Coagulation Therapy Research Articles

Simultaneous treatment of trauma patients in a dual room trauma suite with integrated movable sliding gantry CT system: an observational study

The trauma center of the University Hospital Wuerzburg has developed an advanced trauma pathway based on a dual-room trauma suite with an integrated movable sliding gantry CT-system. This enables simultaneous CT-diagnostics and treatment of two trauma patients. The focus of this study was to investigate the quality of the concept based on defined outcome criteria in this specific setting (time from arrival to initiation of CT scan: tCT; time from arrival to initiation of emergency surgery: tES). We analyzed all trauma patients admitted to the hospital’s trauma suite from 1st May 2019 through 29th April 2020. Two subgroups were defined: trauma patients, who were treated without a second trauma patient present (group 1) and patients, who were treated simultaneously with another trauma patient (group 2). Simultaneous treatment was defined as parallel arrival within a period of 20 min. Of 423 included trauma patients, 46 patients (10.9%) were treated simultaneously. Car accidents were the predominant trauma mechanism in this group (19.6% vs. 47.8%, p < 0.05). Prehospital life-saving procedures were performed with comparable frequency in both groups (intubation 43.5% vs. 39%, p = 0.572); pleural drainage 3.2% vs. 2.2%, p = 0.708; cardiopulmonary resuscitation 5% vs. 2.2%, p = 0.387). At hospital admission, patients in group 2 suffered significantly more pain (E-problem according to Advanced Trauma Life Support principles©; 29.2% vs. 45.7%, p < 0.05). There were no significant differences in the clinical treatment (emergency procedures, vasopressor and coagulant therapy, and transfusion of red blood cells). tCT was 6 (4–10) minutes (median and IQR) in group 1 and 8 (5–15.5) minutes in group 2 (p = 0.280). tES was 90 (78–106) minutes in group 1 and 99 (97–108) minutes in group 2 (p = 0.081). The simultaneous treatment of two trauma patients in a dual-room trauma suite with an integrated movable sliding gantry CT-system requires a medical, organizational, and technical concept adapted to this special setting. Despite the oftentimes serious and life-threatening injuries, optimal diagnostic and therapeutic procedures can be guaranteed for two simultaneous trauma patients at an individual medical level in consistent quality.

Postoperative Outcomes in Patients with Facial Vascular Malformation Regarding Quality of Scar, Satisfaction, and Quality of Life

Background: Both purse-string sutures for surgical skin lesions and laser coagulation therapy are widely used to treat facial vascular malformations. The ultimate goal of using such treatments is to improve the appearance of these lesions and the patient's long-term satisfaction and quality of life. Objectives: Our study aimed to address the outcome of different therapeutic procedures in patients suffering from facial vascular malformations regarding long-term satisfaction, quality of scars, and quality of life. Methods: This self-control before-after interventional case series study was conducted on 60 consecutive patients with congenital vascular lesions. Patients were treated with purse-string methods along with coagulation, excision, and graft and ablation catheter. Before surgery and at intervals of one week, three weeks, six weeks, three months, and six months after surgery, the subjects were evaluated in terms of satisfaction, quality of scars, procedural outcomes, and quality of life. Results: There were significant changes in patients' satisfaction, quality of the scar, procedural outcomes based on the patient-reported outcome measures, and quality of life within six months after interventions. The improvement of the lesions was independent of gender, age, size, and the location of lesions. Conclusions: Regardless of the therapeutic approaches, significant improvements in postoperative outcomes concerning patients' satisfaction, quality of the scar, daily activities, and quality of life are expected in patients suffering from facial vascular malformations.

Prophylactic administration of tranexamic acid combined with thromboelastography-guided hemostatic algorithm reduces allogeneic transfusion requirements during pediatric resective epilepsy surgery: A randomized controlled trial.

Background: Intraoperative bleeding and allogeneic transfusion remain common problems in pediatric resective epilepsy surgery. Tranexamic acid (TXA) is a widely recommended antifibrinolytic drug that reduces blood loss and transfusion requirements for bleeding patients. Thromboelastography (TEG)-guided hemostatic algorithm is commonly used in bleeding management. This trial was designed to validate the efficacy of a multimodal coagulation therapy involving continuous TXA infusion with TEG-guided hemostatic algorithm in reducing allogeneic exposure risk in pediatric resective epilepsy surgery. Methods: Eighty-three children undergoing resective epilepsy surgery were randomized into a treatment group (Group T; n = 42) and a control group (Group C; n = 41). Group T received prophylactic TXA (10 mg/kg followed by 5 mg/kg/h) with TEG-guided hemostatic algorithm, whereas Group C received conventional coagulation management. The primary outcome was allogeneic transfusion rate during surgery, and the secondary outcomes were intraoperative blood loss, incidence of postoperative seizures, and thromboembolic events during hospitalization. Results: The incidence of intraoperative allogeneic transfusion reduced by 34.7% with the use of a multimodal coagulation therapy (19.0% in Group T vs. 53.7% in Group C; RR 0.355, 95% CI 0.179–0.704; p = 0.001). This was mainly triggered by a significant reduction (44.1%) in intraoperative plasma transfusion (7.1% in Group T vs. 51.2% in Group C; RR 0.139, 95% CI 0.045–0.432; p = 0.000). The risk of intraoperative RBC transfusion was lower in Group T than in Group C, but the difference was not statistically significant (14.3% in Group T vs. 29.3% in Group C; RR 0.488, 95% CI 0.202–1.177; p = 0.098). No platelets were transfused in both groups. Further, 19 (45.2%) patients in Group T received fibrinogen concentrates guided by TEG data, whereas 1 (2.4%) patient in Group C received fibrinogen concentrates empirically. There were no significant differences in estimated blood loss and postoperative seizures between the two groups, and no thromboembolic events were observed after surgery. Conclusion: Prophylactic administration of TXA combined with TEG-guided hemostatic algorithm can be an effective multimodal coagulation strategy for reducing allogeneic transfusion requirements during pediatric resective epilepsy surgery. Clinical Trial Registration: www.chictr.org.cn/index.aspx, identifier ChiCTR1800016188.

Congenital hydrocephalus in a trisomy 9p gained child: a case report

BackgroundHydrocephalus caused by excessive liquor production due to choroid plexus hyperplasia is a rare condition that may necessitate unusual treatment paradigms. It can be seen in trisomy 9p where coexisting congenital heart disease additionally may complicate the therapeutic approach as illustrated in the current case report.Case presentationAt 20 months of age, a Caucasian girl with trisomy 9 and family history of an older brother and twin sister having the same syndrome displayed sign of congenital hydrocephalus due to increasing head circumference. Magnetic resonance imaging revealed enlarged lateral ventricles and a prominent choroid plexus, and the girl was treated with a ventriculoperitoneal shunt, which 2 days later had to be replaced with a ventriculoatrial shunt as cerebrospinal fluid formation greatly exceeded the ability of the patient’s abdominal absorptive capability. At 16 years of age, the patient was diagnosed with cardiomyopathy and diminished ejection fraction. Some months later, she was admitted to the neurosurgical ward showing signs of shunt dysfunction due to a colloid cyst in the third ventricle. Cystic drainage through endoscopic puncture only helped temporarily. Revision of the shunt system showed occlusion of the ventricular drain, and replacement was merely temporary alleviating. Intracerebral pressure was significantly increased at around 30 mmHg, prompting externalization of the drain, and measurements revealed high cerebrospinal fluid production of 60–100 ml liquor per hour. Thus, endoscopic choroid plexus coagulation was performed bilaterally leading to an immediate decrease of daily cerebrospinal fluid formation to 20–30 ml liquor per hour, and these values where stabilized by pharmaceutical treatment with acetazolamide 100 mg/kg/day and furosemide 1 mg/kg/day. Subsequently a ventriculoperitoneal shunt was placed. Follow-up after 1 and 2 months displayed no signs of hydrocephalus or ascites.ConclusionsHigh cerebrospinal fluid volume load and coexisting heart disease in children with trisomy 9p may call for endoscopic choroid plexus coagulation and pharmacological therapy to diminish the daily cerebrospinal fluid production to volumes that allow proper ventriculoperitoneal shunting.

Electrolysis Using Carbon Electrodes to Treat Textile Wastewater for Chemical Oxygen Demand, Turbidity and Colour

Large amounts of wastewater comprising stubborn dyes and other textile processing chemicals are often produced by textile factories. It has been shown that the effluents emitted from these enterprises have a significant pollution load (high dissolved solids, COD, color, and chloride content) and are not easily biodegradable. As a result, discharging untreated textile effluent has serious environmental consequences. Historically, biological procedures, adsorption, the membrane process, and chemical coagulation have all been utilized to treat actual textile effluent. It has become more difficult to use conventional technologies to treat high-strength and complicated textile effluent. The idea, history, and several industrial uses of electro coagulation therapy, including optimization, modeling, combination composition, and comparisons to other treatment methods, are described and discussed in detail in this paper.

Retinopathy of Prematurity - Update on Classification, Screening, and Therapy

Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness. This proliferative retinal vascular disease affects only prematurely born infants. Major risk factors include low gestational age and prolonged postnatal oxygen supplementation. ROP screening allows for timely identification of treatment-requiring infants and thus significantly reduces the risk of severe visual impairment and blindness from ROP. Current treatment options comprise retinal laser coagulation and intravitreal anti-vascular endothelial growth factor (VEGF) therapy. We provide a review of scientific data and current treatment recommendations, with special attention to the updated German guideline on ROP screening, the statement of the German ophthalmological societies on anti-VEGF therapy of ROP, and the new third edition of the International Classification of Retinopathy of Prematurity (ICROP3).

Therapeutics in Radiation-induced Proctopathy: A Systematic Review

AbstractMalignant neoplasms are increasingly prevalent in the daily clinical practice. Up to 61% of patients with pelvic malignancies undergo pelvic radiotherapy in different doses, which may cause intestinal damage, and the rectum is the segment most frequently affected due to its fixed position in the pelvis. Currently, there are several strategies to minimize the effects of radiation on the tissues surrounding the neoplastic site; despite those strategies, radiotherapy can still result in serious damage to organs and structures, and these injuries accompany patients throughout their lives. One of the most common damages resulting from pelvic radiotherapy is acute proctitis.The diagnosis is confirmed by visualizing the rectal mucosa through rigid or flexible rectosigmoidoscopy and colonoscopy. The objective of the present study was to review the forms of radiation-induced proctopathytherapy, and to evaluate the results of each method to propose a standardization for the treatment of this pathology. Despite the prevalence of radiation-induced proctopathy, there is no definitive standardized treatment strategy so far. The first approach can be tried with local agents, such as mesalazine and formalin. For refractory cases, control can usually be achieved with argon plasma coagulation, hyperbaric oxygen, and radiofrequency ablation therapies. Regarding the study of radiation-induced proctopathy, there is a lack of robust studies with large samples and standardized therapies to be compared. There is a lack of double-blinded, randomized controlled studies to determine a definitive standard treatment algorithm.

Placental Giant Chorangioma: A Rare Case Report with Favorable Outcome

Chorangiomas are benign non trophoblastic vascular neoplasm arising from primitive chorionic mesenchyme. It isthe most frequent placental tumor occurring in 1% of pregnancies. Giant chorangioma(&gt;5 cms) exemplifies adversefetal and maternal outcomes. Chorangiomas need to be differentiated from chorangiosis, chorangiomatosis,inflammatory myofibroblastic tumor, leiomyomas, placental infarcts and chorangiocarcinomas. USG is thegold standard for diagnosis of chorangioma. Color Doppler is benificial in differentiation of chorangioma fromdegenerated uterine leiomyoma or associated other placental tumors. Therapeutic interventions of chorangiomais controversial like draining excessive amniotic fluid or surgical intervention like laser coagulation and interstitiallaser therapy. All placentas need to be examined histopathologically for confirmation of diagnosis and todifferentiate from other tumors.

Percutaneous Microwave Coagulation Therapy: A Promising Therapeutic Method for Breaking the Barrier of the Intertumor Heterogeneity.

Intertumor heterogeneity is common in various cancers and has been widely accepted as the primary cause of the diversity and variation of the effect of the same treatment on patients with the same type of tumor. Percutaneous microwave coagulation therapy (PMCT) is a minimally invasive and effective approach for destroying tumors by microwave beam under image guidance, which has been applied in lung cancer. However, no previous study has investigated the capability of PMCT solving intertumor heterogeneity. Here, we performed a component analysis of four lung cancer patients' tumor microenvironment (TME) via single-cell RNA sequencing (scRNA-seq) and treated all four cases with PMCT. One patient's TME could be classified into a hot tumor, mainly proinflammatory cytokines, and T cell infiltration. The other three patients' TMEs were cold tumors, where immunosuppressive cells occupied a large proportion, including tumor-associated macrophages and cancer cells. Despite a high level of heterogeneity among their tumor microenvironment compositions, disease type and stage, and basic physical conditions, all four patients presented a stable disease (SD) without any cancer cell detected in the TME of cancer tissues after PMCT. In conclusion, this report uniquely contributed to the knowledge of the PMCT adaptation to tumor heterogeneity. Therefore, PMCT is promising to demonstrate a stable and robust antitumor efficacy in unresectable lung cancers with various TMEs.

A case of Epstein Barr virus-associated primary squamous cell carcinoma of stomach

BackgroundPrimary squamous cell carcinoma (SCC) of stomach is extremely rare. The pathogenesis of SCC of stomach remains unclear. There is only one report that Epstein Barr virus (EBV) infection may be involved in the pathogenesis of SCC arising in the stomach ever before. Here, we report a case of Epstein Barr virus infection-associated primary SCC of stomach in a 70-year-old woman. She was presented to the referring hospital with hematemesis. Initial endoscopy revealed a bleeding gastric ulcer in the upper part of gastric corpus and the coagulation therapy was followed. After a 3-month follow-up, endoscopy revealed a submucosal tumor-like protrusion instead of an ulcer. Computed tomography revealed a mass in the upper part of stomach and swollen lymph nodes along with the lesser curvature and para-aortic lymph node. Biopsy could not confirm the definitive diagnosis. We performed total gastrectomy with para-aortic lymph node sampling. Histological analysis revealed squamous cell carcinoma with EBV infection with lymph node metastases. Tumor cells were positive for EBV-encoded small RNA (EBER) by in situ hybridization. The postoperative course was uneventful and the patient was discharged on day 11 after the operation. CapeOX was started as adjuvant chemotherapy, and the patient remains alive without recurrence 7 months after surgery.ConclusionThis is the first case report of EBV infection-associated primary SCC of the stomach diagnosed by in situ hybridization of EBER. EBV infection may be related to the pathogenesis of primary SCC. Further evidence and studies are required to establish optimal strategy for this rare disease.

Thiol Isomerase Activity of β3 Integrin Psi Domain and L33P Polymorphism: Implications in Blood Coagulation and Anti-Thrombotic Therapy

Background: Integrins are α and β subunit heterodimeric receptors expressed ubiquitously on metazoan cells that play key roles in cell adhesion, movement, and signaling. The αIIbβ3 integrin on platelets is essential for thrombosis and hemostasis through its binding of fibrinogen and other ligands to mediate platelet adhesion and aggregation. The plexin-semaphorin-integrin (PSI) domain is an approximately 54 amino acid sequence at the N-terminus of the β3 subunit located in close proximity to the “knee” region. Our lab recently discovered that two “CXXC” motifs within PSI domains in the integrin family exert endogenous thiol isomerase activity, and blockade of this activity in β3 integrin with our novel anti-PSI domain monoclonal antibodies (mAbs) significantly attenuated platelet adhesion and aggregation without impairing hemostasis (Blood, 2017). Interestingly, intravital microscopy studies demonstrate that our anti-PSI antibodies inhibited thrombosis in vivo 10-30 fold more potent than their effects in vitro under anti-coagulant conditions, suggesting a possible inhibitory effect on blood coagulation. Notably, A L33P polymorphism (HPA-1b) within the β3 integrin PSI domain is linked to an approximately two-fold increased risk for cardiovascular disease (CVD), however, the underlying mechanism for this remains unclear.Methods/Results: To investigate the role of PSI domain in blood coagulation, we first employed thromboelastography (TEG) to compare our anti-PSI domain mAbs with other anti-β3 mAbs that do not directly bind to β3 PSI domain. Results show that anti-PSI domain mAbs inhibited blood coagulation in human and murine whole blood or platelet-rich plasma (PRP) significantly more than anti-αIIbβ3 antibodies JAN-D1, M1, and Abciximab precursor 7E3. To address whether the L33P polymorphism affects PSI domains thiol isomerase activity, we generated L33P PSI domain via site-directed mutagenesis in E. coli. Using a scrambled RNase assay, we found that L33P polymorphism enhanced thiol-isomerase activity relative to WT PSI domain. We further corroborated these findings through an insulin β chain reduction assay, and a MPB (N-Maleimidopropionyl-biocytin) western blot assay, which quantifies thiol isomerase activity through MPB binding to free thiols that have not been oxidized into RNase. Interestingly, TEG results show that recombinant human PSI domain enhanced blood coagulation in platelet-microparticle (PMP) free plasma, which was generated through high-speed centrifugation (17,000 x g) of platelet poor plasma (PPP)for 15 minutes that removed residual platelets and microparticles .Conclusion: We have discovered a novel role of integrin β3 PSI domain in blood coagulation, which is enhanced by the L33P polymorphism (HPA-1b). These data highlight the β3 PSI domain as a suitable therapeutic target for its roles in both platelet adhesion/aggregation, and blood coagulation. Furthermore, these data may explain the increased risk of CVD such as myocardial infarction and deep vein thrombosis for individuals with the L33P polymorphism. DisclosuresNo relevant conflicts of interest to declare.

Effect of Severity of Liver Cirrhosis on Surgical Outcomes of Hepatocellular Carcinoma After Liver Resection and Microwave Coagulation.

BackgroundLiver resection (LR) and percutaneous microwave coagulation therapy (PMCT) are both considered as radical treatments for small hepatocellular carcinoma (HCC). However, it is still unclear whether to select LR or PMCT in HCC patients with different degrees of liver cirrhosis. The purpose of this study was to compare the efficacy of LR and PMCT in the treatment of solitary and small HCC accompanied with different degrees of liver cirrhosis.MethodsIn this study, 230 patients with solitary HCC lesions ≤ 3 cm and Child-Pugh A liver function were retrospectively reviewed. Among these patients, 122 patients underwent LR, and 108 received PMCT. The short- and long-term outcomes were compared between these two procedures. Severity of liver cirrhosis was evaluated by using clinical scoring system (CSS) as previously published. Subgroup analysis based on CSS was performed to evaluate the effect of severity of liver cirrhosis on surgical outcomes after LR and PMCT.ResultsThere was no mortality within 90 days in both groups. Major complications were significantly more frequent in the LR group than in the PMCT group (18.8% vs. 4.6%, p<0.001). However, LR provided better surgical outcomes than PMCT. The 5-year overall survival (OS) rates for the LR and PMCT groups were 65.2% and 42%, respectively (p=0.006), and the corresponding disease-free survival (DFS) rates were 51.7% and 31.5%, respectively (p=0.004). Nevertheless, subgroup analysis showed that PMCT provided long-term outcomes that were similar to LR and lower surgical complications in HCC patients with CSS score≥4.ConclusionsLR may provide better OS and DFS rates than PMCT for patients with solitary HCC lesions ≤ 3 cm and Child-Pugh A liver function irrespective of liver cirrhosis. PMCT should be viewed as the optimal treatment for solitary and small HCC with severe cirrhosis.

Open thoracic and thoracoabdominal aortic repair vs. f/bTEVAR - complementary or competitive?

The classical approach of open repair (OR) for thoracic and thoracoabdominal aortic pathologies, including aneurysms and dissection, has been outnumbered by the use of fenestrated/branched (thoracic) endovascular aortic repair (f/b[T]EVAR) in recent years. Providing OR for complex cases in an aortic service requires a dedicated surgical setup and a huge body of expertise in this particular field.In order to reduce specific complications, such as perioperative mortality, kidney failure, spinal cord ischemia, stroke or bowel ischemia, it is necessary to apply cerebrospinal-spinal fluid drainage, point-of-care coagulation therapy, distal and retrograde aortic perfusion and sequential clamping. Despite the predominance of endovascular solutions, the specific OR expertise is still needed for specific indications, such as young patients, connective tissue disorder or aortic graft infections.Currently, the short and mid term results for f/b(T)EVAR outweigh those for OR, including the shorter hospital stay and less invasive procedures. However, OR provides better long-term results for overall mortality, re-intervention rates and secondary complications.In conclusion, in our opinion OR is a service that is still necessary for dedicated aortic centres, but will most likely become more frequent again in the years to come.

Potential of pharmacological and herbal for COVID-19: a narrative review

The pandemic coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents an unprecedented challenge to identify effective drugs in the prevention and treatment process. At present, there is no proven therapy for this disease, although therapeutic approaches continue to be carried out using traditional medicines (herbal) and pharmacological therapy. Information about SARS-CoV-2 virology has rapidly developed and scientists try to provide a number of potential drugs. Remdesivir has strong in vitro activity against SARS-CoV-2. Several potential drugs are currently underway in a clinical trial. Chloroquine, hydroxychloroquine, and oseltamivir have not been proven to have efficacy, and the benefits of corticosteroids are still diverse. Current clinical evidence does not support the termination of angiotensin-converting enzyme 2 (ACE2) inhibitors or angiotensin receptor blockers, coagulation therapy in patients with COVID-19 concomitant with comorbidities.

Cell cycle regulation in human hair follicle dermal papilla cells using nonthermal atmospheric pressure plasma-activated medium.

Nonthermal atmospheric pressure (NAP) plasmas have recently been developed and have been used for wound healing, blood coagulation, and cancer therapy. NAP plasmas can induce either cell proliferation or cell death, depending on the dose. Due to their efficacy and application easily, plasma activated mediums (PAMs) have been used in human cells recently.In atmosphere, NAP plasmas react with molecular content of air such as N2, O2, H2O vapor, etc, and generate a variety of reactive oxygen and nitrogen species. High reactive oxygen species (ROS) levels promote damage of cellular DNA, proteins, and lipids. Such damage can lead to cell-cycle arrest, and cellular death. However, low levels of ROS have been caused an increase in cell cycle progression.Human skin is arranged in 3 layers, including (from top to bottom) the epidermis (and its appendages), the dermis, and the hypodermis. Human dermal papilla cells (DPCs) are located in the middle or even deep part of the dermis. DPCs play a key role in hair regeneration, and a lot of effort have been made to promote DPC hair formation ability. DPC is increased proliferation, delayed senescence, and enhanced hair by depending on the amount of ROS through the NAP-PAM treatment.In this study, we used NAP plasmas to the human hair follicle DPCs exposed from 0 to 20 minutes, so we were investigated the effects of PAM on cell proliferation and cell cycle progression. After NAP-PAM treatment for 24 hours, cell cycle was arrested in the G0/G1 phase. The NAP-PAM-treated human hair follicle DPCs recovered gradually after 48 hours of the treatment compared to the untreated cells.Therefore, this approach offers promising results for further application of NAP-PAM in clinical dermatology. In future, it can be applied clinically in the form of active water that can delay the progression of baldness and alopecia areata.

Анализ антитромботической терапии у пожилых людей во врачебной клинической практике центров семейной медицины Кыргызской Республики

Введение. Риски тромбоза и кровотечения с возрастом увеличиваются одновременно, при этом пожилой контингент извлекает больше пользы от антитромботической терапии, чем лица молодого возраста. Цель исследования: изучить ситуацию с назначением антикоагулянтной терапии у пациентов пожилого и старческого возраста с фибрилляцией предсердий (ФП) при центрах семейной медицины южных регионов Кыргызской Республики. Материалы и методы. Из 2000 амбулаторных карт медицинского наблюдения отобрано 470 пациентов с неклапанной ФП, которые имели показания для назначения антитромботической терапии: 187 (39,8%) мужчин, 283 (60,2%) женщины, из них 212 (45,1%) городских жителей и 258 (54,9%) сельских жителей. Средний возраст обследованных составил 69,5 ± 10,2 лет. Результаты. Из 377 (80,2%) пациентов должная антикоагулянтная терапия была назначена 162 (42,9%), антиагрегантная терапия — 191 (50,6%), и терапия не была назначена 24 (6,4%) больным при наличии абсолютных показаний. В качестве антикоагулянтной терапии 148 больным был назначен варфарин, адекватная антикоагуляция к концу года составила всего 12,2%. Новый оральный антикоагулянт — ривароксабан был назначен 14 (8,6%) пациентам. Врачами-терапевтами сельской местности 50% больным при необходимости антикоагулянтов была назначена антиагрегантная терапия. Заключение. В южных регионах республики наблюдается неблагоприятная ситуация с назначением антикоагулянтной терапии и ведением пациентов пожилого и старческого возраста. Необходимо продолжить исследования по другим регионам страны для получения полноценной и реальной картины по проблеме и выработки единой и соответствующей рекомендации. Background. The risks of thrombosis and bleeding increase simultaneously with age. At the same time, the elderly population derives more benefit from antithrombotic therapy than young individuals. Objectives: to study the current state of the anticoagulant therapy prescription for elderly and senile patients with atrial fibrillation (AF) at the centers of family medicine in the southern regions of the Kyrgyz Republic. Patients/Methods. From 2000 outpatient medical records, 470 patients with nonvulvar AF were selected who had indications for prescribing antithrombotic therapy: 187 (39.8%) men, 283 (60.2%) women; 212 (45.1%) were urban residents and 258 (54.9%) were village residents. The average age was 69.5 ± 10.2 years. Results. From among 377 (80.2%) patients, needful anticoagulant therapy was prescribed to 162 (42.9%), 191 (50.6%) patients received antiplatelet therapy and therapy was not prescribed to 24 (6.4%) patients in the presence of absolute indications. Warfarin as anticoagulant therapy was prescribed to 148 patients; adequate anticoagulation by the end of the year was only 12.2%. A new oral anticoagulant — rivaroxaban was prescribed to 14 (8.6%) patients. In non-urban area primary care physicians prescribed antiplatelet therapy to 50% of patients who needed anticoagulants. Conclusions. An unfavorable situation is observed with the prescription of anticoagulant therapy and management of elderly and senile patients in the southern regions of the republic. It is necessary to continue study in other regions of the country in order to obtain a complete and real picture of the problem, and to develop a unified and relevant recommendation.

Uterine leiomyosarcoma presenting as septic shock in a 43-year-old woman: A case report

Introduction: Sepsis or septic shock, a life-threatening condition, is rarely reported as the initial manifestation of uterine malignancy. Case report: A 43-year-old woman consulted our hospital for pyrexia, anorexia, dyspnea, and a markedly distended abdomen. Computed tomography images showed a large abdominal tumor occupying almost the entire abdominal cavity with an air-fluid level and multiple masses in both lungs. Pelvic examination revealed necrotic tissues with blood, prolapsing from the uterus, and having a putrid odor. Her vital signs indicated a systemic inflammatory response syndrome. Antibiotic, anti-shock, and anti-disseminated intravascular coagulation therapies were administrated, but the patient died of multiple organ failure at 22 hours after admission. Autopsy and histopathological examination revealed that the giant abdominal mass was a uterine leiomyosarcoma, in which the myometrium was extensively necrotic with a putrid odor. The patient’s blood culture was positive for Escherichia coli, and sepsis and septic shock due to intrauterine infection of the uterine leiomyosarcoma was considered as the cause of death. Conclusions: Physicians should be aware that uterine malignancy could present as sepsis in women with an abdominal mass.

Clinical Scoring Model Determines Surgical Modality for Solitary and Small Hepatocellular Carcinoma with Child-Pugh A Liver Function

Introduction: Previous study indicated that clinical scoring model (CSM) could accurately predict the severity of cirrhosis. This study aimed to compare the therapeutic efficacy of liver resection (LR) and percutaneous microwave coagulation therapy (PMCT) for solitary and small hepatocellular carcinoma (HCC) using CSM.

Venous Lakes of the Lips Successfully Treated With a Sclerosing Agent 1% polidocanol: analysis of 25 report cases

BackgroundVenous lakes of the lip is vascular ectasia that generally appears on the lower lip and other sun-damaged surfaces of skin in elderly patient. There are many local therapies for treatment of lip venous lake such as surgical excision, cryotherapy, infrared coagulation and laser therapy. Sclerotherapy as treatment is used in varicose veins, leg telangiectasia, hemorrhoids and hemangiomas but for lip venous lake only two case has been reported. Therefore, we managed this study to determine the efficacy of injection of 1% polidocanol in the treatment of venous lake lesions. MethodsThis is retrospective study. Twenty five adult patient presenting with several localizations of venous lake were enrolled in the study. Informed consent was given before the treatment and a photo of the venous lake was taken. After the lesion was cleaned with an antiseptic, was slowly injected 1% polidocanol into each patient's lesion, followed by compression for 5 min. Visual Analog Scale (VAS) scale was used to indicate patient satisfaction. ResultLesions were completely cleared in all patients after treatment. The lesions generally disappeared in two cases leaving an insignificant scar, in two cases become angioedema with two sessions of sclerotherapy. İn other cases side effects were not observed. ConclusionSclerotherapy with polidocanol is an easy, inexpensive method and is found very effective in the treatment of lip venous lake. İn the future it offers an alternative to other classic methods.

Cerebellar hemorrhage in patients treated with edoxaban for portal vein thrombosis after hepatobiliary surgery: a report of two cases

BackgroundThe standard therapeutic agent administered for portal vein thrombosis (PVT) in patients with or without cirrhosis is warfarin or low-molecular weight heparin. However, therapy with edoxaban appears to be one of the most promising treatments for patients who require anticoagulation therapy. We encountered two cases of cerebellar hemorrhage in patients treated with edoxaban for PVT after hepatobiliary surgery during the past 2 years.Case presentationCase 1 A 67-year-old male underwent cholecystectomy and choledocholithotomy with choledochoduodenostomy to treat choledocholithiasis after cholangitis. Enhanced computed tomography (CT) on the 1st postoperative day (POD) revealed thrombosis in the left and anterior segment of the portal vein branches. We administered antithrombin III concentrate with heparin for 5 days; thereafter, we switched to 60 mg edoxaban. A sudden decrease in the patient’s level of consciousness was observed due to cerebellar hemorrhage on POD 27. Cerebellar hemorrhage was successfully treated with craniotomy hematoma evacuation and ventricular drainage; however, the patient died from aggravation of hepatic failure due to PVT and intra-abdominal infection. Case 2 A 67-year-old male received laparoscopic microwave coagulation therapy for two hepatic nodules suggestive of hepatocellular carcinoma in the left lobe of the liver due to alcoholic hepatitis. Enhanced CT on POD 5 revealed a thrombosis in the 4th segment branch of the portal vein, and the patient was treated with 60 mg edoxaban. Cerebellar hemorrhage with ventricular perforation occurred on POD 15. Cerebellar hemorrhage was successfully treated by craniotomy hematoma evacuation with ventricular drainage. Prolonged consciousness disorder persisted, and the patient was transferred to another medical facility for rehabilitation 49 days after brain surgery.ConclusionsAlthough edoxaban is recently described to be one of the options for patients with PVT who require anticoagulation therapy instead of heparin or warfarin, it should be used with caution, given its propensity to induce severe hemorrhagic adverse events in cases such as those described above. The monitoring of hepatic dysfunction and decision for continuation of drug may be required during edoxaban use for PVT, especially after hepatobiliary surgery.