Massive Hemorrhage In Patients Research Articles

Fluid resuscitation strategy in patients with placenta previa accreta: a retrospective study.

Obstetric hemorrhage is the leading cause of maternal death worldwide. Placenta previa accreta is one of the major direct causes of postpartum hemorrhage, accounting for two-thirds of obstetric hemorrhage cases. Fluid resuscitation is a life-saving procedure for patients suffering from massive hemorrhage. This study aims at evaluating the risk factors of massive hemorrhage and appropriate fluid resuscitation strategy in patients with placenta previa accreta. This study retrospectively analyzed the risk factors for massive hemorrhage, clinical characteristics, and perinatal outcomes of patients with placenta previa accreta. Maternal noninvasively evaluated hemodynamic indicators, including maternal heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and shock index, were collected and analyzed at nine time points, from the administration of anesthesia until the end of procedures, in patients diagnosed with placenta previa accreta and receiving different fluid supply volumes. Complicated with placenta increta/percreta and gestational age of delivery later than 37 weeks are two independent risk factors of massive hemorrhage in patients with placenta previa accreta. A total of 62.27% (170/273) patients diagnosed with placenta increta/percreta had massive hemorrhage, significantly higher than those diagnosed with placenta previa accreta (5.88%, 6/102). Patients delivered after 37 weeks of gestation had significantly higher ratios (86.84%, 99/114) of massive hemorrhage compared with those delivered between 36 and 36+6 weeks of gestation (35.39%, 63/178). Maternal SBP, DBP, and MAP started to decrease immediately after the baby was delivered and reached a relatively stable trough state at 15-30 min after delivery. No statistical differences were found in hemodynamic indicators, the occurrence of hypotension, or in-hospital days after the procedure among the transfusion volumes < 30 ml/kg, 30-80 ml/kg, and ≥ 80 ml/kg groups. Patients with a suspected diagnosis of placenta previa accreta should plan to deliver before 37 weeks of gestation. The ability to identify concurrent placenta increta/percreta should be improved to schedule a reasonably rapid perioperative plan. Restrictive fluid resuscitation could achieve good effects in maintaining hemodynamic stability in patients with placenta previa accreta. A time period of 15-30 min after delivery is the critical stage for fluid resuscitation.

Portal Hypertensive Mayhem: A Case Report of Colonic Variceal Bleeding Treated by Antegrade Embolization

AbstractIn patients with cirrhosis of the liver, acute variceal bleeding can be fatal. Bleeding colonic varices is a very rare cause of lower gastrointestinal bleeding that can result in massive hemorrhage in patients with cirrhosis. Here we present the case of a 50-year-old gentleman, having cirrhosis of the liver with chronic portal vein occlusion, who presented with massive bleeding per rectum. Contrast computed tomography (CT) revealed a large shunt arising from the superior mesenteric vein forming submucosal colonic varices and joining the right renal vein. He underwent successful obliteration of the varix by antegrade endovascular embolization via the trans-splenic access. Endovascular embolization could be an effective and life-saving treatment option for colonic variceal bleeding.

The relationship between cervical length and area measurements evaluated by MRI and the amount of hemorrhage in PAS cases

BackgroundPlacenta accreta spectrum often leads to massive hemorrhage and even maternal shock and death. This study aims to identify whether cervical length and cervical area measured by magnetic resonance imaging correlate with massive hemorrhage in patients with placenta accreta spectrum.MethodsThe study was conducted at our hospital, and 158 placenta previa patients with placenta accreta spectrum underwent preoperative magnetic resonance imaging examination were included. The cervical length and cervical area were measured and evaluated their ability to identify massive hemorrhage in patients with placenta accreta spectrum.ResultsThe cervical length and area in patients with massive hemorrhage were both significantly smaller than those in patients without massive hemorrhage. The results of multivariate analysis show that cervical length and cervical area were significantly associated with massive hemorrhage. In all patients, a negative linear was found between cervical length and amount of blood loss (r =−0.613), and between cervical area and amount of blood loss (r =−0.629). Combined with cervical length and cervical area, the sensitivity, specificity, and the area under the curve for the predictive massive hemorrhage were 88.618%, 90.209%, and 0.890, respectively.ConclusionThe cervical length and area might be used to recognize massive hemorrhage in placenta previa patients with placenta accreta spectrum.

Efficacy and safety of prophylactic balloon occlusion in the management of placenta accreta spectrum disorder: a retrospective cohort study

ObjectivePlacenta accreta spectrum disorder (PAS) is a serious obstetric complication associated with significant maternal morbidity and mortality. Prophylactic balloon occlusion (PBO), as an intravascular interventional therapies, has emerged as a potential management strategy for controlling massive hemorrhage in patients with PAS. However, current evidence about the clinical application of PBO in PAS patients are still controversial. This study aimed to evaluate the effectiveness and safety of PBO in the management of PAS.MethodsA retrospective cohort study including PAS patients underwent cesarean delivery was conducted in a tertiary hospital from January 2015 to March 2022. Included PAS patients were further divided into balloon and control groups by whether PBO was performed. Groups were compared for demographic characteristics, intraoperative and postoperative parameters, maternal and neonatal outcomes, PBO-related complication and follow up outcomes. Additionally, multivariate-logistic regression analysis was performed to determine the definitive associations between PBO and risk of massive hemorrhage and hysterectomy.ResultsA total of 285 PAS patients met the inclusion criteria were included, of which 57 PAS patients underwent PBO (PBO group) and 228 women performed cesarean section (CS) without PBO (control group). Irrespective of the differences of baseline characteristics between the two groups, PBO intervention did not reduce the blood loss, hysterectomy rate and postoperative hospital stay, but it prolonged the operation time and increased the cost of hospitalization (All P < 0.05) Additionally, there were no significant differences in postoperative complications, neonatal outcomes, and follow-up outcomes(All P > 0.05). In particular, patients undergoing PBO were more likely to develop the venous thrombosis postoperatively (P = 0.001). However, multivariate logistic regression analysis showed that PBO significantly decreased the risk of massive hemorrhage (OR 0.289, 95%CI:0.109–0.766, P = 0.013). The grade of PAS and MRI with S2 invasion were the significant risk factors affecting massive hemorrhage(OR:6.232 and OR:5.380, P<0.001).ConclusionPBO has the potential to reduce massive hemorrhage in PAS patients undergoing CS. Obstetricians should, however, be aware of potential complications arising from the PBO. Additionally, MRI with S2 invasion and PAS grade will be useful to identify PAS patients who at high risk and may benefit from PBO. In brief, PBO seem to be a promising alternative for management of PAS, yet well-designed randomized controlled trials are needed to convincingly demonstrate its benefits and triage the necessity of PBO.

The MRI estimations of placental volume, T2 dark band volume, and cervical length correlate with massive hemorrhage in patients with placenta accreta spectrum disorders.

To identify whether placental volume, T2 dark band volume, and cervical length measured by MRI correlate with massive hemorrhage (MH) in patients with placenta accreta spectrum (PAS) disorders. A total of 163 pregnant women with PAS underwent preoperative MRI examination were divided into MH group and non-MH group. The placental volume, T2 dark band volume, and cervical length of PAS patients were measured and evaluated their ability to identify MH in patients with PAS. Patients with MH had a significantly larger placental volume, larger T2 dark band volume, and shorter cervical length than patients without MH (all P<0.001). Multivariable logistic regression showed that placental volume (>890cm3), T2 dark band volume (>35cm3), and cervical length (<30mm) were significant independent risk factor in identification of MH. In all PAS patients, a positive linear correlation was found between placental volume and amount of blood loss (r=0.527), and between T2 dark band volume and amount of blood loss (r=0.642), and a negative linear correlation was found between cervical length and amount of blood loss (r=-0.597). When combined with the three MRI indicators, the sensitivity and specificity in identifying cases at high risk for MH were 91.638% and 94.051%, respectively, with area under the curve (AUC) of 0.923. The placental volume, T2 dark band volume, and cervical length might be used to predict MH in patients with PAS.

¿Podrían ayudarnos los algoritmos de machine learning en la predicción de hemorragia masiva a nivel prehospitalario?

ObjectiveComparison of the predictive ability of various machine learning algorithms (MLA) versus traditional prediction scales for massive hemorrhage in patients with severe traumatic injury (ETG). DesignOn a database of a retrospective cohort with prehospital clinical variables and massive hemorrhage outcome, a treatment of the database was performed to be able to apply the different MLA, obtaining a total set of 473 patients (80% training and 20% validation). For modeling, proportional imputation and cross validation were performed. The predictive power was evaluated with the ROC metric and the importance of the variables using the Shapley values. SettingOut-of-hospital care of patients with ETG. ParticipantsPatients with ETG treated out-of-hospital by a prehospital medical service from January 2010 to December 2015 and transferred to a trauma center in Madrid. InterventionsNone. Main variables of interestObtaining and comparing the ROC curve metric of 4 MLAs: random forest, support vector machine, gradient boosting machine and neural network with the results obtained with traditional prediction scales. ResultsThe different MLA reached ROC values higher than 0.85, having medians close to 0.98. We found no significant differences between MLAs. Each MLA offers a different set of more important variables with a predominance of hemodynamic, resuscitation variables and neurological impairment. ConclusionsMLA may be helpful in patients with massive hemorrhage by outperforming traditional prediction scales.

Analysis of the Risk Factors for Massive Hemorrhage in Pernicious Placenta Previa and Evaluation of the Efficacy of Internal Iliac Artery Balloon Occlusion.

To investigate the risk factors of intraoperative massive hemorrhage in patients with pernicious placenta previa (PPP) and analyze the value of bilateral internal iliac artery balloon occlusion in Cesarean section for these patients. The clinical data of 134 patients with PPP admitted to the Second Hospital of Shanxi Medical University from January 2012 to January 2019 were analyzed. A logistic regression analysis was used to analyze the risk factors for intraoperative massive hemorrhage in PPP. The study subjects were divided into the intervention group (38 cases) and the routine group (96 cases) according to whether bilateral internal iliac artery balloon occlusion was conducted during the operation. The differences in some clinical indicators were compared between the two groups. The risk factors for intraoperative massive hemorrhage in PPP were age ≥35 years, gestational age ≥34 weeks, complete placenta previa, and the presence of placenta accreta. The differences in the operation time, postoperative transfer to the intensive care unit, postoperative length of the hospital stay, and neonatal weight and score were not statistically significant between the intervention group and the routine group (P > 0.05 for all). While the intraoperative blood loss and the transfusion volume in the intervention group were lower than in the routine group, the hospitalization cost was higher in the former than in the latter, and the differences were statistically significant (P < 0.05 for all). Moreover, there was no case of hysterectomy in the intervention group, while there were two cases of hysterectomies in the routine group. The risk factors for intraoperative massive hemorrhage in PPP were age ≥35 years, gestational age ≥34 weeks, complete placenta previa, and the presence of placenta accreta. Internal iliac artery balloon occlusion during PPP could reduce intraoperative blood loss and the hysterectomy rate.

Criteria for placenta accreta spectrum in the International Federation of Gynaecology and Obstetrics classification, and topographic invasion area are associated with massive hemorrhage in patients with placenta previa.

Placenta previa with placenta accreta spectrum (PAS) is a life-threatening disease that results in massive hemorrhage. The clinical and histologic criteria of PAS were adopted according to the International Federation of Gynaecology and Obstetrics (FIGO) classification. We aimed to investigate whether FIGO criteria and topography were associated with maternal complications in patients with placenta previa. Patients with placenta previa who underwent cesarean section at our institution between January 2003 and December 2019 were identified. First, they were divided based on FIGO classification, as follows: Group A, with clinical criteria; Group B, with histologic criteria; and Group C: without clinical or histologic criteria. Next, cases with PAS were classified according to the topographic invasion area, as follows: type 1, upper posterior bladder; type 2, lower posterior bladder; type 3, parametrium; type 4, posterior lower uterine segment. Predictive factors for massive hemorrhage were retrospectively analyzed. Among the 350 patients, 24 (6.9%) were classified as Group A, 16 (4.6%) as Group B and 310 (88.5%) as Group C. Regarding maternal history and hemostatic procedures, there were no significant factors other than hysterectomy (p<.01) in Groups A and B. The volume of blood loss in both Groups A and B was greater than in Group C (p<.01). The rates of uterine artery embolization and blood transfusion were higher in Groups A and B than in Group C (p<.01). In addition, there were no significant factors other than hysterectomy between Groups A and B. In the multivariate analysis for massive hemorrhage, Group A (odds ratio: 2.73, p=.04) and Group B (odds ratio: 12.69, p<.01) were identified as independent predictive factors. In addition, massive hemorrhage was closely related to the lower posterior bladder and parametrial invasion in both Groups A and B. Both clinical and histologic criteria for PAS in the FIGO classification were associated with massive hemorrhage. Diagnosing clinical PAS using the FIGO classification, additional hemostatic procedures might be necessary according to the topographic invasion area.

A nomogram to predict arterial bleeding in patients with pelvic fractures after blunt trauma: a retrospective cohort study

BackgroundPelvic bone fractures are one of the biggest challenges faced by trauma surgeons. Especially, the presence of bleeding and hemodynamic instability features is associated with high morbidity and mortality in patients with pelvic fractures. However, prediction of the occurrence of arterial bleeding causing massive hemorrhage in patients with pelvic fractures is difficult. Therefore, the aim of this study was to develop a nomogram to predict arterial bleeding in patients with pelvic bone fractures after blunt trauma.MethodsThe medical records of 1404 trauma patients treated between January 2013 and August 2017 were retrospectively reviewed. Patients older than 15 years with a pelvic fracture due to blunt trauma were enrolled (n = 148). The pelvic fracture pattern on anteroposterior radiography was classified according to the Orthopedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen (OTA/AO) system. Multivariable logistic regression modeling was used to determine the independent risk factors for arterial bleeding. A nomogram was constructed based on the identified risk factors.ResultsThe most common pelvic fracture pattern was type A (58.8%), followed by types B (34.5%) and C (6.7%). Of the 148 patients, 28 (18.9%) showed pelvic arterial bleeding on contrast-enhanced computed tomography or angiography, or in the operative findings. The independent risk factors for arterial bleeding were a type B or C pelvic fracture pattern, body temperature < 36 °C, and serum lactate level > 3.4 mmol/L. A nomogram was developed using these three parameters, along with a systolic blood pressure < 90 mmHg. The area under the receiver operating characteristic curve of the predictive model for discrimination was 0.8579. The maximal Youden index was 0.1527, corresponding to a cutoff value of 68.65 points, which was considered the optimal cutoff value for predicting the occurrence of arterial bleeding in patients with pelvic bone fractures.ConclusionsThe developed nomogram, which was based on the initial clinical findings identifying risk factors for arterial bleeding, is expected to be helpful in rapidly establishing a treatment plan and improving the prognosis for patients with pelvic bone fractures.

Probability Model of Massive Hemorrhage in Patients with Placenta Previa

Objective: The aim of this study was to identify the factors affecting massive hemorrhages in patients with placenta previa. We also made probability models and equations for massive hemorrhage. Methods: Seven hundred and sixty-four patients with placenta previa who underwent cesarean section from January 2011 to September 2019 were retrospectively reviewed. Massive hemorrhage was defined as a blood loss exceeding 1,500 mL or receiving over four units of packed red blood cells during cesarean section. Logistic regression analysis was used to create a probability model and identify the predictive factors for massive hemorrhage. Results: Two hundred and seventy-three (35.7%) patients had massive hemorrhages. Preoperative hemoglobin levels, multifetal gestation, emergent surgery, history of a previous cesarean section, location of the placenta, the presence of lacuna, placental adhesion, the type of placenta previa, and multiparity were selected predictive factors for massive hemorrhage. One hundred seventy-eight (23.3%) patients had placenta previa and a history of previous cesarean section. Among them, massive hemorrhage occurred in 101 (56.7%). The selected predictive factors for massive hemorrhage in patients with placenta previa and a history of previous cesarean section were emergent surgery, location of the placenta, the presence of lacuna, placental adhesion, and preoperative hemoglobin levels. An equation for massive hemorrhage in patients with placenta previa was created by combining variables. Conclusion: An equation for massive hemorrhage in patients with placenta previa was created by combining variables. These equations may help in managing placenta previa patients with high risk.

Risk scoring system with MRI for intraoperative massive hemorrhage in placenta previa and accreta.

Placenta previa and accreta are serious obstetric conditions that are associated with a high risk of intraoperative massive hemorrhage. To develop a scoring system for intraoperative massive hemorrhage combining MRI and clinical characteristics to predict the risk of massive hemorrhage in placenta previa and accreta STUDY TYPE: Retrospective cohort study. In all, 374 patients consisting of 259 patients with placenta previa and accreta after previous cesarean section (CS) for the derivation cohort and 115 patients for the validation cohort. 1.5T single-shot fast spin-echo sequence. [Correction added on October 23, 2019, after first online publication: The field strength in the preceding sentence was corrected.] ASSESSMENT: Using the derivation cohort, clinical and MRI data were collected and multivariable logistic regressions analysis was conducted to develop a scoring system for prediction of intraoperative massive bleeding (blood loss volume > 2000 mL). Finally, the scoring system was validated on 115 patients. Student's t-test, Mann-Whitney U-test, X 2 statistics, multivariable analysis, and receiver operating characteristic (ROC) analysis. Ten indicators, including clinically maternal age (1 point), preoperative hemoglobin level (1 point), gravidity number (1 point), number of CS (1 point), and MRI T2 dark intraplacental bands (4 points), cervical canal length (3 points), placenta thickness on the uterine scar area (4 points), empty vascular shadow of the uterus (1 point), low signal discontinuity in the muscular layer of the posterior wall of the bladder (6 points) and attachment position of the placenta (1 point) were imputed. From the ROC analysis, a total score of 7 points was identified as the optimal cutoff value, allowing good differentiation of intraoperative massive bleeding in the derivation cohort (AUC, 0.863; 95% confidence interval [CI]: 0.811-0.916) and in the validation cohort (AUC, 0.933; 95% CI: 0.885-0.980). The scoring system for intraoperative massive hemorrhage consists of MRI and clinical indicators, and using a cutoff value of 7 points for a high risk of massive bleeding, the developed scoring system could accurately assess the risk of intraoperative massive hemorrhage in patients with placenta previa and accreta. This scoring system can potentially reduce the incidence of intraoperative massive bleeding by identifying patients at high risk. 3 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2020;51:947-958.

EP15.03: Does a short cervix predict antepartum massive hemorrhage in patients with placenta previa?

Placenta previa complicates 0.3 - 0.5% of pregnancies and can cause antepartum and/or intrapartum massive hemorrhage, which often necessitates allogenic blood transfusion and/or hysterectomy, rarely leading to maternal death. A useful clinical predictor of identifying patients at high risk for massive hemorrhage has been awaited. As several recent retrospective studies indicate, cervical length (CxL) measured by transvaginal ultrasonography may be a predicting parameter for antepartum massive hemorrhage (AMH) in cases with placenta previa. However, conflicting data exist. Thus, we evaluated if a short cervix is associated with eventual AMH in patients with placenta previa. A retrospective chart review was performed on 129 singleton pregnancies with placenta previa who delivered at our institution from January 2010 to December 2016, and information on patient characteristics and clinical course was collected. The shortest CxL measured throughout gestation in each patient was used for analysis. A receiver-operating characteristics (ROC) curve was plotted to determine the cut-off CxL value in the prediction of AMH defined as bleeding that was uncontrollable and/or over 100 ml. Statistical evaluation also included univariate and multivariate analysis. Institutional Review Board approval was obtained for the study. AMH occurred in 26 patients, and all of them required emergency Caesarean section. ROC analysis determined a cut-off CxL of 35 mm in the prediction of AMH, with a sensitivity of 81% and a specificity of 60%. The area under the curve was 0.74, and the positive and negative predictive values were 34% and 93%, respectively. The adjusted odds ratio for AMH was 5.2 (95% CI, 1.7 – 15.4) in patients with a CxL at or below 35 mm (n = 62), and the ratio for AMH in those with at least one episode of antepartum minor hemorrhage (n = 50) was 5.2 (95% CI, 1.9 – 14.1). Our data indicate that CxL measurements may be useful in determining high-risk patients for AMH.

Postpartum hemorrhage in the setting of a mechanical heart valve

Abstract Background: Therapeutic anticoagulation is required for all patients with prosthetic mitral valves. Anticoagulation with warfarin is recommended; however, warfarin is teratogenic in early pregnancy and therefore alternate anticoagulation regimens are suggested for pregnant patients. Case: A 28-year-old gravida 2, para 1 woman at 36 weeks’ gestation with a prosthetic mitral valve and a history of a corrected anomalous origin of the left coronary artery arising from the left pulmonary artery presented in labor. She underwent a spontaneous vaginal delivery complicated by a postpartum hemorrhage necessitating a hysterectomy. Conclusion: Management of mechanical valves in pregnancy is controversial. The provider must weigh the risks of life threatening valve thrombosis and malfunction against the risk of significant hemorrhage. This case report reviews peripartum anticoagulation protocols and management of massive hemorrhage in patients with prosthetic mechanical valves.

Bleeding sites in elderly trauma patients who required massive transfusion: a comparison with younger patients

IntroductionAmong elderly patients with severe trauma, the sites of massive hemorrhage and their clinical characteristics are not well understood. Therefore, we investigated the sites of massive hemorrhage in patients with severe trauma, and compared the results for younger and elderly patients. MethodsA cohort of severe trauma patients (Injury Severity Score ≥16) admitted from March 2007 to December 2014 was reviewed retrospectively. The inclusion criterion was massive bleeding, which was defined as bleeding that required the transfusion of ≥10 red cell concentrate units within 24 hours of admission, or as cases of early death that occurred despite continuous blood transfusion and before the patient could receive ≥10 red cell concentrate units within the first 24 hours after their admission. ResultsEighty-four patients met our inclusion criterion. The younger group (<65 years old) included 40 patients (48%), whereas the older group (≥65 years old) included 44 patients (52%). The percentage of nondiagnosable cases at the primary survey (massive bleeding due to multisite damage caused by a bone fracture or contusion, retroperitoneal hematoma without a pelvic ring fracture and with stable pelvic ring fracture) was 14% in the younger group and 40% in the older group (odds ratio, 3.92; 95% confidence interval, 1.37-11.27, P = .017). ConclusionsEven if no abnormalities are observed at the primary survey of elderly patients with severe trauma, physicians should consider the possibility of massive bleeding.

Transarterial embolization for acute massive hemorrhage in patients with duodenal ulcer

To assess the feasibility and effectiveness of transarterial embolization for management of acute massive hemorrhage in patients with duodenal ulcer. Twenty-two patients with duodenal ulcer underwent transarterial embolization for acute massive hemorrhage in our hospital between January 2007 and December 2012. Embolic agents were coils and gelatin sponge. The clinical data and embolization procedures of these patients were retrospective analyzed. Bleeding was controlled in 20 of 23 patients after the first embolization procedures. In the other 3 patients with rebleeding, one patient was successfully managed by repeat embolization and two patient underwent surgical treatment. The overall clinical success rate for acute hemorrhage after transarterial embolization was 91% (21/23). No severe complication occurred. Transarterial embolization is safe and effective for acute massive hemorrhage in patients with duodenal ulcer.

Radiation-Induced Massive Hemorrhage After Re-irradiation of Locally-Recurred Nasopharyngeal Carcinoma

Massive hemorrhage is a severe late complication for patients with locally recurrent nasopharyngeal carcinoma and the most common cause of death. The objective of this study was to assess the clinical factors and dosimetric parameters associated with massive hemorrhage in patients treated with intensity-modulated radiation therapy (IMRT) for locally recurrent nasopharyngeal carcinoma (NPC).

Evaluation of Recombinant Factor VIIa Treatment for Massive Hemorrhage in Patients with Multiple Traumas

BackgroundRecent studies and case reports have shown that recombinant factor VIIa (rFVIIa) treatment is effective for reversing coagulopathy and reducing blood transfusion requirements in trauma patients with life-threatening hemorrhage. The purpose of this study is to evaluate the effect of rFVIIa treatment on clinical outcomes and cost effectiveness in trauma patients.MethodsBetween January 2007 and December 2010, we reviewed the medical records of patients who were treated with rFVIIa (N=18) or without rFVIIa (N=36) for life-threatening hemorrhage due to multiple traumas at the Emergency Department of Pusan National University Hospital in Busan, Korea. We reviewed patient demographics, baseline characteristics, initial vital signs, laboratory test results, and number of units transfused, and then analyzed clinical outcomes and 24-hr and 30-day mortality rates. Thromboembolic events were monitored in all patients. Transfusion costs and hospital stay costs were also calculated.ResultsIn the rFVIIa-treated group, laboratory test results and clinical outcomes improved, and the 24-hr mortality rate decreased compared to that in the untreated group; however, 30-day mortality rate did not differ between the groups. Thromboembolic events did not occur in both groups. Transfusion and hospital stay costs in the rFVIIa-treated group were cost effective; however, total treatment costs, including the cost of rFVIIa, were not cost effective.ConclusionsIn our study, rFVIIa treatment was shown to be helpful as a supplementary drug to improve clinical outcomes and reduce the 24-hr mortality rate, transfusion and hospital stay costs, and transfusion requirements in trauma patients with life-threatening hemorrhage.

Diagnosis and treatment of massive hemorrhage in patients with severe acute pancreatitis complicated with false aneurysms

目的 重症急性胰腺炎(SAP)后期出现胰腺及胰周组织坏死、感染,临床上已是非常危重.一旦并发腹腔、胃肠道等处假性动脉瘤破裂大出血,来势凶险,将进一步危及病人的生命,处理非常棘手.因此及时诊断,有效的治疗是挽救病人生命的关键.本文对SAP并发大出血的临床特点和有效的诊治方法进行探讨.方法 自1990年10月至2005年9月共收治的急性胰腺炎286例,其中并发胰周血管分支假性动脉瘤破裂大出血12例,回顾性分析其诊断和治疗方法及疗效.结果 SAP并发假性动脉瘤大出血12例病人:男10例,女2例,平均年龄51.2岁.病因:胆源性胰腺炎6例,高脂血症3例,甲状旁腺机能亢进危象1例,原因不明2例.12例进行选择性血管造影检查发现病变,10例一点法栓塞后获得止血,4例栓塞4～7d后再出血,2例急诊手术缝扎止血;另2例行两点法血管栓塞止血.3例病人死于感染和多器官功能不全综合征(MODS).结论 血管造影、胃镜及腹腔穿刺是诊断SAP并发动脉大出血及其发生部位的主要方法;胰腺血运丰富,两点法血管栓塞止血及急诊手术是治疗SAP并发大出血的有效手段。

Recurrent massive hemorrhage in patients with achlorhydria and atrophic gastritis

Recurrent massive hemorrhage in patients with achlorhydria and atrophic gastritis

Recurrent Massive Hemorrhage in Patients With Achlorhydria and Atrophic Gastritis

Hemorrhagic gastritis has been observed in association with many diseases and following ingestion of alcohol and aspirin.^1,2It was appreciated that erosive gastritis and bleeding could occur in the presence of achlorhydria. However, emphasis has been placed in recent years on the presence of acid as an essential factor in the pathogenesis of the bleeding.³In this report, three patients are described with massive recurrent hemorrhagic gastritis, each of whom had severe atrophic gastritis and achlorhydria. <h3>Report of Cases</h3><h3>Case 1.</h3> —A 73-year-old white man, a former brewery worker and chronic alcoholic was hospitalized repeatedly at the Boston City Hospital because of recurrent melena and anemia and hypotension. In addition, he had calcific aortic stenosis, cardiomegaly, atrial fibrillation and congestive heart failure, and cirrhosis of the liver. Several of the bleeding episodes were preceded by alcohol ingestion, while others were not, and two bouts of bleeding occurred during