Acute Massive Hemorrhage Research Articles

Розрив розшаровуючої аневризми черевного відділу аорти (випадок з практики районного спеціаліста)

Cardiovascular diseases, especially in the elderly, are ranked first in the structure of morbidity and mortality. They serve as abackground for the development of other pathological conditions. In our case, diffuse arterio-atherosclerosis of the vessels in the patient, especially the aorta, led to the development of adissectinganeurysm of the abdominal aorta, which was complicated by the rupture with acute massive intraperitoneal haemorrhage, hemoperitoneum, leading toa fatal end. The diseaseoften starts unnoticed or with insignificant gastrointestinal discomfort. Aim. Drawing attention to the complexityof timely diagnosis and effective treatment of the dissectingabdominal aortic aneurysm. Material and Methods. The clinical case of the disease in the patient O., 75 years old, was analyzed; the results of the laboratory-clinical and instrumental examination were presented. However, the true cause of the severity of the patient's conditionwas not established on time. Results and Discussion. Throughout life and in the process of industrialactivity, amodern person consciously or unknowingly undergoes the influence, sometimes simultaneous and combined one, of various factors, the effect of which is sometimes detrimental to theirhealth. Over time, their negative effects are accumulated,, targetingprimarily cardiovascular and nervous system. Disturbances of macro- and microcirculation often serve as a background for the development of other pathological conditions. With age, an individual is"overgrown" with a number of interconnected, concurringdiseases; there is a polymorbidity with a syndrome of mutual exacerbationin their course. For example, today an unhealthy brand is popular: during a feast people overeat, consuming foodstuffs incompatible in the digestion and absorption (saturated with preservatives, stabilizers, flavors, etc.), accompanied bydrinking alcohol, coffee and smoking. So to what limits does one need to overload, stimulate and excite one’sbody by resorting to the above-mentioned harmful habits?! It is necessary to practice moderation in all respects. The described clinical case clearly demonstrates the difficulty in establishing the etiology of the disease, that is, not always the diagnosis lies on the surface. The beginning of the formation of aortic aneurysms is very difficult to notice in practice. The period of insignificantstretching of the aortic walls, which lasts from a few months toyears, actually does not manifest itself. A milddiscomfort in the abdomen usually goes unnoticed, especially at an older age. The available to us methods of examination and laboratory diagnostics failed contribute to the detection of this gravestate. Unfortunately, only the autopsy of the deceased has had the final say in revealing of the true cause of the serious condition of the patient. Conclusion. The following description of the disease of the patient O. confirms the pointabout the difficulties in the diagnosis of this pathology, due to the presence of nonspecific, sometimes slightly expressed, gastrointestinal symptoms, which arenot paid timely attention byeitherpatients orhealthcare workers. The ultrasound and computer methods of vascular diagnostics, available at present, should be used earlier, more frequentlyand in dynamics, especially in unclear pathological conditions, all the morein the elderly. Detecting and treating morbid conditions at the present time is not always smooth and easy. For some reason, in recent years little attention has been paid to preventing disease. &nbsp

Selected complications of colonoscopy – an anaesthetist’s point of view

Colonoscopy is a commonly performed procedure for the diagnosis and treatment of a wide range of conditions and symptoms, as well as for the screening and surveillance of colorectal neoplasia. Serious complications, such as bleeding and perforation, are reported in patients undergoing colonoscopy, especially during polypectomy. Bleeding is the most common complication of colonic polypectomy. It can occur immediately following polypectomy or be delayed from hours to up to days. Acute post-polypectomy haemorrhage is usually immediately apparent and amenable to endoscopic therapy. Nonendoscopic treatment modalities include angiographic embolization and surgery. Acute massive bleeding (internal bleeding/haemorrhage) into the lower gastrointestinal tract may cause hypovolaemia, which decreases cardiac output and tissue oxygen supply, which may require emergency surgery. Although colonic perforation is a rare complication, it is associated with a high rate of morbidity and mortality. This unpleasant complication could result in surgical intervention, stoma formation, intra-abdominal sepsis, prolonged hospital stay, and even death. An extra-intestinal structure identified during endoscopic examination is the most common clinical feature of colonic perforation. The management of patients with colonic perforation should be individualized based on patients’ clinical status and underlying diseases, the nature of perforation, and concomitant colorectal pathologies. Patients with both acute massive bleeding and lower gastrointestinal perforation may need emergency laparotomy, which requires perioperative cooperation of an endoscopist, a surgeon and an anaesthetist.

Tumor-associated hemorrhage in patients with vestibular schwannoma.

Intratumoral hemorrhage (ITH) associated with vestibular schwannomas (VS) is very rare. We retrospectively analyzed VS patients presenting with ITH in our department to further gain a better understanding of this uncommon clinical presentation. We treated seven patients who had VS presenting with ITH between January 2012 and June 2017. All the patients had preoperative computed tomography (CT), computed tomography angiography (CTA), and magnetic resonance imaging(MRI) done which aided in the radiological diagnosis as well as postoperative MRI to confirm the resection extent of the VS. Continuous electrophysiological monitoring of cranial nerves was carried out during surgery. Of the seven patients, three were male and four were female. Their ages ranged from 42 to 71years (average age, 57.4years). Two patients reported a history of hypertension. Sudden onset or rapid worsening of clinical symptoms occurred in five patients at time of hemorrhage. The mean diameter of the lesions was 4.1cm (range, 3.0-5.0cm). No patient had a pretreatment of stereotactic radiosurgery. Gross total resection was achieved in four cases and subtotal resection in three cases. There were no surgery-related neurological deficits but one patient died 18days after surgery. Follow-up visits were scheduled at 6months postoperatively and two patients had tumor recurrence and received stereotactic radiosurgery again. The incidence of ITH in VS is relatively rare and hypertension may highly correlate with ITH in VS. In comparison with peritumoral adhesion caused by chronic inflammation in multicystic VS with microhemorrhage,ITH caused by acute massive hemorrhage will not increase the extent of peritumoral adhesion immediately. The prognosis of surgery for patients with acute hemorrhagic VS may be better than that for microhemorrhage in multicystic VS. Besides, timely microsurgical treatment is also important to relieve symptoms.

Tissue plasminogen activator-assisted vitrectomy in the early treatment of acute massive suprachoroidal hemorrhage complicating cataract surgery.

Tissue plasminogen activator-assisted vitrectomy in the early treatment of acute massive suprachoroidal hemorrhage complicating cataract surgery.

Emergency transcatheter arterial embolization for massive gastrointestinal arterial hemorrhage.

To evaluate the different arteriographic manifestations of acute arterial massive hemorrhage of the gastrointestinal (GI) tract and the efficacy of emergency transcatheter arterial embolization (ETAE).A total of 88 patients with acute massive GI bleeding who experienced failure of initial endoscopy and/or conservative treatment were referred to our interventional department for acute GI arteriography from January 2007 to June 2015. After locating the source of bleeding, appropriate embolic agents, such as spring coil, hydroxyl methyl acrylic acid gelatin microspheres, polyvinyl alcohol (PVA) particles, etc., were used to embolize the targeted vessels. The angiographic manifestations and the effects of embolization of acute arterial massive hemorrhage of the GI tract were retrospectively analyzed.Of the 88 patients, 54 were diagnosed with arterial hemorrhage of the upper GI tract and 34 with arterial hemorrhage of the lower GI tract. Eighty cases were associated with positive angiography, which showed the following: contrast extravasation (only); gastroduodenal artery stenosis; pseudoaneurysm (only); pseudoaneurysm rupture with contrast extravasation; pseudoaneurysms merged with intestinal artery stenosis; GI angiodysplasia; and tumor vascular bleeding. Eight cases were diagnosed with negative angiography. Seven-two patients underwent successful hemostasis, and a total of 81 arteries were embolized. The technical and clinical success rates (no rebleeding within 30 days) in performing transcatheter embolization on patients with active bleeding were 100% and 84.71%, respectively (72 of 85). Within 30 days, the postoperative rebleeding rate was 15.29% (13/85). Of these rebleeding cases, 2 patients were formerly treated with “blind embolization,” 7 underwent interventional embolic retreatment, and 3 had surgical operations. All cases were followed-up for 1 month, and 3 patients died from multiple organ failure. No serious complications such as bowel ischemia necrosis were observed.ETAE is a safe, effective, and minimally invasive treatment; because of the diversified arteriographic manifestations of acute GI hemorrhage, the proper selection of embolic agents and the choice of reasonable embolization method are essential for successful hemostasis.

Severe neonatal anemia due to acute massive fetomaternal hemorrhage - a case and literature review

Severe neonatal anemia due to acute massive fetomaternal hemorrhage - a case and literature review

Multiple angiodysplasia diagnosed by capsule endoscopy

A 28-year-old Caucasian man was admitted in our unit for acute massive rectal bleeding. Past medical and family history was unremarkable. Hemoglobin was 7.6 g/dL. Blood transfusions were required. Computed tomography and gastrointestinal endoscopy were negative for active bleeding. When patient's hemoglobin was normalized and stable, a video capsule endoscopy was performed. Video relieved the presence of multiple digiunal and ileal angiodysplastic lesions. A double endoscopic argon plasma coagulation procedure was planned on general anaesthesia. Upper and rectal operative approach were performed. Procedure was uneventful. After 2 years follow-up patient had no recurrence of gastrointestinal bleeding.

Multiple angiodysplasia diagnosed by capsule endoscopy

A 28-year-old Caucasian man was admitted in our unit for acute massive rectal bleeding. Past medical and family history was unremarkable. Hemoglobin was 7.6 g/dL. Blood transfusions were required. Computed tomography and gastrointestinal endoscopy were negative for active bleeding. When patient's hemoglobin was normalized and stable, a video capsule endoscopy was performed. Video relieved the presence of multiple digiunal and ileal angiodysplastic lesions. A double endoscopic argon plasma coagulation procedure was planned on general anaesthesia. Upper and rectal operative approach were performed. Procedure was uneventful. After 2 years follow-up patient had no recurrence of gastrointestinal bleeding.

EMERGENCY TRANSRADIAL EMBOLIZATION OF RECURRENT LIFE-THREATENING DUODENAL BLEEDING IN MALIGNANT OBSTRUCTIVE JAUNDICE

Ulcerative lesions of the upper digestive tract often occur in malignant obstructive jaundice due to multiple changes in the coagulation system. Emergency percutaneous arterial embolization is an effective and safe procedure to treat acute massive duodenal bleeding; it is most commonly performed via the standard transfemoral access, which can lead to complications in this area. The paper describes a clinical case of the double use of a unilateral radial access for emergency embolization of life-threatening duodenal bleeding in complications of malignant obstructive jaundice.

Meckelʼs Diverticulum: Thinking Outside the Box with Acute Massive Small Bowel Hemorrhage in an Adult

Introduction: Nonvariceal upper GI bleeding remains a common GI emergency with an incidence of 37-172 cases per 100,000 adults and a mortality rate of 3-14%.1 Meckel's diverticulum, while well described in the pediatric population, is a rare source of bleeding in adults that requires a different diagnostic and treatment approach. Case Report: We report a thirty year old woman with a history of IBS who presented to the emergency department two hours after having two episodes of melena and a subsequent episode of syncope. On arrival, she had stable vital signs but a hemoglobin level of 9.7 g/dl. Initial work-up included an EGD that was normal and a colonoscopy that showed clotted blood throughout the colon but fresh red blood in the terminal ileum. A radionuclide bleeding study the next day was negative. One day later, patient had recurrent bleeding. Repeat radionuclide study was positive in the right lower quadrant, thought to represent a small bowel source. At that point, despite having required 6 units of blood, patient remained hemodynamically stabile. Decision was to hold on angiography and instead pursue a Meckel's scan. Unfortunately, this scan was delayed one day due to interference between the radionuclide and technetium pertechnetate, but the next day the scan was done and was positive. The patient was then taken for surgery the same day and had an uncomplicated resection of the Meckel's diverticulum that was confirmed on pathology. Discussion: In up to 5% of cases of GI bleeding, the source is not found.2 Meckel's diverticulum, while commonly encountered in the pediatric population, remains a rare diagnosis for adults. Other diagnostic tests after negative endoscopies, including video capsule endoscopy, angiography, and radionuclide study are less sensitive and specific than a Meckel's scan and can interfere with making a timely diagnosis; indeed our use of the radionuclide study delayed the diagnosis by 1 day. This case illustrates the importance of keeping Meckel's in the differential diagnosis and the impact of appropriate testing in early diagnosis.

Budget impact analysis of antiplatelet therapy with ticagrelor and clopidogrel in patients with acute coronary syndrome after coronary artery bypass surgery

Clinical and economic examinations were made to study whether it is appropriate to use antiplatelet therapy (APT) with ticagrelor in combination with acetylsalicylic acid (ASA) versus a combination of clopidogrel and ASA in patients with acute coronary syndrome (ACS) following coronary artery bypass surgery (CABS). A budget impact analysis was used. Data on the efficiency and safety of APT were taken from a relevant analysis in the subgroups of the randomized controlled trial PLATO. Direct medical cost due to APT and expenses on therapy for acute myocardial infarction, stroke, and massive bleeding, and those on medical care for patients dying from cardiovascular events and other causes, as well as indirect cost - gross domestic product (GDP) losses due to untimely death, were taken into account. The findings were assessed from the perspectives of society. The analysis indicated that direct medical costs per patient following CABS, both in case of calculation based on the recorded price for ticagrelor and on the median registered prices for clopidogrel generics, and based on the auction prices for comparison agents proved to be lower when clopidogrel was administered because of the higher cost of ticagrelor-based APT. At the same time GDP losses due to untimely death, as calculated per patient with ACS during post-CABS therapy with clopidogrel + ASA, were more than twice above average losses per patient taking ticagrelor in combination with ACA (107,122 and 221,645 rubles, respectively). From the registered price for ticagrelor and the median registered prices for clopidogrel generics, the total costs per patient with ACS following CABS were lower if Brilinta was used in combination with ASA versus therapy with clopidogrel in combination with ASA (210,092 and 273,257 rubles per year, respectively; the cost savings were 63,165 rubles per patient per year when ticagrelor was administered). On the basis of the auction prices for comparison drugs, the total costs per patient with ACS after CABS proved to be lower if Brilinta was used in combination with ASA versus therapy with brand name clopidogrel in combination with ASA (201,018 and 293,982 rubles per patients year, respectively; the cost savings were 92,963 rubles per patient per year when ticagrelor was used). The use of ticagrelor in combination with ASA ensures resource savings to treat ACS patients undergoing CABS as compared with a regiment including a combination of clopidogrel and ASA.

Does simulation have a role in palliative medicine specialty training?

Simulation training has been adopted by other industries, particularly aviation, for many years. With patient safety on every agenda, more recently there has been considerable interest and investment in its...

CHEMOTHERAPY ANALYSIS IN MASSIVE TRANSFUSION SYNDROME.

Massive transfusion is defined as blood transfusion in quantities equal to or greater than the estimated patients' blood volume over a relatively short period of time (3-4 hours). The study was aimed at analyzing the application of chemotherapy in treatment of patients with acute massive bleeding and evaluating the results of hemostasis and platelet counts screening tests in the patients receiving massive transfusions. Attempts were made to fully compensate hemostatic factors in 24 patients (14 male and 10 female, aged 23 to 76 years) with acute massive and uncontrolled surgical bleeding (polytrauma, abdominal aortic aneurysm, digestive tract bleeding as a result of a farina overdose, mortus fetus) over the five-year period, wherein a circulating patients' blood volume was compensated over a relatively short period of time. First the surgical bleeding was stopped. The objective of chemotherapy was the combined use of resuspended red blood cells, fresh frozen plasma, cryoprecipitates and the platelet concentrate in order to maintain the patients' normal circulating blood volume and blood pressure (systolic blood pressure ≥ 100 mmHg) with hemoglobin value higher than 100 g/l and the hematocrit above 0.30 l/l. Transfusion treatment of 24 patients with acute bleeding consisted of an average of 16 to 18 units of resuspended red blood cells (ranging from 4,880 ml to 5,220 ml); fresh frozen plasma (980 ml to 1,220 ml); cryoprecipitates (an average of 10 to 15 units i.e. 500-750 ml) and concentrated platelets (approximately an average of 8 to 12 units i.e. 240 to 360 ml). In our study we have confirmed the pathophysiological mechanism shown in the available medical literature that after transfusion of a large red blood cell concentrate volume, dilutional coagulopathy develops, caused by a sharp drop in platelet count and the significantly reduced activity of unstable coagulation factors in the patient's circulation.

A Study of Cranial Injuries in Road Traffic Accidents in Tirupati Region

Death due to Road Traffic Accidents (RTAs) are increasing at an alarming rate world wide thereby possessing a major epidemiological problem. Victims in RTAs sustain large varieties of injuries and occurrence of cranial injuries is extremely high in RTAs. The cranial injuries associated with injuries to vital organ and acute massive haemorrhage are more fatal or more dangerous to life. The study of cranial injuries associated with fatal outcome helps in the implementation of measures to prevent the fatalities due to RTAs. Hence the present study is conducted to know the pattern of cranial injuries in victims of fatal RTAs, type of victims along with age and sex, survival period, type of offending vehicle. Language: en

G IST Jinx – A Rare Case of Acute Massive Life Threatening Bleed from a Jejunal Gastro-Intestinal Stromal Tumour

A 55-year-old lady presented to us in the emergency services with melaena. Haemoglobin was 3.4 g/dL. A massive blood transfusion was given. Upper Gastrointestinal (GI) endoscopy showed antral erosions without active bleed and colonoscopy was inconclusive. An Ultrasonogram (USG) of the abdomen showed multiple haemangiomas of the liver and no bowel pathology. A Contrast Enhancing Computed Tomogram (CECT) of the abdomen showed an intensely enhancing lesion in the jejunum. Laparotomy revealed a firm hypervascular mass 3x3cm in the proximal jejunum 6cm distal to the duodeno-jejunal junction. The mass was resected and on histopathological examination was found to be a low-risk GIST with adequate margins and c-KIT (CD 117) positivity. Clinically, severe pallor was present. The abdominal examination was within normal limits. Digital rectal examination revealed melaena staining. On proctoscopy, the lower rectum could not be visualised due to the melaena. Laboratory findings: Haemoglobin 3.4 g/dL, bleeding and coagulation parameters were within normal limits On Endoscopy of Upper GI, Antral erosions were noted with no active bleeding. Colonoscopy was inconclusive as rectum was filled with melaena resulting in poor visibility. Abdominal USG showed multiple haemangiomas in the liver with no abnormal bowel pathology visualised. CECT abdomen showed Duodeno-Jejunal intussusception [Table/Fig-1] with intensely enhancing submucosal lesion with the same intensity as that of blood vessels with probable diagnosis being a growth of vascular origin. Multiple liver haemangiomas were also visualised [Table/Fig-2]. [Table/Fig-1]: An abdominal CT transverse slice showing intensely enhancing lesion with duodeno-jejunal intussusception (white arrow). [Table/Fig-2]: An abdominal CT coronal slice showing liver haemangiomas (black arrow) and duodeno-jejunal intussusception with intensely enhancing submucosal lesion (white arrow). Gross findings: Laparotomy revealed a firm well circumscribed mass 3x3cm, arising from the anti-mesenteric border of the jejunum 6 cm distal to the duodeno-jejunal flexure with dilated peritumoural vessels. The intraluminal portion of the affected bowel showed a full diameter transverse slit across the tumour representing rupture which probably caused the massive bleed [Table/Fig-3,​,44]. [Table/Fig-3]: Intraoperative photograph showing the lesion near the duodeno-jejunal junction [Table/Fig-4]: Intra-luminal photograph showing the lesion with intraluminal rupture. Microscopy: Microscopy with classical haematoxylin and eosin staining revealed clusters of spindle shaped cells with elongated nuclei with areas of mitosis. Immunohistochemistry demonstrated positivity for CD 117 [Table/Fig-5,​,66]. [Table/Fig-5]: Photomicrograph showing spindle shaped cells with irregular large nuclei with intervening stroma (H & E, x 400). [Table/Fig-6]: Photomicrograph demonstrating spindle shaped cells with large nuclei with CD117 positivity in few cells (Immunohistochemistry staining, x 100). GISTs are the most common sarcomatous tumours of the GIT, typically seen in patients more than 50 years with slight male preponderance. The most common sites in the GIT include stomach (50-60%), small intestine (25-30%), rectum (5%), oesophagus (2%). Jejunal GISTs are rare, contributing to only 10% of GISTs arising from the GIT [1,2]. Histologically, GISTs consist of a combination of spindle and epitheloid cells. Immunohistochemistry for GISTs typically shows positivity for the tyrosine kinase receptor protein – c-KIT (CD 117) [3]. Most patients with GISTs present symptomatically with variable clinical presentation. Small GISTs usually present as vague abdominal pain or with bleeding. Bleeding is most common into the lumen of the GIT which is usually chronic in presentation. Acute massive life threatening intraluminal bleed is very rare. CECT abdomen findings typically are of a well circumscribed submucosal mass or of an exophytic lesion. Endoscopy can also be used for pre-operative diagnosis in accessible locations. A pre-operative diagnosis is difficult especially in cases presenting as emergency and diagnosis is usually confirmed at surgery. Complete surgical resection forms the mainstay of treatment. Small bowel GIST is an unusual tumour of the GIT and can have varied clinical presentation. Its presentation as acute massive GI haemorrhage is rare. Aggressive resuscitation, a high index of suspicion and thorough clinical and radiological evaluation are necessary to provide the best possible treatment.

Clinical Analysis of 38 Cases of Obstetric Emergency Hysterectomy

<strong>Objective:</strong> To discuss and analyze the clinical situation of emergency obstetric hysterectomy. <strong>Methods:</strong> Retrospective analysis of the clinical data of 38 cases obstetric emergency hysterectomy medical records from 2002 to 2011 in our hospital is made. <strong>Result:</strong> 38 cases of emergency obstetric hysterectomy indications are uterine massive bleeding. placental factor medical records are 20 cases, accounted for 52.3%, with the cure rate of 97.4%, and perinatal child mortality rate is 7.9%. <strong>Conclusion:</strong> Hysterectomy is a quick, effective means of treatment of acute obstetric massive bleeding, effectively reduced the rate of cesarean section, also can reduce the incidence of obstetric hysterectomy.

54 Days Without Anticoagulation in a Patient with Metallic Mitral Valve

In patients with a mechanical heart valve, adequate anticoagulation is extremely important, as coagulation poses a risk of embolism and thrombosis of the valve. However, in patients with a metallic heart valve suffering an intracranial bleed, there is a high mortality rate. This can become a management dilemma, as limited evidence is available to guide clinical decision-making in this situation. Each case must be assessed individually, ideally with a multidisciplinary team approach. Here, we report the case of a woman in her 80s presenting with acute massive subdural hemorrhage because of a fall. We examine the complex repercussions of specific decisions in a very critical clinical scenario. Furthermore, we suggest that a revision of anticoagulation guidelines may be necessary.

Acute massive bleeding after cardiac surgery: a new definition evaluated in a multicenter study

Acute massive bleeding after cardiac surgery: a new definition evaluated in a multicenter study

Effects of epinephrine–saline submucosal injection of different concentrations on endoscopic submucosal dissection

Objective To evalute and compare the efficacy and safety of epinephrine–saline submucosal injection of different concentrations on endoscopic submucosal dissection (ESD), and to discuss the best concentration of submucosal injection. Methods A total of 128 patients who underwent ESD were randomly assigned to submucosal normal saline injection group (group A, n=32), 0.001% epinephrine–saline injection group(group B, n=32), 0.002% epinephrine–saline injection group(group C, n=32), and 0.004% epinephrine–saline injection group (group D, n=32). The incidence of bleeding during and after ESD were counted, the blood preasure and heart rate of preoperative and intraoperative, the amount of submucosal injection, the time of operation were observed. Results ESD was successfully performed on all patients. There were no difference in highest blood preasure and fastest heart rate between preoperative and intraoperative results of each group. No perforation or intraoperative acute massive bleeding occurred. Intraoperative acute minimal bleeding during ESD occurred in 9 patients in group A and 3 in group B, 2 in group C and 2 in group D (P<0.05), but there were no differences among group B, C and D. The amount of submucosal injection of group A was(39.5±10.8)ml, which was more than that of group B(29.4±9.4)ml, group C(27.3±8.2)ml and group D(20.4±11.8)ml with significant difference. There were no differences among group B, C and D, but there was less in group D than group B. The operation time of group A was(82.3±24.78 minutes), which was longer than that of group B(60.7±25.35minutes), group C (54.7±31.72minutes) and group D(59.2±28.49 minutes), but there was no difference among B, C and D group. Conclusion Epinephrine–saline submucosal injection assiting ESD is safe and effective and reduces the operation time and bleeding than normal saline. The increase of the epinephrine–saline concentrations has not been found to be more beneficial. Key words: Endoscopic submucosal dissection; Injections; Epinephrine; Bleeding

Treatment of malignant pleural effusion by simple powdery talcage under medical thoracoscopy

Objective To study the therapeutic effect and safety of pleurodesis with medical thoracoscopy by powdery talc on treatment of malignant pleural effusion. Methods Retrospective analysis were done in 74 cases of malignant pleural effusion accepted simple powdery talc pleurodesis under medical thoracoscopy. Results The doses of powdery talc were from 1g to 5g,average 2.18g in the course of the treatment. After operation, 45(60.8%) cases which were complete remission(CR) were full pleural adhesion and complete lung recruitment, 14cases(18.9%), which were partial remission(PR),were less pleural adhesion and most lung recruitment, and 10cases(13.6%) were stable diseases(SD), while 5cases(6.7%), which were progressive diseases(PD), were without pleural reaction. The total effective rate, including CR,PR and SD, was 93.3%(69/74). The complications of simple powdery talcage under medical thoracoscopy were included in:95.9%(71/74) with chest pain,64.8%(48/74) with fever,28.4%(21/74) with shortness of breath,12.2%(9/74) with mediastinal and subcutaneous emphysema,5.4%(4/74)with nausea and vomiting,4.1%(3/74) with abdominal distension, while the complications of acute pulmonary edema, massive hemorrhage, pulmonary embolism and wound infection were not observed. Conclusion Treatment of malignant pleural effusion by simple powdery talcage under medical thoracoscopy has definite clinic therapeutic effect, which is safe, costeffective, less trauma and worthy of clinical application. Key words: Pleural effusion,malignant; Thoracoscopy; Pleurodesis; Talc