Digestive Tract Bleeding Research Articles

Massive digestive tract bleeding due to pancreatic pseudocyst: a case report

Massive digestive tract bleeding due to pancreatic pseudocyst: a case report

Clinical nursing of patients with cirrhotic portal hypertension complicated with upper digestive tract hemorrhage

目的 探讨肝硬化门脉高压并发上消化道出血患者的临床护理措施.方法 对收治的68例肝硬化门脉高压并发上消化道出血患者采取预见性护理和针对性护理措施,并对结局进行观察.结果 经积极治疗及护理后康复出院60例,未愈自动出院7例,死亡1例.结论 护理干预措施对肝硬化门脉高压并发上消化道出血患者起到降低死亡率、提高生存质量的重要作用,值得临床推广。

High-intensity focused ultrasound combined with transarterial chemoembolization for unresectable hepatocellular carcinoma: Long-term follow-up and clinical analysis

High-intensity focused ultrasound (HIFU) combined with transarterial chemoembolization (TACE) has been used to treat unresectable HCC, but its long-term effects and major prognostic factors remain to be determined. The purpose of this study was to assess its long-term effects and find major prognostic factors to help us select eligible patients in the future. 73 patients with unresectable HCC received follow-up after HIFU+TACE. The variables of sex, age, AFP level, liver function, tumor location, tumor number, tumor size, TNM staging (5th edition), TNM staging (6th edition), portal vein invasion, ultrasonic pathway of HIFU, TACE session and ablation response were evaluated by univariate analysis. Those variables with significant difference were assessed by multivariate analysis. The mean follow-up time was 11.7±11.1 months (range, 1-60 months). The median survival time and overall survival rates of 1, 2, 3-year were 12 months, 49.1%, 18.8%, 8.4%, respectively. 45.2% patients achieved complete ablation. At the end of follow-up, 51 patients (69.9%) died from tumor progression (27 patients), liver function failure (18 patients), hemorrhage of upper digestive tract (3 patients) and infection (3 patients). 1 with liver abscess, 2 with serious skin burns and 2 with rib fracture were observed after HIFU. On univariate analysis, age (P=0.017), tumor size (P=0.000), tumor number (P=0.039), the 5th edition of TNM staging (P=0.023), portal vein invasion (P=0.02) and ablation response (P=0.000) had significant difference. On multivariate analysis, ablation response (P=0.001) and tumor size (P=0.013) were major prognostic factors. HIFU combined with TACE is a safe method with a low rate of severe complications. As major prognostic factors, ablation response and tumor size may help us predict the survival and select eligible patients clinically.

Relative factors for and early treatment of craniocerebral trauma in the elderly

Objective To discuss the relative factors and clinical features of the elderly patients with craniocerebral trauma so as to improve the level of diagnosis and treatment of craniocerebral trauma.Methods A retrospective study was conducted on 139 patients with craniocerebral trauma treated in our department from June 2006 to August 2009. The post-injury pathogenesis, Glasgow Coma Scale (GCS)score, injury type, major complications and treatment method were summarized and analyzed to find the correlation of various factors with prognosis. Results It was revealed that the mortality was closely related with GCS score, injury type and post-tranmatic complications. The lower GCS score induced higher mortality. The high mortality was manifested in patients with craniocerebral trauma who presented diffuse cerebral edema, contusion and laceration combined with multiple hematomas and brain stem injury. The prognosis was impacted by lung infection, failure of respiratory function, hemorrhage in upper digestive tract, or simultaneous 2-3 complications after craniocerebral trauma. Conclusions The prognosis is directly affected by injury severity, injury type and complications of craniocerebral trauma. The elderly patients demonstrate delayed reaction, which deserves active early examinations and treatment to improve the prognosis. Key words: Craniocerebral trauma; Prognosis; Aged

Treatment of ring slippage after gastric bypass: long-term results after endoscopic dilation with an achalasia balloon (with videos)

Silastic rings are used in gastric bypass procedures for the treatment of obesity, but ring slippage may lead to gastric pouch outlet stenosis (GPOS). Conventional management has been ring removal through abdominal surgery. To describe a novel, safe, minimally invasive, endoscopic technique for the treatment of GPOS caused by ring slippage after gastric bypass. Case series. Federal University of Pernambuco and São Paulo University. This study involved 39 consecutive patients who were screened for inclusion. Endoscopic dilation with an achalasia balloon. Technical success and safety of the procedure. Among the 39 patients, 35 underwent endoscopic dilation at the ring slippage site for the relief of GPOS. The 4 patients who did not undergo endoscopic dilation underwent surgical removal of the ring, based on the exclusion criteria. The endoscopic approach was successful in 1 to 4 sessions in 100% of cases with radioscopic control (n = 12). The duration of the procedures ranged from 5 to 30 minutes, and the average internment was 14.4 hours. Dilation promoted either rupture (65.7%) or stretching (34.3%) of the thread within the ring, thereby increasing the luminal diameter of the GPOS. Complications included self-limited upper digestive tract hemorrhage (n = 1) and asymptomatic ring erosion (n = 4). There were no recurrences of obstructive symptoms during the follow-up period (mean of 33.3 months). This was not a randomized, comparison study, and the number of patients was relatively small. The technique described promotes the relief of GPOS with low overall morbidity and avoids abdominal reoperation for ring removal.

入院加療を行った深頸部膿瘍例の検討

We reviewed 42 cases of deep neck abscess drained surgically or treated conservatively between February 2001 and August 2008, based on age, gender, primary focus, main symptom, abscess location, systemic disease, pathogenic bacteria, hospital treatment, hospitalization length, complications and long-term hospitalization. Of the 42, 26 were men and 16 women aged 14 to 80 (central age: 54.5 years). Abscess was caused most by tonsil inflammation (38.1%). Main symptom were sore throat (54.8%) and neck swelling (35.7%). Abscesses were found in the supra- and infrahyoid region in 30 cases and extended to the mediastinum in 2. Of the 42, 14 (33.3%) had hypertension and 11 (26.2%) diabetes mellitus (DM). Inflammation was due to aerobic bacteria (mainly Streptococcus milleri) in 23 cases (54.8%) and to anaerobic bacteria (mainly Peptostreptococcus) in 11 cases (26.2%). Flexible fiberscopic examination was important in evaluating pharyngeal and laryngeal mucosal disorders and enhanced computed tomography was useful in both diagnosis and postoperative observation. Of the 42, 38 required surgical drainage and 4 were cured using needle aspiration and antibiotics. Of the 38 undergoing surgery-tracheostomy was required in 22. Hospitalization for those with tracheostomy and DM was longer than in those without these factors. Complications included 2 cases each of, mediastinal abscess, sepsis, disseminated intravascular coagulation (DIC), acute renal failure, severe pneumonia, upper digestive tract bleeding and swallowing disorder. Early surgical drainage and intravenous antibiotic administration are thus essential for treating deep neck abscesses.

The value of digital subaction angiography in iagnosis and treatment of gastrointestional hemorrhage

Objective To evaluate the application value of DSA diagnosis and interventional therapy in gas-trointestinal hemorrhage. Methods 36 cases of gastrointestinal hemorrhage used DSA examination, according to the reason and position,26 cases of the patients that were positive of DSA opacification utilized interventional therapy with different embolic agents or vasopressin peffusion. Results 26 cases of patients in 36 had gastrointestinal hemorrhage, 12 cases of patients in 16 that have extravasation of contrast media were hemostasis by treating with embolization ther-apy and vasopressin peffusion, hemorrhage of eholecyst and biliary tract after operation,the patients of small intestinal hemorrhage, gastroduodenal hemorrhage after the operation of pancreatic carcinoma were embolized with gelfoam ,PVAand/or colis were done. The stopped bleeding immediately oceured in 84. 6% (22/26). Conclusion DSA are more valuable methods for the diagnosis of gastrointestinal hemorrhage. Arterial embolization and/or perfusion of vasoconl-rictor substance for treatment of hemorrhage of digestive tract is safe, effec is reliable. Key words: Gastrointestinal hemorrhage; Selective angiography; Perfusion

Ultra-early surgery for severe intracranial aneurismal hemorrhage

Objective To discuss the possibility and therapeutic effect of ultra-early surgery for grade IV～V intraeranial aneurysms scored by Hunt-Hess grading system.Methods Thirteen cases suffered from intracranial aneurysms determined by 3D-CTA were treated by ultra-early surgery under general anesthesia within 24 hours(5 casses were treated within 6 hours and 8 Cases in 6-24 hours).Preoperative Hunt-Hess grade:10 cases were grade IV and 3 cases were grade V.The therapeutic effects were evaluated by Glasgow Outcome Score(COS).Results In operation,difficult dissection occurred in 6 cases,rupture of aneurysm occurred and temporary obstructions were performed in 4 Cases.After the clipping of aneurysms,there wei-e 3 cases underwent V-P shunt because of hydrocephalus,3 cases of pulmonary infection,2 cases of hypothalamus reaelion accompanied with hemorrhage in upper digestive tract and 1 case of frontal infarction.The therapeutic effects were good in 6 cases,worse in 5 cases,dead in 2 cases.Conclusions IThe ultra-early surgery could avoid early re-bleeding of intraeranial aneurysm and is suitable for intracranial aneurysrm of Hunl-Hess grade IV-V.The application of 3D-CTA could make it possible for using ultra-early surgery,and improve the therapeutic effect. Key words: Intracranial alleutysim; Ultra-early; Surgery

Rupture of gastroesophageal varices DEA managing

This article on upper digestive tract bleeding, dedicated to the rupture of gastroesophageal varices, deals with the issues connected to their treatment in the Emergency Room. The authors refer to concepts of epidemiology, natural history, physiopathology of the oesophageal and gastric varices and elements of therapy, including both specific (stabilisation) and specific (pharmacology and endoscopy) aspects, based on the latest scientific evidence. The main interest of the ER doctor obviously involves the measures needed to achieve haemodynamic stabilisation and specific pharmacological therapy. Although the article does not examine the endoscopic and prophylactic measures taken by ER doctors, these are dealt with briefly for a better understanding of the issue as a whole.

Endoscopic embolization combined with variceal ligation in the treatment of gastroesophageal variceal bleeding

Objective To explore the therapeutic effect of combined endoscopic embolization and variceal ligation （EVL） for management in cirrhotic patients with gastroesophageal varieeal bleeding. Methods One hundred and fifty-six cases of active gastric fundal variceal bleeding combined with esophageal varices of over degree Ⅱ , and with other causes leading to upper digestive tract bleeding excluded, were randomized into therapeutic group （ n = 80） and control group （ n = 76）. For the therapeutic group, endoscopic eyanoacrylate injection for embolization of gastric fundal varices and EVL for esophageal varices were performed simultaneously. For the control group, EVL was performed 2 months after embolization. Results There was no complication in both groups. The rate of hemostasis in therapy group was 96. 3% （77/80） , and that in control group was 97.4% （ 74/76, P 〉 0. 05 ）. There was significant difference between two groups, regarding the rates of early re-bleeding [ 6. 4% （ 5/78 ） vs 21.3% （ 16/75 ） , P 〈 0. 05 ] and rebleeding at 6 months [ 13.0% （9/69） vs 25.4% （ 17/67）, P 〈0. 05]. There was no significant difference between two groups, regarding the effective rate in disappearance of gastric fundus varices （61.6% vs 59. 1% ）, and in that of esophageal varices （74. 0% vs 67. 9% ）. Conclusion Endoscopic embolization of gastric fundus varices, combined with EVL for esophageal varices, is a safe and effective procedure for the treatment of gastroesophageal variceal bleeding, and it can reduce the rate of re-bleeding. Key words: Esophageal and gastric varices ; Embolization, theraputic ; Ligation ; Endoscopy

Treatment of special proximal femoral fractures with less invasive stabilization system

Objective To discuss the indications, surgical techniques and outcome of less invasive stabilization system (LISS) in treatment of special proximal femoral fractures. Methods Twenty-eight patients with special proximal femoral fractures were treated with LISS from June 2005 to December 2007. All fractures could not be reduced by close reduction with traction table. There were eight patients with in-tertrochanterie fractures ( including type 31-A2.2 fractures in three, type 31-A2.3 in two, type 31-A3.1 in three and type 31-A3.3 in two according to AO classification), 19 with subtrochanteric fractures (including type ⅡA fractures in three, type ⅢB in one and type Ⅴ in 15 according to Seinsheimer classification) and one with peripheral fractures ( type Vancouver B1 fracture) of the femoral prosthesis. The data about opera-tion duration, intraoperative blood loss, postoperative complications, fracture healing time and postoperative hip function score were recorded. Results The operation lasted for mean 88 minutes (45-120 minutes), with intra-operative blood loss of average 320 ml (50 -700 ml). There occurred deep vein thrombosis of lower limb in two patients, myocardial infarction in one and lower digestive tract bleeding in one after oper-ation, with no incision complications. One patient with breast cancer was died of brain metastasis after op-eration and three lost follow-up. Other 24 patients were followed up for mean 18 months (6-33 months), which showed that 23 patients got fracture healing 2-5 months ( average 3 months) postoperatively but that one patient with type Seinsheimer V fracture had breakage of proximal locking screws six months postopera-tively because of nonunion of subtrochanteric fracture. The Harris score of the hip was 70-99 points ( aver-age 84 points). Conclusions Reverse femoral LISS has advantages of minimal invasion, easy opera-tion, stable fixation, high degree of safety and minor complications for treatment of special proximal femoral fractures. Skillful reduction, correct positioning of guide wire into hole A and avoidance of immediate weight bearing are key to success of the operation. Key words: Femoral fractures; Fracture fixation, intramedullary; Less invasive stabilizationsystem

Fifteen years’ experience with transjugular intrahepatic portosystemic shunt (TIPS) using bare stents: retrospective review of clinical and technical aspects

The authors present a retrospective analysis of a large series of patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement. Between March 1992 and December 2006, 658 patients were referred to our centre for TIPS placement. Indications for the procedure were digestive tract bleeding (52.8%), refractory ascites (35.3%), preservation of portal vein patency prior to liver transplantation (3.0%) and thrombosis of the suprahepatic veins (2.3%). Other indications (6.6%) included pleural ascites, portal thrombosis and hepatorenal and hepatopulmonary syndromes. All patients were evaluated with colour Doppler ultrasonography and in a few cases with computed tomography. The portal system was punctured under sonographic guidance. Wallstent, Palmaz and Nitinol thermosensitive stents were used. Embolisation of persistent varices was performed in 6.8% of cases. Technical success was 98.9%. During a 1,500-day follow-up, the cumulative incidence of stent revision was 25.7% (Nitinol), 32.9% (Wallstent) and 1.8% (Palmaz). Mortality rates were 31.1%, 38.5% and 56.4%, respectively. The technical complications included six cases of heart failure, six of haematobilia, three of stent migration, two of intrahepatic haematoma and one of haemoperitoneum. Eight patients with severe portosystemic encephalopathy (PSE) were treated with a reduction stent. TIPS placement is safe and effective and may act as a bridge to liver transplantation. Ultrasonography plays a fundamental role in the preliminary assessment, in portal vein puncture and during the follow-up. Stent patency is satisfactory.

Nursing on hemorrhage of chronic lower digestive tract treated by combination of traditional Chinese medicine with western medicine

目的 探讨中西医结合治疗慢性下消化道出血的护理.方法 中药保留灌肠配合中药汤剂口服治疗慢性下消化道出血,从情志、经络、津液、失眠、服药、灌肠等方面给予中西医结合护理,观察血便情况、临床主要症状改善情况.结果 84例患者经过中药治疗及中西医结合护理,血便改善总有效率89.29%,临床主要症状改善总有效率85.71%.结论 中药保留灌肠及中药汤剂口服,并配合情志、经络、津液、失眠、服药、灌肠等中西医结合护理,治疗慢性下消化道出血可取得很好的疗效。

Management of Malignant Gastric Outlet Obstruction with Expandable Metallic Stent Placement.

BackgroundTo investigate the efficacy and procedural skills of metallic stent placement for malignant gastric outlet obstruction.MethodsNine patients with malignant gastric outlet obstruction were performed metallic stent placement. Two stent placement methods were employed, the first, stents were placed under guidance of endoscopy in 7 patients (stent introducer: 140 mm in length and 4-6 mm in diameter); the second, duodenal stents were placed through endoscopic biopsy channel (3.2 or 4.2 mm in diameter) in 2 patients.ResultsThe stent placement succeeded at the first attempt in all 9 patients. Among the 9 patients, 3 placed with 2 x 10 cm stents, and 6 with 2 x 8 cm stents. Pylorus stents, duodenal stents, and esophageal stents were placed in 2 patients, 6 patients and 1 patient, respectively. Stents expanded about 90% confirmed by fluoroscopy 24 - 48 h after the procedure. the patients started liquid food 24 h after stent placement. The common post-procedural complications included nausea, vomiting, upper digestive tract hemorrhage and upper abdominal pain. Post-procedural obstructive jaundice occurred in 1 patient. During the 3 months follow-up, no stent migration, removal and occlusion occurred. Of the 9 patients, 3 survived 10-15 days and 2 survived 1-2 months, the rest 4 patients survived 3 months. The mean stent patency was 53.4 days.ConclusionsExpandable metallic stents placed in patients with malignant obstruction of gastric outlet effectively palliate the obstructive symptoms. Technical skills play important roles in stent placement in treatment of malignant gastric outlet obstruction, and the efficacy of metallic stent placement is associated with the location of metallic stents and therapeutic indications.

Positive rate comparison between immunological and chemical methods of fecal occult blood test in upper digestive tract bleeding

Positive rate comparison between immunological and chemical methods of fecal occult blood test in upper digestive tract bleeding

Application of double-balloon enteroscopy in the diagnosis and therapy of small intestinal diseases

X-ray of the digestive tract and radionuclide examination could not accurately detect diseases of the small intestine. Double-balloon enteroscopy has been used to increase the detection rate of these diseases in addition to endoscopic biopsy and therapy. The purpose of this study was to determine the value of double-balloon enteroscopy in the diagnosis and treatment of diseases of the small intestine. A total of 258 double-balloon enteroscopies via the mouth and/or anus were performed in 208 patients. If no lesion was detected on one side (mouth or anus), examination on the other side (anus or mouth) was made. If active small intestinal bleeding was detected, endoscopic hemostasis was done to treat the bleeding. In the 208 patients, 50 were subjected to double-balloon enteroscopy via both mouth and anus. Lesions were detected in 151 patients, giving a rate of 72.6% (151/208). The detection rates for obscure digestive tract bleeding, diarrhea, abdominal pain and weight loss were 90.2% (92/102), 64.9% (24/37), 48.5% (16/33) and 43.3% (13/30), respectively. Lesions of the 151 patients were confirmed by endoscopic biopsy, surgery, clinical studies, and follow-up. In the 102 patients with bleeding of the digestive tract, active bleeding was detected in 27 patients. Endoscopic hemostasis was successful in 25 of them (92.6%, 25/27). No serious complications occurred in all the patients, the average time for the procedure was 100 minutes. Double-balloon enteroscopy is safe, effective in the diagnosis of diseases of the small intestine in addition to endoscopic therapy.

Detail nursing for patients with hepatocirrhosis combined hemorrhage of upper digestive tract during the course of vein transfusion

据资料分析,大部分医疗纠纷的发生,多因细节引起,细节决定人的安危,决定医护职业的成败.随着医疗事故处理条例的实施,人们对护理的要求越来越高,更重视护理活动中的一些细节,因此注意细节护理是回避护理风险的关键.本文仅就肝硬化并上消化道出血患者谈谈静脉输液过程中应注意的细节问题,现报道如下。

Primary Disease and Endoscopic Hemostasis of the Lower Digestive Tract Hemorrhage

Primary Disease and Endoscopic Hemostasis of the Lower Digestive Tract Hemorrhage

Embolization combined with endoscopic variceal ligation for the treatment of esophagogastric variceal bleeding in patients with cirrhosis

Esophagogastric variceal bleeding caused by cirrhosis is a kind of emergent condition in the clinic. This study was conducted to explore the therapeutic effect and superiority of embolization of gastric fundus varices combined with endoscopic variceal ligation (EVL) of esophageal varices for the treatment of patients with esophagogastric variceal bleeding caused by cirrhosis. Totally 172 patients were diagnosed by endoscopic examination within 24 hours of hospitalization with active gastric fundus variceal bleeding and grade II above esophageal varices caused by cirrhosis. Other causes leading to upper digestive tract bleeding were excluded. Patients were randomly divided into a control group (n = 82) and a therapy group (n = 90) following a random number table method. For the former, embolization for gastric fundus varices was performed, then an EVL for esophageal varices was performed 2 months later. For the therapy group, embolization for gastric fundus varices and EVL for esophageal varices were performed at the same time. The rate of emergency hemostasis in the therapy group was 100.0%, higher than that in the control group (87.8%, P < 0.05). The rate of early rebleeding in the therapy group was 6.7% while the rate in the control group was 23.6% (P < 0.05). No complications related to treatment occurred in both groups. Embolization for gastric fundus varices combined with EVL for esophageal varices is a safe and effective method for the treatment of patients with esophagogastric variceal bleeding caused by cirrhosis.

Gastrointestinal stromal tumors: experience in 49 patients

Gastrointestinal stromal tumours (GIST) are mesenchymal tumours of the digestive tract originated in the interstitial cells of Cajal. They express the tyrosine kinase c-kit (CD117) activity receptor. Mutations in this receptor cause neoplastic development. Curative treatment continues to be radical resection of the tumour and is resistant to commonly employed chemotherapy regimens. Imatinib mesilate is a drug that inhibits c-kit activity expressed by GIST and its activity in these tumours has been demonstrated. Retrospective study of all cases of leiomyoma, leiomyosarcoma, schwannoma, and stromal or mesenchymal tumors from 1989 to July 2004. C-kit and CD34 proteins were detected at immunohistochemical study in addition to the usual markers for mesenchymal tumours. 49 GISTs were diagnosed, 26 males and 23 females (mean age 64.1). Symptoms were digestive tract bleeding (n = 13), abdominal pain (n = 13), intestinal occlusion (n = 4) and others. The lesion was located in small bowel (n = 22), stomach (n = 19), rectum (n = 3), peritoneum (n = 2), esophagus (n = 1), omentum (n = 1), and retroperitoneum (n = 1). Forty-three of the 49 patients underwent surgery; radical resection was performed in 37 (75.5%) and palliative surgery in the other six (16.2%). Two of the patients that did not undergo surgery received chemotherapy. At the time of study, 28 (57.14%) patients remained alive, 23 (46.9%) of whom were disease- free and five (10.2%) were not. Nineteen (38.7%) patients died. The results of our series are similar to the others published. Before the year 2001, surgery was the only successful option for the GIST. Surgical resection continues being the best treatment to definitively cure this disease. Imatinib is used to treat not only resectable tumours, but even to allow the possibility to make a subsequent rescue surgery. On the other hand, Imatinib is used in the treatment of the metastatic disease.