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At least 1,387 records · Page 77Linked to original sources
PubMed1999

Prevention of a first episode of variceal bleeding: role of duplex Doppler sonographic measurement of the acute response to beta-blockers.

The aim of our study was to assess whether acute variations in portal vein Doppler sonographic parameters induced by administration of a single beta-blocker agent are predictive of the long-term effects of these drugs in the prevention of a first episode of variceal bleeding. In 30 patients with liver cirrhosis at high risk for variceal bleeding, duplex Doppler sonographic parameters (maximal portal flow velocity, portal blood flow, and congestion index) were measured before and 4 h after the administration of 40 mg of propranolol. Twenty-three of these patients started chronic therapy with propanolol and were evaluated periodically (seven patients were excluded because they did not continue the therapy). The percentage of patients free from bleeding was 86.9% at the first year and 77.8% at the second year. Among a series of clinical, laboratory, and instrument-based parameters, the only one related to first bleeding, selected by the Cox regression model, was the percentage decrease in maximal portal flow velocity observed after initial administration of propranolol (P < 0.01). The best cutoff value for the percentage decrease in portal flow velocity (portal flow velocity test) was 12%. The prevalence of bleeding had been 25% (3 of 12) in patients with positive portal flow velocity test results (12% decrease or more), versus 64% (7 of 11) in patients with negative portal flow velocity test results. The actuarial probability of remaining free from bleeding (Kaplan-Meier analysis) was different in these two groups (log rank P < 0.01). The portal flow velocity test represents a safe and feasible method to predict the efficacy of beta-blockers in the prevention of a first bleeding episode in patients with cirrhosis. In patients with negative results on the portal flow velocity test, an alternative therapeutic approach should be considered.

Actuarial Analysis↗
PubMed1998

Treatment of bleeding oesophageal varices with endoscopic sclerotherapy--first results.

Patients with bleeding oesophageal varices represent 5% of cases of upper GIT bleeding. Varices develop and bleed as a result of portal hypertension which is a complication occurring in 30% of patients who suffer from chronic liver diseases. The mortality rate for the first bleeding episode is 50% and 30% for subsequent episodes. Almost 100% of those who survive the first episode, bleed again within the following two years. The risk of rebleeding is higher with varices increasing their number, length and extension, varices of III and IV degrees, portal pressure over 16 mm Hg. Despite of some recent advances the endoscopic sclerotherapy still remains the initial treatment of choice in patients with bleeding oesophageal varices. Authors report of having achieved control over bleeding in 80 to 90% of patients. Over the next few days of the same hospitalisation 10 to 20% of those patients rebleed and require a second sclero-therapy session. When the latter fails in controlling the hemorrhage, the mortality rate is estimated as high as 100% which prompts more invasive surgical and radiological interventions.

Adult↗
PubMed1999

[Perioperative bleeding tendency in a hemodialysis patient during gastrectomy under total intravenous anesthesia using propofol infusion].

A 64-year-old female receiving hemodialysis (HD) underwent subtotal gastrectomy for gastric cancer under total intravenous anesthesia. Anesthesia was performed using continuous infusion of propofol (5-8 mg.kg-1.h-1), buprenorphine i.v. (2.5 micrograms.kg-1), 2% mepivacaine epidural infusion (7 ml.h-1) and appropriate doses of vecuronium. The blood pressure and heart rate were stable within 120% of the preoperative level. However, 3 and half hours after propofol anesthesia, increased bleeding from the surgical field was observed. The activated clotting time (ACT) was 144 seconds. Furthermore, at the end of the operation (5 hours after propofol anesthesia), the ACT (219 sec), PT (14.8 sec), PT-INR (1.94) and APTT (102.5 sec) were significantly prolonged. The platelet count was unchanged. The intraoperative total bleeding was 844 g. The total propofol infusion time and dose were 310 minutes and 1,580 mg, respectively. Immediate recovery with spontaneous ventilation was observed. Postoperative bleeding from the wound continued. Finally, 7 hours after the surgery, the bleeding ceased and the ACT (125 sec), PT (12.4 sec), PT-INR (1.34) and APTT (22.5 sec) were normalized. The total postoperative bleeding was 404 g. Despite the advantage of short-acting anesthetic agent, we suspect that propofol induced the bleeding tendency via platelet inhibition. This platelet inhibition may gradually increase with time and the dose of propofol. We should utilize propofol cautiously for patients receiving HD or with bleeding tendency.

Anesthesia, Epidural↗
PubMed1976

Abnormal uterine bleeding.

The management of patients with abnormal uterine bleeding requires a logical, rational approach, and an awareness of etiologic factors. A careful history and examination should attempt to answer these questions: (1) Is the bleeding truly from the uterus? (2) Is the bleeding superimposed upon ovulatory cycles or (3) is the bleeding anovulatory? The endometrial biopsy obtained during the bleeding episode, and the basal temperature chart are diagnostically useful. Massive uterine bleeding not due to a complication of pregnancy, neoplasis, or blood dyscrasia, usually responds immediately to curettage, done in operating room or office; follow-up hormonal therapy with progesterone and a progestational agent should control the episode. More chronic forms of abnormal uterine bleeding are approached by identifying and treating the etiologic cause. If the cause is not correctable (e.g., obesity), most patients will respond satisfactorily to the cyclic administration of a progestational agent, or, if indicated, to induction of ovulation.

Dilatation and Curettage↗
PubMed1999

Women and inherited bleeding disorders: menstrual issues.

Von Willebrand, who described a bleeder family from Aland in 1926 in whom the index patient died at the fourth menses, stated, "the trait seems to be seen among women." Menorrhagia is defined objectively as a menstrual blood loss of at least 80 mL. However, even though 5% of women aged 30 to 49 years consult their general practitioner and 12% of gynecologic referrals are for menorrhagia, the diagnosis is difficult. A pictorial bleeding assessment chart (PBAC) has a specificity and sensitivity of more than 80%, with a score of > or = 100 being equivalent to more than 80 mL of blood loss. Using this chart to screen 150 women with menorrhagia who attended a gynecology clinic, an inherited bleeding disorder was diagnosed in 17%. Menorrhagia with onset at the menarche was predictive of an inherited bleeding disorder in 65% of von Willebrand's disease (vWD) and 67% of factor XI (FXI)-deficient patients. A retrospective survey in patients with inherited bleeding disorders using the PBAC showed menorrhagia in 74% of patients with vWD, 57% of carriers of hemophilia A or B, and 59% of FXI-deficient patients, compared with 29% of control individuals. Menorrhagia was the most common symptom in 60% of patients with FVII deficiency studied. Menorrhagia in women with bleeding disorders can be controlled with tranexamic acid with good effect. More recently, a desmopressin acetate (DDAVP) spray has been shown to achieve good FVIII and von Willebrand factor (vWF) levels and is efficacious for women with these deficiencies. The oral contraceptive pill may be useful. Since bleeding disorders are found in a substantial number of women with menorrhagia, it is important that such patients are investigated for these disorders before invasive procedures are done; hysteroscopy and hysterectomy in these patients are associated with a high rate of postoperative bleeding.

Family Health↗
PubMedDate not supplied

Causes and clinical outcome of acute upper gastrointestinal bleeding: a prospective analysis of 1534 cases.

Despite considerable improvement in the diagnostic and therapeutic approach to patients with acute upper gastrointestinal (GI) bleeding, several studies suggest there has been no overall change in mortality. The aim of this study was to evaluate prospectively the effect of early emergency diagnostic and therapeutic endoscopy and medico-surgical collaboration in the clinical outcome of 1534 patients with acute upper GI bleeding treated in our hospital over the past five years. Emergency endoscopy and injection haemostasis were performed within 24 hours of admission, or immediately after resuscitation, in patients with massive bleeding; patients were then treated with close co-operation between surgeons and gastroenterologists. We observed an increase in the incidence of peptic ulcer (67%) with a simultaneous decrease in the incidence of gastroduodenitis (13.5%) as a cause of bleeding compared with the previous decade. In peptic ulcer bleeding, emergency surgical haemostasis was required in 92 patients (8.9%), while none of the patients with erosive gastroduodenitis required surgical intervention. Overall mortality was 2.9%, and in peptic ulcer bleeding patients 2.1% with a postsurgical mortality of 8.7%. Peptic ulcer remains the main cause of upper GI bleeding. Improved clinical outcome and low mortality can be achieved with early diagnostic and therapeutic endoscopy and medico-surgical collaboration.

Adolescent↗
PubMed1999

[Intravenous gastric acid inhibition for stress ulcers and bleeding peptic ulcers].

Intravenous acid inhibition is used in the prevention of upper gastrointestinal bleeding in intensive care unit patients and in the treatment of peptic ulcer bleeding. The strongest risk factors for upper gastrointestinal bleeding are mechanical ventilation for more than 48 hours and coagulopathy. However, a subgroup of critically ill patients without these risk factors may still be at risk of upper gastrointestinal bleeding. Stress ulcer prophylaxis with sucralfate is not effective. Patients who receive intravenous ranitidine (50 mg every 8 hours) run a significantly lower risk of gastrointestinal bleeding. In one study stress ulcer prophylaxis with oral omeprazole was more effective than prophylaxis with intravenous ranitidine. Endoscopic therapy is the cornerstone in modern therapy of peptic ulcer bleeding. Addition of acid inhibition may be effective in preventing clot lysis. H2-receptor antagonists do not influence the natural history of peptic ulcer bleeding. In addition to endoscopic therapy acid inhibition with proton pump inhibitors like omeprazole is more effective than acid inhibition with H2-receptor antagonists. However, the optimal dose and way of administration of omeprazole are not known.

Administration, Oral↗
PubMedDate not supplied

Injection sclerotherapy for variceal bleeding in patients with irresectable hepatocellular carcinoma.

BACKGROUND/AIMS: Patients with cirrhosis and advanced hepatocellular carcinoma are seldom cured, and have limited survival. Bleeding from esophageal varices in such patients is a major complication which, if untreated, may be a terminal event. This study evaluated the efficacy of injection sclerotherapy in controlling acute bleeding from esophageal varices and the benefit of repeated injection to eradicate varices in patients with cirrhosis and irresectable hepatocellular carcinoma. METHODOLOGY: Between 1975 and 1997, nineteen of 688 patients (2.8%) treated for bleeding esophageal varices had cirrhosis and irresectable hepatocellular carcinoma. There were 13 men and 6 women; median age, 42 years (range: 20-81). Eight patients were Child's-Pugh grade B and 11 grade C; 11 patients were Okuda stage II and 8 stage III. RESULTS: In 13 patients (68.4%) bleeding was controlled by injection sclerotherapy after a mean of 3 injections (range: 1-5), and of these esophageal varices were completely eradicated in 7 patients (53.9%), none of whom rebled. Twelve patients (63%) were discharged from hospital and had a mean survival of 100 days. Seven patients died in hospital, 5 of liver failure precipated by recurrent bleeding and 2 of hepatocellular carcinoma. Median survival for Child's-Pugh grade B patients was 80 days (range: 9-405) compared to 28 days (range: 8-117) for the grade C (P = 0.25). CONCLUSIONS: Injection sclerotherapy controlled acute variceal bleeding in most patients with hepatocellular carcinoma and provided effective palliative therapy with no further bleeding after eradication of varices.

Adult↗
PubMed1979

In vivo platelet retention in human bleeding-time wounds. II. Effect of aspirin ingestion.

PRB was studied in normal human subjects before and after aspirin ingestion. Aspirin ingestion resulted in a prolongation of individual bleeding times greater than 2.4 min (greater than 2 S.D. beyond the group mean before aspirin) in 62.5% of 48 paired studies. The relationship of platelets retained vs. time was linear during the first 3 min of bleeding before and after aspirin. The mean PRB decreased from 22.1 +/- 9.2 to 9.6 +/- 8.6 (p less than 0.001) after aspirin ingestion. Subjects whose bleeding time was prolonged greater than 2.4 min had a significantly higher mean PRB before aspirin and a significantly greater mean decrease in PRB after aspirin than those whose bleeding time was prolonged less than or equal to 2.4 min. Aspirin ingestion reduced the number of EDTA-irreversible clumped platelets present in wound blood approximately 50% during the second and third minute of bleeding, but large numbers of EDTA-reversible platelet clumps were observed in wound blood before and after aspirin. Although platelet retention was significantly decreased during the first 3 min of bleeding after aspirin, the percent of venous blood platelets present in wound blood just prior to the arrest of hemorrhage was equal before and after aspirin. These observations indicate that aspirin prolongs the bleeding time by decreasing platelet clumping and slowing the rate of platelet thrombus formation in severed blood vessels. The presence of platelet clumps in wound blood after aspirin ingestion indicates that alternative mechanisms of platelet aggregation, independent of the arachidonate pathway of prostaglandin synthesis, proceed in vivo unaltered by aspirin.

Adult↗
PubMed2001

[Upper gastrointestinal bleeding in patients treated by low-dose aspirin].

AIM OF THE STUDY: To estimate the number of people treated by low-dose aspirin (<330 mg daily) in France and to evaluate the risk of upper gastrointestinal bleeding associated with low-dose aspirin treatment. SUBJECTS AND METHODS: One thousand six hundred and two patients with upper gastrointestinal bleeding were included between January and June 1996 in 4 French areas. Data about patients characteristics, drugs recently used, and bleeding lesions were prospectively collected. Five hundred seventy five cases were matched for sex, age and area with control people without previous upper gastrointestinal bleeding. Low-dose aspirin intake in the population was estimated from the control group. Aspirin intake in the previous 7 days in cases and in controls was compared by logistic regression, adjusted for other gastrotoxic drugs intake. RESULTS: Low-dose aspirin is taken by about 1.2 millions adults in France. In 1 602 patients, gastrointestinal bleeding was related to a peptic ulcer in 34%. Aspirin was associated with higher risk of upper gastrointestinal bleeding: OR=1.68 (1.03-2.74) with low-dose, and OR 1.42 (0.91-2.21) with higher doses. CONCLUSION: About 2.8% of the population is exposed to low-dose aspirin in France. This treatment seems to be associated with a high risk of upper gastrointestinal bleeding.

Adult↗
PubMed2001

[Scintigraphic localization of colonic bleeding].

BACKGROUND: Endoscopy and, occasionally, X-ray studies are used to discover the focus of a gastrointestinal bleeding. MATERIAL AND METHODS: We describe a case of severe gastrointestinal bleeding where these methods failed. Scintigraphy after labelling of erythrocytes with 99m technetium was performed in a continuous manner for 60 minutes. Scintigrams were also taken three, ten and 23 hours after the injection. RESULTS: No bleeding was revealed after 60 minutes, but two hours later a slight radioactivity was encountered in the right part of the abdomen and the later images localised the bleeding to the right colon. The bleeding ceased after right-sided hemicolectomy. INTERPRETATION: Scintigraphy is of value in localisation of gastrointestinal bleeding and should be performed in a continuous manner until the bleeding focus is localised. Secretion of unbound technetium through the mucosa of the stomach and its presence in the urinary tract should be taken in account.

Aged↗
PubMed1995

[Aspirin, a risk factor for bleeding at dental procedures].

Aspirin is widely used as an antithrombotic drug in the prevention of cardiovascular events. It causes a usually mild bleeding tendency. When used before dental or surgical procedures, aspirin increases the risk of bleeding, contrary to the postoperative administration of aspirin, which has not been associated with increased risk of bleeding. To estimate the risk of bleeding, a history on bleeding tendency and information on the recent use of aspirin is worthwhile. It is recommended to delay procedures for at least one week after the last ingestion of aspirin, if possible. In case of urgent surgical procedures or in patients who suffer from serious bleeding due to the use of aspirin, a single preoperative transfusion of a suspension of platelets is usually sufficient to antagonize the effects of aspirin. Tranexamic acid can be given alternatively. The preferred policy depends on the type of the procedure to be performed, or the nature of the bleeding.

Antifibrinolytic Agents↗
PubMedDate not supplied

A review of the causes of upper gastrointestinal tract bleeding in children.

Bleeding may occur anywhere along the gastrointestinal tract, which covers a large surface area and is highly vascularized. While gastrointestinal bleeding is an alarming symptom for patients of any age, it can cause panic for children and their care givers. Early diagnosis and treatment of gastrointestinal bleeding may be essential. The differential diagnosis of bleeding from the upper gastrointestinal tract in infants and children includes numerous possibilities ranging from benign disorders which require little or no treatment at all, to serious diseases which require immediate intervention. This article reviews a variety of disorders which may cause upper gastrointestinal bleeding in infants and children. This is part one, of a two part series, on gastrointestinal bleeding in children. Part two will discuss bleeding from the lower gastrointestinal tract.

Child↗
PubMed2001

Re-exploration for hemorrhage following open heart surgery differentiation on the causes of bleeding and the impact on patient outcomes.

OBJECTIVES: To differentiate surgical bleeding requiring re-exploration from postoperative coagulopathy and determine the differences in patient outcomes. METHODS: This was a retrospective chart review of 2,263 adult patients undergoing elective and emergency open heart procedures encompassing coronary artery bypass, valvular, and a combined procedure to determine the impact of source of bleeding leading to re-exploration. RESULTS: Eighty-two patients (3.6%) required re-exploration. Sixty-six percent had surgical bleeding; the remaining 34% were coagulopathic. Postoperative coagulopathy was associated with preoperative heparin use (37% vs. 19.9% for controls p<0.05). Re-operative procedures combined bypass/ valve (p<0.001) and prolonged cardiopulmonary bypass and aortic cross-clamp times (p<0.05) were more prevalent in the coagulopathy group. Postoperative inotrope use was increased in patients who were re-explored (p<0.001), as were cardiac, pulmonary, renal and abdominal complications (p<0.001), and in all cases those patients with medically related bleeding had worse acute outcomes than the group with surgical causes for re-exploration. The hospital stay was prolonged for both patients with surgical bleeding (23.5 days) and patients with coagulopathy (27.1 days) compared to patients not undergoing re-exploration for bleeding (12.0 days, p<0.001). Survival was 91.3% for patients with surgical bleeding, 87.5% for patients with coagulopathy, and 98.0% for all others (p<0.01). CONCLUSIONS: Severe postoperative hemorrhage is associated with significant morbidity and increased mortality. Postoperative hospital stay, morbidity, and mortality were significantly worse in patients suffering from coagulopathy when compared to those patients with hemorrhage from surgical causes.

Cardiac Surgical Procedures↗
PubMed2002

[Treatment of upper gastrointestinal bleeding caused by peptic ulcer].

INTRODUCTION: The diagnosis and treatment of gastrointestinal bleeding represent a major problem even today. Nearly 50% of upper gastrointestinal bleedings are originating from peptic ulcers of different locations. Thanking to the modern gastroenterological treatment the number of elective operations carried out because of peptic ulcers is very low. On the other hand the number of urgent operations required by the complications--mainly by bleeding--of the ulcers is still rather high. AIM: Summarizing the possible treatments of these patients. METHODS AND DISCUSSION: The therapeutic endoscopy accompanied by the medical treatment has the primary role in the treatment of bleeding peptic ulcers. If this treatment fails, the surgical treatment is mandatory. Also surgical treatment is necessary in case of massive rebleeding. These kinds of operations are accompanied by a high morbidity and mortality, so it is understandable that the surgeons are trying to avoid them. After spontaneous or successful endoscopic cessation of bleeding in some cases rebleeding can be expected. The probability of rebleeding can be predicted with the consideration of predictive factors. With the help of such prognosis we can decide the indication of "early elective operation". In the surgical treatment we can expect better results with more "aggressive" type of operations (resections). The delay of an indicated operation, or repeatedly carried out endoscopic and medical treatment can reduce the survival chance of the bleeding patients. CONCLUSIONS: The treatment of upper gastrointestinal bleeding is a multidisciplinary task, which needs the correct cooperation of gastroenterologists, intensive therapists and surgeons.

Elective Surgical Procedures↗
PubMedDate not supplied

Early elective surgery for bleeding ulcer in the posterior duodenal bulb. Own results and review of the literature.

BACKGROUND/AIMS: Acute upper gastrointestinal bleeding represents the major, potentially life-threatening complication of gastroduodenal ulcer disease with an average mortality of 10%. To decrease mortality a risk-dependent combined endoscopic and operative approach for the treatment of bleeding ulcer in the posterior duodenal wall was developed. METHODOLOGY: Between 1998 and 2000 in our hospital a total of 22 patients with bleeding posterior duodenal bulb ulcer were treated following a differentiated endoscopic-surgical concept. High-risk patients with high bleeding activity (n = 8) underwent early elective surgery after primary endoscopic treatment of the bleeding and stabilization of the patient in an intensive care unit. The management of patients presenting a low-risk profile (n = 14) included careful surveillance and a consecutive second endoscopy 24 hours after the initial endoscopy. RESULTS: Patients that underwent surgery showed more severe secondary diseases than patients of the endoscopic group. Hemoglobin concentration in patients requiring surgery was significantly lower, they showed a higher incidence of hypovolemic shock and received more blood transfusions within the first 24 hours. Mortality was 0% in both groups, a relevant rebleeding occurred in one patient after endoscopic therapy, which was successfully treated by reendoscopy with fibrin injection. CONCLUSIONS: Due to these results as well as results of other groups we recommend early elective surgery in high-risk patients with bleeding duodenal bulb ulcer after primary endoscopic treatment of the bleeding.

Adult↗
PubMedDate not supplied

Endoscopic findings of bleeding esophagogastric varices.

BACKGROUND/AIMS: Endoscopic findings of bleeding gastric and esophageal varices were compared. METHODOLOGY: Seventy patients with first bleeding esophagogastric varices without prior treatments were treated: 47 patients had bleeding esophageal varices (EV group), 11 patients had bleeding cardiac varices (CV group), and 12 patients had bleeding cardiofundic or fundic varices (FV group). RESULTS: The red color sign was more common in the EV group (45 patients) than in the CV group (4 patients) or FV group (no patients) (P < 0.0001); Mucosal erosion over the varices at the site of bleeding was more common in the CV group (9 patients, P < 0.0005) and FV group (12 patients, P < 0.0001) than in the EV group (12 patients). An ulcer at the bleeding point was more common in the CV group (7 patients, P < 0.01) and FV group (10 patients, P < 0.0001) than in the EV group (11 patients). Gastric ulcer was more common in the CV group (7 patients, P < 0.05) and FV group (10 patients, P < 0.001) than in the EV group (14 patients). Erosive gastritis was more frequent in the FV group (12 patients, P < 0.02) than in the EV group (30 patients). CONCLUSIONS: Violation of the mucosa barrier overlying gastric varices, especially cardiofundic or fundic varices, might be an important step leading to variceal hemorrhage.

Aged↗
PubMed2002

Uterine bleeding pattern during low dosage Noretisterone acetate and 17-b-Estradiol treatment in postmenopausal patients.

BACKGROUND: Recent years have been characterized by progressive optimization of postmenopausal hormonal replacement therapy. More physiological therapeutic protocols have been, in fact, proposed to control the possible symptomatology and to prevent the associated risks, with estro-progestinic compounds characterized by lower effective dosages and suitable for the single patient need. However this therapy is not widely accepted by the women from our country for the fears and the inconvenience raised around such side effects as abnormal uterine bleeding and spotting. AIM: to obtain a good compliance and clinical benefits a continuous administration protocol of the hormonal replacement therapy, alternatively to the sequential one has been proposed. METHODS: Our research group has been observing a sample of 42 patients for 12 months, taking oral 17-b-estradiol 1 mg/noretisterone 0.5 mg in continuous administration. All of them were aged from 42 to 63 years and had been in symptomatic menopause for at least 3 months. The characteristics, the onset and the trend of vaginal bleeding were registered in appropriate monthly diaries. Endometrial thickness was evaluated by transvaginal sonography before starting the administration, not exceeding 4 mm in all the women considered. RESULTS: The incidence of bleeding (calculated as a percent of women who experienced a vaginal bleeding for al least a day during a menstrual cycle) was from 26% to 32% in the 1st trimester, reducing during the following months. At 6 months of therapy only 5% of women reported evident vaginal bleeding; at 12 months 90% of women complained with absence of bleeding or spotting. At 12 months no women showed an endometrial thickness over 6 mm. CONCLUSIONS: This observational study suggests that the majority of treated patients proved to be positively responsive to the treatment and that the 17-b-estradiol 1 mg/noretisterone 0.5 mg association reduces the incidence of bleeding and spotting with a sufficient endometrial protection from hyperplasia.

Adult↗