Extravasation Of Blood Research Articles

An unusual cause of upper gastrointestinal bleeding

A 46-year-old man with stage IV esophageal cancer (Figure 1, left) presented with dysphagia and weight loss. A palliative esophageal stent (ultraflex) was placed to relieve the dysphagia (Figure 1, right) in another hospital for symptom relief. He was administered concurrent chemoradiotherapy after oral intake resumed. On the third hospital day of the fourth chemotherapy course, he experienced sudden-onset large-volume hematemesis and went into shock. After resuscitation, an emergency endoscopy demonstrated bloody content in the esophagus, and the bleeding was uncontrollable. A contrast-enhanced chest computed tomography (CT) was performed (Figure 2). What is the diagnosis? The chest CT demonstrated active contrast extravasation from the aorta (Figure 2, left) into the upper margin of the esophageal stent (Figure 2, right), and aortoesophageal fistula (AEF) was diagnosed. The patient declined surgery because of advanced esophageal cancer. Emergency endovascular repair using an aortic stent was performed to control the bleeding. The patient experienced severe pneumonia after resolution of the bleeding episode, and a tracheoesophageal fistula was found. A week later, he died of multiple organ failure. Esophageal stent for advanced esophageal cancer is aimed at maintaining oral intake to improve the quality of life.1-3 Stent-related major complications, such as perforation and hemorrhage, occur more frequently after radiotherapy and limit its use as a bridge to surgery or before preoperative chemoradiotherapy.1 Patients with AEF may experience mid-thoracic pain, heralded hemorrhage, and then fatal hemorrhage due to rapid blood extravasation from the aorta to the esophagus, so-called Chiari's triad.4 Unlike other causes of upper gastrointestinal bleeding, AEF can be diagnosed using endoscopy in less than 10% of cases. Diagnosis is usually made using CT arteriogram showing active extravasation of blood from the aorta to the esophagus. The treatment options for AEF include definitive surgical aortic replacement, temporary endovascular aortic repair, or further esophageal stenting. The prognosis is poor because most of these patients have contraindications to major surgery due to poor general condition. The authors receive funding from Changhua Christian Hospital 106-CCHIRP-030 for this manuscript. The authors declare no conflict of interest. Yu-Chun Hsu performed the endoscopy and final approval of the manuscript. Chia-Bung Chen provided 3-D reconstruction of the image and final approval of the manuscript. Hsu-Heng Yen was involved in drafting, writing and final approval and drafting of the manuscript.

Tomografía computarizada del divertículo de Meckel complicado en adultos

ObjectiveTo review the embryology, the clinical findings and the appearance in multidetector computed tomography (MDCT) of complicated Meckel's diverticulum (DM) in adults. ConclusionThe presence of an MD in a MDCT should be suspected when a blind tubular structure connected to the terminal ileum by a neck of variable size is observed. Multiplanar 2D reconstructions images and CT enterography can help in the diagnosis. In patients with symptoms of obstruction or intestinal inflammation, the possibility of a complication secondary to a MD should be considered, especially when the terminal ileum and the vermiform appendix are normal. MDCT angiography, in cases of acute gastrointestinal bleeding, can identify contrast extravasation and accumulation of blood in the MD, and could demonstrate the persistent omphalomesenteric artery, which is diagnostic of MD. Other MDCT findings such as the presence of enteroliths or associated inflammatory changes around the MD can facilitate the preoperative diagnosis of MD complications.

Evaluation of Role of Captopril and Erdosteine in Protection of The Lung against Bleomycin-Induced Injury in Rats

Background:bleomycin (BLM) is a chemotherapeutic agent having a wide use in the clinical field. Its most serious side effect is the life-threatening pulmonary toxicity.Objective:this study aimed to evaluate the role of captopril and erdosteine (ERD) in lung protection against BLM-induced injury in rats. Material and Methods:thirty-two rats were categorized into 4 equal groups. Group I: rats received distilled water. Group II: rats injected intaperitonealy with 0.5 mg of BLM sulphate dissolved in 0.5 ml saline twice weekly for 4 weeks. Group III: rats received BLM in a dose as in group II &ERD by a dose of 10 mg/kg/day orally, 2 days before BLM administration. Group IV: rats received BLM in a dose as in group IIand captopril with a dose of 5 mg∕kg orally for 4 weeks, 2 days before BLM administration. Results: rats treated with BLM revealed disturbance of lung structure. There were marked cellular infiltration and thickening in alveolar septa with wide variation in the diameter of alveoli. Blood vesselswere congested. Extravasation of blood into interalveolar septa was observed. Large number of vacuolated cuboidal cells was noticed. Large amounts of collagen fibers around the bronchioles and few collagen fibers in the interalveolar septa were detected. Sections of rats treated with BLM and ERD showed apparently normal lung structure but, some collapsed alveoli with thick septa were still noticed. Sections treated with BLM and captopril showed lesser structural improvement than ERD-treated sections.Conclusion: administration of captopril and ERD partially improved BLM-induced pulmonary fibrosis in rats.

Multimodal Imaging Analyses of Brain Hippocampal Formation Reveal Reduced Cu and Lipid Content and Increased Lactate Content in Non-Insulin-Dependent Diabetic Mice.

Non-insulin-dependent diabetes mellitus (NIDDM) is reported to increase the risk of cognitive impairment and dementia. However, the underlying mechanisms are not fully understood. While the brain homeostasis of metals and lipids is pivotal to maintaining energy metabolism and redox homeostasis for healthy brain function, no studies have reported hippocampal metal and biochemical changes in NIDDM. Therefore, we here utilized direct spectroscopic imaging to reveal the elemental distribution within the hippocampal subregions of an established murine model of NIDDM, db/db mice. In 26-week-old insulin resistant db/db mice, X-ray fluorescence microscopy revealed that the Cu content within the dentate gyrus and CA3 was significantly greater than that of the age-matched nondiabetic control mice. In addition, Fourier transform infrared (FTIR) spectroscopy analysis indicated a significant increase in the abundance of lactate within the corpus callosum (CC), dentate gyrus, CA1, and CA3 regions of diabetic db/db mice compared to that of the control, indicating altered energy metabolism. FTIR analysis also showed a significant decrease in the level of lipid methylene and ester within the CC of db/db mice. Furthermore, immunomicroscopy analyses demonstrated the increase in the level of glial fibrillary acidic protein expression and peri-vascular extravasation of IgG, indicating astrogliosis and blood-brain barrier dysfunction, respectively. These data suggest that astrogliosis-induced alterations in the supply of Cu, lipids, and energy substrates may be involved in the mechanisms of NIDDM-associated cognitive decline.

Unicornual Uterine Twist in Non-Pregnant Bitch

Background: Uterine twisting in bitches is an uncommon disease in which the difficulty of diagnosis is due to nonspecific clinical signs. This condition is more commonly observed in pluriparous females and is usually associated with a pregnant uterus close to birth, or associated with hemometra, pyometra and neoplasms in non-pregnant bitches. This study reports a case of an 11-year-old Poodle bitch with a rare case of uterine twisting in a non-pregnant womb.Case: A 11-year-old Poodle dog, weighing 3.2 kg, was admitted at the institution with a history of anorexia, oligodipsia and apathy during one day. There was no information on the last phase of estrus or previous pregnancies. The patient arrived at the emergency room of the veterinary hospital with cardiorespiratory arrest and was resuscitated with mechanical ventilation, cardiac massage and administration of adrenaline (0.1 mg/kg IV, 1 mg/ml concentration), tramadol hydrochloride (2 mg/kg via IV) and oxygen therapy. Clinical examination revealed a distended and tense abdomen with a palpable mass in the mesogastric region. Ultrasound examination showed a heterogeneous structure (> 10cm. in diameter), with cavitary areas filled with heterogeneous anechoic content and septations, located between the liver and urinary bladder. It was not possible to identify in which organ or structure the mass originated, and the possibility of gestation and fetal death was discarded. The female died six hours after admission. The patient was submitted to necropsy and histopathological analysis revealed a dark red and enlarged segment of the uterine horn with a 360º twist, occupying most of the abdominal cavity. The left uterine horn was about 10 cm in diameter and firm, and cystic areas were observed on a reddish-black surface containing a large amount of bloody fluid. The right uterine horn was normal in appearance, but with a small amount of fluid, slightly viscous and translucent. The histopathological examination of the structure found in the left uterine horn showed areas of partially organized hematomas with red blood cells inside the vessels, without neoplastic or inflammatory cells. The definitive diagnosis was unilateral uterine twist, unrelated to the gestational or neoplastic process. Discussion: Uterine twist is an uncommon problem in most domestic species. The occurrence of this condition is higher in the gravid uterus, usually in pluriparous females at the end of gestation or delivery, or in non-pregnant bitches secondary to hemometra or pyometra. During uterine twist, occlusion of blood vessels occurs, with subsequent engorgement and vascular rupture, leading to intraluminal hemorrhage and tissue ischemia, which may lead to extravasation of blood into uterine lumen. Thus, the main suspect for the occurrence of unicornual twisting was hemometra in the left uterine horn, associated with relaxation of the uterine ligaments due to the advanced age of the patient. These factors may have favored abnormal mobility and the twist of the organ within the abdominal cavity, even in the absence of the most common predisposing factors, such as gestation and delivery. The rarity of the case is highlighted by the absence of a gestational process associated with the condition. In addition, due to the non-specific clinical signs, the difficulty in the accurate and immediate diagnosis was demonstrated, as well as the potential to cause a rapid clinical deterioration of the patient.

Lifesaving surgery for a ruptured invasive thymoma using the hemi-clamshell approach: a case report

BackgroundAmong anterior mediastinal tumors, a teratoma is known to rupture with growth, but there have been few previous reports about thymoma rupture. We here report a rare case of an invasive thymoma with intrapulmonary and intrathoracic rupture requiring emergency life-saving surgery. To our knowledge, this is the first such case in the literature.Case presentationA 56-year-old woman suddenly experienced right precordial pain and hemoptysis. Enhanced computed tomography revealed a large mediastinal tumor pressing against the pulmonary hilar vascularity, with extravasation of blood into the right lung. Tumor rupture into the lungs was suspected. Given the deterioration of her respiratory status and hemodynamics, thymomectomy with removal of the involved tissues was urgently performed using the hemi-clamshell approach and intrapericardial dissection, with veno-arterial extracorporeal membrane oxygenation on standby. She survived, and no recurrence has been noted for 2 years postoperatively.ConclusionsA large thymoma can suddenly rupture into the thorax, similar to the rupture of a teratoma. Additionally, in cases with hemoptysis, an appropriate procedure should be selected to reach both the pulmonary hilum and thorax for complete resection, as hemoptysis might suggest tumor invasion into the lungs.

Effects of exposure to gibberellic acid during pregnancy and lactation on the postnatal development of the renal cortex in the albino rat

Background Gibberellic acid (GA3) is one of the plant growth regulators that are widely used in Egypt, to increase the growth of fruits and vegetables. Little is known about the effects of GA3 on the mammalian tissues. Aim of the work This work was aimed to reveal the effects of exposure to GA3 during pregnancy and lactation on the postnatal development of the renal cortex in the albino rat. Materials and methods Forty pregnant females, weighing 200–300 g, were divided into two equal groups: group A (control) and group B (experimental). The pregnant rats of group B were given GA3 in a dose of 0.2 g/l of drinking water (equivalent to 55 mg/kg of body weight) from the 14th day of pregnancy until day 21 after delivery. The same dose of GA3 was given to the offsprings after weaning (day 21) till adulthood (3 months). The offsprings were sacrificed at the following ages: newborn, 10 days, and adult (3 months). Kidney specimens were processed for light microscopic examination, electron microscopic examination, and immunohistochemical study. In addition, morphometrical and statistical analysis of the renal cortical thickness was done. Results The renal glomeruli and the convoluted tubules showed degenerative changes in the three treated studied ages with delayed development of the glomeruli in addition to extravasation of blood and inflammatory cellular infiltration in the interstitial tissue. Conclusion and recommendation GA3 has harmful effects on the histological development of the renal cortex. So, it should be used cautionary.

Lichen planus-like keratosis: clinicopathological evaluation of 1366 cases.

Lichen planus-like keratosis (LPLK) is a frequent skin lesion usually biopsied to rule out basal cell carcinoma (BCC). Because of overlapping histopathological characteristics, LPLK is frequently muddled with lichen planus (LP), lichenoid actinic keratosis (LAK), and lupus erythematosus (LE). To investigate the clinical and histopathological characteristics of LPLK. A clinicopathologic review was performed of all LPLK cases (1366) signed in one calendar year in a busy academic practice. LPLK occurs mostly as a single lesion (97%) with the chest (41.4%) being the most common site. It is almost equally present in women and men (51.5%-48.5%). The most common clinical concern (65%) is basal cell carcinoma. Parakeratosis, red blood extravasation, and presence of dermal eosinophils and plasma cells, usually not seen in lichen planus, are helpful signs to suggest LPLK but are seen only in a minority of cases. Clinicopathologic correlation is necessary to diagnose lichen planus-like keratosis, as the most consistent feature is a clinical history of a lesion/neoplastic process rather than an inflammatory process. There are histopathologic features that can help distinguish lichen planus-like keratosis from lichen planus; however, these features are nonspecific and lacking in almost half of the cases.

Laporan Kasus: Tatalaksana Hematoma Akibat Trauma

Hematoma is a large collection of extravasation of blood due to trauma, causing a palpable mass. The cause of hematoma is usually due to trauma or due to a systemic bleeding disorder. The differential diagnosis of this lesion is ecchymosis and hemangioma. A strong examination and history are needed to determine the diagnosis. Hematomas usually do not require treatment because of self-limiting. A 19-year-old woman came for control after 1 week of cleaning tartar/scaling. There was a swelling that the patient does not realize is under the dark red tongue with a size of ± 2mm. The patient had no history of systemic disease. OHI-S is good and other objective examinations are within normal limits. Therapy was given in the form of dental health education and evaluation of lesions for ± 1 week. Hematomas were generally caused by trauma resulting in extravasation of blood to the tissues that affect the underlying blood vessels. Hematoma could disappear spontaneously so there is no need for treatment.

Hemosuccus Pancreaticus in a Patient With Pancreatic Neuroendocrine Tumor

Hemosuccus pancreaticus is a rare cause of gastrointestinal bleeding, which is most commonly caused by splenic artery pseudoaneurysm secondary to chronic pancreatitis. It can also be seen with pancreatic malignancies. Though often severe, the bleeding is typically intermittent, which makes it challenging to diagnose. A 71-year-old female with pancreatic neuroendocrine tumor presented with a 3-month history of obscure gastrointestinal bleeding. Previous endoscopic studies did not identify a source of bleeding. On presentation, she was experiencing intermittent episodes of hematochezia and melena, though she remained hemodynamically stable. Physical examination was normal. Laboratory testing revealed hemoglobin 7.3 (normal, 12.0-15.5 g/dL), platelets 212 x 109/L (normal, 150-450 x 109/L), and international normalized ratio 1.0. She underwent CT angiography which was negative for active small bowel hemorrhage, but did show extensive tumoral involvement of the pancreas with extension near the ampulla with multiple regional small arteries. Given the CT findings and recurrent nature of her bleed, she underwent EGD with endoscopic ultrasound, which demonstrated active blood extravasation from the Ampulla of Vater, consistent with hemosuccus pancreaticus. Our patient underwent mesenteric arteriogram with embolization of the gastroduodenal, dorsal pancreatic, and inferior pancreaticoduodenal arteries. Following this, her hemoglobin improved, and she has had no further bleeding. Hemosuccus pancreaticus is extremely rare, and is described by hemorrhage from the Ampulla of Vater through the pancreatic duct.1 In clinical practice, it remains a diagnostic challenge, and can sometimes be identified by angiography or upper gastrointestinal endoscopy. If found, bleeding is typically treated with percutaneous angiographic embolization. Anecdotally, hemosuccus pancreaticus carries a high risk of mortality if left untreated.1993_A Figure 1. EGD-obtained image showing blood extravasation from the Ampulla of Vater (white arrow) within the second portion of the duodenum.1993_B Figure 2. CTA scan of the abdomen with oral and IV contrast using triphase enterography protocol showing protrusion of the pancreatic tumor into the second portion of the duodenum (yellow arrow) with small arteries surrounding the tumor (red circle).

Hemosuccus Pancreaticus: Side-Viewing Endoscopic Diagnosis of a Rare but Fatal Cause of Gastrointestinal Hemorrhage

Hemosuccus pancreaticus (HP) is an extremely rare disease that is usually defined as bleeding in the pancreatic duct. Although it is infrequent, HP can lead to massive gastrointestinal bleeding, which is potentially life threatening. 70-year-old male with a history of chronic alcohol abuse, chronic pancreatitis and UGIB presented with melena. Initial physical examination was unremarkable and vitals were stable. Laboratory studies were significant for hemoglobin of 8.7 g/dL. Endoscopy was insignificant. Patient had repeat episode of melena but repeat endoscopy was again insignificant for cause of bleed. After 3 days, LFT's increased: possibly from drug-induced liver injury or obstructing lesion. CT scan showed a large 4.2x2.9 cm pseudoaneurysm in the head of the pancreas possibly from gastroduodenal artery. Interventional radiology (IR) performed coil embolization, but follow-up ultrasound showed vascular mass enlarged to 5.6x5.8cm. Patient reported melena again and dark blood noted on rectal examination. CT angiography also could not identify the cause of his bleeding. The patient underwent repeat endoscopy with side-viewing scope, Blood extravasation was noted from the ampulla consistent with HP (Figure 1A,B,C). Patient continued to have intermittent bleeding requiring transfusions. After discussion with IR, decision was made to attempt repeat embolization, but the patient clinically worsened and passed away. Although HP is a rare cause of gastrointestinal hemorrhage, it is very important to include it in the differential in patients with history of chronic pancreatitis. HP frequently occurs as a complication of pancreatitis with rupture of a visceral artery aneurysm, but can be caused by trauma, neoplasms, or iatrogenic causes. [1,2] Although CT angiography is the gold standard, it can fail to diagnose HP. In terms of management, surgery or endovascular therapy by interventional radiology showed promising outcomes. [3] In this case, repeated attempt with endoscopy and CT angiography could not identify the HP lesion, which was subsequently successfully detected utilizing a side-viewing endoscope.1378_A.tif Figure 1: No Caption available.1378_B.tif Figure 2: No Caption available.1378_C.tif Figure 3: Repeat endoscopy using side-viewing endoscope showing blood extravasation from ampulla in the duodenum consistent with hemosuccus pancreaticus.

Innovations in molecular biology and proteomics adapted to in vivo peptide phage display define active protein domains as biomarkers in multiple sclerosis neuroinflammation

With the double goal to streamline biomarker discovery of Multiple Sclerosis neuroinflammatory pathology entangled by non-affected Central Nervous System tissue and to better characterize the complex molecular interactions at the altered blood brain barrier (BBB) that becomes permissive to extravasation of blood derived immune cells and compounds, we choose to identify peptide ligands reacting with inflammatory CNS lesions. With no “a-priori” for targets by applying in vivo the phage displayed 12aa peptide screening in CNS neuroinflammation of the experimental autoimmune encephalomyelitis (EAE) rat model of MS and healthy controls, we generated two complex phage displayed peptide repertoires. By developing molecular DNA subtraction of both phage repertoires we generated a subtraction phage repertoire of EAE specific peptides. In a bioinformatics approach aligning the 270,612 EAE peptides to the human proteome the formed peptide clusters allowed the ranking of proteins being potential “mimicked” indicators of functional protein interactions. Experimentally, among the most high score mimicked proteins, derived synthesized short peptides (22aa) of mimicked domains were tested for labeling of BBB alterations in CNS sections of MS and other chronic neurodegenerative diseases. In vitro studies using the BBB model hCMEC/D3 confirmed their binding to human endothelial cells under proinflammatory stimulation. Finally, with a derived peptide covalently linked to a nanocarrier contrast agent, we could target in vivo and monitor by MRI, experimentally induced inflammatory CNS lesions. Our strategy of combining the developed molecular biology and bioinformatics approaches adapted to phage display is applicable to many disease models to identify biomarkers and functional proteins/domains.

Successful treatment of a patient with herbal drug-induced immune thrombocytopenic purpura using freshly donated blood

BackgroundDrug-induced thrombocytopenia (DITP), which also includes thrombocytopenia induced by beverages, foods, and herbal remedies, is an important clinical problem for haematologists. Drug-induced thrombocytopenia is often misdiagnosed as immune thrombocytopenic purpura with resulting inappropriate treatment. Immune thrombocytopenic purpura (ITP) is a clinical disorder that leads to easy bruising (purpura), excessive bleeding or extravasation of blood from capillaries into skin and mucous membranes (petechiae). The bleeding tendency is due to decreased number of circulating platelets (thrombocytopenia). There is production of antibodies against the platelets by the patient’s immune system. This case report was conducted to introduce the effectiveness of freshly donated blood and steroids on patients with immune thrombocytopenic purpura (ITP) after ingestion of herbal drugs.Case descriptionDT was a 30-year old female who presented with bleeding per vagina, gum bleeding and weakness. The patient did not have any systemic disease that would cause any spontaneous hemorrhage. The patient was referred to a hematologist urgently and her thrombocyte count was found to be 2000/ìL. Other test results were in normal range. Full blood count revealed severe thrombocytopenia. Freshly donated whole blood was given to the patient and then the changes in her general condition were analyzed, as well as the blood test results.ConclusionIn the absence of platelet concentrate especially in rural settings and resource-poor countries, freshly donated whole blood can be used in the management of a case of severe thrombocytopenia from ITP.

Inflammation: a highly conserved, Janus-like phenomenon-a gastroenterologist' perspective.

Inflammation is the result of the loss of host's resilience towards the surrounding world. At gross tissue level, inflammation coincides with fluid leakage from vessels, swelling, and blood stasis and extravasation of mononuclear/macrophage cells. Biochemically, these events lead to anoxia and dramatic changes: interruption of the mitochondrial oxidative phosphorylation, influx of the M1 macrophage subset, which live on anaerobic glycolysis. Fall of ATP then leads to energy shortage and debt. In their chronic forms, these phenomena are now known to mark a number of degenerative disorders that have invaded the Western World since the last century: Parkinson's disease, Alzheimer's syndromes, rheumatic diseases, metabolic diseases. Intriguingly, these affections seem to derive from the gut, along two possible pathways. A sort of ascending loss of function caused by accumulation of (and hyperreactivity to) proteins released to restrain spread of enteric viruses: the alpha-synucleins, now increasingly spotted in relation to Parkinson's pathogenesis. The second pathway would entail the intellectual decline perhaps brought about by large use of food containing the proteins of red processed meat. The bacterium Bilophila wadsworthia, thriving in this meat, can erode the mucus layer on colon surfaces, allowing further bacterial flora to approach lining cells, so upgrading the alarm state. We discuss two strategies to prevent such instability from ending up to full-blown inflammatory bowel disease: physical exercise and systematic switch to fibre-containing diets.

Rho Guanine Nucleotide Exchange Factor ARHGEF17 Is a Risk Gene for Intracranial Aneurysms.

Intracranial aneurysm (IA) is usually a late-onset disease, affecting 1% to 3% of the general population and leading to life-threatening subarachnoid hemorrhage. Genetic susceptibility has been implicated in IAs, but the causative genes remain elusive. We performed next-generation sequencing in a discovery cohort of 20 Chinese IA patients. Bioinformatics filters were exploited to search for candidate deleterious variants with rare and low allele frequency. We further examined the candidate variants in a multiethnic sample collection of 86 whole exome sequenced unsolved familial IA cases from 3 previously published studies. We identified that the low-frequency variant c.4394C>A_p.Ala1465Asp (rs2298808) of ARHGEF17 was significantly associated with IA in our Chinese discovery cohort (P=7.3×10-4; odds ratio=7.34). It was subsequently replicated in Japanese familial IA patients (P=0.039; odds ratio=4.00; 95% confidence interval=0.832-14.8) and was associated with IA in the large Chinese sample collection comprising 832 sporadic IA-affected and 599 control individuals (P=0.041; odds ratio=1.51; 95% confidence interval=1.02-Inf). When combining the sequencing data of all familial IA patients from 4 different ethnicities (ie, Chinese, Japanese, European American, and French-Canadian), we identified a significantly increased mutation burden for ARHGEF17 (21/106 versus 11/306; P=8.1×10-7; odds ratio=6.6; 95% confidence interval=2.9-15.8) in cases as compared with controls. In zebrafish, arhgef17 was highly expressed in the brain blood vessel. arhgef17 knockdown caused blood extravasation in the brain region. Endothelial lesions were identified exclusively on cerebral blood vessels in the arhgef17-deficient zebrafish. Our results provide compelling evidence that ARHGEF17 is a risk gene for IA.

Efficacy Of First Time Furosemide Use In Thoroughbred Racehorses In Brazil

Racehorses are commonly affected by a condition known as Exercise Induced Pulmonary Haemorrhage (EIPH) which consists of rupture of alveolar membranes and extravasation of blood into the airways. EIPH is considered to negatively affect racehorse performance and there is no current treatment. In order to reduce the amount of bleeding the diuretic furosemide has been used prior to exercise and competition in some racing jurisdictions. Efficacy of furosemide in reducing EIPH is documented in this research through endoscopic observation of the airways of horses positive for EIPH in two consecutive races.

Sa1270 AN UNUSUAL CAUSE OF OVERT, OBSCURE GI BLEED: A REMINDER TO THINK OUTSIDE THE BOX (OR LUMEN)

A 64-year-old man with a history of clinically diagnosed hereditary hemorrhagic tenalgiectasias (HHT) presented with one year of recurrent hematochezia requiring transfusion of a total of over 130 units of RBCs. Workup included multiple prior upper endoscopies, colonoscopies, capsule endoscopy and two double balloon enteroscopies (DBE) with findings of several small non-bleeding arteriovenous malformations that were treated with argon plasma coagulation but no lesion to explain the severity of his bleeding episodes. He presented with another episode of overt bleeding which resulted in hypotension and severe anemia with a hemoglobin of 5.4 g/dL. At that time he complained of sharp abdominal pain that often preceded the episodes of bleeding. Lipase was elevated at 318 U/L. Both upper endoscopy and capsule endoscopy were unremarkable. CT angiogram (CTA) showed extravasation of blood into the duodenum but no clear source for embolization. Inpatient DBE showed blood extruding from the ampulla. This prompted a hepatic arteriogram, which showed diffusely abnormal visceral arteries with a severe beaded appearance, and multiple arterial aneurysms including a 9x6 mm pseudoaneurysm of the gastroduodenal artery (GDA) that was embolized. Following embolization, the bleeding ceased and the patient was discharged shortly thereafter. On follow up over a year later, the patient has had no recurrent GI bleeding. The findings of abnormal vasculature seen on CTA brought the diagnosis of HHT into question, and subsequent genetic testing for HHT was negative. He is currently being worked up for other systemic vascular diseases that could account for his abnormal beaded vasculature with diffuse aneurysms, with particular concern for vascular Ehlers-Danlos syndrome. Hemosuccus pancreaticus, defined as bleeding from the pancreatic duct, is a rare cause of GI bleeding that is most often caused by communication of a splanchnic artery pseudoaneurysm with the pancreatic duct, either by erosion or fistula formation. Pseudoaneurysms occur as a result of vascular injuries or erosions such as in trauma or inflammation. They often form as a result of pancreatitis but have been reported to occur secondary to congenital vascular abnormalities. GDA pseudoaneurysm is a very rare entity, representing only 1.5% of visceral artery aneurysms. This case of a patient with recurrent obscure, overt GI bleeding ultimately found to be secondary to a GDA pseudoaneurysm, caused by either pancreatitis or possibly a rare vascular abnormality, illustrates the importance of maintaining a broad differential diagnosis in cases of obscure GI bleeding. Though small bowel hemorrhage is the source of bleeding in the majority of cases of obscure GI bleeding, it is essential to consider extra-luminal etiologies in order to prevent a significant delay in diagnosis and treatment.Blood extruding from the ampulla visualized on double balloon enteroscopyView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Assessment of a topical product based on a mixture of polysulfated galactosaminoglycan in the topical treatment of postoperative blood extravasation (ecchymosis-hematoma) in phlebology.

The onset of bruising in surgery is a frequent event that can be a source of complications and delays in the patient's healing process (pigmentations, fibrosis, etc.). Having the help of an effective topical product that speeds up the resorption of blood extravasation can be an advantage in phlebological surgery and surgery in general. Twenty-three patients both male and female (age range: 30-72 years) were enrolled. Twenty-two of them completed the study, all underwent venous surgery of the lower extremities (invagination stripping of the internal or external saphenous and Muller's ambulatory phlebectomy). The 22 patients were divided into 2 groups of 11 each and in a single blind study received topical daily therapy (every 12 hours) either in the form of a medication cream (active ingredient), or a placebo cream. All patients wore compression one-leg tights immediately after surgery, following measurement of the lower limb (Struva® 35 mmHg, Medi Italia, Zola Predosa, Bologna, Italy). The 30-day observational study was carried out using a standard photographic survey procedure. The topical application of polysulfated galactosaminoglycan showed a significantly higher rate of resorption of blood extravasations than in patients in the single blind study receiving topical therapy with the placebo (Fisher's Exact Test, dichotomous variable outcome, N.=22, with result P=0.0001<0.05). Topical therapy with a mixture of polysulfated galactosaminoglycans provides valid protection in the therapy of blood extravasations in phlebology and general surgery.

Aortic Aneurysm Eroding into the Spine.

Aortic aneurysms are usually asymptomatic until catastrophic rupture occurs. Ruptured abdominal aortic aneurysms classically present with acute back pain, shock, and a pulsatile abdominal mass. The natural history of some aortic aneurysms also includes a stage of contained rupture. This occurs when extravasation of blood from the ruptured aneurysm is contained by surrounding tissues. Here, the authors report the case of a chronic contained abdominal aortic aneurysm rupture that resulted in erosion of the spine.

Overview of Intracerebral Hemorrhage

Stroke is categorized into two major subtypes i.e., ischemic and hemorrhagic and is one of the major causes of morbidity and mortality worldwide. Primary intracerebral hemorrhage (ICH), i.e. spontaneous extravasation of blood into the brain parenchyma, begins very suddenly and is a medical catastrophe. The well-known risk factors for ICH are hypertension, heavy drinking of alcohol, and anticoagulant medication. Risk factors for early death include clinical and radiological severity of the bleeding. Moreover, intraventricular bleeding, use of anticoagulants, and high blood pressure on admission also predict early death after ICH. CT brain imaging is the immediate modality for establishing diagnosis and supplemented with MR imaging depending upon aetiology. Treatment of patients with ICH includes standard supportive care, medical management and surgical intervention.