01

    OBJECTIVE: To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. DESIGN: Educational intervention study. SETTING: Rural referral hospital in Northern Tanzania. POPULATION: Clinicians, nurse-midwives, medical attendants, and ambul......OBJECTIVE: To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. DESIGN: Educational intervention study. SETTING: Rural referral hospital in Northern Tanzania. POPULATION: Clinicians, nurse-midwives, medical attendants...... low (3% pass rate for basic delivery and management of postpartum hemorrhage). CONCLUSIONS: The HMS BAB simulation-based training has potential to contribute to education of health care providers. We recommend a full day of training and validation of the facilitators to improve the training....

  12. Treatment and prognosis in peptic ulcer bleeding.

    Science.gov (United States)

    Laursen, Stig Borbjerg

    2014-01-01

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

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

    Science.gov (United States)

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

    2010-01-01

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

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

    Science.gov (United States)

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

    2018-03-07

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

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

    DEFF Research Database (Denmark)

    Guo, Yutao; Zhu, Hang; Chen, Yundai

    2018-01-01

    predictive ability for major bleeding (c-index 0.63, 95% confidence interval 0.56-0.69) and intracranial hemorrhage (0.72, 0.65-0.79) but nonsignificantly (and poorly) predicted extracranial bleeding (0.55, 0.54-0.56; P = .361). The HAS-BLED score was superior to predict bleeding events compared...

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  17. Jejunal Diverticula Causing Unusual Massive Lower Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Chiong-Hee Wong

    2008-09-01

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

  18. [ENDOSCOPIC INJECTION TREATMENT OF BLEEDING PEPTIC ULCER

    Science.gov (United States)

    Díaz, Freddy; Contardo, Carlos; Román, Rossana; Eduardo, Vesco; Dávalos, Milagros; Velásquez, Hermes; Soriano, César; Espejo, Hernán

    1997-01-01

    BACKGROUND: Objectives were two. (1) to determine theefficiency of the endoscopic injection therapy (EIT) in patients suffering from bleeding caused by peptic ulcer disease with high risk of recurrence, and (2) to recognize clinical and endoscopical risk factors that influence recurrence of hemorrhage and mortality from this pathology. METHODS: This is a retrospective study that included 121 patients, who were admitted by a unit specialized in managing gastrointestinal hemorrhage owing to peptic ulcer with active bleeding or non-bleeding visible vessel, and who underwent EIT with epinephrine between March, 1994 and February, 1996.RESULTS: Initial success was achieved in 119 patients who underwent EIT (99,1%). Bleeding persisted in one patient (0,9%), and in another one, EIT was not sucessful because of inaccessible location. Definite hemostasis was achieved in 93 patients (77,5%) and there was recurrence in 28 cases (23,5%). Twenty-six patients underwent surgical therapy (21,5%). The univariable analysis showed that hemorrhage recurrence was related to the presence of shock (p = 0,002), hematemesis (p = 0,2), age over 60 (p = 0,009), number of blood units transfused (p = 0,00000) and ulcer diameter larger than 2 cm (p = 0,018). The global mortality in our patients was of 10%, and surgical mortality was of 34,6%. Factors significantly related to mortality were hemorrhage recurrence (p = 0,000003), presence of concomitant disease (p = 0,05), and presence of gastric ulcer (p = 0,021), in addition to age (over 60), presence of shock and ulcer diameter larger than 2 cm (p = 0,05).CONCLUSION: EIT is a valuable procedure for the treatment of hemorrhage caused by peptic ulcer with high risk of recurrence (active hemorrhage or visible vessel), with a definite hemostasis of 77,5%. The presence of shock, hematemesis, age over 60, transfusion requirements of more than 3 blood units, and ulcer diameter of more than 2 cm are factors that increase the probability of hemorrhage

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

    Directory of Open Access Journals (Sweden)

    Amy M Hurwitz

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

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

    Directory of Open Access Journals (Sweden)

    Joaquim Natércia

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

  1. Differential expression of gastrointestinal glutathione peroxidase (GI-GPx) gene during mouse organogenesis.

    Science.gov (United States)

    Baek, I-J; Yon, J-M; Lee, S-R; Kim, M-R; Hong, J T; Lee, B J; Yun, Y W; Nam, S-Y

    2011-06-01

    Gastrointestinal glutathione peroxidase (GI-GPx) is an antioxidant enzyme that has been known to be restricted to the gastrointestinal tract in rodents. In an effort to determine the expression pattern of GI-GPx mRNA during organogenesis, quantitative real-time PCR and in situ hybridization for GI-GPx mRNA were conducted in whole embryos or each developing organ of mice. GI-GPx mRNA was expressed more abundantly in the extraembryonic tissues, including placenta than in embryos on embryonic days (EDs) 7.5-18.5 (P embryonic organs during organogenesis but also may perform a mutual compensatory role with the cGPx in the protection of embryos and extraembryonic tissues against the reactive oxygen species generated in ontogenetic periods. © 2011 Blackwell Verlag GmbH.

  2. Kaks musketäri. 20 aastat hiljem / Tristan Priimägi

    Index Scriptorium Estoniae

    Priimägi, Tristan, 1976-

    2007-01-01

    Tristan Priimägi kohtumisest Londoni klubis Hard Rock Cafe ameerika rockansambli Aerosmith liikmetega, intervjuu Steven Tyleriga. Heliplaatidest "Aerosmith", "Toys in the Attic", Run D.M.C & Aerosmith "Walk This Way", Get a Grip"

  3. Standardi juhid maksid 37, 5 miljonit krooni / Aivar Hundimägi

    Index Scriptorium Estoniae

    Hundimägi, Aivar, 1975-

    2004-01-01

    Standardi juhatuse esimees Enn Veskimägi ning juhatuse liikmed Priit Tamm ja Mati Peekma omandasid 58% Standardi aktsiatest, makstes Indoor Group'ile ja riskikapitaliinvestorile BaltCap tehingu eest väidetavalt 37, 5 miljonit krooni

  4. Kalevi juhtfiguur Priimägi lõi ajalehti kirjastava firma / Toivo Tänavsuu

    Index Scriptorium Estoniae

    Tänavsuu, Toivo

    2007-01-01

    Kalevi nõukogu liige Heino Priimägi on ajalehtede ja ajakirjade kirjastamisega tegeleva firma Complus Solutions juhatuse liige. Kalevi pressiesindaja Aire Milli väitel ei ole Complus Solutions Kaleviga seotud firma

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

    Index Scriptorium Estoniae

    Veskimägi, Taavi, 1974-

    2006-01-01

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

  6. Quaternary structure of a G-protein-coupled receptor heterotetramer in complex with Gi and Gs.

    Science.gov (United States)

    Navarro, Gemma; Cordomí, Arnau; Zelman-Femiak, Monika; Brugarolas, Marc; Moreno, Estefania; Aguinaga, David; Perez-Benito, Laura; Cortés, Antoni; Casadó, Vicent; Mallol, Josefa; Canela, Enric I; Lluís, Carme; Pardo, Leonardo; García-Sáez, Ana J; McCormick, Peter J; Franco, Rafael

    2016-04-05

    G-protein-coupled receptors (GPCRs), in the form of monomers or homodimers that bind heterotrimeric G proteins, are fundamental in the transfer of extracellular stimuli to intracellular signaling pathways. Different GPCRs may also interact to form heteromers that are novel signaling units. Despite the exponential growth in the number of solved GPCR crystal structures, the structural properties of heteromers remain unknown. We used single-particle tracking experiments in cells expressing functional adenosine A1-A2A receptors fused to fluorescent proteins to show the loss of Brownian movement of the A1 receptor in the presence of the A2A receptor, and a preponderance of cell surface 2:2 receptor heteromers (dimer of dimers). Using computer modeling, aided by bioluminescence resonance energy transfer assays to monitor receptor homomerization and heteromerization and G-protein coupling, we predict the interacting interfaces and propose a quaternary structure of the GPCR tetramer in complex with two G proteins. The combination of results points to a molecular architecture formed by a rhombus-shaped heterotetramer, which is bound to two different interacting heterotrimeric G proteins (Gi and Gs). These novel results constitute an important advance in understanding the molecular intricacies involved in GPCR function.

  7. Management of overt upper gastrointestinal bleeding in a low resource setting: a real world report from Nigeria.

    Science.gov (United States)

    Alatise, Olusegun I; Aderibigbe, Adeniyi S; Adisa, Adewale O; Adekanle, Olusegun; Agbakwuru, Augustine E; Arigbabu, Anthony O

    2014-12-10

    Upper gastrointestinal bleeding (UGIB) remains a common medical problem worldwide that has significant associated morbidity, mortality, and health care resource use. This study outlines the aetiology, clinical presentation, and treatment outcomes of patients with UGIB in a Nigerian low resource health facility. This was a descriptive study of consecutive patients who underwent upper gastrointestinal (GI) endoscopy for upper GI bleeding in the endoscopy unit of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria from January 2007 to December 2013. During the study period, 287 (12.4%) of 2,320 patients who underwent upper GI endoscopies had UGIB. Of these, 206 (72.0%) patients were males and their ages ranged from 3 to 100 years with a median age of 49 years. The main clinical presentation included passage of melaena stool in 268 (93.4%) of individuals, 173 (60.3%) had haematemesis, 110 (38.3%) had haematochezia, and 161 (56.1%) were dizzy at presentation. Observed in 88 (30.6%) of UGIB patients, duodenal ulcer was the most common cause, followed by varices [52 (18.1%)] and gastritis [51 (17.1%)]. For variceal bleeding, 15 (28.8%) and 21 (40.4%) of patients had injection sclerotherapy and variceal band ligation, respectively. The overall rebleeding rate for endoscopic therapy for varices was 16.7%. For patients with ulcers, only 42 of 55 who had Forrest grade Ia to IIb ulcers were offered endoscopic therapy. Endoscopic therapy was áin 90.5% of the cases. No rebleeding followed endoscopic therapy for the ulcers. The obtained Rockall scores ranged from 2 to 10 and the median was 5.0. Of all patients, 92.7% had medium or high risk scores. An increase in Rockall score was significantly associated with length of hospital stay and mortality (p < 0.001). The overall mortality rate was 5.9% (17 patients). Endoscopic therapy for UGIB in a resource-poor setting such as Nigeria is feasible, significantly reduces morbidity and mortality

  8. Using the gut microbiota as a novel tool for examining colobine primate GI health

    Directory of Open Access Journals (Sweden)

    Katherine R. Amato

    2016-07-01

    Full Text Available Primates of the Colobinae subfamily are highly folivorous. They possess a sacculated foregut and are believed to rely on a specialized gut microbiota to extract sufficient energy from their hard-to-digest diet. Although many colobines are endangered and would benefit from captive breeding programs, maintaining healthy captive populations of colobines can be difficult since they commonly suffer from morbidity and mortality due to gastrointestinal (GI distress of unknown cause. While there is speculation that this GI distress may be associated with a dysbiosis of the gut microbiota, no study has directly examined the role of the gut microbiota in colobine GI health. In this study, we used high-throughput sequencing to examine the gut microbiota of three genera of colobines housed at the San Diego Zoo: doucs (Pygathrix (N=7, colobus monkeys (Colobus (N=4, and langurs (Trachypithecus (N=5. Our data indicated that GI-healthy doucs, langurs, and colobus monkeys possess a distinct gut microbiota. In addition, GI-unhealthy doucs exhibited a different gut microbiota compared to GI-healthy individuals, including reduced relative abundances of anti-inflammatory Akkermansia. Finally, by comparing samples from wild and captive Asian colobines, we found that captive colobines generally exhibited higher relative abundances of potential pathogens such as Desulfovibrio and Methanobrevibacter compared to wild colobines, implying an increased risk of gut microbial dysbiosis. Together, these results suggest an association between the gut microbiota and GI illness of unknown cause in doucs. Further studies are necessary to corroborate these findings and determine cause-and-effect relationships. Additionally, we found minimal variation in the diversity and composition of the gut microbiota along the colobine GI tract, suggesting that fecal samples may be sufficient for describing the colobine gut microbiota. If these findings can be validated in wild individuals, it

  9. Analyste junior en gestion de l'information (GI) (h/f) | CRDI - Centre ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    fournissant un soutien et une formation de base en GI, par exemple en matière de gestion des documents et d'architecture de l'information;; participant à la formation d'employés, du siège comme des bureaux régionaux, en ce qui concerne l'application des lignes directrices et des politiques en matière de GI;; aidant des ...

  10. [Recurrent epidemics of gastroenteritis caused by norovirus GI.3 in a small hotel].

    Science.gov (United States)

    Soini, Jani; Hemminki, Kaisa; Pirnes, Aija; Roivainen, Merja; Al-Hello, Haider; Maunula, Leena; Kauppinen, Ari; Miettinen, Likka; Smit, Pieter W; Huusko, Sari; Toikkanen, Salla; Rimhanen-Finne, Ruska

    2016-01-01

    Recurrent cases of gastroenteritis occurred in a small hotel. The causative agent of disease could not be detected. The cause and the source of the disease were established through epidemiological investigations and laboratory diagnosis. The causative agent of the disease was norovirus GI.3. Norovirus GI was detected in the water from the well and on surfaces at the hotel. Both epidemiological investigations and laboratory diagnostics are needed in resolving epidemics. Continuous development of laboratory methods is important.

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

    Science.gov (United States)

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

    2016-02-25

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

  12. Prenatal and Postnatal Epigenetic Programming: Implications for GI, Immune, and Neuronal Function in Autism

    Directory of Open Access Journals (Sweden)

    Mostafa I. Waly

    2012-01-01

    Full Text Available Although autism is first and foremost a disorder of the central nervous system, comorbid dysfunction of the gastrointestinal (GI and immune systems is common, suggesting that all three systems may be affected by common molecular mechanisms. Substantial systemic deficits in the antioxidant glutathione and its precursor, cysteine, have been documented in autism in association with oxidative stress and impaired methylation. DNA and histone methylation provide epigenetic regulation of gene expression during prenatal and postnatal development. Prenatal epigenetic programming (PrEP can be affected by the maternal metabolic and nutritional environment, whereas postnatal epigenetic programming (PEP importantly depends upon nutritional support provided through the GI tract. Cysteine absorption from the GI tract is a crucial determinant of antioxidant capacity, and systemic deficits of glutathione and cysteine in autism are likely to reflect impaired cysteine absorption. Excitatory amino acid transporter 3 (EAAT3 provides cysteine uptake for GI epithelial, neuronal, and immune cells, and its activity is decreased during oxidative stress. Based upon these observations, we propose that neurodevelopmental, GI, and immune aspects of autism each reflect manifestations of inadequate antioxidant capacity, secondary to impaired cysteine uptake by the GI tract. Genetic and environmental factors that adversely affect antioxidant capacity can disrupt PrEP and/or PEP, increasing vulnerability to autism.

  13. Maaväe visioon. II osa : maavägi 2020+ väga kasutatav maavägi / Meelis Kiili, Aron,Mitt,Peeter Kalmus

    Index Scriptorium Estoniae

    Kiili, Meelis, 1965-

    2007-01-01

    Maaväe tulevikuvisioonist "Tulevikumaavägi 2020+". Graafik: Tulevikukonflikti spekter. Skeem: Väe elemendid; Tulevikumaaväe arendamine; Integreeritud Lahinguruum; Maaväe komponendi võimalik struktuur; Tüüpstruktuur. Vt. ka: Sõdur nr. 3 lk. 22-32

  14. Predicting major bleeding in patients with noncardioembolic stroke on antiplatelets: S2TOP-BLEED

    NARCIS (Netherlands)

    Hilkens, Nina A.; Algra, Ale; Diener, Hans-Christoph; Reitsma, Johannes B.; Bath, Philip M.; Csiba, Laszlo; Hacke, Werner; Kappelle, L. Jaap; Koudstaal, Peter J.; Leys, Didier; Mas, Jean-Louis; Sacco, Ralph L.; Amarenco, Pierre; Sissani, Leila; Greving, Jacoba P.; Gent, M.; Beaumont, D.; Blanchard, J.; Bousser, M. G.; Coffman, J.; Easton, J. D.; Hampton, J. R.; Harker, L. A.; Janzon, L.; Kusmierek, Jje; Panak, E.; Roberts, R. S.; Shannon, S.; Sicurella, J.; Tognoni, G.; Topol, E. J.; Verstraete, M.; Warlow, C.; Blard, J. M.; Capildeo, R.; Diener, H. C.; Ersmark, B.; Escartin, A.; Ferro, J.; Galvin, R.; Hogenhuis, Lah; Laterre, C.; Provincial, L.; Rinne, U. K.; Bovim, G.; Lowenthal, A.; Bogousslavsky, J.; Brass, L.; Cimminiello, C.; Csiba, L.; Kaste, M.; Leys, D.; Matias-Guiu, J.; Rupprecht, H. J.; Berger, P. B.; Bhatt, D. L.; Black, H. R.; Boden, W. E.; Cacoub, P.; Cohen, E. A.; Creager, M. A.; Flather, M. D.; Fox, Kaa; Hacke, W.; Haffner, S. M.; Hamm, C. W.; Hankey, G. J.; Johnston, S. C.; Mak, K. H.; Mas, J. L.; Montalescot, G.; Pearson, T. A.; Steg, P. G.; Steinhubl, S. R.; Weber, M. A.; Aichner, F.; Algra, A.; Chamorro, A.; Chen, Cplh; de Schryver, Ellm; Ferro, J. M.; van Gijn, J.; Hertzberger, L. I.; Koudstaal, P. J.; Ricci, S.; Ringelstein, E. B.; Vanhooren, G.; Venables, G. S.; Albers, G.; Bath, P.; Bornstein, N.; Chan, B.; Chen, S.-T.; Cunha, L.; Dahlöf, B.; DeKeyser, J.; Donnan, G.; Estol, C.; Gorelick, P.; Lu, C.; Pais, P.; Roberts, R.; Sacco, R.; Skvortsova, V.; Teal, P.; Toni, D.; Weber, M.; Yoon, B. W.; Yusuf, S.; Amarenco, P.; Bousser, M.-G.; Fisher, M.; Ford, I.; Fox, K. M.; Hennerici, M. G.; Mattle, H. P.; Rothwell, P.; Sissani, L.; Labreuche, J.; Steg, G.; Vicaut, E.

    2017-01-01

    To develop and externally validate a prediction model for major bleeding in patients with a TIA or ischemic stroke on antiplatelet agents. We combined individual patient data from 6 randomized clinical trials (CAPRIE, ESPS-2, MATCH, CHARISMA, ESPRIT, and PRoFESS) investigating antiplatelet therapy

  15. Otorrhagia bleeding due to leech bite

    Directory of Open Access Journals (Sweden)

    Narges Askari

    2012-01-01

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

  16. Non-professional user`s understanding of Geographic Information

    DEFF Research Database (Denmark)

    Arleth, Mette

    2003-01-01

    Public participation in the planning process requires well developed communication between the authorities and the public; communication in wich various types of geographic information (GI) plays an important role. With the growth of the Internet this communication has been enriched with the assets......-based online services and comprehend the information contents? Using the Gi-based online services qualitatively in the participatory process obviously requires knowledge of the non-professional user`s understanding and use of GI. This paper discusses the needs for research into this field as well as relevant...

  17. Use of over-the-scope clips (OTSC) for hemostasis in gastrointestinal bleeding in patients under antithrombotic therapy.

    Science.gov (United States)

    Lamberts, Regina; Koch, Anna; Binner, Christian; Zachäus, Marcus; Knigge, Ingrid; Bernhardt, Mark; Halm, Ulrich

    2017-05-01

    Background and study aims  In patients taking different regimens of antithrombotic and/or anticoagulant therapy, endoscopic management of gastrointestinal bleeding represents a major challenge due to failing endogenous hemostasis. In this retrospective study we report on success rates with the over-the-scope clip (OTSC) system in upper and lower gastrointestinal bleeding in this high-risk patient population. Patients and methods  Between February 2011 and June 2014, 75 patients were treated with an OTSC for active gastrointestinal bleeding. Success rates with the first endoscopic therapy, rebleeding episodes, their management and the influence of antithrombotic or anticoagulant therapy were analyzed retrospectively. Results  Application of the OTSC resulted in immediate hemostasis (primary success rate) in all 75 patients. However, in 34.7 % a rebleeding episode was noted that could be treated by further endoscopic interventions. Only 3 patients had to be sent to the operating room because of failure of endoscopic therapy. In the rebleeding group the use of antiplatelet therapies was higher (73.1 % vs. 48.9 %). Conclusions  Application of the OTSC in GI bleeding results in a high rate of primary hemostasis. Rebleeding occurs in up to 35 % of patients receiving antithrombotic/anticoagulant therapy but can be managed successfully with further endoscopic treatments. Patients in the rebleeding group were more frequently treated with antiplatelet agents. Radiological or surgical therapy was reserved for a small subgroup not successfully managed by repeated endoscopic therapies. OTSC application is the treatment of choice in high-risk patients when conventional clips used as first-line treatment fail.

  18. Abnormal Uterine Bleeding: American College of Nurse-Midwives.

    Science.gov (United States)

    2016-07-01

    Variations in uterine bleeding, termed abnormal uterine bleeding, occur commonly among women and often are physiologic in nature with no significant consequences. However, abnormal uterine bleeding can cause significant distress to women or may signify an underlying pathologic condition. Most women experience variations in menstrual and perimenstrual bleeding in their lifetimes; therefore, the ability of the midwife to differentiate between normal and abnormal bleeding is a key diagnostic skill. A comprehensive history and use of the PALM-COEIN classification system will provide clear guidelines for clinical management, evidence-based treatment, and an individualized plan of care. The purpose of this Clinical Bulletin is to define and describe classifications of abnormal uterine bleeding, review updated terminology, and identify methods of assessment and treatment using a woman-centered approach. © 2016 by the American College of Nurse-Midwives.

  19. A randomised clinical study to evaluate the efficacy of alcohol-free or alcohol-containing mouthrinses with chlorhexidine on gingival bleeding

    Science.gov (United States)

    Jose, A.; Butler, A.; Payne, D.; Maclure, R.; Rimmer, P.; Bosma, M. L.

    2015-01-01

    Objectives Gingival bleeding following twice-daily use of 0.2% w/v chlorhexidine digluconate mouthrinse with and without alcohol (0.2% CHX-alcohol; 0.2% CHX-alcohol-free, respectively) and brushing with a standard fluoride toothpaste was compared to brushing alone. Methods Three hundred and nineteen subjects with mild-to-moderate gingivitis (with ≥16 gradable permanent teeth including four molars, bleeding after brushing and ≥20 bleeding sites) completed this randomised, examiner-blinded, parallel-group study. A prophylaxis was performed at baseline. Gingival Severity Index (GSI; primary objective), Gingival Index (GI) and Plaque Index (PI) were assessed at baseline and after 6 weeks of treatment. Adverse events (AEs) were recorded throughout the study. Results Between treatment differences at week 6 demonstrated significantly lower GSI for the 0.2% CHX-alcohol and 0.2% CHX-alcohol-free groups compared to brushing alone (primary endpoint; treatment difference −0.061 [95% CI −0.081, −0.041] and −0.070 [95% CI −0.090, −0.050], respectively; both p Chlorhexidine mouthrinse with or without alcohol as an adjunct to brushing with regular fluoride toothpaste significantly reduces bleeding scores, plaque and gingival inflammation compared to brushing alone. TRAEs are characteristic of those associated with the use of chlorhexidine and are similar for both mouthrinses. PMID:26271869

  20. New Trends in Acute Management of Colonic Diverticular Bleeding

    OpenAIRE

    Cirocchi, Roberto; Grassi, Veronica; Cavaliere, Davide; Renzi, Claudio; Tabola, Renata; Poli, Giulia; Avenia, Stefano; Farinella, Eleonora; Arezzo, Alberto; Vettoretto, Nereo; D?Andrea, Vito; Binda, Gian Andrea; Fingerhut, Abe

    2015-01-01

    Abstract Colonic diverticular disease is the most common cause of lower gastrointestinal bleeding. In the past, this condition was usually managed with urgent colectomy. Recently, the development of endoscopy and interventional radiology has led to a change in the management of colonic diverticular bleeding. The aim of this systematic review is to define the best treatment for colonic diverticular bleeding. A systematic bibliographic research was performed on the online databases for studies ...

  1. New Trends in Acute Management of Colonic Diverticular Bleeding

    Science.gov (United States)

    Cirocchi, Roberto; Grassi, Veronica; Cavaliere, Davide; Renzi, Claudio; Tabola, Renata; Poli, Giulia; Avenia, Stefano; Farinella, Eleonora; Arezzo, Alberto; Vettoretto, Nereo; D’Andrea, Vito; Binda, Gian Andrea; Fingerhut, Abe

    2015-01-01

    Abstract Colonic diverticular disease is the most common cause of lower gastrointestinal bleeding. In the past, this condition was usually managed with urgent colectomy. Recently, the development of endoscopy and interventional radiology has led to a change in the management of colonic diverticular bleeding. The aim of this systematic review is to define the best treatment for colonic diverticular bleeding. A systematic bibliographic research was performed on the online databases for studies (randomized controlled trials [RCTs], observational trials, case series, and case reports) published between 2005 and 2014, concerning patients admitted with a diagnosis of diverticular bleeding according to the PRISMA methodology. The outcomes of interest were: diagnosis of diverticulosis as source of bleeding; incidence of self-limiting diverticular bleeding; management of non self-limiting bleeding (endoscopy, angiography, surgery); and recurrent diverticular bleeding. Fourteen studies were retrieved for analysis. No RCTs were found. Eleven non-randomized clinical controlled trials (NRCCTs) were included in this systematic review. In all studies, the definitive diagnosis of diverticular bleeding was always made by urgent colonoscopy. The colonic diverticular bleeding stopped spontaneously in over 80% of the patients, but a re-bleeding was not rare. Recently, interventional endoscopy and angiography became the first-line approach, thus relegating emergency colectomy to patients presenting with hemodynamic instability or as a second-line treatment after failure or complications of hemostasis with less invasive treatments. Colonoscopy is effective to diagnose diverticular bleeding. Nowadays, interventional endoscopy and angiographic treatment have gained a leading role and colectomy should only be entertained in case of failure of the former. PMID:26554768

  2. Predictive factors of recurrent bleeding in Mallory-Weiss syndrome.

    Science.gov (United States)

    Kim, Jae Woo; Kim, Hyun Soo; Byun, Jong Won; Won, Chan Sik; Jee, Myeong Gwan; Park, Yong Soon; Baik, Soon Koo; Kwon, Sang Ok; Lee, Dong Ki

    2005-12-01

    Although the majority of patients with Mallory-Weiss syndrome (MWS) have a benign course, MWS patients with recurrent bleeding have an unfavorable outcome and require intensive care. Therefore, this study was carried out to identify the risk factors for recurrent bleeding in MWS patients. The medical records of patients with MWS between January 1999 and December 2003, were reviewed retrospectively. Demographics, initial clinical and laboratory parameters, and endoscopic findings of the patients with and without recurrent bleeding were compared and the potential risk factors predicting recurrent bleeding in MWS were evaluated. A total of one hundred and fifty-nine patients (22 women, 137 men, mean age 48.1 years old) were enrolled in the study. Recurrent bleeding was observed in 17 patients (10.7%). Those patients with recurrent bleeding showed higher frequency for the presence of shock at initial manifestation, combined liver cirrhosis and endoscopic findings of active bleeding, lower hemoglobin level and platelet count, higher amount of transfusions and epinephrine-mixed fluid injections, and longer hospital stay than those patients without recurrent bleeding. Significant risk factors predicting the recurrent bleeding in MWS were the presence of shock at initial manifestation (OR 3.71, 95% CI 1.07-14.90) and the evidence of active bleeding on endoscopic examination (OR 9.89, 95% CI 1.88-51.98) on multivariate analysis. Intensive care with close monitoring is required for the patients with shock on initial manifestation or with evidence of active bleeding on endoscopic examinations since these are independent risk factors predicting the recurrent bleeding in MWS patients.

  3. CERVICAL ECTOPIC PREGNANCY WITH MASSIVE BLEEDING: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Slavcho Tomov

    2015-05-01

    Full Text Available A 29-year-old patient with cervical ectopic pregnancy (CEP presented as "suspected" cervical mass, and irregular vaginal bleeding was directed to a gynecologic oncologist for consultation. During the examination a massive bleeding occurred. After an unsuccessful attempt to stop the bleeding with a balloon catheter and vaginal tamponade, a total abdominal hysterectomy was performed. The predisposing factors, the differential diagnostic possibilities and the clinical approaches in CEP are discussed. Total abdominal hysterectomy is the procedure of choice for treatment of cervical pregnancy under conditions of urgency and life-threatening bleeding.

  4. Recent Update of Embolization of Upper Gastrointestinal Tract Bleeding

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-02-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-04-15

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

  6. [Dutch College of General Practitioners' practice guideline on 'Vaginal bleeding'].

    Science.gov (United States)

    de Vries, Corlien J H; Meijer, Loes J; Janssen, C A H Ineke; Burgers, Jako S; Opstelten, Wim

    2015-01-01

    The revised Dutch College of General Practitioners' practice guideline on 'Vaginal bleeding' provides recommendations for abnormal bleeding in women in the reproduction phase of life and for post-menopausal bleeding. This guideline is closely attuned to the guideline on 'Heavy menstrual bleeding' of the Dutch Society of Obstetrics and Gynaecology. Transvaginal sonography is not reliable for excluding endometrial carcinoma in women with abnormal vaginal bleeding treated with tamoxifen. The choice of medical treatment is determined in consultation with the patient. The following factors are assessed: severity and bother, long-term need for contraception, preference for cycle control, desire to have a child, pain during menstruation, comorbidity and use of medication. Treatment options are nonhormonal (NSAIDs, or tranexamic acid) or hormonal (a levonorgestrel-releasing intrauterine system, or combined oral contraceptive). In women of reproductive age, referral is indicated if medical treatment is not effective. Other indications are intracavitary abnormalities diagnosed by transvaginal sonography, tamoxifen use, persistent contact bleeding, and suspicion of coagulation disorders. Indications for referral for post-menopausal bleeding include: sonographic endometrial thickness > 4 mm, abnormal cervical cytology, tamoxifen use, irregular bleeding during use of hormone therapy for vasomotor symptoms and persistent or recurrent bleeding, regardless of endometrial thickness.

  7. Abnormal Bleeding during Menopause Hormone Therapy: Insights for Clinical Management

    Directory of Open Access Journals (Sweden)

    Sebastião Freitas De Medeiros

    2013-01-01

    Full Text Available Objective Our objective was to review the involved mechanisms and propose actions for controlling/treating abnormal uterine bleeding during climacteric hormone therapy. Methods A systemic search of the databases SciELO, MEDLINE, and Pubmed was performed for identifying relevant publications on normal endometrial bleeding, abnormal uterine bleeding, and hormone therapy bleeding. Results Before starting hormone therapy, it is essential to exclude any abnormal organic condition, identify women at higher risk for bleeding, and adapt the regimen to suit eachwoman's characteristics. Abnormal bleeding with progesterone/progestogen only, combined sequential, or combined continuous regimens may be corrected by changing the progestogen, adjusting the progestogen or estrogen/progestogen doses, or even switching the initial regimen to other formulation. Conclusion To diminish the occurrence of abnormal bleeding during hormone therapy (HT, it is important to tailor the regimen to the needs of individual women and identify those with higher risk of bleeding. The use of new agents as adjuvant therapies for decreasing abnormal bleeding in women on HT awaits future studies.

  8. Comparison of Two Major Perioperative Bleeding Scores for Cardiac Surgery Trials: Universal Definition of Perioperative Bleeding in Cardiac Surgery and European Coronary Artery Bypass Grafting Bleeding Severity Grade.

    Science.gov (United States)

    Bartoszko, Justyna; Wijeysundera, Duminda N; Karkouti, Keyvan; Callum, Jeannie; Rao, Vivek; Crowther, Mark; Grocott, Hilary P; Pinto, Ruxandra; Scales, Damon C; Achen, Blaine; Brar, Sukhpal; Morrison, Doug; Wong, David; Bussières, Jean S; de Waal, Tonya; Harle, Christopher; de Médicis, Étienne; McAdams, Charles; Syed, Summer; Tran, Diem; Waters, Terry

    2018-03-15

    Research into major bleeding during cardiac surgery is challenging due to variability in how it is scored. Two consensus-based clinical scores for major bleeding: the Universal definition of perioperative bleeding and the European Coronary Artery Bypass Graft (E-CABG) bleeding severity grade, were compared in this substudy of the Transfusion Avoidance in Cardiac Surgery (TACS) trial. As part of TACS, 7,402 patients underwent cardiac surgery at 12 hospitals from 2014 to 2015. We examined content validity by comparing scored items, construct validity by examining associations with redo and complex procedures, and criterion validity by examining 28-day in-hospital mortality risk across bleeding severity categories. Hierarchical logistic regression models were constructed that incorporated important predictors and categories of bleeding. E-CABG and Universal scores were correlated (Spearman ρ = 0.78, P model discrimination based on predictors of perioperative mortality increased with additional inclusion of the Universal score (c-statistic increase from 0.83 to 0.91) or E-CABG (c-statistic increase from 0.83 to 0.92). When other major postoperative complications were added to these models, the association between Universal or E-CABG bleeding with mortality remained. Although each offers different advantages, both the Universal score and E-CABG performed well in the validity assessments, supporting their use as outcome measures in clinical trials.

  9. Bleeding Time, Volume of Shed Blood Collected at the Bleeding Time Site, and the Peripheral Venous Hematocrit.

    Science.gov (United States)

    1995-01-10

    Journal of Obstetrics and Gynaecology 1991;98:327-328. 20. Bain B, Forster T. A sex difference in the bleeding time. 21. Smith PS, Baglini R, Meissner GF...Description of a method for determining the bleeding time and coagulation time and report of three cases of hemorrhagic disease relieved by...OFFICE OF NAVAL RESEARCH CONTRACT N00014-88-C-0118 CONTRACT N00014-94-C-0149 TECHNICAL REPORT 95-01 BLEEDING TIME, VOLUME OF SHED BLOOD

  10. Molecular Signaling and Dysfunction of the Human Reactive Enteric Glial Cell Phenotype: Implications for GI Infection, IBD, POI, Neurological, Motility, and GI Disorders.

    Science.gov (United States)

    Liñán-Rico, Andromeda; Turco, Fabio; Ochoa-Cortes, Fernando; Harzman, Alan; Needleman, Bradley J; Arsenescu, Razvan; Abdel-Rasoul, Mahmoud; Fadda, Paolo; Grants, Iveta; Whitaker, Emmett; Cuomo, Rosario; Christofi, Fievos L

    2016-08-01

    Clinical observations or animal studies implicate enteric glial cells in motility disorders, irritable bowel syndrome, inflammatory bowel disease, gastrointestinal (GI) infections, postoperative ileus, and slow transit constipation. Mechanisms underlying glial responses to inflammation in human GI tract are not understood. Our goal was to identify the "reactive human enteric glial cell (rhEGC) phenotype" induced by inflammation, and probe its functional relevance. Human enteric glial cells in culture from 15 GI-surgical specimens were used to study gene expression, Ca, and purinergic signaling by Ca/fluo-4 imaging and mechanosensitivity. A nanostring panel of 107 genes was designed as a read out of inflammation, transcription, purinergic signaling, vesicular transport protein, channel, antioxidant, and other pathways. A 24-hour treatment with lipopolysaccharide (200 μg/mL) and interferon-γ (10 μg/mL) was used to induce inflammation and study molecular signaling, flow-dependent Ca responses from 3 mL/min to 10 mL/min, adenosine triphosphate (ATP) release, and ATP responses. Treatment induced a "rhEGC phenotype" and caused up-regulation in messenger RNA transcripts of 58% of 107 genes analyzed. Regulated genes included inflammatory genes (54%/IP10; IFN-γ; CxCl2; CCL3; CCL2; C3; s100B; IL-1β; IL-2R; TNF-α; IL-4; IL-6; IL-8; IL-10; IL-12A; IL-17A; IL-22; and IL-33), purine-genes (52%/AdoR2A; AdoR2B; P2RY1; P2RY2; P2RY6; P2RX3; P2RX7; AMPD3; ENTPD2; ENTPD3; and NADSYN1), channels (40%/Panx1; CHRNA7; TRPV1; and TRPA1), vesicular transporters (SYT1, SYT2, SNAP25, and SYP), transcription factors (relA/relB, SOCS3, STAT3, GATA_3, and FOXP3), growth factors (IGFBP5 and GMCSF), antioxidant genes (SOD2 and HMOX1), and enzymes (NOS2; TPH2; and CASP3) (P glial cells. ATP release increased 5-fold and s100B decreased 33%. The "rhEGC phenotype" is identified by a complex cascade of pro-inflammatory pathways leading to alterations of important molecular and functional

  11. Do statins protect against upper gastrointestinal bleeding?

    DEFF Research Database (Denmark)

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

    2009-01-01

    AIMS: Recently, an apparent protective effect of statins against upper gastrointestinal bleeding (UGB) was postulated in a post hoc analysis of a randomized trial. We aimed to evaluate the effect of statin use on acute nonvariceal UGB alone or in combinations with low-dose aspirin and other...... antithrombotic drugs. METHODS: A population-based case-control study was conducted in the County of Funen, Denmark. Cases (n = 3652) were all subjects with a first discharge diagnosis of serious UGB from a hospital during the period 1995 to 2006. Age- and gender-matched controls (10 for each case) (n = 36 502...... significant protective effect was observed for concurrent users of low-dose aspirin [OR 0.43 (0.18-1.05)]. CONCLUSION: Statins do not prevent UGB, except possibly in users of low-dose aspirin....

  12. Thromboembolic and bleeding risks in patients undergoing atrial fibrillation ablation: oral anticoagulation perspectives.

    Science.gov (United States)

    Briceño, David F; Madan, Nidhi; Romero, Jorge; Londoño, Alejandra; Villablanca, Pedro A; Natale, Andrea; Di Biase, Luigi

    2017-07-01

    Atrial fibrillation (AF) is a cause of significant morbidity and mortality. Catheter ablation for AF (CAAF) has emerged as an effective treatment option of rhythm control for patients with symptomatic AF. However, the risk of thromboembolism and bleeding in the periprocedural period represent a worrisome complication of this therapy. The reported incidence of thromboembolic and bleeding events associated with CAAF varies from 0.9% to 5% depending on the CAAF strategy and the anticoagulation regimen used in the periprocedural period. Areas covered: The different anticoagulation regimens used prior to, during, and after CAAF to minimize the risk of thromboembolic and bleeding events are reviewed. The use of uninterrupted oral anticoagulation and appropriate heparin dosing to achieve safe activated clotting time levels are also detailed. A comprehensive approach with assessment of individual risk for thromboembolic and bleeding complications, and understanding the pharmacokinetics of the anticoagulant agents available is also reviewed. Expert opinion: The key advances done in the periprocedural anticoagulation field include the use of uninterrupted anticoagulation strategies in patients undergoing AF ablation and efforts to simplify the selection of patients who need LAA thrombus screening prior to ablation.

  13. ENDOSCOPIC DIAGNOSIS AND TREATMENT OF UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    Daniela Benedeto-Stojanov

    2015-06-01

    Full Text Available Upper gastrointestinal bleeding (UGB is a common medical emergency problem with significant morbidity and mortality. The aim of this paper is to establish the incidence of upper gastrointestinal bleeding in relation to sex and age, determine the prevalence of bleeding lesions and perform analysis of bleeding peptic ulcer in relation to the location, age, gender, Forrest classification and the need for endoscopic hemostasis. Thе prospective study included 70 patients with UGB, 42 men and 28 women, mean age 68.64±13.66 years. The diagnosis of bleeding lesions was made exclusively by means of esophagogastroduodenoscopy. Forrest classification was used in the evaluation of the activity of bleeding ulcers of the stomach and duodenum. The largest number of bleeding patients was of male sex (60%. Bleeding most commonly occurred in patients older than 60 years (84.29%. Statistically, female patients were significantly older than patients of male gender (p=0.001. The most common cause of bleeding was peptic ulcer (65.71%. The average age of patients with gastric ulcer was 70.57±15.68 years, with a duodenal ulcer 63.78±16.70 years. In the duodenum, Forrest Ib, IIa and IIb ulcers were usually confirmed, whereas Forrest IIc ulcers were identified in the stomach. Endoscopic hemostasis was required in 55.56% of patients with duodenal and in 23.81% of patients with gastric ulcer. The incidence of UGB is higher in men and it increases with age. The most common cause of bleeding is ulcer disease. Patients with gastric ulcer are older than patients with duodenal ulcer, while both gastric and duodenal ulcers are found in the oldest patients. Duodenal ulcers cause serious bleeding and more often require endoscopic hemostasis.

  14. GeoNetwork powered GI-cat: a geoportal hybrid solution

    Science.gov (United States)

    Baldini, Alessio; Boldrini, Enrico; Santoro, Mattia; Mazzetti, Paolo

    2010-05-01

    To the aim of setting up a Spatial Data Infrastructures (SDI) the creation of a system for the metadata management and discovery plays a fundamental role. An effective solution is the use of a geoportal (e.g. FAO/ESA geoportal), that has the important benefit of being accessible from a web browser. With this work we present a solution based integrating two of the available frameworks: GeoNetwork and GI-cat. GeoNetwork is an opensource software designed to improve accessibility of a wide variety of data together with the associated ancillary information (metadata), at different scale and from multidisciplinary sources; data are organized and documented in a standard and consistent way. GeoNetwork implements both the Portal and Catalog components of a Spatial Data Infrastructure (SDI) defined in the OGC Reference Architecture. It provides tools for managing and publishing metadata on spatial data and related services. GeoNetwork allows harvesting of various types of web data sources e.g. OGC Web Services (e.g. CSW, WCS, WMS). GI-cat is a distributed catalog based on a service-oriented framework of modular components and can be customized and tailored to support different deployment scenarios. It can federate a multiplicity of catalogs services, as well as inventory and access services in order to discover and access heterogeneous ESS resources. The federated resources are exposed by GI-cat through several standard catalog interfaces (e.g. OGC CSW AP ISO, OpenSearch, etc.) and by the GI-cat extended interface. Specific components implement mediation services for interfacing heterogeneous service providers, each of which exposes a specific standard specification; such components are called Accessors. These mediating components solve providers data modelmultiplicity by mapping them onto the GI-cat internal data model which implements the ISO 19115 Core profile. Accessors also implement the query protocol mapping; first they translate the query requests expressed

  15. DiGi Corporate Social Responsibility: A Case Study

    OpenAIRE

    Abdo, Lina Abdulmalek Saeed

    2010-01-01

    Corporate social responsibility strategy and competitive advantage are important issues for the contemporary discussion on corporations in society. This study addresses CSR implementation in practice by first understanding a firm’s corporate social responsibility motives, then exploring how these motives translate to CSR programmes and their alignment to core business and strategy. The objective of the study is met through studying relevant literature and the implementation of practical resea...

  16. MENUMBUHKEMBANGKAN KESADARAN DAN KETERAMPILAN METAKOGNISI MAHASISWA JURUSAN BIOLOGI MELALUI PENERAPAN STRATEGI PBL DAN KOOPERATIF GI

    Directory of Open Access Journals (Sweden)

    Muhammad Danial

    2010-11-01

    Full Text Available The teaching of the educational levels including at the university level is still emphasized on the aspect of cognitive ability. The emphasis on the aspect of empowering the metacognitive is not touched yet. As a matter of fact, there are some techniques of teaching that can be applied to empower their metacognitive ability such Problem-based Learning (PBL and cooperative Group Investigation (GI strategy applies. This study aims to explain the effect of PBL and cooperative GI strategy to the metacognition and this study use “Pretest-Posttest Nonequivalent Control Group Design”. This study indicates that students that learned with PBL and GI strategy have scores of metacognition from pretest to posttest higher than students that learned with conventional strategy. Based on the ANACOVA test showed that there were significance differences of students’ metacognition ability between the students who were thought through PBL strategy and the students who were thought through conventional and GI strategy.   Kata kunci: PBL, kooperatif GI, metakognisi

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

    International Nuclear Information System (INIS)

    Nakamura, Akira; Shibuya, Keiko; Matsuo, Yukinori; Nakamura, Mitsuhiro; Shiinoki, Takehiro; Mizowaki, Takashi; Hiraoka, Masahiro

    2012-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-10-01

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

  19. Challenges in the Management of Bleeding Disorders in Nigeria

    African Journals Online (AJOL)

    2018-04-04

    Apr 4, 2018 ... Background: Bleeding disorders (BDs) are characterized by abnormal bleeding for which effective management requires a combination of skill, workforce, diagnostic facilities, and adequate therapeutic options. Objectives: The objectives of this study were to determine the capacity of Nigerian hematologists ...

  20. The efficacy of endoscopic therapy in bleeding peptic ulcer patients ...

    African Journals Online (AJOL)

    Background. Endotherapy is the primary modality for the control of bleeding from peptic ulceration. Objective. To assess the efficacy of endoscopic intervention for high-risk bleeding peptic ulcer disease and to benchmark our surgical and mortality rates. Methods. Two hundred and twenty-seven patients with peptic

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

    African Journals Online (AJOL)

    days, menstrual cycle of 80ml. Rather than this specific figures, however, abnormal uterine bleeding should be defined in terms of deviation from an individual patient's established menstrual pattern1,2. Leech bite as a cause pf abnormal vaginal bleeding has been reported in ...

  2. Pattern recognition in menstrual bleeding diaries by statistical cluster analysis

    Directory of Open Access Journals (Sweden)

    Wessel Jens

    2009-07-01

    Full Text Available Abstract Background The aim of this paper is to empirically identify a treatment-independent statistical method to describe clinically relevant bleeding patterns by using bleeding diaries of clinical studies on various sex hormone containing drugs. Methods We used the four cluster analysis methods single, average and complete linkage as well as the method of Ward for the pattern recognition in menstrual bleeding diaries. The optimal number of clusters was determined using the semi-partial R2, the cubic cluster criterion, the pseudo-F- and the pseudo-t2-statistic. Finally, the interpretability of the results from a gynecological point of view was assessed. Results The method of Ward yielded distinct clusters of the bleeding diaries. The other methods successively chained the observations into one cluster. The optimal number of distinctive bleeding patterns was six. We found two desirable and four undesirable bleeding patterns. Cyclic and non cyclic bleeding patterns were well separated. Conclusion Using this cluster analysis with the method of Ward medications and devices having an impact on bleeding can be easily compared and categorized.

  3. First-trimester vaginal bleeding and complications later in pregnancy

    DEFF Research Database (Denmark)

    Lykke, Jacob Alexander; Dideriksen, Katrine Lehrmann; Lidegaard, Øjvind

    2010-01-01

    To evaluate the association of first-trimester bleeding without miscarriage and complications later in the first pregnancy as well as in the next pregnancy.......To evaluate the association of first-trimester bleeding without miscarriage and complications later in the first pregnancy as well as in the next pregnancy....

  4. Increased accuracy in heparin and protamine administration decreases bleeding

    DEFF Research Database (Denmark)

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

    2009-01-01

    Three to 5 percent of the patients undergoing cardiac surgery are reoperated because of bleeding. When a surgical cause can be excluded, heparin/protamine mismatch may be considered. Insufficient reversal of heparin and overdosing of protamine may cause postoperative bleeding. The purpose...

  5. Endoscopic injection sclerotherapy for bleeding varices in children ...

    African Journals Online (AJOL)

    Endoscopic injection sclerotherapy for bleeding varices in children with intrahepatic and extrahepatic portal venous obstruction: Benefit of injection tract embolisation. ... In a previous study at our institution, sclerotherapy was associated with a high re-bleeding rate and oesophageal ulceration. Embolisation of the injection ...

  6. 14 CFR 33.66 - Bleed air system.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Bleed air system. 33.66 Section 33.66 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: AIRCRAFT ENGINES Design and Construction; Turbine Aircraft Engines § 33.66 Bleed air system. The...

  7. Recombinant activated factor VII for uncontrolled bleeding postcardiac surgery

    Directory of Open Access Journals (Sweden)

    Aly Makram Habib

    2016-10-01

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

  8. [Prophylaxis for stress ulcer bleeding in the intensive care unit].

    Science.gov (United States)

    Avendaño-Reyes, J M; Jaramillo-Ramírez, H

    2014-01-01

    The critically ill patient can develop gastric erosions and, on occasion, stress ulcers with severe gastrointestinal bleeding that can be fatal. The purpose of this review was to provide current information on the pathophysiology, risk factors, and prophylaxis of digestive tract bleeding from stress ulcers in the intensive care unit. We identified articles through a PubMed search, covering the years 1970 to 2013. The most relevant articles were selected using the search phrases "stress ulcer", "stress ulcer bleeding prophylaxis", and "stress-related mucosal bleeding" in combination with "intensive care unit". The incidence of clinically significant bleeding has decreased dramatically since 1980. The most important risk factors are respiratory failure and coagulopathy. Proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs) are used in stress ulcer bleeding prophylaxis. Both drugs have been shown to be superior to placebo in reducing the risk for gastrointestinal bleeding and PPIs are at least as effective as H2RAs. Early enteral feeding has been shown to reduce the risk for stress ulcer bleeding, albeit in retrospective studies. Admittance to the intensive care unit in itself does not justify prophylaxis. PPIs are at least as effective as H2RAs. We should individualize the treatment of each patient in the intensive care unit, determining risk and evaluating the need to begin prophylaxis. Copyright © 2014 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

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

    African Journals Online (AJOL)

    Oesophageal varices were the most frequent cause of bleeding (45.3%) followed by non-ulcer peptic acid disease (23.7%) and peptic ulcer disease (16.9%). Gastric cancer and Mallory-Weiss syndrome were rare with each accounting for 1.9% of the cases. In 11 (10.4%) patients no source of bleeding could be identified.

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

    African Journals Online (AJOL)

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

  11. Histopathological findings of Post-Menopausal bleeding in ...

    African Journals Online (AJOL)

    Background: Postmenopausal bleeding is an alarming sign that may be associated with uterine malignancy. In recent years about 60% of women with post menopausal bleeding are said to have no organic cause in developed countries. There is no data concerning about this issue in Ethiopia. Objective: To determine ...

  12. Prediction models in women with postmenopausal bleeding: a systematic review

    NARCIS (Netherlands)

    van Hanegem, Nehalennia; Breijer, Maria C.; Opmeer, Brent C.; Mol, Ben W. J.; Timmermans, Anne

    2012-01-01

    Postmenopausal bleeding is associated with an elevated risk of having endometrial cancer. The aim of this review is to give an overview of existing prediction models on endometrial cancer in women with postmenopausal bleeding. In a systematic search of the literature, we identified nine prognostic

  13. Clinical approach to a patient with abnormal uterine bleeding

    African Journals Online (AJOL)

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

  14. Gastrointestinal bleeding in patients with hereditary hemorrhagic telangiectasia

    DEFF Research Database (Denmark)

    Kjeldsen, A D; Kjeldsen, J

    2000-01-01

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

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

    African Journals Online (AJOL)

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

  16. 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

  17. Alternative Treatment for Bleeding Peristomal Varices: Percutaneous Parastomal Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Pabon-Ramos, Waleska M., E-mail: waly.pr@duke.edu [Duke University Hospital, Department of Radiology (United States); Niemeyer, Matthew M. [Washington University Medical Center, Mallinckrodt Institute of Radiology (United States); Dasika, Narasimham L., E-mail: narasimh@med.umich.edu [University of Michigan Health System, Department of Radiology (United States)

    2013-10-15

    Purpose: To describe how peristomal varices can be successfully embolized via a percutaneous parastomal approach. Methods: The medical records of patients who underwent this procedure between December 1, 2000, and May 31, 2008, were retrospectively reviewed. Procedural details were recorded. Median fluoroscopy time and bleeding-free interval were calculated. Results: Seven patients underwent eight parastomal embolizations. The technical success rate was 88 % (one failure). All embolizations were performed with coils combined with a sclerosant, another embolizing agent, or both. Of the seven successful parastomal embolizations, there were three cases of recurrent bleeding; the median time to rebleeding was 45 days (range 26-313 days). The remaining four patients did not develop recurrent bleeding during the follow-up period; their median bleeding-free interval was 131 days (range 40-659 days). Conclusion: This case review demonstrated that percutaneous parastomal embolization is a feasible technique to treat bleeding peristomal varices.

  18. Simulating magnetospheres with numerical relativity: The GiRaFFE code

    Science.gov (United States)

    Babiuc-Hamilton, Maria; Etienne, Zach

    2016-01-01

    Numerical Relativity has shown success over the past several years, especially in the simulation of black holes and gravitational waves. In recent years, teams have tackled the problem of the interaction of gravitational and electromagnetic waves. But where there are plasmas, the simulations often have trouble reproducing nature. Neutron stars, black hole accretion disks, astrophysical jets—all of these represent extreme environments both gravitationally and electromagnetically. We are creating the first open-source, dynamical spacetime general relativity force-free electrodynamics code: GiRaFFE.We present here the performance of GiRaFFE in testing. With this code, we will simulate neutron star magnetospheres, collisions between neutron stars and black holes, and particular attention will be paid to the production of jets through the Blandford-Znajek mechanism.GiRaFFE will be made available to the community.

  19. GI-cat extensions for OGC 06-131 and OGC 07-038 support

    Science.gov (United States)

    Boldrini, E.; Papeschi, F.; Mazzetti, P.; Bigagli, L.; Vitale, F.; Nativi, S.

    2009-04-01

    In this presentation we discuss the extensions developed in order to enable GI-cat to support the OGC CSW ebRIM application profile and its extension packages: EO (Earth Observation) and CIM (Cataloging of ISO Metadata). In an Service-Oriented Architecture (SOA) framework, GI-cat implements a distributed catalog service providing advanced capabilities, such as: caching, brokering and mediation functionalities. GI-cat applies a distributed approach, being able to distribute queries to the remote service providers of interest in an asynchronous style, and notifies the status of the queries to the caller implementing an incremental feedback mechanism. GI-cat functionalities were made available through two standard catalog interfaces: the OGC CSW ISO and CSW Core Application Profiles. The presented extensions will add two new and standard interfaces: the CSW ebRIM CIM and EO interfaces. GI-cat is able to interface a multiplicity of discovery and access services serving heterogeneous Earth and Space Sciences resources. They include international standards like the OGC Web Services - i.e. OGC CSW, WCS, WFS and WMS, as well as interoperability arrangements (i.e. community standards) such as: UNIDATA THREDDS/OPeNDAP, SeaDataNet CDI (Common Data Index), GBIF (Global Biodiversity Information Facility) services, and SibESS-C infrastructure services. The GI-cat distributed catalog service has been successfully deployed and experimented in the framework of different projects and initiative, including the SeaDataNet FP7 project, GEOSS IP3 (Interoperability Process Pilot Project) and GEOSS AIP-2 (Architectural Implementation Project - Phase 2). Commonly, a catalog application profile and/or extension package introduces a specific data model. Hence, an important objective of the developed expansion module is to define and implement an effective and flexible strategy to support the new data model, in the context of the existing information model - i.e the GI-cat data model. Besides

  20. Bleeding disorders in the tribe: result of consanguineous in breeding

    Directory of Open Access Journals (Sweden)

    Borhany Munira

    2010-09-01

    Full Text Available Abstract Objective To determine the frequency and clinical features of bleeding disorders in the tribe as a result of consanguineous marriages. Design Cross Sectional Study Introduction Countries in which consanguinity is a normal practice, these rare autosomal recessive disorders run in close families and tribes. Here we describe a family, living in village Ali Murad Chandio, District Badin, labeled as haemophilia. Patients & Methods Our team visited the village & developed the pedigree of the whole extended family, up to seven generations. Performa was filled by incorporating patients, family history of bleeding, signs & symptoms, and bleeding from any site. From them 144 individuals were screened with CBC, bleeding time, platelet aggregation studies & RiCoF. While for PT, APTT, VWF assay and Factor VIII assay, samples were kept frozen at -70 degrees C until tested. Results The family tree of the seven generations comprises of 533 individuals, 63 subjects died over a period of 20 years and 470 were alive. Out of all those 144 subjects were selected on the basis of the bleeding history. Among them 98(68.1% were diagnosed to have a bleeding disorder; 44.9% patients were male and 55.1% patients were female. Median age of all the patients was 20.81, range (4 months- 80 yrs. The results of bleeding have shown that majority had gum bleeding, epistaxis and menorrhagia. Most common bleeding disorder was Von Willebrand disease and Platelet functional disorders. Conclusion Consanguineous marriages keep all the beneficial and adversely affecting recessive genes within the family; in homozygous states. These genes express themselves and result in life threatening diseases. Awareness, education & genetic counseling will be needed to prevent the spread of such common occurrence of these bleeding disorders in the community.

  1. Does painless rectal bleeding equate to a colonic polyp?

    Science.gov (United States)

    Campbell, Alison Morag; Sugarman, Ian

    2017-11-01

    It is often stated that if a patient presents with 'painless rectal bleeding' then a rectal polyp is the probable diagnosis. The aim of this study is to review our experience of children undergoing endoscopy to assess if the above statement is correct. The senior author keeps a prospective database of every child undergoing flexible sigmoidoscopy or colonoscopy. As part of this database, the symptoms and signs that the patient presents with, specifically abdominal pain, diarrhoea, mucous per rectum and rectal bleeding, are recorded. These results have been analysed specifically to assess whether the opening statement is correct. Between 2000 and 2014, a total of 401 children have undergone flexible sigmoidoscopy (21) or colonoscopy (380) to investigate rectal bleeding. Of these 401 patients, 42 (10.5%) had at least one polyp. Four polyps (9%) occurred in 159 patients with no rectal bleeding during the study period. The remaining 42 polyps (91%) were identified in patients with rectal bleeding. Of these 42 polyps, painless rectal bleeding was the only symptom in 24 (57%). However, 123 patients were endoscoped with painless rectal bleeding alone, giving a polyp rate of 19.5% for this symptom. The polyp pickup rate was increased to 28% if rectal bleeding and mucous per rectum were present; however, only 25 patients had this clinical history. We confirm that the most common symptom of rectal polyps is painless rectal bleeding. However, only one in five patients with this clinical history has a rectal polyp at endoscopy. The polyp pickup rate at endoscopy is greater (28%) when a history of both rectal bleeding and mucous per rectumispresent. This information can be used to counsel parents preoperatively. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Pulsatile flow-induced angiogenesis: role of G(i) subunits.

    Science.gov (United States)

    Cullen, John P; Sayeed, Shariq; Sawai, Rebecca S; Theodorakis, Nicholas G; Cahill, Paul A; Sitzmann, James V; Redmond, Eileen M

    2002-10-01

    Angiogenesis plays a key role in the growth and function of normal and pathological tissues. We investigated the effect of pulsatile flow on endothelial cell (EC) in vitro angiogenic activity. Bovine aortic ECs were exposed to "static" or "flow" (1.2 to 67.0 mL/min, shear stress 1.4 to 19.2 dyne/cm2) conditions for 2 to 24 hours. After exposure, angiogenesis was measured as tubule formation on Matrigel, and EC migration was assessed by filter migration assay. Pulsatile flow increased angiogenesis and EC migration in a temporal and force-dependent manner, with a maximal effect at 16 hours (13.2 dyne/cm2). Pertussis toxin completely inhibited the effect of pulsatile flow on angiogenesis and migration. Transfection of ECs with inhibitory mutants of the alpha subunit of G(i)1 or G(i)3, but not G(i)2, inhibited the flow-induced angiogenic response by 61+/-2% and 32+/-6%, respectively, whereas transfection with constitutively activated mutants of the alpha subunit of G(i)1 or G(i)3, but not G(i)2, increased the flow-induced response by 202+/-23% and 70+/-4%, respectively. In contrast, inhibition of Gbetagamma by the carboxy terminal fragment of beta-adrenergic receptor kinase overexpression increased the flow-induced response by 82+/-8%. These results suggest that pulsatile flow stimulates angiogenesis and that this effect is mediated by activation of G(ialpha)1 or G(ialpha)3, but not Gbetagamma, subunits.

  3. The prevalence of underlying bleeding disorders in patients with heavy menstrual bleeding with and without gynecologic abnormalities

    NARCIS (Netherlands)

    Knol, H. Marieke; Mulder, Andre; Bogchelman, Dick H.; Kluin-Nelemans, Hanneke C.; van der Zee, Ate G. J.; Meijer, Karina

    OBJECTIVE: The purpose of this study was to assess the prevalence of underlying bleeding disorders in women with heavy menstrual bleeding (HMB) with and without gynecologic abnormalities. STUDY DESIGN: We performed a single-center prospective cohort study of 112 consecutive patients who were

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

    International Nuclear Information System (INIS)

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

    2011-01-01

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

  5. Löögiüksuse "Admiral Pitka" formeerimine ja tegevus / Toomas Hiio

    Index Scriptorium Estoniae

    Hiio, Toomas, 1965-

    2008-01-01

    Johan Pitka tegevusest 1940-1944. Tema lähematest kaastöölistest Paul Laamannist ja Evald Karotoomest. Löögiüksuse formeerimisest Saksa ametkondade asjaajamises ning Evald Karotoomi ja Paul Laamanni tunnistuste järgi. Kes kuulusid Pitka löögirühma. Saadik Aleksander Warma suhtumisest Pitka löögiüksuse moodustamisse. Vastuolust Soomes viibinud mõõdukate eestlaste ja Harald Vellneri ning Karl Talpaku vahel. Löögirühma tegevusest Tallinnas sakslaste taandumise ajal.

  6. Giant bleeding renal angiomyolipoma: diagnosis and management

    International Nuclear Information System (INIS)

    Ashebu, S.D.; Elshebiny, Y.H.; Dahniya, M.H.; Varro, J.; Al-khawari, H.

    2002-01-01

    A case of a giant bleeding renal angiomyolipoma is presented. The patient was a 40-year-old Egyptian male with no clinical or radiological evidence of tuberous sclerosis. The radiological features and management, including the role of angiography are briefly discussed and the medical reviews on this subject are briefly considered. There was no fever. He had a history of renal calculi. Physical examination revealed a mass in the right loin. His haemoglobin was 9.9 g/dL, blood pressure 110/70 and pulse 96 b.p.m. Routine biochemical investigations were normal. A plain radiograph of the abdomen suggested a right upper pole renal mass. Intravenous urography (IVU) confirmed a large space-occupying lesion. Ultrasonography (US) discovered mixed echogenicity but predominantly echogenic. A few hours after admission, the patient's blood pressure and haematocrit dropped. Plain and contrast enhanced CT (CECT) performed after resuscitation with three units of blood revealed a huge, heterogeneously enhancing and very vascular right renal tumour, with multiple small pseudoaneurysms. The tumour was predominantly of fat density, with soft tissue components and extended beyond the kidney into the perinephric space. The appearance was typical of an angiomyolipoma (AML). Small AML were demonstrated in the left kidney. Copyright (2002) Blackwell Science Pty Ltd

  7. Agonist-induced platelet reactivity correlates with bleeding in haemato-oncological patients

    NARCIS (Netherlands)

    Batman, B.; van Bladel, E. R.; van Hamersveld, M.; Pasker-De Jong, Pieternel C M; Korporaal, S. J.A.; Urbanus, R. T.; Roest, M.; Boven, Leonie A; Fijnheer, R.

    2017-01-01

    Background and objective: Prophylactic platelet transfusions are administered to prevent bleeding in haemato-oncological patients. However, bleeding still occurs, despite these transfusions. This practice is costly and not without risk. Better predictors of bleeding are needed, and flow cytometric

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

    NARCIS (Netherlands)

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

    2018-01-01

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

  9. Management of dysfunctional uterine bleeding based on endometrial thickness

    Directory of Open Access Journals (Sweden)

    Ozgul Muneyyirci-Delale

    2010-09-01

    Full Text Available Ozgul Muneyyirci-Delale1,2, Anuja Gupta1,2, Cynthia Abraham1, Ashadeep Chandrareddy1, Charles H Bowers Jr2, Jed B Cutler2Departments of Obstetrics and Gynecology, 1SUNY Downstate Medical Center, 2Kings County Hospital Center, Brooklyn, New York, USAObjective: To manage patients with dysfunctional uterine bleeding (DUB according to endometrial thickness.Methods: A retrospective chart review of 49 patients who reported 8 or more days of bleeding was performed. They were then divided into three groups based on endometrial thickness (mm: less than 6, 6–11, and greater than 11. These three groups were treated with combined oral contraceptive pills (OCP, conjugated estrogen plus progesterone and megestrol respectively. Patients given megestrol also underwent endometrial biopsy before treatment. Patients recorded the degree of bleeding each day for one month after starting treatment.Results: Mean endometrial thickness in the combined OCPs, conjugated estrogen plus progesterone and megestrol groups were 4, 8 and 14 mm, respectively. Combined OCPs decreased bleeding from 46 to 8 days (P < 0.05, n = 8. Conjugated estrogen plus progesterone decreased the number of days of bleeding from a mean of 41 to 9 (P < 0.01, n = 16. Megestrol decreased bleeding from 54 to 3 days (P < 0.001, n = 25. 52% of patients given megestrol had endometrial hyperplasia.Conclusion: These results support the effectiveness of treating patients with DUB according to endometrial thickness.Keywords: DUB, abnormal uterine bleeding, endometrium, hyperplasia, megestrol acetate

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

    Science.gov (United States)

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

    2005-05-01

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

  11. Bleeding related to etonogestrel subdermal implant in a US population.

    Science.gov (United States)

    Casey, Petra M; Long, Margaret E; Marnach, Mary L; Bury, Jessica E

    2011-05-01

    The etonogestrel subdermal implant received US Food and Drug Administration approval in 2006. Menstrual changes represent a common reason why recipients of this implant request early implant removal. Retrospective review of medical records of 155 patients with placement of this implant at Mayo Clinic in Rochester, Minnesota, and medical literature review. In 151 patients (97.4%), this implant was placed for contraception. Sixty-four patients (41.3%) contacted a health care provider about implant-related issues after insertion, including 39 (25.2%) for abnormal bleeding. Mean body mass index (BMI) was 28.5, higher than prior studies of implant-related bleeding. Implant removal rate was 25.2% (mean interval, 9.8 months), with 14.8% requesting removal for bleeding changes. No insertion or postinsertion complications or contraceptive failures were found. Age, race, BMI, parity, prior contraception method, and postpartum and breastfeeding status did not predict bleeding or removal for bleeding risk. Removal rates were higher for amenorrhea, occasional spotting or bleeding, and regular menses than for prolonged or continuous bleeding. Copyright © 2011 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Richard G. Stefanacci

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Dr. Yaminee Rana

    2017-12-01

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

  14. Teaching Teaching & Understanding Understanding

    DEFF Research Database (Denmark)

    2006-01-01

    "Teaching Teaching & Understanding Understanding" is a 19-minute award-winning short-film about teaching at university and higher-level educational institutions. It is based on the "Constructive Alignment" theory developed by Prof. John Biggs. The film delivers a foundation for understanding what...

  15. Therapeutic Options for Patients Bleeding with Peptic Ulcers

    Directory of Open Access Journals (Sweden)

    ABR Thomson

    1994-01-01

    Full Text Available It is likely that the best outcome for the patient with an acute upper gastrointestinal bleed (GIB includes early diagnosis: for a bleeding lesion with a high risk of rebleeding, in an older patient with systolic h.ypotension or in a person with multiple medical problems. Early therapeutic endoscopy with meticulous control of intragastric pH will Likely achieve the best outcome. The ideal pH criterion to stop bleeding or to prevent recurrence is unknown. An algorithm is presented to guide the clinical management of patients with GIB, and to focus on important questi.ons for future therapeutic studies.

  16. Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

    International Nuclear Information System (INIS)

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

    2006-01-01

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

  17. Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

    International Nuclear Information System (INIS)

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

    2006-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  19. Gastrointestinal bleeding from supraduodenal artery with aberrant origin

    Directory of Open Access Journals (Sweden)

    Qiong Han, MD, PhD

    2017-09-01

    Full Text Available Angiography and endovascular embolization play an important role in controlling acute arterial upper gastrointestinal hemorrhage, particularly when endoscopic intervention fails to do so. In our case, the patient presented with recurrent life-threatening bleed in spite of multiple prior endoscopic interventions and gastroduodenal artery embolization. Our teaching points focus on the role of angiography in acute upper gastrointestinal bleed and when to conduct empiric embolization, while reviewing the supraduodenal artery as an atypical but important potential culprit for refractory upper gastrointestinal bleed.

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

    Science.gov (United States)

    Wheeler, Karen C; Goldstein, Steven R

    2017-03-01

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

  1. Predicting Major Bleeding in Ischemic Stroke Patients With Atrial Fibrillation.

    Science.gov (United States)

    Hilkens, Nina A; Algra, Ale; Greving, Jacoba P

    2017-11-01

    Performance of risk scores for major bleeding in patients with atrial fibrillation and a previous transient ischemic attack or ischemic stroke is not well established. We aimed to validate risk scores for major bleeding in patients with atrial fibrillation treated with oral anticoagulants after cerebral ischemia and explore the net benefit of oral anticoagulants among bleeding risk categories. We analyzed 3623 patients with a history of transient ischemic attack or stroke included in the RE-LY trial (Randomized Evaluation of Long-Term Anticoagulation Therapy). We assessed performance of HEMORR 2 HAGES (hepatic or renal disease, ethanol abuse, malignancy, older age, reduced platelet count or function, hypertension [uncontrolled], anemia, genetic factors, excessive fall risk, and stroke), Shireman, HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly), ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation), and ORBIT scores (older age, reduced haemoglobin/haematocrit/history of anaemia, bleeding history, insufficient kidney function, and treatment with antiplatelet) with C statistics and calibration plots. Net benefit of oral anticoagulants was explored by comparing risk reduction in ischemic stroke with risk increase in major bleedings on warfarin. During 6922 person-years of follow-up, 266 patients experienced a major bleed (3.8 per 100 person-years). C statistics ranged from 0.62 (Shireman) to 0.67 (ATRIA). Calibration was poor for ATRIA and moderate for other models. The reduction in recurrent ischemic strokes on warfarin was larger than the increase in major bleeding risk, irrespective of bleeding risk category. Performance of prediction models for major bleeding in patients with cerebral ischemia and atrial fibrillation is modest but comparable with performance in patients with only atrial fibrillation. Bleeding risk scores cannot

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-05-01

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

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

    International Nuclear Information System (INIS)

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

    2005-01-01

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

  4. Teismeliste üksindus ja kommerts - teema nii Londonis kui ka meil / Tõnis Mägi

    Index Scriptorium Estoniae

    Mägi, Tõnis, 1948-

    2007-01-01

    Muusik räägib, mida huvitavat ta nägi Londonis. Lähemalt Peter Shafferi näidendi "Equus" lavastusest, peaosades Richard Griffith ja Daniel Radcliffe. Artikkel ilmub Teatrikülgedel rubriigis "Teater & küljed" 5/17

  5. Sundmüügi põhiseaduslikud alused / Kadriann Ikkonen

    Index Scriptorium Estoniae

    Ikkonen, Kadriann, 1976-

    2004-01-01

    Sissenõudja ja võlgniku omandipõhiõiguse kollisioonist sundmüügi (ja üldse täitemenetluse) käigus ning võimalustest selle lahendamiseks, teistest sundmüüki õigustavatest põhiseaduse sätetest

  6. Es war einmal ... : raamatunäitus baltisaksa kirjandusest / Sirje Lusmägi, Tiiu Reimo

    Index Scriptorium Estoniae

    Lusmägi, Sirje, 1952-

    2012-01-01

    2011. a augustis Tallinnas toimunud baltisaksa kultuuripäevade raames avati Tallinna Keskraamatukogus ka raamatunäitus, korraldajaks Baltisaksa Kultuuri Selts Eestis. Näituse koostasid Sirje Lusmägi ja Tiiu Reimo RR-i ja TLÜAR-i kogude põhjal

  7. Eesti Miss teeb videofilmi / Evelyn Mikomägi ; interv. Valdo Jahilo

    Index Scriptorium Estoniae

    Mikomägi, Evelyn

    2001-01-01

    Eesti Miss Estonia 2000 Evelyn Mikomägi tegi koos sõbra, Sven-Olof Svenne Englundiga dokfilmi Küprosel peetud maailma suurimast iludusvõistlusest Miss Universe 2000. Neile kuulub ühisfirma "Living Frames" Rootsis, mille peategevus on suunatud 16mm ja 35mm filmide tootmisele

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

    Science.gov (United States)

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

    2017-01-01

    The gastrointestinal (GI) tract performs key functions that regulate the relationship between the host and the microbiota. Research has shown numerous benefits of probiotic intake in the modulation of immune responses and human metabolic processes. However, unfavorable attention has been paid to temporal changes of the microbial composition and diversity of the GI tract. This study aimed to investigate the effects of yogurt consumption on the GI microbiome bacteria community composition, structure and diversity during and after a short-term period (42 days). We used a multi-approach combining classical fingerprinting techniques (T-RFLPs), Sanger analyses and Illumina MiSeq 16S rRNA gene amplicon sequencing to elucidate bacterial communities and Lactobacilli and Bifidobacteria populations within healthy adults that consume high doses of yogurt daily. Results indicated that overall GI microbial community and diversity was method-dependent, yet we found individual specific changes in bacterial composition and structure in healthy subjects that consumed high doses of yogurt throughout the study. PMID:28212267

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

    Science.gov (United States)

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

    2017-02-15

    The gastrointestinal (GI) tract performs key functions that regulate the relationship between the host and the microbiota. Research has shown numerous benefits of probiotic intake in the modulation of immune responses and human metabolic processes. However, unfavorable attention has been paid to temporal changes of the microbial composition and diversity of the GI tract. This study aimed to investigate the effects of yogurt consumption on the GI microbiome bacteria community composition, structure and diversity during and after a short-term period (42 days). We used a multi-approach combining classical fingerprinting techniques (T-RFLPs), Sanger analyses and Illumina MiSeq 16S rRNA gene amplicon sequencing to elucidate bacterial communities and Lactobacilli and Bifidobacteria populations within healthy adults that consume high doses of yogurt daily. Results indicated that overall GI microbial community and diversity was method-dependent, yet we found individual specific changes in bacterial composition and structure in healthy subjects that consumed high doses of yogurt throughout the study.

  10. Tiit Linnamägi - metsaga peab olema sina peal / Merle Rips

    Index Scriptorium Estoniae

    Rips, Merle, 1950-

    2015-01-01

    Raplamaal Märjamaa vallas Purga külas Orava talus elab tänavu metsakultuuri kandja austava nimetuse pälvinud loodusemees Tiit Linnamägi. Kodumetsi majandab ta poeg Märdiga nii, et sealsed looduslikud ja kultuurilised rikkused säiliksid. Vestlusest Tiit ja Märt Linnamägiga

  11. Bookinghouse peatas Air Balticu piletite müügi / Ann-Marii Nergi

    Index Scriptorium Estoniae

    Nergi, Ann-Marii

    2011-01-01

    Lennupiletite vahendamisega tegelev Leedu portaal Bookinghouse peatas 27. juunil makseraskustes vaevleva Läti lennundusfirma Air Balticu piletite müügi, põhjendades seda Läti lennufirma finantsseisu kohta avalikuks tulnud infoga. Air Baltic väidab, et Bookinghouse on korduvalt reisijatele valeinformatsiooni jaganud ja teeb seda ka praegu

  12. Living in the face of death: Studies on palliative care in upper GI cancer patients

    NARCIS (Netherlands)

    M.J. Uitdehaag (Madeleen)

    2012-01-01

    textabstractThis thesis explores palliative care provided to patients with advanced upper gastrointestinal (GI) cancer. The 5-year survival rates for these cancer sites range between 4 and 17%, which implies that many of these patients require palliative care. Considering the fact that there is no

  13. Zombid, kanep ja psühhedeelia / Tristan Priimägi

    Index Scriptorium Estoniae

    Priimägi, Tristan, 1976-

    2010-01-01

    Katusekino filmiprogrammi filmidest: Alejandro Jodorowsky filmist "Püha mägi" ("Holy Mountain", Mehhiko-USA 1973), George A. Romero filmist "Elavate surnute öö" ("Night of the Living Dead", USA 1968), Louis Gasnier' filmist "Kanepihullus" ("Reefer Madness", USA 1936)

  14. Priimägi asub linna kultuurinõunikuks / Maria-Elisa Rannajõe

    Index Scriptorium Estoniae

    Rannajõe, Maria-Elisa

    2007-01-01

    Tallinna Ülikooli dotsent Linnar Priimägi hakkab nõustama Tallinna linnavolikogu 2011. aasta kultuuripealinna sihtide saavutamiseks. Volikogu liige Nikolai Stelmach on otsusest hämmastuses, sest L. Priimäge taheti volikogu haridus- ja kultuurikomisjonist hoopis välja heita, kuna ta osaleb harva komisjoni koosolekutel

  15. redMaGiC: selecting luminous red galaxies from the DES Science Verification data

    Energy Technology Data Exchange (ETDEWEB)

    Rozo, E. [Univ. of Arizona, Tucson, AZ (United States). et al.

    2016-05-30

    We introduce redMaGiC, an automated algorithm for selecting Luminous Red Galaxies (LRGs). The algorithm was developed to minimize photometric redshift uncertainties in photometric large-scale structure studies. redMaGiC achieves this by self-training the color-cuts necessary to produce a luminosity-thresholded LRG sam- ple of constant comoving density. Additionally, we demonstrate that redMaGiC photo-zs are very nearly as accurate as the best machine-learning based methods, yet they require minimal spectroscopic training, do not suffer from extrapolation biases, and are very nearly Gaussian. We apply our algorithm to Dark Energy Survey (DES) Science Verification (SV) data to produce a redMaGiC catalog sampling the redshift range z ϵ [0.2,0.8]. Our fiducial sample has a comoving space density of 10-3 (h-1Mpc)-3, and a median photo-z bias (zspec zphoto) and scatter (σz=(1 + z)) of 0.005 and 0.017 respectively.The corresponding 5σ outlier fraction is 1.4%. We also test our algorithm with Sloan Digital Sky Survey (SDSS) Data Release 8 (DR8) and Stripe 82 data, and discuss how spectroscopic training can be used to control photo-z biases at the 0.1% level.

  16. Public administration GI-based web-sites for spatial planning

    DEFF Research Database (Denmark)

    Campagna, Michele; Arleth, Mette

    2005-01-01

    This paper presents the results of an ongoing comparative study on the accessibility of Geographic Information at public authorities’ websites in Denmark and Italy. Qualitative and quantitative mappings of the level of accessibility to GI in the two countries are made and the results are compared...

  17. Hypoglycemia: Role of Hypothalamic Glucose-Inhibited (GI Neurons in Detection and Correction

    Directory of Open Access Journals (Sweden)

    Chunxue Zhou

    2018-03-01

    Full Text Available Hypoglycemia is a profound threat to the brain since glucose is its primary fuel. As a result, glucose sensors are widely located in the central nervous system and periphery. In this perspective we will focus on the role of hypothalamic glucose-inhibited (GI neurons in sensing and correcting hypoglycemia. In particular, we will discuss GI neurons in the ventromedial hypothalamus (VMH which express neuronal nitric oxide synthase (nNOS and in the perifornical hypothalamus (PFH which express orexin. The ability of VMH nNOS-GI neurons to depolarize in low glucose closely parallels the hormonal response to hypoglycemia which stimulates gluconeogenesis. We have found that nitric oxide (NO production in low glucose is dependent on oxidative status. In this perspective we will discuss the potential relevance of our work showing that enhancing the glutathione antioxidant system prevents hypoglycemia associated autonomic failure (HAAF in non-diabetic rats whereas VMH overexpression of the thioredoxin antioxidant system restores hypoglycemia counterregulation in rats with type 1 diabetes.We will also address the potential role of the orexin-GI neurons in the arousal response needed for hypoglycemia awareness which leads to behavioral correction (e.g., food intake, glucose administration. The potential relationship between the hypothalamic sensors and the neurocircuitry in the hindbrain and portal mesenteric vein which is critical for hypoglycemia correction will then be discussed.

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

    Directory of Open Access Journals (Sweden)

    Daniel J. Lisko

    2017-02-01

    Full Text Available The gastrointestinal (GI tract performs key functions that regulate the relationship between the host and the microbiota. Research has shown numerous benefits of probiotic intake in the modulation of immune responses and human metabolic processes. However, unfavorable attention has been paid to temporal changes of the microbial composition and diversity of the GI tract. This study aimed to investigate the effects of yogurt consumption on the GI microbiome bacteria community composition, structure and diversity during and after a short-term period (42 days. We used a multi-approach combining classical fingerprinting techniques (T-RFLPs, Sanger analyses and Illumina MiSeq 16S rRNA gene amplicon sequencing to elucidate bacterial communities and Lactobacilli and Bifidobacteria populations within healthy adults that consume high doses of yogurt daily. Results indicated that overall GI microbial community and diversity was method-dependent, yet we found individual specific changes in bacterial composition and structure in healthy subjects that consumed high doses of yogurt throughout the study.

  19. Uudiste lõpp ehk kuidas Facebook ajakirjanduse alla neelas / Priit Hõbemägi

    Index Scriptorium Estoniae

    Hõbemägi, Priit, 1957-

    2016-01-01

    Priit Hõbemägi refereeris Cambridge ülikooli professori ja Columbia ajakirjanduskooli digitaalse ajakirjanduse keskuse direktori Emily Belli meedia­maailmas laineid löönud kõnet sotsiaalmeedia ettevõtete mõju kasvust uudiste levitamise ja sellega raha teenimise üle

  20. Functional activity of Gi alpha protein in detergent resistant membrane domains from rat brain cortex

    Czech Academy of Sciences Publication Activity Database

    Stöhr, Jiří; Rudajev, Vladimír; Bouřová, Lenka; Lisý, Václav; Novotný, Jiří; Svoboda, Petr

    2007-01-01

    Roč. 101, Suppl.1 (2007), s. 52-52 ISSN 0022-3042. [European Society for Neurochemistry Meeting /17./. 19.05.2007-22.05.2007, Salamanca] Institutional research plan: CEZ:AV0Z50110509 Keywords : cpo1 * GABAB receptor * Gi protein * membrane domains Subject RIV: ED - Physiology

  1. The geographical identification (GI under geographic perspective for coalho cheese in agreste region of Pernambuco state

    Directory of Open Access Journals (Sweden)

    Janieire Dorlamis Cordeiro Bezerra

    2017-02-01

    Full Text Available This theme, geographic identification, although it has an intrinsic relationship with space and the organization of it, is little studied in Geography. For GI becomes tool to promote territorial development this should be linked to a policy not only economic but social and environmental, seeking to reach the marginalized producers in order to avoid social exclusion. GI coalho cheese Agreste of Pernambuco is indication of origin (IO which will help in spatial changes. To obtain a certification studies will required to contribute to the achievement of the GI, and futher after certification further research will be extremely necessary in order to manage the certification process and inclusion of family farming. Therefore, it will possible to conclude that the coalho cheese GI Agreste Pernambuco in fact included the family farmer, enhancing production, improving their income and enabling the rise. Therefore, the certification will bring beyond recognition in the region, a socio-spatial change, which in the future will involve studies of socio-economic indicators, with the interaction of man with the territory, how to adopt it and use it, contextualizing the space changes.

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

    Directory of Open Access Journals (Sweden)

    M. Barreiro de Acosta

    2007-07-01

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

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

    Science.gov (United States)

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

    2012-10-01

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

  4. PENERAPAN MODEL PEMBELAJARAN GROUP INVESTIGATION (GI UNTUK MENINGKATKAN AKTIVITAS DAN HASIL BELAJAR SISTEM PENGAPIAN KONVENSIONAL

    Directory of Open Access Journals (Sweden)

    Ahfid Husni Mubarok

    2016-06-01

    Full Text Available The aim of this research to determine the increase in activity and learning outcomes conventional ignition system by applying the learning model of Group Investigation (GI. The hypothesis in this research is application of Group Investigation (GI learning model’s can increase the activity and learning outcomes conventional ignition system. The research is a Classroom Action Research (CAR conducted collaboratively between teachers and researches. The subjects in this study is 20 students from class TKR of SMK, while the object of this research is the application of Group Investigation learning model’s (GI to increase the activity and student learning outcomes in conventional ignition system subjects. The experiment was conducted with three (3 cycles. Data collection techniques using observation, testing and documentation. Data were analyzed using quantitative description of the statistical formula. Results of this research by applying the Group Investigation learning model’s (GI showed the presence of increasing activity and learning outcomes conventional ignition system in every cycle. This is indicated by: 1. The increase of learning outcomes was showed by percentage of learning activity more than (≥ enough, before action only 25% increased by 22,4% into 47,4% after doing first cycles. When doing second cycles increased by 10,5% into 63,2% and third cycles increased by 10,5% into 73,7%. 2. Another increase was showed by learning outcomes of students who passed, from learning outcomes before action only 40% and after doing first cycles increased by 12,6% to 52,6%. Then second cycles increased by 8,5% into 61,1% and third cycles increased by 17,8% into 78,9%. From the above data it can be conclude by applying the learning model of Group Investigation (GI on the subjects of conventional ignition system  can increase the activity and learning outcomes, in line with the hypotesis of this action research

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

    Science.gov (United States)

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

    2017-05-12

    Acute gastroenteritis is a common cause of morbidity and mortality in humans worldwide. The rapid and specific identification of infectious agents is crucial for correct patient management. However, diagnosis of acute gastroenteritis is usually performed with diagnostic panels that include only a few pathogens. In the present bicentric study, the diagnostic value of FilmArray™ GI panels was assessed in unformed stool samples of patients with acute gastroenteritis and in a series of samples collected from pediatric patients with heamorragic diarrhea. The clinical performance of the FilmArray™ gastrointestinal (GI) panel was assessed in 168 stool samples collected from patients with either acute gastroenteritis or hemorragic diarrhea. Samples showing discordant results between FilmArray and routine methods were further analyzed with an additional assay. Overall, the FilmArray™ GI panel detected at least one potential pathogen in 92/168 (54.8%) specimens. In 66/92 (71.8%) samples, only one pathogen was detected, while in 26/92 (28.2%) multiple pathogens were detected. The most frequent pathogens were rotavirus 13.9% (22/168), Campylobacter 10.7% (18/168), Clostridium difficile 9.5% (16/168), and norovirus 8.9% (15/168). Clostridium difficile was identified only in patients with acute gastroenteritis (p Campylobacter spp., Salmonella spp., EPEC and E. coli producing Shiga-like toxin were more frequently detected in patients with hemorragic diarrhea (p < 0.05). The overall percent agreement calculated in samples was 73.8% and 65.5%, while 34.5% were discordant. After additional confirmatory analyses, the proportion of discordant samples decreased to 7.7%. Rotavirus and astrovirus were the most frequently unconfirmed pathogens. In conclusion, the FilmArray™ GI panel has proved to be a valuable new diagnostic tool for improving the diagnostic efficiency of GI pathogens.

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

    Science.gov (United States)

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

    2015-09-09

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

  7. Mis meelde on jäänud : Episoode ja meeleolusid / Arvo Mägi ; Eessõna "Mägi eesti kultuurimaastikul": Janika Kronberg

    Index Scriptorium Estoniae

    Mägi, Arvo, 1913-2004

    1996-01-01

    Järg: nr. 10, lk. 2209-2238 ; nr. 11, lk. 2433-2463 ; nr. 12, lk. 2655-2688. 1997, nr. 1, lk. 193-221 ; nr. 2, lk. 413-445 ; nr. 3, lk. 637-669 ; nr. 4, lk. 861-893 ; nr. 5, lk. 1085-1117 ; nr. 6, lk. 1309-1341.Vastukajad: Kaalep, Ain. Arvo Mägi - memuarist ja kroonik. // Akadeemia (1997) nr. 9, lk. 1973-1975 ; Helk, Vello, Reinans, Alur. Pagulaste-väliseestlaste probleemidest // Akadeemia (1998) nr. 2, lk. 396-407

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

    Science.gov (United States)

    Deligeoroglou, Efthimios; Karountzos, Vasileios

    2018-04-01

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

  9. Hormone Replacement Therapy: Can It Cause Vaginal Bleeding?

    Science.gov (United States)

    Hormone replacement therapy: Can it cause vaginal bleeding? I'm taking hormone therapy for menopause symptoms, and my monthly ... mayoclinic.org/diseases-conditions/menopause/expert-answers/hormone-replacement-therapy/FAQ-20058499 . Mayo Clinic Footer Legal Conditions ...

  10. Predictive factors for intraoperative excessive bleeding in Graves’ disease

    Directory of Open Access Journals (Sweden)

    Kosho Yamanouchi

    2015-01-01

    Conclusion: A huge goiter presented as a predictive factor for excessive bleeding during surgery for Graves’ disease, and preparation for blood transfusion should be considered in cases where thyroids weigh more than 200 g.

  11. Management of bleeding and leakage after pancreatic surgery

    NARCIS (Netherlands)

    de Castro, S. M. M.; Busch, O. R. C.; Gouma, D. J.

    2004-01-01

    Pancreatic surgery has advanced considerably during the past decades. Recent studies report reduced morbidity rates and virtually no mortality after resection. However, postoperative complications are still a formidable menace. In this chapter we discuss the management of postoperative bleeding and

  12. Anode reactive bleed and injector shift control strategy

    Science.gov (United States)

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

    2012-01-03

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  14. Pregnancy Complications: Bleeding and Spotting from the Vagina

    Science.gov (United States)

    ... miscarry have bleeding or spotting before the miscarriage. Ectopic pregnancy. This is when a fertilized egg implants itself ... of the uterus and begins to grow. An ectopic pregnancy cannot result in the birth of a baby. ...

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

    Directory of Open Access Journals (Sweden)

    Zeytunlu Murat

    2009-01-01

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

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

    Science.gov (United States)

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

    2015-09-01

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

  17. Saliency-Based Bleeding Localization for Wireless Capsule Endoscopy Diagnosis

    Directory of Open Access Journals (Sweden)

    Hongda Chen

    2017-01-01

    Full Text Available Stomach bleeding is a kind of gastrointestinal disease which can be diagnosed noninvasively by wireless capsule endoscopy (WCE. However, it requires much time for physicians to scan large amount of WCE images. Alternatively, computer-assisted bleeding localization systems are developed where color, edge, and intensity features are defined to distinguish lesions from normal tissues. This paper proposes a saliency-based localization system where three saliency maps are computed: phase congruency-based edge saliency map derived from Log-Gabor filter bands, intensity histogram-guided intensity saliency map, and red proportion-based saliency map. Fusing the three maps together, the proposed system can detect bleeding regions by thresholding the fused saliency map. Results demonstrate the accuracy of 98.97% for our system to mark bleeding regions.

  18. Transarterial embolization for management of severe postcoital bleeding

    Directory of Open Access Journals (Sweden)

    Armen Eskandari

    2016-08-01

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

  19. Appendicular bleeding: an excepcional cause of lower hemorrhage

    Directory of Open Access Journals (Sweden)

    Marta Magaz-Martínez

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

  20. Practical Approach to Endoscopic Management for Bleeding Gastric Varices

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Young Suk [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2012-02-15

    Bleeding from gastric varices is generally more severe than bleeding from esophageal varices, although it occurs less frequently. Recently, new endoscopic treatment options and interventional radiological procedures have broadened the therapeutic armamentarium for gastric varices. This review provides an overview of the classification and pathophysiology of gastric varices, an introduction to current endoscopic and interventional radiological management options for gastric varices, and details of a practical approach to endoscopic variceal obturation using N-butyl-2-cyanoacrylate.

  1. Abnormal uterine bleeding in reproductive-aged women.

    Science.gov (United States)

    Matthews, Michelle L

    2015-03-01

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

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  3. Bleeding disorders in dental practice: A diagnostic overview

    Directory of Open Access Journals (Sweden)

    Abhirup Goswami

    2014-01-01

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

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

    International Nuclear Information System (INIS)

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

    2017-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-12-15

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

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

    Science.gov (United States)

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

    2012-01-01

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

  7. Transcatheter embolization for treatment of acute lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Uflacker, R.

    1987-01-01

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

  8. Epidemiology of RHDV2 (Lagovirus europaeus/GI.2) in free-living wild European rabbits in Portugal.

    Science.gov (United States)

    Rouco, C; Abrantes, J; Serronha, A; Lopes, A M; Maio, E; Magalhães, M J; Blanco, E; Bárcena, J; Esteves, P J; Santos, N; Alves, P C; Monterroso, P

    2018-04-01

    As the detection of the first outbreak of a novel aetiological agent of rabbit haemorrhagic disease commonly called RHDV2 or RHDVb (Lagovirus europaeus/GI.2, henceforth GI.2) in France in 2010, the virus rapidly spread throughout continental Europe and nearby islands such as Great Britain, Sardinia, Sicily, the Azores and the Canary Islands among others. The outbreaks of this new lagovirus cause important economic losses in rabbitries, and ecological disruptions by affecting the conservation of rabbit-sensitive top predators. We analysed 550 rabbit carcasses collected in the field between May 2013 and March 2016, to investigate the epidemiology of GI.2 in free-living populations and to perform a comparative analysis with the epidemiology of classical rabbit haemorrhagic disease virus forms (RHDV, henceforth GI.1) in Portugal. Rabbits were sexed, aged and liver and blood samples were collected for subsequent RHDV screening and serology. A total of 172 samples were PCR-positive to GI.2, whereas GI.1 strains were not detected in any of the samples. The outbreaks of GI.2 revealed a marked seasonality, with peaks during the breeding season (November-May). We also found that approximately, one-third of free-ranging European rabbits in Portugal have seroconverted to GI.2. We demonstrate that the GI.2 lagovirus is currently widespread in wild populations in Portugal and is affecting a high proportion of adults and juveniles. Therefore, ongoing monitoring and surveillance are required to assess the effects of GI.2 on wild rabbit populations, its evolution, and to guide management actions aimed at mitigating the impacts of rabbit declines in the ecosystem and in rural economies. © 2017 Blackwell Verlag GmbH.

  9. Decision making by auxiliary nurses to assess postpartum bleeding in a Dominican Republic maternity ward.

    Science.gov (United States)

    Foster, Jennifer; Regueira, Yadira; Heath, AnneMarie

    2006-01-01

    To understand the process of decision making by auxiliary nurses regarding postpartum bleeding among women in the Dominican Republic. An ethnographic qualitative design of semistructured interviews and participant observation. Twenty four auxiliary nurses on a maternity unit of a referral hospital in the Dominican Republic. Auxiliary nurses use specific criteria and logic to decide if postpartum maternal bleeding is excessive. However, systematic postpartum assessments are not routinely conducted on every woman. A decision tree that traces how auxiliary nurses evaluate postpartum bleeding indicates that they have knowledge of contemporary obstetric nursing care, but the organization of care delivery is not structured for them to apply it routinely. A collaboration of U.S. midwives and Dominican nurses will build on the assets of the auxiliary nurses. Rather than focusing the content of educational conferences on current knowledge of labor and delivery, an important next step is modeling woman- and family-centered care. The U.S. midwives and Dominican nurses are committed to finding empowering and effective ways to improve maternity care.

  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

    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...... a significant relation with an increased risk of bleeding or death: high plasma volume (p varices (p

  11. War and Marriage: Assortative Mating and the World War II GI Bill.

    Science.gov (United States)

    Larsen, Matthew F; McCarthy, T J; Moulton, Jeremy G; Page, Marianne E; Patel, Ankur J

    2015-10-01

    World War II and its subsequent GI Bill have been widely credited with playing a transformative role in American society, but there have been few quantitative analyses of these historical events' broad social effects. We exploit between-cohort variation in the probability of military service to investigate how WWII and the GI Bill altered the structure of marriage, and find that it had important spillover effects beyond its direct effect on men's educational attainment. Our results suggest that the additional education received by returning veterans caused them to "sort" into wives with significantly higher levels of education. This suggests an important mechanism by which socioeconomic status may be passed on to the next generation.

  12. GiGabit Ethernet mezzanines for DAQ and Trigger links of LHCb

    CERN Document Server

    Müller, H; Guirao, A

    2003-01-01

    The LHCb experiment uses IEEE 802.ab (GiGabit ethernet) technology for the data transport and readout network layer between the L1 data buffers and the CPU farm. The common way to interface the L1 buffers in LHCb to the physical layers of GiGabitEthernet (GBE) is specified in this document. The SPI-3 industry standard is used as a narrow, FiFo-like interface which can be easily implemented in the FPGAs of the L1 boards. The SPI-3 protocol on the mezzanine cards is handled by commercial chips. Up to 4 bidirectional GBE channels can be implemented on a 149*74 mm mezzanine of stackheight 11 mm. These are interfaced through one 150 pin, high-speed connector which is defined here as LHCb standard.

  13. Fasting for haemostasis in children with gastrointestinal bleeding.

    Science.gov (United States)

    Luo, Shuang-Hong; Guo, Qin; Liu, Guan J; Wan, Chaomin

    2016-05-19

    Gastrointestinal bleeding refers to loss of blood from any site of the digestive tract. In paediatric clinical practice, it is usually a complaint of children attending the emergency department as a symptom of diseases such as ulcers, gastric or oesophageal varices, gastritis, Mallory-Weiss tears, anorectal fissures, allergic colitis, infectious colitis, intussusception, Henoch-Schonlein purpura, and Meckel's diverticulum; it also occurs with high incidence in critically ill children hospitalised in intensive care units and is caused by stress-induced gastropathy. No matter what the cause of gastrointestinal bleeding, fasting is believed to be necessary due to the fear that eating may affect haemostasis or aggravate bleeding. To assess the effects and safety of fasting for haemostasis in gastrointestinal bleeding in children. We searched EBM Reviews - the Cochrane Central Register of Controlled Trials (CENTRAL) (May 2016), Ovid MEDLINE(R) (1946 to 3 May 2016), EMBASE (1980 to 2016 Week 18), Chinese Biomedical Database (CBM) (1978 to 3 May 2016), China National Knowledge Infrastructure (CNKI) (1979 to 3 May 2016), VIP Database (1989 to 4 May 2016) and Wanfang Data (1990 to 4 May 2016). We used no restrictions on language or study setting and limited searches in CNKI and Wanfang Data to the medical field. Randomised controlled trials (RCTs) or quasi-RCTs in children with gastrointestinal bleeding that compared fasting with feeding. Two review authors independently screened the literature search results, and there were no disagreements. We identified no RCTs or quasi-RCTs that compared the effects and safety of fasting with feeding for haemostasis in children with gastrointestinal bleeding. No study fulfilled the criteria for considering studies for our review. There is currently no information available from RCTs or quasi-RCTs to support or refute the use of fasting for haemostasis in children with gastrointestinal bleeding.

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

    Science.gov (United States)

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

    2014-03-01

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

  15. Results of endoscopic vacuum-assisted closure device for treatment of upper GI leaks.

    Science.gov (United States)

    Bludau, Marc; Fuchs, Hans F; Herbold, Till; Maus, Martin K H; Alakus, Hakan; Popp, Felix; Leers, Jessica M; Bruns, Christiane J; Hölscher, Arnulf H; Schröder, Wolfgang; Chon, Seung-Hun

    2018-04-01

    Esophageal perforations and postoperative leakage of esophagogastrostomies are considered to be life-threatening conditions due to the potential development of mediastinitis and consecutive sepsis. Vacuum-assisted closure (VAC) techniques, a well-established treatment method for superficial infected wounds, are based on a negative pressure applied to the wound via a vacuum-sealed sponge. Endoluminal VAC (E-VAC) therapy as a treatment for GI leakages in the rectum was introduced in 2008. E-VAC therapy is a novel method, and experience regarding esophageal applications is limited. In this retrospective study, the experience of a high-volume center for upper GI surgery with E-VAC therapy in patients with leaks of the upper GI tract is summarized. To our knowledge, this series presents the largest patient cohort worldwide in a single-center study. Between October 2010 and January 2017, 77 patients with defects in the upper gastrointestinal tract were treated using the E-VAC application. Six patients had a spontaneous perforation, 12 patients an iatrogenic injury, and 59 patients a postoperative leakage in the upper gastrointestinal tract. Complete restoration of the esophageal defect was achieved in 60 of 77 patients. The average duration of application was 11.0 days, and a median of 2.75 E-VAC systems were used. For 21 of the 77 patients, E-VAC therapy was combined with the placement of self-expanding metal stents. This study demonstrates that E-VAC therapy provides an additional treatment option for esophageal wall defects. Esophageal defects and mediastinal abscesses can be treated with E-VAC therapy where endoscopic stenting may not be possible. A prospective multi-center study has to be directed to bring evidence to the superiority of E-VAC therapy for patients suffering from upper GI defects.

  16. For-Profit Colleges and the GI Bill: A Worthwhile Investment?

    Science.gov (United States)

    2012-05-12

    enroll in a for-profit college take out a loan ,25 and therefore many of the students who withdraw from for- profit schools are encumbered with a...significant amount of student loan debt. This includes servicemembers using the GI Bill and Tuition Assistance programs. For-profit schools leave...8 for for-profit colleges could indicate an inability of the student to obtain employment or a sufficient salary to make the student loan payments

  17. Lühifilm "Argentiina tango" ja Ants Anderi elujanu / Margus Mikomägi

    Index Scriptorium Estoniae

    Mikomägi, Margus, 1956-

    2009-01-01

    Valmivast lühifilmist "Argentiina tango" (Film Tower Kuubis), mille stsenarist, kunstnik ja režissöör on Ervin Õunapuu. Viimasest võttepäevast Tallinnas Vabaduse väljaku kunstigaleriis, kus Margus Mikomägi oli ajakirjaniku rollis. Peaosas Roman Baskin. Kunstiteadlase osa mänginud Ants Anderist. Valik Ervin Õunapuu filme

  18. The busy period of order n in the GI/D/infinity queue

    International Nuclear Information System (INIS)

    Dvurecenskij, A.

    1982-01-01

    The problem of determination of the distribution function, integral equation and all moments of the busy period of order n, that is, the period when at least n servers are busy from infinitely many servers of the GI/D/infinity queueing system are investigated. The idle period of order n, i. e., the period between two neighbouring busy periods of order n is also studied. Those problems arise in the blob length determination in track chambers in high energy physics

  19. A GPR-protein interaction surface of Gi(alpha): implications for the mechanism of GDP-release inhibition.

    Science.gov (United States)

    Natochin, Michael; Gasimov, Karim G; Artemyev, Nikolai O

    2002-01-08

    Proteins containing G-protein regulatory (GPR) motifs represent a novel family of guanine nucleotide dissociation inhibitors (GDIs) for G(alpha) subunits from the Gi family. They selectively interact with the GDP-bound conformation of Gi(alpha) and transducin-alpha (Gt(alpha)), but not with Gs(alpha). A series of chimeric proteins between Gi(alpha)(1) and Gs(alpha) has been constructed to investigate GPR-contact sites on G(alpha) subunits and the mechanism of GPR-protein GDI activity. Analysis of the interaction of two GPR-proteins-AGS3GPR and Pcp2-with the chimeric G(alpha) subunits demonstrated that the GPR-Gi(alpha)(1) interface involves the Gi(alpha)(1) switch regions and Gi(alpha)(1)-144-151, a site within the helical domain. Residues within Gi(alpha)(1)-144-151 form conformation-sensitive contacts with switch III, and may directly interact with a GPR-protein or form a GPR-binding surface jointly with switch III. The helical domain site is critical to the ability of GPR-proteins to act as GDIs. Our data suggest that a mechanism of the GDI activity of GPR-proteins is different from that of GDIs for monomeric GTPases and from the GDI-like activity of G(betagamma) subunits. The GPR-proteins are likely to block a GDP-escape route on G(alpha) subunits.

  20. Dose distributions of patients from chest fluoroscopy, upper GI-tract radiography and cinematography in Japan

    International Nuclear Information System (INIS)

    Kusama, T.; Kai, M.; Ohta, K.

    1996-01-01

    The per caput dose from medical exposure in Japan is several times higher than in other developed countries. There are no dose limitations for medical exposure. Then, the appropriate applications of radiation diagnosis/treatments (justification of practices) and the quality control of diagnosis/treatments (optimization of protection) are needed to reduce the doses from medical exposure. It is well documented that patient doses from a X-ray diagnosis are distributed in the broad range. Recently, the IAEA introduced guidance levels for some typical X-ray diagnosis and in vivo nuclear medicines. We carried out the investigation of dose distribution of patients from the X-ray examinations of chest, cardiovascular cinematography and upper GI-tract X-ray examination in order to give the basic information on the quality control of each X-ray diagnosis. These X-ray diagnoses are performed frequently in Japan, and especially chest X-ray examinations are carried out periodically to all population more than 18 years old as legal health check and GI-tract X-ray examinations to the persons more than 35 years old. The cardiovascular cinematography and the upper GI-tract X-ray examination bring higher effective dose for patients. More information is therefore, needed for the reduction and quality control of medical exposure in Japan. (author)

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

    NARCIS (Netherlands)

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

    2008-01-01

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

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

    NARCIS (Netherlands)

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

    2008-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jan Yi-Yin

    2006-01-01

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

  4. Bleed water testing program for controlled low strength material

    International Nuclear Information System (INIS)

    Langton, C.A.

    1996-01-01

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

  5. Computed tomography angiography in patients with active gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Reis, Fatima Regina Silva; D'Ippolito, Giuseppe

    2015-01-01

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

  6. Computed tomography angiography in patients with active gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-11-15

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

  7. Portable semiconductor laser system to stop internal bleeding

    Science.gov (United States)

    Rediker, Robert H.; Durville, Frederic M.; Cho, George; Boll, James H.

    1995-03-01

    One significant cause of death during a sever trauma (gun wound or stab wound) is internal bleeding. A semiconductor diode laser system has been used in in vitro studies of cauterizing veins and arteries to stop bleeding. The conditions of laparoscopic surgery, including bleeding conditions (blood flow and pressure), are simulated. Results have been obtained both with and without using a hemostat (e.g., forceps) to temporarily stop the bleeding prior to the cautery. With the hemostat and a fiber-coupled 810-nm laser, blood vessels of up to 5 mm diameter were cauterized with an 8 W output from the fiber. Great cautions must be used in extrapolating from these in vitro results, since the exact conditions of bleeding in a living being are impossible to exactly reproduce in a laboratory in-vitro experiment. In a living being, when blood flow stops the cessation of nourishment to the vessels results in irreversible physiological changes. Also, the blood itself is different from blood in a living being because an anti-clotting agent (heparin) was added in order to inhibit the blood's natural tendency to coagulate.

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

    Science.gov (United States)

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

    2013-03-01

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

  9. DSA diagnosis and interventional management of postoperative bleeding

    International Nuclear Information System (INIS)

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

    2009-01-01

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

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

    Science.gov (United States)

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

    2014-04-01

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

  11. An endoscopic study of upper-GI mucosal changes in patients with congestive heart failure.

    Science.gov (United States)

    Raja, Kaiser; Kochhar, Rakesh; Sethy, Pradeepta K; Dutta, Usha; Bali, Harinder K; Varma, Jagmohan S

    2004-12-01

    Congestive heart failure results in an increase in systemic venous pressure that is transmitted to the inferior vena cava and to the hepatic veins. This can cause GI vascular and mucosal congestion. The aim of this study was to define upper-GI mucosal changes in patients with congestive heart failure. A total of 57 patients with congestive heart failure presenting with GI symptoms underwent upper endoscopy. Echocardiography was performed in all patients to determine the ejection fraction and the degree of tricuspid regurgitation. Transabdominal US was performed to measure the diameters of the hepatic veins, the inferior vena cava, and the portal vein. The presence and the severity of gastropathy and duodenopathy were compared with the parameters relating to severity of cardiac failure. Of the 57 patients studied, gastric mucosal changes were observed in 50 (88%), duodenal mucosal changes in 31 (54%), and esophageal mucosal changes in none. Gastric mucosal changes were the following: mosaic-like pattern (n = 50), punctate spots (n = 34), thickened folds (n = 5), watermelon stomach (n = 3), and telangiectasia (n = 10). Duodenal mucosal changes were the following: mosaic-like pattern (n = 29), thickened folds (n = 8), and telangiectasia (n = 2). Upper-GI symptoms were associated with gastropathy ( p = 0.027) and duodenopathy ( p = 0.003). The presence and the severity of duodenopathy showed a high degree of positive correlation with the presence and the severity of gastropathy (gamma value 0.690; p value <0.001). Patients with gastropathy and duodenopathy had higher mean inferior vena cava and hepatic vein diameters than those without gastropathy and duodenopathy. The severity of duodenopathy but not that of gastropathy was significantly associated with increasing severity of tricuspid regurgitation ( p = 0.001), larger portal vein diameter ( p = 0.02), and lower ejection fraction ( p = 0.008). Among patients with congestive cardiac failure with GI symptoms, changes

  12. Bleeding Jejunal Diverticulosis in a Patient with Myasthenia Gravis

    Directory of Open Access Journals (Sweden)

    I. Zuber-Jerger

    2008-01-01

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

  13. No impact of fish oil supplements on bleeding risk

    DEFF Research Database (Denmark)

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

    2017-01-01

    Abstract Introduction: Fish oil supplementation may inhibit platelet aggregation and can potentially increase the risk of bleeding. The aim of the present systematic review was to evaluate the effect of fish oil supplements on haemostasis and bleeding risk, and to provide recommendations on whether...... it is necessary to discontinue fish oil supplementation prior to surgery. Methods: Studies were identified through PubMed and Embase searches and by reviewing the reference lists of the included papers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Included...... of the included studies were randomised controlled trials or included a control group. Overall, fish oil supplements reduced platelet aggregation in healthy subjects. Fish oil exposure in surgical patients did not increase bleeding or blood transfusions either during or after surgery. Conclusion: Fish oil...

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

    Directory of Open Access Journals (Sweden)

    V. V. Izbitsky

    2013-06-01

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

  15. Computed tomography diagnosis of active bleeding into the thyroid gland.

    Science.gov (United States)

    Veverková, Lucia; Bakaj-Zbrožková, Lenka; Hallamová, Lucie; Heřman, Miroslav

    2013-10-01

    Fine-needle biopsy of the thyroid gland is the most common interventional procedure used to diagnose thyroid diseases. Serious complications are rare in this procedure. They comprise an infection with abscess formation and hemorrhage. To date, only a few case reports have described an ultrasound diagnosis of active bleeding into the thyroid gland. We established such a diagnosis using computed tomography (CT). A 74-year-old woman presented to the emergency department of our hospital with complications after fine-needle biopsy of the thyroid gland. Ultrasound revealed a large hematoma surrounding the gland. A subsequent CT scan confirmed the presence of hematoma and, moreover, showed active bleeding. This finding prompted rapid surgical intervention. CT has the capability to show active bleeding into the thyroid gland.

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

    Science.gov (United States)

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

    1980-01-01

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

  17. Effects of Aglumin on the rectal bleeding following radiotherapy

    International Nuclear Information System (INIS)

    Yamashita, Michitaka; Tanaka, Motoshi; Yoshimura, Osamu; Matsubayashi, Shigeru

    1978-01-01

    Aglumin was administered to 20 cases which had rectal bleeding following radiotherapy. The results were as follows. Rectal bleeding decreased in 16 of 20 cases (80%): remarkably effective, 15%; effective, 25%; slightly effective, 40%. Bleeding time decreased in 11 cases (55%). Rumpel-Leede test gave remarkable improvement in 10 of 14 cases which had been abnormal (71.4%). Platelet increased in 18 of 20 cases (90%). Liver function test and peripheral blood findings showed no remarkable changes. No side effects such as intestinal disturbance etc were noted. In the series of symptomatic treatment for rectal disturbance resulting from radiotherapy, this drug had considerable effect of hemostasis. It was concluded that this drug is useful in combined use with other antiphlogistics, analgesic, and hematinic etc. (Ueda, J.)

  18. PALM-COEIN Nomenclature for Abnormal Uterine Bleeding.

    Science.gov (United States)

    Deneris, Angela

    2016-05-01

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

  19. Upper gastrointestinal bleeding: risk factors for mortality in two urban centers in Latin America Hemorragia digestiva alta: factores de riesgo para mortalidad en dos centros urbanos de América Latina

    Directory of Open Access Journals (Sweden)

    C. H. Morales Uribe

    2011-01-01

    Full Text Available Objective: to describe the experience with upper gastrointestinal bleeding (UGIB in two major Latin American hospitals; its main cuses, treatment and prognosis, while exploring some risk factors associated with death. Design: prospective cohort study. Patients and methods: We included 464 patients older than 15 years of age from two reference centers. We studied some demographic variables, history, clinical presentation, treatment and mortality. We explored the association betwen those variables and death. Results: The mean age was 57.9 years, and the male: female ratio was 1.4:1. Three hundred and fifty nine patients (77.4% were seen for gastrointestinal bleeding (outpatients bleeding and 105 patients (22.6% were inpatients seen for UGIB. A total of 71.6% of patients admitted with the diagnosis of upper GI bleeding underwent upper GI emdoscopy (EGD within 24 hours. The main causes of bleeding were peptic ulcer (190 patients, 40.9%, erosive disease (162 patients, 34.9% and variceal bleeding (47 patients, 10.1%. Forty four patients died (9.5%. Patient who presented with bleeding due to other causes during hospitalization has a higher mortality risk than those whose complaints were related to gastrointestinal bleeding (RR 2.4, 95% CI 1.2-4.6. An increasing number of comorbidities such as those described in the Rockall Score, were also associated with a higher risk of mortality (RR 2.5 95% CI 1.1-5.4. Conclusion: Intrahospital upper GI bleeding and the presence of comorbilities ares risk factors for a fatal outcome. Identifying patients with a higher risk would help improve the management of patients with UGIB.Objetivo: presentar la experiencia con la hemorragia de vías digestivas alta (HDA en dos hospitales centros de referencia de un país latinoamericano, las principales causas, tratamiento, pronóstico y explorar algunos factores de riesgo asociados con la mortalidad. Diseño: estudio de cohortes prospectivo. Pacientes y métodos: se

  20. The timing of neovascularization in fingertip replantation by external bleeding.

    Science.gov (United States)

    Han, Seung-Kyu; Chung, Heung-Soo; Kim, Woo-Kyung

    2002-09-15

    To overcome venous congestion in fingertip replantation with no venous anastomosis, the authors have used a salvage procedure that consists of continuous external bleeding through a stab incision on the paraungual area and dripping a heparinized saline solution at the incision site to maintain external bleeding. Because this method requires continuous bleeding for a certain period of time, it may be a great burden on the patient; therefore, it is most important to minimize the duration of bleeding. Many authors have studied the timing of the new venous channel formation of the flap. However, to our knowledge, a study on fingertip replantations has not yet been performed. From June of 1985 to November of 1999, the authors performed fingertip replantations on 144 fingers of 137 patients using our salvage procedure at Korea University Guro Hospital. Among the 144 fingers, 101 fingers of 96 patients were successfully transplanted, including those with partial necrosis. The authors reviewed the medical records of these 101 fingers retrospectively; they compared and analyzed the necessary duration of external bleeding according to sex, age, level of injury, cause of amputation, and the type of injury. The average period of the salvage procedure was 7.6 days. Regarding age, the shortest period (5.5 days) was required for patients younger than 10 years. On the basis of the types of injuries, the duration of bleeding was shortest for the guillotine injury group (5.9 days) compared with crush (8.2 days) or avulsion (8.0 days) injuries. Sex and level of injury did not make much difference in the duration of the procedure.

  1. Neurosurgical management in children with bleeding diathesis: auditing neurological outcome.

    Science.gov (United States)

    Zakaria, Zaitun; Kaliaperumal, Chandrasekaran; Crimmins, Darach; Caird, John

    2018-01-01

    OBJECTIVE The aim of this study was to assess the outcome of neurosurgical treatment in children with bleeding diathesis and also to evaluate the current management plan applied in the authors' service. METHODS The authors retrospectively analyzed all cases in which neurosurgical procedures were performed in pediatric patients presenting with intracranial hematoma due to an underlying bleeding tendency over a 5-year period at their institution. They evaluated the patients' neurological symptoms from the initial referral, hematological abnormalities, surgical treatment, neurological outcome, and scores on the Pediatric Glasgow Outcome Scale-Extended (GOS-E Peds) obtained 1 year after the last operation. RESULTS Five patients with a bleeding diathesis who underwent surgery for intracranial hematoma were identified; the diagnosis was hemophilia A in 3 cases, idiopathic thrombocytopenic purpura in 1 case, and severe aplastic anemia in 1 case. Intracerebral hematoma (ICH) (n = 4) and acute subdural hematoma (n = 1) were confirmed on radiological investigations. In 2 of the 4 patients with ICH, the diagnosis of bleeding diathesis was made for the first time on presentation. Four patients (all male) were younger than 2 years; the patient with severe aplastic anemia and spontaneous ICH was 15 years old and female. The duration of symptoms varied from 24 hours to 5 days. Neurological examination at 1 year's follow-up showed complete recovery (GOS-E Peds score of 1) in 3 cases and mild weakness (GOS-E Peds score of 2) in 2 cases. CONCLUSIONS Neurosurgical management of patients with bleeding diathesis should be carried out in a tertiary-care setting with multidisciplinary team management, including members with expertise in neuroimaging and hematology, in addition to neurosurgery. Early diagnosis and prompt treatment of a bleeding diathesis is crucial for full neurological recovery.

  2. Therapeutic and Diagnostic Tactics for Bleedings from Esophagogastric Varices

    Directory of Open Access Journals (Sweden)

    F. G. Nazyrov

    2010-01-01

    Full Text Available Objective: to elaborate therapeutic and diagnostic tactics for bleedings from esophagogastric varices (EGV in an intensive care unit (ICU. Subjects and methods: The experience in treating 102 patients with profuse bleeding from EGV, admitted to the ICU, Acad. V. Vakhidov Republican Specialized Center of Surgery, in 2000—2008, was summarized. Results. The findings show that just less than 40% of the patients with hepatic cirrhosis are admitted for the clinical manifestations of active bleeding from EGV, the latter being profuse in 17.6%. These indicate that the noticeable admission preponderance of patients with first-degree blood loss and the low proportion of those with critical third-degree blood loss are noteworthy. Retrospective analysis demonstrated that hemostasis was achieved in 97 (95.1% patients, by applying solely conservative measures using a Blakemore tube (in both variants of its use. After removal of the Blakemore tube, stable hemostasis retained in 88.9% of the patients with bleedings from the veins of the middle third of the esophagus, in 71.8% of cases of those from its lower third and only in 24.1% of the patients with those from the cardiac stomach. Conclusion. According to the results of the study, we propose the therapeutic and diagnostic tactics for patients with profuse bleedings from EGV, which involve the use of a Blakemore tube and a complex of conservative measures with traditional hemostatic therapy, the administration of portal pressure-reducing agents to prevent or treat hepatic failure. Key words: bleeding, esophagogastric varices, hepatic failure, intensive therapy.

  3. Mifepristone-induced abortion and vaginal bleeding in subsequent pregnancy.

    Science.gov (United States)

    Liang, Hong; Gao, Er-sheng; Chen, Ai-min; Luo, Lin; Cheng, Yi-min; Yuan, Wei

    2011-12-01

    The aim of this study is to explore the effect of first-trimester mifepristone-induced abortion on vaginal bleeding in subsequent pregnancy. This observational cohort study was conducted during 1998-2001 at antenatal clinics in Beijing, Chengdu, and Shanghai, China. The study enrolled 4,931 women with one previous mifepristone-induced abortion, 4,925 women with no history of induced abortion, and 4,800 women with one previous surgical abortion and followed them through pregnancy and childbirth. The rates of vaginal bleeding in pregnant women with a history of medical abortion, no abortion, and surgical abortion were 16.5%, 13.9%, and 17.3%, respectively. The women with medical abortion had a higher risk (adjusted relative risk (aRR)=1.17, 95% confidence interval (CI): 1.07, 1.29) of vaginal bleeding compared with those with no abortion but similar risk to prior surgical abortion. When the correlation between medical abortion and vaginal bleeding was examined by period, increased risk was observed only in the early period (abortion and no abortion showed that the observed risks increased particularly in those with abortion at gestational age ≤ 7 weeks (aRR=1.33, 95% CI: 1.18, 1.49), those followed by a postabortion curettage (aRR=1.58, 95% CI: 1.37, 1.84) or complications (aRR=1.99, 95% CI: 1.67, 2.37). There was no difference between women with medical abortion and women with surgical abortion in the occurrence of vaginal bleeding for either period. One previous mifepristone-induced abortion increased the risk of vaginal bleeding in early gestation period of subsequent pregnancy compared with no abortion, especially if abortion occurred before 7 weeks of gestation and was followed by a curettage or complications. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. Emergency management of lower gastrointestinal bleed in children.

    Science.gov (United States)

    Balachandran, Binesh; Singhi, Sunit

    2013-03-01

    Lower gastro intestinal bleed (LGIB) is defined as any bleeding that occurs distal to the ligament of Treitz (situated at the duodeno jejunal junction). It constitutes the chief complaint of about 0.3 % of children presenting to the pediatric emergency department(ED). Among Indian children the most common causes are colitis and polyps. In most of the cases of LGIB the bleeding is small and self limiting, but conditions like Meckel's diverticulum often presents with life threatening bleeds. The approach in ED should include in order of priority-assessment and maintenance of hemodynamic stability, confirmation of LGIB and then to attempt for specific diagnoses and their management. This is achieved with help of rapid cardiopulmonary assessment, focused history and examination. The management of all serious hemodynamically significant bleeds includes, rapid IV access, volume replacement with normal saline 20 ml/kg, blood sampling (for cross matching, hematocrit, platelet, coagulogram and liver function tests), Inj. Vit K 5-10 mg IV, acid suppression with H2 antagonists/PPI and nasogastric lavage to rule out upper gastrointestinal bleed. Continuous ongoing monitoring of vital signs is important after stabilization. In ill looking infant, infectious colitis, Necrotizing enterocolitis (NEC), Hirschsprung enterocolitis and volvulus and in older infants and children, intussusceptions, typhoid fever, volvulus should be looked for. Proctosigmoidoscopy remains the first investigation to be done and reveals majority of etiology. Multidetector CT scan, Tc 99 m RBC scan, angiography and Push enteroscopy are the further investigation choices according to the clinical condition of the child. Intra operative enteroscopy is reserved for refractory cases with an obscure etiology.

  5. Cost-effectiveness of treatments for heavy menstrual bleeding.

    Science.gov (United States)

    Spencer, Jennifer C; Louie, Michelle; Moulder, Janelle K; Ellis, Victoria; Schiff, Lauren D; Toubia, Tarek; Siedhoff, Matthew T; Wheeler, Stephanie B

    2017-11-01

    Heavy menstrual bleeding affects up to one third of women in the United States, resulting in a reduced quality of life and significant cost to the health care system. Multiple treatment options exist, offering different potential for symptom control at highly variable initial costs, but the relative value of these treatment options is unknown. The objective of the study was to evaluate the relative cost-effectiveness of 4 treatment options for heavy menstrual bleeding: hysterectomy, resectoscopic endometrial ablation, nonresectoscopic endometrial ablation, and the levonorgestrel-releasing intrauterine system. We formulated a decision tree evaluating private payer costs and quality-adjusted life years over a 5 year time horizon for premenopausal women with heavy menstrual bleeding and no suspected malignancy. For each treatment option, we used probabilities derived from literature review to estimate frequencies of minor complications, major complications, and treatment failure resulting in the need for additional treatments. Treatments were compared in terms of total average costs, quality-adjusted life years, and incremental cost-effectiveness ratios. Probabilistic sensitivity analysis was conducted to understand the range of possible outcomes if model inputs were varied. The levonorgestrel-releasing intrauterine system had superior quality-of-life outcomes to hysterectomy with lower costs. In a probabilistic sensitivity analysis, levonorgestrel-releasing intrauterine system was cost-effective compared with hysterectomy in the majority of scenarios (90%). Both resectoscopic and nonresectoscopic endometrial ablation were associated with reduced costs compared with hysterectomy but resulted in a lower average quality of life. According to standard willingness-to-pay thresholds, resectoscopic endometrial ablation was considered cost effective compared with hysterectomy in 44% of scenarios, and nonresectoscopic endometrial ablation was considered cost effective

  6. An unusual case of vaginal myoma presenting with postmenopausal bleeding.

    Directory of Open Access Journals (Sweden)

    Lajya Devi Goyal

    2013-06-01

    Full Text Available Vaginal leiomyomas are uncommon benign tumour with variable clinical presentation. These tumours arise most commonly from anterior vaginal wall. We report a case of 50-year old postmenopausal woman who presented with urinary retention, profuse vaginal bleeding and mass protruding into vagina. Local examination revealed a pedunculated mass attached to the posterior vaginal wall with vascular stalk one cm below the cervix. Mass was hanging outside vulva and vascular pedicle was profusely bleeding. The pedicle was ligated and tumour was excised. Subsequent histopathology revealed a vaginal myoma.

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

    Directory of Open Access Journals (Sweden)

    Atakan Savrun

    2015-12-01

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

  8. Systematic review: tranexamic acid for upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

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

    2008-01-01

    BACKGROUND: Tranexamic acid may reduce upper gastrointestinal bleeding and stabilize patients before endoscopic treatments. AIM: To review randomized trials on tranexamic acid for upper gastrointestinal bleeding. METHODS: Manual and electronic searches of The Cochrane Library, MEDLINE, EMBASE...... were unclearly reported. Data from three of the included trials suggested that tranexamic acid did not significantly increase the risk of thromboembolic disease. CONCLUSIONS: The present review suggests that tranexamic acid may reduce all-cause mortality. However, because of limitations in the internal...... and external validity of included trials, additional evidence is needed before treatment recommendations can be made Udgivelsesdato: 2008/5...

  9. Premenopausal abnormal uterine bleeding and risk of endometrial cancer.

    Science.gov (United States)

    Pennant, M E; Mehta, R; Moody, P; Hackett, G; Prentice, A; Sharp, S J; Lakshman, R

    2017-02-01

    Endometrial biopsies are undertaken in premenopausal women with abnormal uterine bleeding but the risk of endometrial cancer or atypical hyperplasia is unclear. To conduct a systematic literature review to establish the risk of endometrial cancer and atypical hyperplasia in premenopausal women with abnormal uterine bleeding. Search of PubMed, Embase and the Cochrane Library from database inception to August 2015. Studies reporting rates of endometrial cancer and/or atypical hyperplasia in women with premenopausal abnormal uterine bleeding. Data were independently extracted by two reviewers and cross-checked. For each outcome, the risk and a 95% CI were estimated using logistic regression with robust standard errors to account for clustering by study. Sixty-five articles contributed to the analysis. Risk of endometrial cancer was 0.33% (95% CI 0.23-0.48%, n = 29 059; 97 cases) and risk of endometrial cancer or atypical hyperplasia was 1.31% (95% CI 0.96-1.80, n = 15 772; 207 cases). Risk of endometrial cancer was lower in women with heavy menstrual bleeding (HMB) (0.11%, 95% CI 0.04-0.32%, n = 8352; 9 cases) compared with inter-menstrual bleeding (IMB) (0.52%, 95% CI 0.23-1.16%, n = 3109; 14 cases). Of five studies reporting the rate of atypical hyperplasia in women with HMB, none identified any cases. The risk of endometrial cancer or atypical hyperplasia in premenopausal women with abnormal uterine bleeding is low. Premenopausal women with abnormal uterine bleeding should first undergo conventional medical management. Where this fails, the presence of IMB and older age may be indicators for further investigation. Further research into the risks associated with age and the cumulative risk of co-morbidities is needed. Contrary to practice, premenopausal women with heavy periods or inter-menstrual bleeding rarely require biopsy. © 2016 The Authors BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal

  10. Effects of genetically modified T2A-1 rice on the GI health of rats after 90-day supplement

    Science.gov (United States)

    Yuan, Yanfang; Xu, Wentao; He, Xiaoyun; Liu, Haiyan; Cao, Sishuo; Qi, Xiaozhe; Huang, Kunlun; Luo, Yunbo

    2013-01-01

    Bacillus thuringiensis insecticidal toxin (Bt) rice will be commercialized as a main food source. Traditional safety assessments on genetically modified products pay little attention on gastrointestinal (GI) health. More data about GI health of Bt rice must be provided to dispel public' doubts about the potential effects on human health. We constructed an improved safety assessment animal model using a basic subchronic toxicity experiment, measuring a range of parameters including microflora composition, intestinal permeability, epithelial structure, fecal enzymes, bacterial activity, and intestinal immunity. Significant differences were found between rice-fed groups and AIN93G-fed control groups in several parameters, whereas no differences were observed between genetically modified and non-genetically modified groups. No adverse effects were found on GI health resulting from genetically modified T2A-1 rice. In conclusion, this study may offer a systematic safety assessment model for GM material with respect to the effects on GI health. PMID:23752350

  11. Uudised : Neeme Järvi San Franciscos. Tõnis Mägi Moskvas. TMKK Norras ja Ungaris / Priit Kuusk

    Index Scriptorium Estoniae

    Kuusk, Priit, 1938-

    2000-01-01

    N. Järvi juhatab San Francisco Ooperis Rimski-Korsakovi ooperit "Tsaari mõrsja", esietendus 11. sept. T. Mägi esines 1. sept. Eesti Suursaatkonnas Moskvas. TMKK Kammerkoori kontsertreisidest Norrasse ja Ungarisse

  12. Expression of bovine herpesvirus 1 glycoproteins gI and gIII in transfected murine cells

    International Nuclear Information System (INIS)

    Fitzpatrick, D.R.; Zamb, T.; Parker, M.D.; van Drunen Littel-van den Hurk, S.; Babiuk, L.A.; Lawman, M.J.P.

    1988-01-01

    Genes encoding two of the major glycoproteins of bovine herpesvirus 1 (BHV-1), gI and gIII, were cloned into the eucaryotic expression vectors pRSVcat and pSV2neo and transfected into murine LMTK - cells, and cloned cell lines were established. The relative amounts of gI or gIII expressed from the two vectors were similar. Expression of gI was cell associated and localized predominantly in the perinuclear region, but nuclear and plasma membrane staining was also observed. Expression of gI was additionally associated with cell fusion and the formation of polykaryons and giant cells. Expression of gIII was localized predominantly in the nuclear and plasma membranes. Radioimmunoprecipitation in the presence or absence of tunicamycin revealed that the recombinant glycoproteins were proteolytically processed and glycosylated and had molecular weights similar to those of the forms of gI and gIII expressed in BHV-1 infected bovine cells. However, both recombinant glycoproteins were glycosylated to a lesser extent than were the forms found in BHV-1 infected bovine cells. For gI, a deficiency in N-linked glycosylated of the amino-terminal half of the protein was identified; for gIII, a deficiency in O-linked glycosylation was implicated. The reactivity pattern of a panel of gI- and gIII-specific monoclonal antibodies, including six which recognize conformation-dependent epitopes, was found to be unaffected by the glycosylation differences and was identical for transfected of BHV-1-infected murine cells. Use of the transfected cells as targets in immune-mediated cytotoxicity assays demonstrated the functional recognition of recombinant gI and gIII by murine antibody and cytotoxic T lymphocytes

  13. Spatial and temporal analysis of stem bleeding disease in coconut palm in the state of Sergipe, Brazil.

    Science.gov (United States)

    Carvalho, Rejane R da Costa e; Souza, Paulo E de; Warwick, Dulce R N; Pozza, Edson A; Filho, José L S de Carvalho

    2013-01-01

    Stem bleeding disease (resinosis) of coconut palm is caused by Thielaviopsis paradoxa and is very important in the state of Sergipe, Brazil. Understanding the epidemiological behavior of the disease is essential for establishing more efficient control strategies. Thus, we characterized the temporal progression and spatial distribution of stem bleeding in a commercial orchard under conditions of natural infection in the area of Neopolis, Sergipe. Three plots with 729 plants each were selected and evaluated every two months for stem bleeding incidence. In the temporal analysis, the monomolecular model gave the best fit to data on disease incidence, as it accurately showed the temporal dynamics of the disease during the experiment period. The spatial pattern of stem bleeding varied over time, with initial infections presenting random pattern and then evolving to aggregate pattern during evaluations. This indicates that the disease may have originated from the pathogen survival structures, followed by auto infections caused by dissemination from plant to plant, either by humans, by contact between roots, or by the vector Rhynchophorus palmarum.

  14. Spatial and temporal analysis of stem bleeding disease in coconut palm in the state of sergipe, Brazil

    Directory of Open Access Journals (Sweden)

    REJANE R. DA COSTA E CARVALHO

    2013-10-01

    Full Text Available ABSTRACT Stem bleeding disease (resinosis of coconut palm is caused by Thielaviopsis paradoxa and is very important in the state of Sergipe, Brazil. Understanding the epidemiological behavior of the disease is essential for establishing more efficient control strategies. Thus, we characterized the temporal progression and spatial distribution of stem bleeding in a commercial orchard under conditions of natural infection in the area of Neopolis, Sergipe. Three plots with 729 plants each were selected and evaluated every two months for stem bleeding incidence. In the temporal analysis, the monomolecular model gave the best fit to data on disease incidence, as it accurately showed the temporal dynamics of the disease during the experiment period. The spatial pattern of stem bleeding varied over time, with initial infections presenting random pattern and then evolving to aggregate pattern during evaluations. This indicates that the disease may have originated from the pathogen survival structures, followed by auto infections caused by dissemination from plant to plant, either by humans, by contact between roots, or by the vector Rhynchophorus palmarum.

  15. Radiation microsphere-induced GI ulcers after selective internal radiation therapy for hepatic tumors: an underrecognized clinical entity.

    Science.gov (United States)

    Konda, Amulya; Savin, Michael A; Cappell, Mitchell S; Duffy, Michael C

    2009-09-01

    Intra-arterial infusion of yttrium-90 (Y-90) microspheres is locoregional radiation therapy for unresectable hepatic neoplasms. Literature on GI complications of this novel therapy is sparse. Clinically and pictorially characterize selective internal radiation therapy (SIRT)-induced GI injury and review the published literature. Retrospective chart analysis. Single-center tertiary referral community hospital. One hundred three patients treated with SIRT for hepatic neoplasms between 2006 and 2008. SIRT for unresectable hepatic neoplasms followed by upper endoscopy with biopsy in symptomatic patients. GI ulcers after SIRT. Five patients with suspected GI injury after SIRT were identified. Significant postprocedural symptoms included nausea/vomiting, odynophagia, hematemesis, and melena. Radiation ulcers occurred mostly in the gastric antrum, pylorus, and duodenum. Biopsy specimens of ulcer margins in 4 patients showed pathognomonic radiation microspheres. Angiographic review of the fifth patient revealed a previously unrecognized arterial branch supplying the corresponding region of GI ulceration noted on endoscopy. Small retrospective study and follow-up limited by terminal disease states in most patients. The reported incidence of GI complications after SIRT for hepatic neoplasia varies from 3% to 24% of patients. Incidence can be minimized by strict adherence to published SIRT protocols. Diagnosis requires a high degree of clinical suspicion along with endoscopy and biopsy of ulcer margins. Characteristic radiation microspheres in biopsy specimens are pathognomonic. Gastroenterologists and pathologists must be cognizant of this complication.

  16. Increased Copper in Individuals with Autism Normalizes Post Zinc Therapy More Efficiently in Individuals with Concurrent GI Disease

    Directory of Open Access Journals (Sweden)

    Anthony J. Russo

    2011-01-01

    Full Text Available Aim To assess plasma zinc and copper concentration in individuals with autism. Subjects and Methods Plasma from 79 autistic individuals, and 18 age and gender similar neurotypical controls, were tested for plasma zinc and copper using inductively-coupled plasma-mass spectrometry. Results Autistic individuals had significantly elevated plasma levels of copper and Cu/Zn and lower, but not significantly lower, plasma Zn compared to neurotypical controls. Zn levels increased significantly in autistic individuals with and without GI disease after zinc therapy. Cu decreased significantly after zinc therapy in the GI disease group but not in the autistic group without GI disease. Autistic children significantly improved with respect to hyperactivity and stimming after zinc therapy in autistic children with GI disease. Autistic children without GI disease did not improve in these symptoms after the same therapy. Discussion These results suggest an association between zinc and copper plasma levels and autism, and they suggest that zinc therapy may be most effective at lowering copper levels in autistic children with GI disease.

  17. Postmortem computed tomographic (PMCT) demonstration of the relation between gastrointestinal (GI) distension and hepatic portal venous gas (HPVG)

    International Nuclear Information System (INIS)

    Shiotani, Seiji; Kohno, Mototsugu; Ohashi, Noriyoshi; Yamazaki, Kentaro; Nakayama, Hidetsugu; Watanabe, Ko

    2004-01-01

    The purpose of this study was to investigate the relation between gastrointestinal (GI) distension and hepatic portal venous gas (HPVG) on postmortem computed tomography (PMCT). Our subjects were 190 PMCT obtained within two hours of non-traumatic death [175 patients underwent cardiopulmonary resuscitation (CPR) and 15 patients did not undergo CPR]. We evaluated the incidence and location of GI distension (0=no distension, 1=stomach and duodenum, 2=more distal than 1) and HPVG (0=no gas, 1=left lobe, 2=1+right anterior lobe, 3=2+right posterior lobe). GI distension (grade 0/1/2=58/55/62 patients) and HPVG (grade 0/1/2/3=114/10/28/23 patients) were observed in 175 patients who underwent CPR. The grade of HPVG increased significantly in accordance with the advancement of GI distension. Fifteen patients without undergoing CPR showed no GI distension but one patient showed grade 1 HPVG. PMCT indicates the presence of a relation between GI distension and HPVG. (author)

  18. The use of carbon dioxide for insufflation during GI endoscopy: a systematic review.

    Science.gov (United States)

    Dellon, Evan S; Hawk, James S; Grimm, Ian S; Shaheen, Nicholas J

    2009-04-01

    Insufflation of the lumen is required for visualization during GI endoscopy. Carbon dioxide (CO(2)) has been proposed as an alternative to room air for insufflation. To assess the safety and efficacy of CO(2) insufflation for endoscopy. Systematic review that focuses on evidence from randomized controlled trials (RCT). Two investigators independently searched MEDLINE from 1950 to February 13, 2008, to identify all articles that reported the use of CO(2) in a GI endoscopy application. Bibliographies of relevant articles were also hand searched to identify other pertinent reports. Data from RCTs, as well as from nonrandomized studies, were extracted. Nine RCTs were identified that compared CO(2) and air insufflation for GI endoscopy. Fifteen other nonrandomized studies or reports were also reviewed. In the 8 RCTs in which postprocedural pain was assessed, pain was lower in the CO(2) insufflation group compared with the air group. Two RCTs found decreased flatus in the CO(2) group compared with the air group, and 3 RCTs showed there was decreased bowel distention on abdominal radiography in the CO(2) group compared with the air group. Also, in all 9 RCTs and 6 additional studies in which safety was assessed, there was no CO(2) retention and no adverse pulmonary events related to CO(2) insufflation. Because of study heterogeneity, meta-analytic techniques could not be used. Consistent RCT evidence indicates that CO(2) insufflation is associated with decreased postprocedural pain, flatus, and bowel distention. CO(2) insufflation also appears to be safe in patients without severe underlying pulmonary disease.

  19. Rectal Dieulafoy Lesions: A Rare Etiology of Chronic Lower Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Ugur Dogan

    2014-01-01

    Full Text Available Dieulafoy lesion is rarely seen, yet it can be life-threatening. This lesion makes up to 1-2% of gastrointestinal bleedings and must definitely be considered in gastrointestinal bleedings whose source cannot be identified. In this case study, the 75-year-old woman was suffering from active, fresh, and massive rectal bleeding. Colonoscopy was applied in order to find out the source of bleeding. In the typical endoscopic appearance of the lesion a single round mucosal defect in the rectum and arterial bleeding were observed. To procure hemostasis, epinephrine was injected into the lesion and the bleeding vein was sutured.

  20. PALYNOLOGY OF TÖGI NDRAWA CAVE,COASTAL AREA OF NIAS ISLAND, NORTH SUMATERA

    Directory of Open Access Journals (Sweden)

    A.A Polhaupessy

    2017-07-01

    Full Text Available Environmental study of the Tögi Ndrawa Cave by means of pollen analysis has been carried out. The interpretation is made based on the occurring pollen types as guide, the resulted pollen spectra, and curves exhibited in the pollen diagram. Combined evidences obtained from the palynological, geological and archaeologi cal studies provide the basis for the interpretation of plant ecology of shore and further the vegetational history of the marine area. In the meantime, plant ecology itself is concerned not only with plant communities but also the interaction among the plants involved, and their environmental factors. Keyword: Environmental, Pollen Analysis, Ndrawa Cave

  1. Determination of Stress Profiles in Expanded Austenite by Combining Successive Layer Removal and GI-XRD

    DEFF Research Database (Denmark)

    Fernandes, Frederico Augusto Pires; Christiansen, Thomas Lundin; Somers, Marcel A. J.

    2014-01-01

    The present work deals with the evaluation of the residual-stress profile in expanded-austenite by successive removal steps using GI-XRD. Preliminary results indicate stresses of several GPa's from 111 and 200 diffraction lines. These stresses appear largest for the 200 reflection. The strain......-free lattice parameter decayed smoothly with depth, while for the compressive stress a maximum value is observed at some depth below the surface. Additionally a good agreement was found between the nitrogen profile determined with GDOES analysis and the strain-free lattice parameter from XRD....

  2. Anaesthesia care for emergency endoscopy for peptic ulcer bleeding

    DEFF Research Database (Denmark)

    Duch, Patricia; Haahr, Camilla; Møller, Morten Hylander

    2016-01-01

    OBJECTIVE: Currently, no standard approach exists to the level of monitoring or presence of staff with anaesthetic expertise required during emergency esophago-gastro-duodenoscopy (EGD) for peptic ulcer bleeding (PUB). We assess the association between anaesthesia care and mortality. We further...

  3. Duodenal Diverticulum Co-Existing with a Bleeding Duodenal Ulcer ...

    African Journals Online (AJOL)

    Background: Duodenal diverticula are characterized by the presence of sac-like mucosal herniations through weak points in the duodenal wall. Duodenal diverticula co-existing with a bleeding duodenal ulcer is rare. Objective: The objective of this case report is to illustrate an uncommon case of two duodenal diverticula ...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-05-15

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

  5. Predictors of post operative bleeding and blood transfusion in ...

    African Journals Online (AJOL)

    blood requirements. Objective: To evaluate the impact of some perioperative predictors of post-operative bleeding, and blood transfusion after heart surgery and offer suggestions on preventive measures. Design and Methods: A prospective analytical study. The perioperative factors studied were haemoglobin level, ...

  6. Colorectal polyps: an important cause of rectal bleeding.

    OpenAIRE

    Perisic, V N

    1987-01-01

    Seventy one children with rectal bleeding were examined by total fibreoptic colonoscopy. Large bowel polyps were found in 45; 27 (60%) had solitary rectal polyps. Altogether, 83% of resected polyps were juvenile. No complication of colonoscopic polypectomy occurred. New polyps reoccurred in four (9%) treated children.

  7. Kleinke's "Bleeding Edge" sees utility role for providers.

    Science.gov (United States)

    Johnson, D E

    1998-10-01

    Hospitals will evolve into units of health care delivery systems that will eventually resemble utilities, like water and the telephone, according to a new book. Donald E.L. Johnson reviews Bleeding Edge: The Business View of Health Care in the New Century, by J.D. Kleinke, and discusses the strategic implications of Kleinke's predictions.

  8. Prophylactic Dosing of Vitamin K to Prevent Bleeding

    NARCIS (Netherlands)

    Witt, Mauri; Kvist, Nina; Jorgensen, Marianne Horby; Hulscher, Jan B.F.; Verkade, Henkjan J.

    BACKGROUND AND OBJECTIVES: Based on a high incidence of Vitamin K deficiency bleeding (VKDB) in breastfed infants with thus far unrecognized cholestasis, such as biliary atresia (BA), the Dutch regimen to prevent VKDB in breastfed infants was changed from a daily oral dosage of 25 mu g to 150 mu g

  9. Oral contraception and menstrual bleeding during treatment of venous thromboembolism

    DEFF Research Database (Denmark)

    Klok, F A; Schreiber, K; Stach, K

    2017-01-01

    INTRODUCTION: The optimal management of oral contraception and menstrual bleeding during treatment of venous thromboembolism (VTE) is largely unknown. We aimed to elicit expert opinion and compare that to current practice as assessed by a world-wide international web-based survey among physicians...

  10. Attitude of Nigerian women to abnormal menstrual bleeding from ...

    African Journals Online (AJOL)

    Background: Depot Medroxyprogesterone acetate (DMPA) and Norethisterone Enanthate (Net-En) are frequently used progestogen-only injectable contraceptives in many developing countries including Nigeria. Their use is often complicated by abnormal and unpredictable menstrual bleeding patterns. This has often been ...

  11. Abnormal Uterine Bleeding: Current Classification and Clinical Management.

    Science.gov (United States)

    Bacon, Janice L

    2017-06-01

    Abnormal uterine bleeding is now classified and categorized according to the International Federation of Gynecology and Obstetrics classification system: PALM-COEIN. This applies to nongravid women during their reproductive years and allows more clear designation of causes, thus aiding clinical care and future research. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    African Journals Online (AJOL)

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

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

    NARCIS (Netherlands)

    Berend, Kenrick; Levi, Marcel

    2009-01-01

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

  14. Profiling lifetime episodes of upper gastrointestinal bleeding among ...

    African Journals Online (AJOL)

    Profiling lifetime episodes of upper gastrointestinal bleeding among patients from rural Sub-Saharan Africa where schistosoma mansoni is endemic. ... female sex, history of blood transfusion, abdominal collaterals, esophageal varices, pattern x periportal fibrosis, anemia, and thrombocytopenia) significantly associated ...

  15. Localization and Treatment of Small and Large Bowel Bleeding

    Directory of Open Access Journals (Sweden)

    Richard H Hunt

    1992-01-01

    Full Text Available Bleeding from the small or large bowel may present a diagnostic dilemma for the clinician, requiring careful consideration and multidisciplinary consultation before the problem is located. Careful selection of the appropriate investigations in the most logical order is important to minimize delay to diagnosis, inconvenience, discomfort and risk to the patient and costs to health care delivery.

  16. A sensitive venous bleeding model in haemophilia A mice

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  17. Oral misoprostol in the prevention of uterine bleeding after surgical ...

    African Journals Online (AJOL)

    2013-03-13

    Mar 13, 2013 ... Oral misoprostol in the prevention of uterine bleeding after surgical evacuation of first trimester abortion: A comparative study of three uterotonic agents. TM Aramide, AK Olusegun1, AC Akinfolarin2, DF Oriola. Department of Obstetrics and Gynaecology, LAUTECH Teaching Hospital, Ogbomoso, Oyo State, ...

  18. Bleeding in children with cancer | Dippenaar | Continuing Medical ...

    African Journals Online (AJOL)

    Before the success story of leukaemia treatment started in the 1950s, many patients succumbed to the disease because of severe haemorrhage. A bleeding tendency is one of the hallmarks of haematological malignancies such as leukaemia, since together with anaemia and an increased susceptibility to infection it ...

  19. The role of acid suppressants in upper gastrointestinal ulcer bleeding

    NARCIS (Netherlands)

    van Leerdam, M. E.; Rauws, E. A.

    2001-01-01

    Re-bleeding and mortality remain significant in peptic ulcer haemorrhage despite the widespread use of endoscopic therapy. The acidic gastric environment interferes with coagulation. In vitro studies show that an intragastric pH of above 6 results in normal blood coagulation and platelet function.

  20. Clinical approach to a patient with abnormal uterine bleeding ...

    African Journals Online (AJOL)

    Abnormal excessive uterine bleeding forms a large proportion of gynaecological complaints. Of postpubertal girls who experience excessive menstrual loss, about one quarter will never regain a normal cycle and flow. As she grows older many other factors may arise causing menstrual abnormalities. South African Family ...

  1. Clinical predictors of outcome in acute upper gastrointestinal bleeding

    African Journals Online (AJOL)

    Objective. Endoscopy has traditionally been used to risk stratify patients with upper gastrointestinal bleeding (UGIB). This is problematic in resource-poor environments. The study aimed to identify patients who would not require urgent endoscopy by identifying clinical variables before endoscopy that predict uneventful ...

  2. Primary prevention and management of variceal bleeding: Review ...

    African Journals Online (AJOL)

    Background: Prevention and control of active bleeding caused by portal hypertension is still a challenge. Surgery used to be the only option in the earlier days, but now many options exist. Choice of the correct mode of treatment is important and is determined by many factors dictated by the condition of each patient and the

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

    African Journals Online (AJOL)

    53.9 years, p=0.001). The most common cause of UGIB was peptic ulcer (37.1%) of which duodenal ulcer was the most common (30.7% of all UGIB), especially amongst male patients (36.4%). The second most common cause was bleeding due to varices (29.8%), especially amongst females (35.1%). Additionally, smoking ...

  4. Open heart surgery: management of nonsurgical bleeding in the peri ...

    African Journals Online (AJOL)

    The data analyzed were patients' demographics, the total number of open heart surgery cases, the number that had perioperative nonsurgical bleeding,clinical detection strategies,treatment and preventive modalities as well as the outcome. RESULTS: During the period,a total number of 78 cases of open heart surgery ...

  5. Therapeutic Plasma Transfusion in Bleeding Patients: A Systematic Review.

    Science.gov (United States)

    Levy, Jerrold H; Grottke, Oliver; Fries, Dietmar; Kozek-Langenecker, Sibylle

    2017-04-01

    Plasma products, including fresh frozen plasma, are administered extensively in a variety of settings from massive transfusion to vitamin K antagonist reversal. Despite the widespread use of plasma as a hemostatic agent in bleeding patients, its effect in comparison with other available choices of hemostatic therapies is unclear. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed Central, and databases of ongoing trials for randomized controlled trials that assessed the efficacy and/or safety of therapeutic plasma as an intervention to treat bleeding patients compared with other interventions or placebo. Of 1243 unique publications retrieved in our initial search, no randomized controlled trials were identified. Four nonrandomized studies described the effect of therapeutic plasma in bleeding patients; however, data gathered from these studies did not allow for comparison with other therapeutic interventions primarily as a result of the low number of patients and the use of different (or lack of) comparators. We identified two ongoing trials investigating the efficacy and safety of therapeutic plasma, respectively; however, no data have been released as yet. Although plasma is used extensively in the treatment of bleeding patients, evidence from randomized controlled trials comparing its effect with those of other therapeutic interventions is currently lacking.

  6. A longitudinal study of the prevalence of gingival bleeding among ...

    African Journals Online (AJOL)

    Objective: To assess the prevalence of gingival bleeding following gentle periodontal probing during pregnancy as compared to after child birth in the same set of women. Method: Three hundred and eighty-four consecutive pregnant women in third trimester were selected at the antenatal clinics of Adeoyo Maternity ...

  7. The diagnostic work-up of women with postmenopausal bleeding

    NARCIS (Netherlands)

    van Hanegem, N.

    2015-01-01

    In this thesis we describe the diagnostic work-up that can be used to diagnose or exclude endometrial cancer in women with postmenopausal bleeding. Despite the many studies investigating this, there is no consensus in literature. The diagnostic steps vary in different guidelines, depending on the

  8. Massive bleeding from colonic diverticular disease in an elderly ...

    African Journals Online (AJOL)

    Colonic diverticular disease is one of the most common and costly gastrointestinal disorders among industrialized countries. The disease was thought to be rare in the African population, but is being increasingly diagnosed with the advent of modern imaging techniques and colonoscopy. Diverticular bleeding is a common ...

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

    International Nuclear Information System (INIS)

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

    2010-01-01

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

  10. Gynecologic bleeding revealing vaginal metastasis of renal cell ...

    African Journals Online (AJOL)

    Tumour was classified pT3bN0M0 and grade III of Furhmann grading. One year later, scanner discovered mediastinal and lombo-aortic lymph nodes. She received 2 months of immunotherapy associated with bevacizumab, but stopped because of intolerance. She was readmitted in our institute for vaginal bleeding. Clinical ...

  11. Non-bleeding Spontaneous Rupture of Hepatocellular Carcinoma ...

    African Journals Online (AJOL)

    Non-bleeding Spontaneous Rupture of Hepatocellular Carcinoma. M Islam, P Deka, R Kapur, AM Ansari. Abstract. Rupture of hepatocellular carcinoma (HCC) is not uncommon and most ruptured HCC present with hemoperitoneum and hemorrhagic shock. Management of ruptured HCC is different than non.ruptured one.

  12. Nodular Purpura and Intracranial Bleeding due to Late Onset ...

    African Journals Online (AJOL)

    She developed nodular purpuric spots for about three days prior to the intracranial bleeding. She was unconscious and responding only to pain, and was severely pale. She was transfused with two units of whole blood and underwent a craniotomy for draining the hemorrhage. She was treated with Vitamin K supplements.

  13. Does any relationship exist between self reported gingival bleeding ...

    African Journals Online (AJOL)

    Individuals with gingival bleeding were significantly more likely to rate their dental and gingival health as fair/poor, use strong brushing stroke during tooth brushing and report worsening condition of teeth despite daily tooth brushing, express worry about the gingival color and less likely to be satisfied about the appearance ...

  14. The effect of different interdental cleaning devices on gingival bleeding.

    Science.gov (United States)

    Rosema, Nanning A M; Hennequin-Hoenderdos, Nienke L; Berchier, Claire E; Slot, Dagmar E; Lyle, Deborah M; van der Weijden, Godefridus A

    2011-01-01

    To compare the effectiveness of an oral irrigator (OI) with a prototype jet tip or a standard jet tip to floss as adjunct to daily toothbrushing on gingival bleeding. In this single masked, 3-group parallel, 4-week home use experiment, 108 subjects were randomly assigned to one of three groups: 1) 01 with a prototype jet tip; 2) OI with a standard jet tip; 3) waxed dental floss. All groups used their assigned product once a day as adjunct to twice daily toothbrushing for two minutes with a standard ADA reference toothbrush. Professional instructions were given by a dental hygienist in 01 use or floss use according to written instructions. All subjects also received a toothbrush instruction leaflet (Bass technique). Subjects were assessed for both bleeding and plaque at baseline and after two weeks and four weeks and were instructed to brush their teeth approximately 2 to 3 hours prior to their assessment. With respect to mean bleeding scores the ANCOVA analysis with baseline as covariate and week 4 as dependent variable showed a significant difference between groups in favor of both the oral irrigator groups. For plaque, however, no significant difference among groups was observed. When combined with manual toothbrushing the daily use of an oral irrigator, either with prototype or standard jet tip, is significantly more effective in reducing gingival bleeding scores than is the use of dental floss, as determined within the limits of this 4-week study design.

  15. Vaginal Bleeding In 6 Years Old Young Female: Diagnostic Challenge

    African Journals Online (AJOL)

    A 6 year old young girl was referred to Mendefera (Zoba Debub Referral) Hospital with vaginal bleeding of 4 days duration. She had a history of swimming in a river prior to the incident. An aquatic leech bloated with blood detached from the vagina after 100 milliliters of normal saline flushing into the vagina. The patient was ...

  16. The effect of different interdental cleaning devices on gingival bleeding

    NARCIS (Netherlands)

    Rosema, N.A.M.; Hennequin-Hoenderdos, N.L.; Berchier, C.E.; Slot, D.E.; Lyle, D.M.; van der Weijden, G.A.

    2011-01-01

    Objective: To compare the effectiveness of an oral irrigator (OI) with a prototype jet tip or a standard jet tip to floss as adjunct to daily toothbrushing on gingival bleeding. Methods: In this single masked, 3-group parallel, 4-week home use experiment, 108 subjects were randomly assigned to one

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

    African Journals Online (AJOL)

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

  18. Selective serotonin reuptake inhibitors and risk for gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Batić-Mujanović Olivera

    2014-01-01

    Full Text Available The most of the known effects of selective serotonin reuptake inhibitors, beneficial or harmful, are associated with the inhibitory action of the serotonin reuptake transporter. This mechanism is present not only in neurons, but also in other cells such as platelets. Serotoninergic mechanism seems to have an important role in hemostasis, which has long been underestimated. Abnormal activation may lead to a prothrombotic state in patients treated with selective serotonin reuptake inhibitors. On one hand there may be an increased risk of bleeding, and on the other hand reduction in thrombotic risk may be possible. Serotonin is critical to maintain a platelet haemostatic function, such as platelet aggregation. Evidences from the studies support the hypothesis that antidepressants with a relevant blockade of action of serotonin reuptake mechanism may increase the risk of bleeding, which can occur anywhere in the body. Epidemiological evidences are, however, the most robust for upper gastrointestinal bleeding. It is estimated that this bleeding can occur in 1 in 100 to 1 in 1.000 patient-years of exposure to the high-affinity selective serotonin reuptake inhibitors, with very old patients at the highest risk. The increased risk may be of particular relevance when selective serotonin reuptake inhibitors are taken simultaneously with nonsteroidal anti-inflammatory drugs, low dose of aspirin or warfarin.

  19. Risk of bleeding after dentoalveolar surgery in patients taking anticoagulants

    NARCIS (Netherlands)

    Broekema, Ferdinand I.; van Minnen, Baucke; Jansma, Johan; Bos, Rudolf R. M.

    To avoid increasing the risk of thromboembolic events, it is recommended that treatment with anticoagulants should be continued during dentoalveolar operations. We have evaluated the incidence of bleeding after dentoalveolar operations in a prospective study of 206 patients, 103 who were, and 103

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

    African Journals Online (AJOL)

    The erosion of a pancreatic pseudocyst into an adjacent artery is a rare and highly lethal complication of pancreatitis with reported death rates of 12% to 40%. The majority of patients had bleeding from the splenic artery, the gastroduodenal artery and the anterior pacreaticoduodenal artery. Exceptionally, some cases with ...