Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Bleeding”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,045 records · Page 58Linked to original sources
PubMed1992

Changing epidemiology of gastrointestinal angiodysplasia with increasing recognition of clinically milder cases: angiodysplasia tend to produce mild chronic gastrointestinal bleeding in a study of 47 consecutive patients admitted from 1980-1989.

It is important to recognize patients with gastrointestinal bleeding who are at high risk of having angiodysplasia, because these patients should be evaluated by endoscopy rather than barium studies. Sixty-two clinical and epidemiologic parameters were compared between 47 consecutive patients bleeding from angiodysplasia and 47 consecutive controls bleeding from other lesions admitted to two university teaching hospitals from 1980 through 1989. This study demonstrated statistically significant differences between these two groups. The patients with angiodysplasia generally presented with symptoms and clinical findings compatible with hemodynamically well-compensated, chronic bleeding: they were more likely than other gastrointestinal bleeders to experience weakness or fatigue, less likely to experience dizziness or syncope, and less likely to be orthostatic or hypotensive. They had more prior admissions for gastrointestinal bleeding, particularly for gastrointestinal bleeding of undetermined etiology. They were more likely than other gastrointestinal bleeders to be smokers. Patients with angiodysplasia had a milder hospital course: they had fewer transfusions of packed erythrocytes, shorter hospitalizations, and a lower mortality. The in-hospital mortality of patients bleeding from angiodysplasia was 2.1%. Despite the futility of diagnosing angiodysplasia by barium studies, patients ultimately diagnosed as having angiodysplasia were more often initially evaluated by barium studies than the other gastrointestinal bleeders. The currently identified risk factors for bleeding from angiodysplasia should help to select which gastrointestinal bleeders should be evaluated initially by endoscopy.

Adult↗
PubMed1991

A differential study between antemortem bleeding and a postmortem infiltration of hemoglobin.

In a differential study to distinguish antemortem bleeding from a postmortem infiltration of hemoglobin, glycophorins, a component of the erythrocytic membrane, were extracted from two experimental skin tissue models, i.e., skin samples taken on autopsy into which healthy human blood was injected, and skin samples undergoing a postmortem infiltration of hemoglobin; this extraction accomplished by utilizing an anti-glycophorin serum over set periods of time, after which differences between the two models were then evaluated. In all of the bleeding samples from day 0 to day 9, and in 40% of the 12-day-old bleeding samples, glycophorins were clearly detected qualitatively by counterimmunoelectrophoresis and by double-immunodiffusion. In the remaining 12-, 15-, and 18-day-old bleeding samples, glycophorins were only faintly detected by counterimmunoelectrophoresis. Additionally, in a quantitative study by rocket-immunoelectrophoresis, the mean glycophorin value of 0-day-old bleeding samples was 118.5 +/- 5.6 micrograms per 0.5 g of tissue. Further, the recovery of glycophorins from the bleeding samples was satisfactory for up to 9 days, though after 12 days there was a rapid glycophorin decrease. In 15- and 18-day-old bleeding samples, the mean glycophorin values were 19.3 +/- 1.0 and 17.8 +/- 1.0 micrograms per 5 g of tissue, or about 16% and 15% of the 0-day values, respectively. In contrast, no glycophorins were detected in any of the hemoglobin-infiltrated skin samples or our control samples at any time interval. These results suggest that a differential diagnosis between antemortem cutaneous bleeding and postmortem hemoglobin infiltration into the tissue is achievable within 9 to 12 postmortem days.

Cadaver↗
PubMed1991

Early vaginal bleeding, late prenatal care, and misdating in adolescent pregnancies.

Vaginal bleeding early in pregnancy may be mistaken for menstrual bleeding and delay entry into prenatal care by delaying the diagnosis of pregnancy. This study tests the hypotheses that (1) more adolescents report early first-trimester vaginal bleeding than do adults and (2) a history of vaginal bleeding is associated with later entry into prenatal care, particularly among adolescents. Reports of early vaginal bleeding were prospectively obtained from black, predominantly primiparous, unmarried poor women (136 adolescents and 53 adults). As hypothesized, more adolescents reported early first-trimester vaginal bleeding than did adults (16.9% vs 5.7%; P less than .01). Adolescents who reported early vaginal bleeding also entered prenatal care later (16.2 weeks) than did adolescents who reported no bleeding (12.7 weeks) (P less than .03); this was not true for adults. If dating of the gestation is based solely on last menstrual period history, inflation of the incidence of preterm births to adolescents and the mean birth weights of those preterm neonates may occur. The findings suggest that new strategies focusing on the recognition of menstrual irregularities as a symptom of pregnancy may be needed to promote early prenatal care among adolescents. Additionally, adolescent pregnancies should be dated by both ultrasound and Dubowitz examinations.

Adolescent↗
PubMed1990

Preventing postoperative acute bleeding of the upper part of the gastrointestinal tract.

Two hundred and ninety-eight critically ill patients at risk for the development of postoperative stress ulcers and bleeding were randomized into three groups. The first group comprised 85 patients who received meciadanol, a new bioflavonoid, 500 milligrams every six hours through a nasograstric tube; the second group comprised 100 patients who received sucralfate (crushed tablets), 1,000 milligrams every six hours through a nasogastric tube, and the third group comprised 113 patients who received an antacid (Maalox [magnesium aluminum hydroxide gel]) through a nasogastric tube at an initial dose of 15 milliliters every hour. The gastric pH was measured hourly and titrated to a pH greater than or equal to 4.0 in patients in the group receiving the antacid. The gastric pH was measured every two hours in the other two groups. Bleeding in the upper part of the gastrointestinal tract was determined visually (frank blood in gastric contents) or by guaiac testing. Bleeding occurred in seven patients receiving meciadanol, nine receiving sucralfate and six receiving the antacid. The difference in rates of bleeding was not statistically significant. Correlation between the severity of illness index and the development of bleeding was poor, at least in the low and intermediate index range. In contrast, there was a strong correlation between the age of the patient and the development of bleeding. Only one patient younger than 50 years had bleeding develop. Apparently, meciadanol exerts its action by a mechanism other than pH control. It may, therefore, fill an important gap in the ability to prevent postoperative stress ulcers and bleeding.

Acute Disease↗
PubMed1979

A prospective evaluation of injection sclerotherapy in the treatment of acute bleeding from esophageal varices.

In a 25 month study of massive upper-gastrointestinal hemorrhage, 64 patients were shown to have esophageal varices on emergency endoscopy. Twenty-four patients were actively bleeding from varices and were treated with a Sengstaken tube, and in 22 this was followed by emergency injection sclerotherapy using a rigid esophagoscope and general anesthesia. These 22 patients were followed prospectively and had 51 episodes of endoscopically proven active bleeding from esophageal varices which required Sengstaken tube control of hemorrhage during 36 separate admissions. This group included our total experience of injection sclerotherapy in acute variceal bleeding. The majority (14 of 22 patients) had alcoholic cirrhosis. Definitive control of variceal bleeding during the period of hospitalization was achieved in 33 hospital admissions (92%), usually with a single injection (27 hospital admissions: 75%). The results were satisfactory in 26 hospital admissions (72%). There were nine deaths (41% overall patient mortality rate), but no patient died primarily of variceal bleeding, and exsanguinating variceal bleeding was no longer a problem. The mortality rate per injection was 18%, and the mortality rate per hospital admission was 25%. Injection sclerotherapy is proposed as the emergency treatment of choice for patients with proven bleeding esophageal varices who do not stop bleeding on initial conservative treatment.

Acute Disease↗
PubMed1986

Upper gastrointestinal bleeding: predictors of outcome.

We reviewed the records of 115 patients treated for upper gastrointestinal (UGI) bleeding on a general surgical and trauma service from January 1981 to June 1984. Clinical variables were analyzed with regard to three outcome criteria: mortality rate, blood transfusion requirements, and need for operation. Endoscopy was performed in all patients, usually within 24 hours of detection of bleeding. Thirty-six patients required greater than or equal to 5 U of blood, 27 patients required an operation for bleeding, and 26 patients (23%) died in the hospital. In 19 patients, death was attributed to the patient's underlying disease; in seven patients, death was due to bleeding or operation. Significant predictors of death were: age greater than or equal to 60 years old (p less than or equal to 0.02), disease in three organ systems (p less than 0.05), 5 U transfusion requirement (p less than 0.001), operation for bleeding necessary (p less than 0.03), lung/liver disease (p less than 0.03), and recent stress of major operation, trauma, or sepsis. Mortality rates were highest for bleeding varices (36%) and lowest for duodenal ulcers (7.7%) and gastric ulcers (15.8%). Endoscopy accurately determined the cause of UGI bleeding in most patients. The data suggest that the unchanging mortality rate for UGI bleeding is largely due to underlying disease or injury for which the success of current treatment is limited.

Adult↗
PubMed1985

Controlled trial of liquid monopolar electrocoagulation in bleeding peptic ulcers.

The aim of this study was to evaluate the efficacy and the safety of liquid monopolar electrocoagulation in the endoscopic control of major haemorrhage from peptic ulcers. During the 24-month period of the trial, emergency endoscopy was performed on 480 patients consecutively admitted with acute upper gastrointestinal tract hemorrhage. Ulcers were seen in 168 cases (35%). Seventy-eight of these were included in the trial. Active bleeding was present in 21 cases and stigmata of recent bleeding were observed in 57. Immediate hemostasis was achieved in nine of 11 patients with active bleeding ulcers. However, active bleeding can stop spontaneously (as in four of 10 control patients), which reemphasizes the importance of randomized studies. There was a trend toward hemostatic benefit for the electrocoagulation-treated patients with actively bleeding ulcers. In the group of 31 patients with visible vessels, the electrocoagulation treatment reduced significantly both the rate of rebleeding and the emergency surgery. In the group of 26 patients with other stigmata of recent bleeding (fresh or altered clot, or black spots), only in two cases allocated to placebo treatment occurred rebleeding. These patients are at minimal risk of further bleeding. The results offer support to the contention that liquid monopolar electrocoagulation is a safe and effective method of reducing the incidence of further bleeding and emergency surgery. This new technique has the advantages of low cost, easy maintenance, durability, and portability.

Adult↗
PubMed1983

Predictive value of intramural pH and other risk factors for massive bleeding from stress ulceration.

We have devised and validated an indirect method for measuring the intramural pH in the stomachs of patients in the intensive care unit and have assessed its value in predicting the occurrence of massive hemorrhage from stress ulceration. The 103 patients, studied on an average of 3.8 +/- 0.6 consecutive days, were assigned to one of five groups: no bleeding, weakly positive guaiac, strongly positive guaiac, massive bleeding from an extragastric site, and massive bleeding from stress ulceration. The pH in gastric juice, arterial blood, and the wall of the stomach, PCO2 and PO2 in gastric juice and arterial blood, and [HCO3-] in arterial blood were recorded, together with history of treatment with antacids, cimetidine, and heparin and the number of risk factors known to be associated with bleeding from stress ulceration. Massive bleeding from stress ulceration occurred in 7 patients, all of whom were receiving antacids. Six of these patients died. A logistic analysis of the data obtained showed that the occurrence of bleeding from stress ulceration was best predicted by consideration of the combination of the number of risk factors and intramural pH (p less than 0.0001). Prediction by these variables was not improved by inclusion of any of the other variables recorded. Bleeding from stress ulceration was only seen in patients whose intramural pH had fallen below the lower limit of normality. The data indicate that intensive care unit patients would be better monitored if the intramural pH were measured, and that the occurrence of massive bleeding from stress ulceration would be better averted by maintaining the intramural pH at normal levels.

Adolescent↗
PubMed1994

Clinical and epidemiological characteristics of bleeding duodenal ulcer patients with and without dyspepsia.

The most relevant clinical presentations of duodenal ulcer disease are pain and acute bleeding. The purpose of this study was to investigate the relevance of dyspepsia in patients with bleeding duodenal ulcer, and to compare the clinical and epidemiological characteristics of bleeding patients with and without dyspepsia. A total of 82 patients with isolated duodenal ulcer and bleeding were included in this study. There were 48 (58.5%) dyspeptic and 34 (41.5%) nondyspeptic patients. The patients with and without dyspepsia were almost identical with regard to their age (52.9 +/- 11.9 vs 53.4+/- 10.2 years, p > 0.05). In the dyspeptic group, significantly more patients had duodenitis and a deformed bulb (chi 2 = 4.05, p < 0.05 and chi 2 = 3.99, p < 0.05, respectively). Patients with bleeding duodenal ulcers and dyspepsia were more likely to have taken non-steroidal anti-inflammatory drugs (45.8 vs 8.8%; chi 2 = 11.18, p < 0.001), whereas significantly more patients in the nondyspeptic group have taken histamine H2 antagonists (85.3 vs 8.3%; chi 2 = 45.87, p < 0.01). No significant difference was found between the dyspeptic and nondyspeptic groups with regard to the previous diagnosis of peptic ulcer bleeding, the presence of environmental stress, gastritis, and alcohol or tobacco consumption. Furthermore, there was no significant difference in regard to the rebleeding, the need for urgent operation or hospital stay. The results of this study support the evidence that in patients with bleeding duodenal ulcers the dyspeptic symptoms were more often associated with objective signs of duodenal pathology, and the use of non-steroidal anti-inflammatory drugs and maintenance treatment with histamine H2 antagonists was associated with silent duodenal ulcer bleeding.

Adult↗
PubMed1995

[Study on the relationship between uterine bleeding with intrauterine device and viral infection].

OBJECTIVE: To study the relationship between uterine bleeding with intrauterine device (IUD) and virus infection. METHODS: Virus isolation from endometrium samples both with IUD and without IUD was performed with rabbit kidney cell. The cell pathogen effect (CPE) directed the positive isolation. All isolated viruses were further identified by polymerase chain reaction (PCR) for human cytomegalovirus (HCMV) and by neutralizing test for herpes simplex virus type II (HSV-II). RESULTS: The endometrial samples were obtained from four groups: 113 patients with uterine bleeding with IUD; 109 healthy women, without uterine bleeding with IUD; 24 healthy women without IUD and 11 patients with uterine bleeding without IUD. The rates of virus isolation in four groups mentioned above were 59.29%, 19.27%, 16.67% and 63.64% respectively. The positive rates for HCMV and HSV-II in the four groups were 38.81%, 19.05%, 1/4, 3/7 and 23.88%, 23.87%, 1/4, 0.00% respectively. The unidentified viruses were 37.31%, 57.14%, 2/4 and 4/7 respectively. CONCLUSIONS: These results showed that some endometrial samples from both the bleeding groups and the controls were infected by HCMV and HSV-II. The incidence of virus infection in women with uterine bleeding with IUD was much higher than that of the controls, but similar to that is the patients with uterine bleeding without IUD. The results suggested that IUD could activate latent viruses (HCMV, HSV-II) infection and induce bleeding in certain conditions.

Adult↗
PubMed1995

Rare causes of acute non-variceal gastrointestinal bleeding episodes: results of endoscopic therapy.

In this study the frequency of rare causes of acute upper gastrointestinal bleeding was studied retrospectively using the case load of a large teaching hospital. Nine hundred and eighty patients with a clinical diagnosis of upper gastrointestinal bleeding were endoscoped between November 1987 and February 1993. Of these, 156 patients were found to be actively bleeding or had a visible vessel. Rare causes of bleeding were identified in 11 patients (7%). A Dieulafoy ulcer was found in five cases, and a mesenchymal tumor of the stomach in three patients. In the three remaining patients a bleeding gastric polyp, hemobilia and ischemic necrosis of the small bowel were identified as the source of bleeding. In three of these 11 patients the diagnosis was delayed and only made on repeat endoscopy the following day. Therapeutic endoscopy with circumlesional injection of epinephrine was successful in the majority of patients, and only three patients underwent emergency surgery. Two patients died during the acute bleeding episode, one of them had a Dieulafoy ulcer, the other suffered from ischemic bowel necrosis. Diagnosis of rare causes of acute upper gastrointestinal bleeding may be delayed, morbidity and mortality increased. Familiarity with these conditions may improve the outcome.

Adult↗
PubMed1995

Vaginal bleeding in pregnancy.

The process of identifying and evaluating the common causes of vaginal bleeding during pregnancy changes as the pregnancy progresses to term. The most common identifiable causes of vaginal bleeding during early pregnancy include spontaneous abortion and ectopic pregnancy. Pelvic ultrasound and quantitative beta-human chorionic gonadotropin measurements are used in the evaluation of early-stage bleeding in pregnancy. During the middle and late stages of pregnancy, placental abnormalities become important in the differential diagnosis of vaginal bleeding. Placenta previa classically presents as painless bleeding and is evaluated with ultrasound. Patients with placental abruption may present with abdominal pain and bleeding. As pregnancy progresses to term, bloody show must be considered as a common source of bleeding. Vaginal and cervical lesions can cause vaginal bleeding in any stage of pregnancy.

Female↗
PubMed1994

Development and validation of a prognostic index predicting death after upper gastrointestinal bleeding in patients with liver cirrhosis: a multicenter study.

Prognostic factors of the outcome of upper gastrointestinal bleeding in patients with cirrhosis are insufficiently defined. Pertinent clinical, biochemical, and endoscopic data of 332 upper gastrointestinal bleedings in 268 patients with cirrhosis observed in the participating centers during 31 months were recorded. Clinical data were analyzed until 40 days after bleeding. A further set of 82 bleedings was used as a validation group. Ninety-two of the 268 patients died within the time of the study, and 28 of the 82 patients of the validation group died. According to a stepwise logistic regression analysis, s-creatinine, ascites on admission, previous diagnosis of hepatocellular carcinoma, s-bilirubin, prothrombin index, varices as definite or probable source of bleeding, gender, and presentation with hemathemesis were the best set of covariates for predicting outcome. From them a prognostic index was developed and validated in the 82 further bleedings. Sensitivity and specificity in the cumulated training and test sets were 75 and 80%, respectively. In the present material, the prognostic index was significantly more efficient than Child-Pugh score or the prognostic index proposed by Garden et al. These data show that it is possible to predict the outcome of upper gastrointestinal bleeding in cirrhosis on the basis of few easily available data. The prognostic index we proposed and validated may become useful to predict the outcome of a bleeding and to select or stratify patients in clinical trials.

Esophageal and Gastric Varices↗
PubMed1994

The accuracy of technetium-99m-labeled red cell scintigraphy in localizing gastrointestinal bleeding.

OBJECTIVE: To evaluate the success of technetium-99m-labeled red blood cell scintigraphy in localizing the site of gastrointestinal bleeding, and to identify the clinical and technical factors that contribute to scan accuracy. METHODS: A retrospective review was conducted of all patients who underwent a tagged red blood cell scan for the evaluation of gastrointestinal bleeding at our institution from 1981 to 1991. RESULTS: Of a total of 153 patients, 90 (59%) had positive scans, whereas, in 63 (41%), they were negative. Of the 90 patients who had positive scans, it was possible to assess scan accuracy in 44 who had corrective surgery or an additional diagnostic procedure which definitively localized the site of bleeding. Of those 44 patients, the correct bleeding site was identified by red blood cell scanning in 33 patients (75%) overall and in all six patients with a left colon bleeding site. In this group of 44 patients, 22 scans were positive within 2 h, and of these the scan was accurate in localizing the bleeding site in 19 of 22 (86%). When the three subjects with upper gastrointestinal bleeding were excluded, the scan was positive in 100% of the remaining 19 patients. CONCLUSION: The technetium-labeled red blood cell scan is a reliable tool for the assessment of unexplained lower gastrointestinal bleeding when the scan is positive within the first 2 h, and an upper gastrointestinal source has already been excluded.

Aged↗
PubMed1993

Acute gastrointestinal bleeding from portal hypertensive gastropathy: prevalence and clinical features.

The clinical and endoscopic features of patients diagnosed with acute bleeding due to portal hypertensive gastropathy (PHG) were evaluated. Acute bleeding from PHG was diagnosed in 12 patients (0.8%) of 1496 patient admissions prospectively evaluated by our Gastrointestinal Bleeding Team over a 3-yr period, and accounted for 8% of nonvariceal bleeding diagnosed in patients with liver disease. The median age of PHG patients (8M:4F) was 66 yr (range, 37-72). The most common underlying liver disease was alcoholic cirrhosis (five patients). The majority of patients presented with melena. There was no hemodynamic instability. Six patients had prior sclerotherapy. Esophageal varices, grades 1 (five patients) and 2 (three patients), were present. Severe PHG was encountered in seven patients. There was no correlation between the presence or absence of varices, the grade of esophageal varices, and prior sclerotherapy on the severity of PHG or continued bleeding. The mean hospital stay was 6 days. An average of 4 units of blood was transfused per patient (range, 2-8). Continued bleeding occurred in nine patients (75%), one of whom had mild PHG. Two patients with continued bleeding subsequently were diagnosed with portal hypertensive vasculopathy distal to the stomach. There was one episode of encephalopathy and no related mortality. Acute (overt) bleeding from PHG is uncommon, likely to recur, and can evolve into a pattern of chronic blood loss.

Acute Disease↗
PubMed1993

Comparison of transdermal and oral sequential gestagen in combination with transdermal estradiol: effects on bleeding patterns and endometrial histology.

OBJECTIVE: To assess prospectively the effect on bleeding patterns, transformation of the endometrium, and rate of endometrial hyperplasia of transdermal norethisterone acetate when administered sequentially in combination with transdermal estradiol (E2), and to compare it to a regimen using oral medroxyprogesterone acetate. METHODS: Two hundred eighteen women were randomized to receive either transdermal E2 0.05 mg/day for 14 days followed by transdermal E2 0.05 mg/day plus transdermal norethisterone acetate 0.25 mg/day for 14 days, or transdermal E2 0.05 mg/day for 25 days with the addition of oral medroxyprogesterone acetate 10 mg/day on days 16-25, followed by a 3-day treatment-free period. Treatment was planned for 13 cycles of 28 days. The subjects kept daily bleeding diaries, and endometrial biopsies were taken before and at the end of treatment. RESULTS: The mean duration of bleeding (regular) induced by the gestagen was 7.33 days in the transdermal gestagen-treated group, which was 1.54 days longer than in the oral gestagen-treated group (P = .0001). The mean cycle day of onset was 25.74. Bleeding was spotting or light in the transdermal group in 77% of the days in which bleeding occurred. When comparing the two groups, there were no differences in the overall mean cycle day of onset or in the intensity of gestagen-induced bleeding. Breakthrough (irregular) bleeding episodes occurred in 42% of the transdermal subjects, lasted a mean of 4.18 days, and were spotting or light in 87% of the days when they occurred. There were no differences between the treatment groups. There was only one case (1.3%) of confirmed simple hyperplasia and five cases of failure of gestagenic transformation of the endometrium in 77 women treated for a mean of 367 days with transdermal gestagen. CONCLUSION: A transdermal system delivering a combination of E2 and norethisterone acetate for 14 days in sequence with E2 delivered transdermally for 14 days produced bleeding patterns that are clinically acceptable and comparable to those produced by oral medroxyprogesterone acetate given in sequence with E2 delivered transdermally for 25 days. The use of the combination system was not associated with a significant risk of endometrial hyperplasia.

Administration, Cutaneous↗
PubMed1996

Experience with transjugular intrahepatic portosystemic shunts for gastroesophageal variceal bleeding.

BACKGROUND: Variceal bleeding is a major life-threatening complication of cirrhosis of the liver. Transjugular intrahepatic portosystemic shunts (TIPS) have been accepted as an effective method for portal decompression. Experiences here with the use of TIPS for control of gastroesophageal variceal bleeding is presented. METHODS: Sixteen TIPS procedures were performed for 15 patients who suffered from intractable gastroesophageal variceal bleeding. Nine cases (60%) were hepatitis-related cirrhosis of liver, four (27%) were alcoholic liver cirrhosis and two were cryptogenic in origin. Liver function tests revealed four patients were Child-Pugh's classification A, five were B and six, C. Twelve cases had received failed endoscopic management of varices; and one patient had recurrent variceal bleeding after devascularization. TIPS procedure was performed electively in nine cases and, as an emergency in six cases. RESULTS: Fifteen of the 16 TIPS procedures attempted were successfully performed. The technically successful rate was 94% (15/16), but two cases with successful TIPS procedure expired at the end of the procedure from hypovolemic shock and acute respiratory distress, respectively; thus the completely successful rate was 81% (13/16), The initial bleeding control rate was 83% (5/6) for the six patients with active bleeding. Portal venous pressure was significantly decreased from 30.8 +/- 5.8 mmHg before TIPS to 21.7 +/- 6.0 mmHg after the procedure (P < 0.01) and the porto-systemic pressure gradient also significantly decreased from 23.0 +/- 3.6 mmHg to 11.9 +/- 2.7 mmHg after TIPS (P < 0.01). Recurrent variceal bleeding was noted in four patients (33%) and that was managed by percutaneous transluminal angioplasty (PTA) of shunt, placement of additional stent, second TIPS procedure and a devascularization operation. Hepatic encephalopathy was noted in three patients (25%) after TIPS. CONCLUSIONS: TIPS is an effective method to control variceal bleeding caused by portal hypertension, especially when endoscopic or surgical management has failed or is contraindicated.

Adult↗
PubMed1998

Relationship between circulating estradiol levels, body mass index, and breakthrough bleeding in postmenopausal women receiving hormone replacement therapy.

OBJECTIVE: The purpose of this prospective study was to investigate the association of breakthrough bleeding with circulating estradiol levels and obesity in postmenopausal women receiving hormone replacement therapy. DESIGN: Fifty postmenopausal women receiving 0.625 mg conjugated estrogen with 2.5 mg medroxyprogesterone acetate were included in the study. Patients are recalled at 1st, 5th and 9th weeks for the measurements of the serum estradiol levels. RESULTS: Twenty women (40%) had a bleeding episode within 9 weeks of therapy. Of the 25 women who had a body mass index (BMI) of > 25, 13 (52%) had bleeding. Of the 25 women who had a BMI of < 25, 7 (28%) had bleeding. There was a trend toward a relation between BMI and breakthrough bleeding, although the relation did not achieve significance (p = 0.14). Serum estradiol levels of both bleeders and nonbleeders remained similar throughout the study. Endometrial histology revealed proliferative endometrium in two cases and secretory endometrium in one case at baseline; two cases of proliferative endometrium were found during bleeding. The remaining samples revealed atrophy. CONCLUSIONS: No relation was found between serum estradiol levels and breakthrough bleeding. Nevertheless, increased BMI may have an impact on breakthrough bleeding in postmenopausal women receiving hormone replacement therapy.

Atrophy↗