Recurrent Bleeding Research Articles

Repeated Radiosynovectomy in Haemophilia: Revealing Long-Term Effectiveness and Safety.

Radiosynovectomy (RS), which uses beta particle-emitting radiocolloids, has proven highly effective in significantly reducing the occurrence of haemarthroses and breaking the cycle of bleeding and synovitis. This study now presents the long-term outcomes of repeated RS in individuals with haemophilia. Repeated RS was administered to 48 joints in 37 people with haemophilia (PwHs) diagnosed with chronic haemophilic synovitis. The frequency of bleeding episodes was meticulously recorded during the 6-month periods preceding and following each of the initial and subsequent RS procedures. Treatment failure was designated by the necessity for additional RS injections. The results for 48 joints were analysed. The mean bleeding frequency of the joints was 12.5±7.29 (median 10) within the last 6 months in the pre-treatment evaluation and after the treatment, the mean bleeding frequency of the joints decreased to 2.25±3.82 (median 0.5) for the first 6 months (p<0.001) after the first RS. The mean survival of the first intervention was 40.52±33.79 months (range, 1-124 months). In the second RS, the mean bleeding frequency of the joints was 10.29±7.66 (median 8) within the last 6 months in the pre-treatment evaluation and after the treatment, and the mean bleeding frequency of the joints decreased to 0.93±1.69 (median 0) for the first 6 months (p<0.001). The survival rate of the second RS was 94% at 12 months, and 87% at 36 months. Repeated RS was proven to be an effective and safe treatment for Pwh with recurrent bleeding episodes during long-term follow up. Thirty-six months survival rate was 87% (42 of 48 joints).

Uterine artery embolisation in symptomatic patients with placenta accreta spectrum disorders.

Postpartum haemorrhage is the most common cause of mortality among women after childbirth. Therefore, this work aims to highlight the possibility of endovascular treatment of postpartum haemorrhage due to remnants in patients with placenta accreta spectrum disorders (PAS disorders) using selective UAE after failure of the standard management. This procedure is a relatively safe and technically nondemanding, with a low risk of recurrent vaginal bleeding. This article presents an evaluation of the results of eight patients (age between 19-39 years) who underwent selective transarterial embolisation of uterine arteries from January 2022 to August 2023 at the angio-interventional department of our university hospital center. Based on a multidisciplinary consensus of sonographically detected residues of placenta accreta with typical hypervascularisation, unilateral/bilateral embolisation of the uterine artery was performed with a microcatheter using polyvinyl alcohol embolisation particles, possibly in combination with gelatine foam. There were no periprocedural complications during embolisation, nor were there episodes of repeated bleeding or other postprocedural complications during the follow-up. Two patients underwent surgical revision of the uterine cavity with extirpation of devascularised residual tissue. Thus far, this procedure has proven to be a safe and relatively technically nondemanding method supplementing the management of symptomatic patients with PAS disorders with a low risk of rebleeding.

Clinical application of mineralized collagen scaffolds in surgical treatment of skull defects

To explore the clinical application value of mineralized collagen (MC) bone scaffolds in repairing various types of skull defects, and to assess the suitability and repair effectiveness of porous MC (pMC) scaffolds, compact MC (cMC) scaffolds, and biphasic MC composite (bMC) scaffolds. A retrospective analysis was conducted on the clinical data of 105 patients who underwent skull defect repair with pMC, cMC, or bMC between October 2014 and April 2022. The cohort included 63 males and 42 females, ranging in age from 3 months to 55 years, with a median age of 22.7 years. Causes of defects included craniectomy after traumatic surgery in 37 cases, craniotomy in 58 cases, tumor recurrence or intracranial hemorrhage surgery in 10 cases. Appropriate MC scaffolds were selected based on the patient's skull defect size and age: 58 patients with defects <3 cm² underwent skull repair with pMC (pMC group), 45 patients with defects ≥3 cm² and aged ≥5 years underwent skull repair with cMC (cMC group), and 2 patients with defects ≥3 cm² and aged <5 years underwent skull repair with bMC (bMC group). Postoperative clinical follow-up and imaging examinations were conducted to evaluate bone regeneration, the biocompatibility of the repair materials, and the occurrence of complications. All 105 patients were followed up 3-24 months, with an average of 13 months. No material-related complication occurred in any patient, including skin and subcutaneous tissue infection, excessive ossification, and rejection. CT scans at 6 months postoperatively showed bone growth in all patients, and CT scans at 12 months postoperatively showed complete or near-complete resolution of bone defects in all patients, with 58 cases repaired in the pMC group. The CT values of the defect site and the contralateral normal skull bone in the pMC group at 12 months postoperatively were (1 123.74±93.64) HU and (1 128.14±92.57) HU, respectively, with no significant difference ( t=0.261, P=0.795). MC exhibits good biocompatibility and osteogenic induction ability in skull defect repair. pMC is suitable for repairing small defects, cMC is suitable for repairing large defects, and bMC is suitable for repairing pediatric skull defects.

Challenging Situations in the Treatment of Cancer-Associated Thrombosis.

Cancer-associated thrombosis (CAT) is a common clinical problem in the treatment of cancer patients posing some unique challenges. These include the need to balance between the risk of recurrent thromboembolic events and bleeding complications in the individual cancer patient. A frequently encountered dilemma is the need for long-term anticoagulation in the setting of active malignancy. Until now, optimal duration, intensity, and type of anticoagulation in cancer patients remain an area of ongoing debate. In this case-based review, we present several challenging clinical scenarios and provide guidance on management. For optimal treatment results, CAT generally requires a multidisciplinary approach including specialists for thrombosis and hemostasis as well as hematology and oncology. Individual patient preferences should always be taken into account, especially in clinical situations with weak treatment evidence.

Infective endocarditis causing recurrent cerebral infarction, cerebral hemorrhage and septic meningitis: A case report.

We reported a rare case of recurrent cerebral infarction, intracerebral hemorrhage, and purulent meningitis, culminating in the diagnosis of a young patient with infective endocarditis who had been treated in 3 hospitals for a long course of illness for 8 months prior to diagnosis. It aims to enhance clinicians' understanding of the neurological complications caused by infective endocarditis. A 25-year-old male, student, was hospitalized for an 8-hour history of speech impairment and drooling with dysphagia. Magnetic resonance imaging (MRI) showed massive cerebral infarction in the right frontotemporal and insular lobes, and the first diagnosis was "cerebral infarction." Later, the patient developed recurrent cerebral infarction, intracerebral hemorrhage, and purulent meningitis. Recurrent cerebral infarction, intracerebral hemorrhage, and purulent meningitis were confirmed to be caused by infective endocarditis. The patient was treated with antiplatelet drugs such as aspirin and clopidogrel, mannitol to reduce intracranial pressure, and ceftriaxone and vancomycin to fight infection, and the patient's condition improved. The patient was diagnosed with infective endocarditis after 8 months without a clear diagnosis, and the patient was finally diagnosed with infective endocarditis during the final follow-up. Febrile patients should be aware of infective endocarditis, particularly if the fever is persistent of unknown origin or structural changes in the heart with neurologic lesions. Cardiogenic neurological diseases are relatively more severe, have a worse prognosis, and have a higher recurrence rate than primary neurological diseases, so early diagnosis and treatment are more urgently needed.

Risk factors for peptic ulcer bleeding one year after the initial episode

BackgroundPeptic ulcers are a common gastrointestinal disease that could cause death when combined with bleeding. The aim of this study was to identify risk factors for peptic ulcer bleeding (PUB) recurrence after the initial episode.MethodsThis retrospective study analyzed medical records of PUB patients who were admitted through the emergency department between January 1, 2020, and December 31, 2022. A multivariate logistic regression model was used to identify independent risk factors predicting readmission due to recurrent PUB within one year.ResultsA total of 775 PUB inpatient samples were collected, among which 172 and 603 were placed respectively in the readmission group and non-readmission group. Multivariate analysis indicated that PUB inpatients who were aged 70 or above (OR = 1.62, 95% CI: 1.06–2.47), had more severe ulcers (Forrest 1a, 1b, 2a, or 2b) (OR = 2.41, 95% CI:1.57–3.71), had a CCI score of 3 or higher (OR = 2.25, 95% CI:1.45–3.50), had a medical history of peptic ulcers (OR = 3.87, 95% CI:2.56–5.85), had a medical history of cardiovascular disease (CVD) (OR = 2.31, 95% CI:1.53–3.50), or had an international normalized ratio (INR) > 1.2 on admission (OR = 2.14, 95% CI:1.28–3.57) were respectively more likely to be readmitted within a year due to PUB than those who were under the age of 70, had less severe ulcers (Forrest 2c or 3), had a CCI score of less than 3, had no medical history of peptic ulcers, had no medical history of CVD, or had admission INR ≤ 1.2.ConclusionThis study confirmed that age (≥70 years), Forest classification (Forrest 1a, 1b, 2a, or 2b), multiple comorbidities, a medical history of peptic ulcers, a medical history of CVD, and admission INR > 1.2 were independent risk factors for patient readmission within a year due to recurrent PUB.

Outpatient Management of Cancer-Associated Pulmonary Embolism: A Systematic Review and Meta-Analysis.

Outpatient management of pulmonary embolism (PE) remains controversial in patients with cancer due to their higher risks of mortality, recurrent venous thromboembolism (VTE) and bleeding complications. This systematic review and meta-analysis aimed to evaluate the safety and feasibility of outpatient management of cancer-associated PE. We searched MEDLINE, Embase, Cochrane Central, and Scopus databases from inception to May 30, 2024, for studies on outpatient management of cancer-associated PE. Eligible studies included randomized controlled trials, cohort studies, and case-control studies with ≥10 patients. The primary outcome was 30-day-all-cause mortality; secondary outcomes included VTE-related mortality, major bleeding and recurrent VTE at 30 days. Meta-analysis was performed using random effects models, and heterogeneity was assessed with the I2 statistic. Nineteen studies (13 full-article, 6 abstract-only) with a total of 1589 patients managed as outpatients were identified. Criteria for outpatient management of cancer-associated PE were reported in 14 studies. The pooled 30-day all-cause mortality rate was 1.74% (95% CI: 0.99-3.03; I2=0%, 691 patients, 6 full-article). The 30-day major bleeding pooled rate was 2.71% (95% CI: 1.51-4.83; I2=0%; 406 patients, 6 full-article), and the 30-day recurrent VTE pooled rate was 1.26% (95% CI: 0.53-3.00; I2=0%; 396 patients, 5 full-article). Selected patients with cancer-associated PE managed as outpatients appear to have low short-term rates of mortality, major bleeding and recurrent VTE suggesting this may be a safe strategy. Further research with larger, prospective studies is needed to confirm these findings and refine risk stratification protocols.

Optimal timing of oral anticoagulation initiation in patients with acute ischaemic stroke and atrial fibrillation: a comprehensive meta-analysis and systematic review

The optimal timing for initiating direct oral anticoagulants (DOACs) for secondary stroke prevention in patients with atrial fibrillation and acute ischaemic stroke remains controversial due to concerns about haemorrhagic transformation....

Laparoscopic cholecystectomy plus common bile duct exploration for extrahepatic bile duct stones and postoperative recurrence-associated risk factors

BACKGROUND There remain controversies regarding the surgical treatment of extrahepatic bile duct stones (EHBDSs) in clinical practice. AIM To explore the curative effect of laparoscopic cholecystectomy (LC) plus common bile duct exploration (CBDE) for the surgical treatment of EHBDSs and to analyze the risk factors that affect postoperative stone recurrence. METHODS Eighty-two patients with EHBDSs admitted between March 2017 and March 2023 were selected. Among them, patients treated with open choledocholithotomy plus LC or open cholecystectomy (OC) were set as the control group (n = 40), and those treated with LC plus CBDE served as the observation group (n = 42). The surgical outcomes of the two groups were compared, the surgical complications and Gastrointestinal Quality of Life Index (GIQLI) scores were counted, and the one-year prognostic recurrence was recorded. Independent factors for postoperative recurrence were determined using univariate and multivariate analyses. RESULTS The two groups were comparable in the stone residual rate (P &gt; 0.05). The operation time (P &lt; 0.05), intraoperative bleeding (P &lt; 0.05), and total complication rate (P = 0.005) were lower in the observation group than in the control group. The observation group exhibited a marked increase in the GIQLI score, which was higher than the control group (P &lt; 0.05). A lower one-year recurrence rate was determined in the observation group vs the control group (P = 0.027). Sphincter of Oddi dysfunction [odds ratio (OR) = 5.712, P = 0.007] and the treatment scheme of open choledocholithotomy plus LC or OC (OR = 6.771, P = 0.008) were the independent risk factors for one-year recurrence in patients after surgery. CONCLUSION LC plus CBDE for patients with EHBDSs can reduce stone residuals, intraoperative bleeding, complications, and postoperative recurrence.

Dental-dedicated magnetic resonance imaging in the follow-up of lower third molar removal.

The objective is to present a dental-dedicated magnetic resonance imaging (ddMRI)-based follow-up of inferior third molar removal over 12months. A 30-year-old female presented with recurrent pain and bleeding from her lower right third molar. With adding diagnostic information from a panoramic image, the tooth was referred for removal. The patient underwent ddMRI using a dental coil with a proton density (PD) weighed turbo spin echo (TSE) sequence and a PD-TSE-STIR with fat suppression to highlight possible inflammatory processes. The scans were performed pre-operatively, immediately post-operatively, and in a rigorous follow-up (weekly basis for the first 6weeks, bi-weekly from 7 to 12weeks, and once at 6 and 12months post-operatively). Using ImageJ software, circular ROIs were selected in the extraction alveolus coronary, middle, and apical regions. Mean grey values (MGVs) and standard deviation (SD) were obtained. A trend of decreasing MGVs in the PD (TSE) pulse sequence was observed over time, irrespective of the root third. Considering the PD-STIR (TSE), no trend was observed. ddMRI is feasible in the follow-up assessment of inferior third molar removal. Further clinical trials with larger samples are needed to define the usability of follow-up with ddMRI, considering a potential added diagnostic value.

Hormone-related thrombosis: duration of anticoagulation, risk of recurrence, and the role of hypercoagulability testing.

Hormone-related venous thromboembolism (VTE) is common and entails scenarios in which VTE occurs during exposure to exogenous or endogenous female sex hormones, typically estrogen and progestogen. For the management of hormone-related VTE, it is important to realize that many patients use these hormones for a vital purpose often strongly related to the patient's well-being and quality of life. In this review we discuss clinical cases of VTE related to hormonal contraceptive use and pregnancy to illustrate key considerations for clinical practice. We cover practice points for primary VTE treatment and detail the evidence on the risk of recurrent VTE and bleeding in this population. The potential value of thrombophilia testing is described, including "who, why, when, what, and how." We also discuss key aspects of shared decision-making for anticoagulant duration, including a reduced-dose anticoagulant strategy in hormone-related VTE.

Treatment of VTE in the thrombocytopenic cancer patient.

Thrombocytopenia is a frequent complication in patients with cancer, mostly due to the myelosuppressive effects of antineoplastic therapies. The risk of venous thromboembolism (VTE) in patients with cancer is increased despite low platelet counts. The management of cancer-associated VTE in patients with thrombocytopenia is challenging, as the risk of both recurrent VTE and bleeding complications is high. Moreover, the time-dependent nature of thrombocytopenia over the course of antineoplastic therapies further complicates the management of patients in clinical practice. In the absence of evidence from high-quality studies, the management of anticoagulation therapy for VTE must be personalized, balancing the individual risk of VTE progression and recurrence against the risk of hemorrhage. In the present case-based review, we highlight the clinical challenges that arise upon managing cancer-associated VTE in the setting of present or anticipated thrombocytopenia, summarize the available evidence, and provide a comparative overview of available guidelines.

Treatment of mycotic rhinitis caused by aspergillus fumigatus in a quarter horse mare using topical clotrimazole and oral potassium iodide.

Fungal rhinitis in horses is rare, although severe, due to the progressive nasal obstruction. Aspergillus is one of the fungi most often involved in these cases. A 7-year-old Quarter Horse mare weighing 325kg was admitted with a history of recurrent nasal discharge and bleeding, foul smell, reluctance to exercise, and abortion. Laboratory and imaging examinations revealed eosinophilia, scarring and erosion areas in the nasal mucosa, purulent and bloody secretions, and remarkable yellowish plaques. Histopathological examination revealed fungal rhinitis and bacterial culture revealed the presence of β-hemolytic Streptococcus and Staphylococcus sp. Fungal culture and molecular diagnosis confirmed Aspergillus fumigatus as the etiological agent. A tracheostomy was necessary due to the patient's dyspnea. For the treatment, topical application of clotrimazole ointment was carried out in the rostral portion of the nasal cavity once a day and in the caudal portion of the nasal cavity, endoscopic guided every 48h. In the fifth endoscopy-guided application, a significant improvement was noticed; however, the animal exhibited a hypersensitivity reaction, and the treatment was discontinued. Thus, potassium iodide therapy was initiated (67mg/kg, PO, SID, 14 days). The patient demonstrated favorable clinical improvement, achieved resolution of the fungal infection, and was discharged after 25 days of hospitalization. Topical clotrimazole demonstrated a probable efficacy as a standalone treatment, although its use had to be prematurely discontinued due to the emergence of a hypersensitivity reaction. The combination of clotrimazole and potassium iodide effectively treated fungal rhinitis in a shorter time than previously reported. This report provides useful guidance for other cases of fungal rhinitis, although further studies are needed.

Early minimally invasive image-guided eNdoscopic evacuation of iNTracerebral hemorrhage: a phase II pilot trial.

Whether minimally invasive endoscopic surgery (ES) improves survival and functional outcome in people with spontaneous supratentorial intracerebral hemorrhage (SSICH) is unknown. This is a single-center pilot study performed between July 2021 to January 2023. Any supratentorial hematoma with a volume between 20 mL and 100 mL was endoscopically evacuated within 24 h after bleeding onset. Participants were followed-up for 6 months, assessing clinical and radiological outcomes. The primary feasibility outcome was satisfactory hematoma removal (<15 mL residual volume on the first postinterventional CT study) and the primary efficacy outcome was reaching a modified Rankin Scale 0-3 (mRS) at 6 months. Secondary outcomes were mortality and morbidity rates. Ten participants (median age 72.5 years [IQR 67-81], 70% male, median baseline hematoma volume 34.1 [IQR 25.5-58.0]) were included. Satisfactory hematoma evacuation was achieved in 70% (7/10) with a median evacuation percentage of 69.5% [IQR 45.3-93.9%]. The median duration of surgery was 91 min [IQR 73-111]. Favorable outcome at 6 months was observed in 60% of the participants and improved from within 24 h before the intervention to the last follow-up (6 months). Five participants (50%) experienced a total of six complications, two recurrent bleedings, three pneumonias and one epilepsy. Mortality rate was 30%, while one participant died from pneumonia, one from a recurrent bleeding, and one participant due to a glioblastoma. ES appears to be feasible, with satisfactory hematoma removal being achieved in the majority of participants. Based on the descriptive results of this pilot trial, a national multicenter RCT comparing ES to best medical treatment is currently ongoing. https://clinicaltrials.gov/, identifier NCT05681988.

Brainstem Cavernomas: Functional Results and Prognosis Long-Term Follow-Up Cohort of Patients Treated Non-Operatively and Operatively

Introduction: Cerebral cavernous malformation (CCM) is an abnormally large collection of low flow vascular channels without brain parenchyma intervening between the sinusoid vessels. Brainstem Cavernoma Malformations (BSCMs) account for 0.5 to 0.9 % in the literature. Functional results, bleeding and subsequent bleeding have been reported in several studies in the literature relative to the management both for surgery and non-operative treatment. Our study aimed to evaluate long term functional outcomes of patients treated both operatively and non-operatively. Materials and Methods: A cohort of 44 patients has been followed for 29 years either retrospectively and prospectively. The retrospective period extended from October 1992 to September 2020 while the prospective one was the one year follow-up (FU) till September 2021. Data have been collected from patients’ archived files, schedule visits to the physician and phone calls. Patients in whom the diagnosis of BSCMs have been confirmed clinically and by image findings were included in our study. Functional status were assessed using both modified Rankin Scale (mRs) score over an interval from 0 to 5 and Karnosky Index (KI) from 0 to 100. Muscle strength was assessed by muscular testing over an interval from 0 to 5. Zero meant absence of muscular contraction while 5 was normal muscle motion. Magnetic Resonance Imaging (MRI) was systematically carried out in patients who had not got imaging control for 2 years. During FU period each patient who presented a new and sudden clinical symptom related to the involvement of brainstem was reassessed clinically and image work-up to rule out a rebleeding episode. Univariate analysis was conducted for establishing statistical significance between early haemorrhages, rebleeding, clinical and demographic features. Results: Forty patients presented 57 bleeding episodes. Thirteen patients (29.54 %) underwent surgery. Thirteen ones had eighteen recurrent bleeding episodes, i.e. a rate of 31.69±0.65 SD. Initial average mRs score was 0.67±0.79 SD for the conservative treatment group while the operated on patients had 2.15±1.14 SD. Postoperatively, mRs score was 2.07±1.44 SD. Final FU mRs was 0.93±00 SD and 1.81±00 SD for non-operative and operative treatment respectively. Surgery reduced the rate of rebleeding (p=0.04). The long-term functional outcome improvement was similar between non-operative and operative treatment (p=0.27). The predictive factors of bleeding and rebleeding reported were woman gender (p=0.0074) and pons location (p=0.0001) while age and Zabramski radiologic type were not significant. Conclusion: Our finding sustains similar functional outcomes to both non-operative and operative treatment. Nevertheless, surgery reduced the rate of rebleeding and remains largely related to the precise patient selection regarding clinical, radiologic and microsurgery features.

Abstract 4140134: Impact of Cancer on Outcomes in Patients with Acute Myocardial Infarction; a Systematic Review and Meta-analysis.

Background: Cardiovascular diseases are the second leading cause of death among cancer patients, after cancer-related mortality. It has not been well established if a patient's malignancy status increases their risk of cardiovascular events following a myocardial infarction (MI). Hypothesis: This study aims to assess the impact of cancer on cardiovascular outcomes following an acute myocardial infarction. Methods: We systematically searched electronic databases such as Pubmed, Embase and Cochrane Library from inception until March 2024 using the appropriate Mesh terms, “ cancer,” “myocardial infarction,” and “cardiovascular mortality”, “in-hospital mortality”. Pooled relative risk and their corresponding confidence interval were calculated using the random effect model. A p-value of &lt;0.05 was considered statistically significant. Results: A meta-analysis was conducted with seven articles, with 32856 cancer patients and 520421 noncancer patients with MI. Pooled analysis showed that patients with cancer had to have a significantly higher risk of recurrent MI in (RR 1.49, 95% CI:1.03-1.96), major bleeding (RR 1.96, 95% CI: 1.28-2.64), cerebral infarction (RR 1.29, 95% CI: 1.21-1.38), the in-hospital mortality rate (RR 1.62, 95% CI: 1.04-2.20), cardiovascular mortality (RR 1.57, 95% CI: 1.00-2.13), and hospitalization due to heart failure (RR 1.51, 95% CI 1.46, 1.56) when compared with noncancer patients. Conclusion: This study shows that cancer is strongly associated with an increased risk of recurrent MI, major bleeding, cerebral infarction, hospital mortality, cardiovascular mortality, and hospitalisation due to heart failure in patients with acute MI. Proper monitoring of cardiac function and lab markers can be effective in reducing morbidity and mortality.

Endoscopic resection of a juvenile jejunum polyp which caused recurrent intestinal bleeding in a 12-month-old child: clinical observation

BACKGROUND: To verify a source of obscure gastrointestinal bleeding leading to iron deficiency anemia is a challenging diagnostic problem. Intestinal polyps can be one of such sources. Sporadic juvenile intestinal polyps are extremely rare at the first year of life. The authors present a clinical case which demonstrates endoscopic diagnostics and resection of a jejunum polyp in a 12-month-old child weighing 6.3 kg. We did not find similar publications in literature. CLINICAL CASE DESCRIPTION: A 12-month-old boy was admitted to our clinic with long-lasting complaints of dark stool and iron deficiency anemia. For the first time, gastrointestinal bleeding symptoms appeared at the age of one month. The child was repeatedly examined, but gastrointestinal bleeding source was not found. The child was prescribed symptomatic therapy for iron deficiency anemia including red blood cell transfusion. At current hospitalization in our clinic an intestinal polyp and transient small intestinal intussusception were suspected at ultrasound examination. The child underwent esophagogastroduodenoscopy, video capsule endoscopy, colonoscopy, laparoscopy. But the source of the bleeding was not found. During the repeated enteroscopy at 40 cm distally to the pylorus a sporadic juvenile jejunum polyp 17×15 mm was found and resected. The postoperative period was uneventful. In 1 month, there were no complaints as for the catamnesis, the child's stool had the usual characteristics, the indicators of "red blood" corresponded to the age norm. CONCLUSION: A sporadic juvenile jejunal polyp may be a cause of obscure recurrent intestinal bleeding in children. Modern intraluminal endoscopy allows not only to put diagnosis, but also to perform a minimally invasive surgical intervention.

Study of the effectiveness factors of microsurgical treatment of cerebral arterial aneurysms

BACKGROUND: Despite improvements in diagnostic methods and microsurgical techniques for treating arterial aneurysms of the cerebral vessels, there remains a high probability of mortality and persistent disability among the working population. AIM: To determine the factors influencing the effectiveness of surgical interventions in patients with cerebral arterial aneurysms. MATERIALS AND METHODS: This scientific work presents the results of examination and surgical treatment of 86 patients operated on from 2017 to 2023 y. at the Neurosurgery Clinic of the National Hospital. The age of the patients ranged from 23 to 78 years (average age - 47±1.7 years), among them there were 48 (55.8%) men, 38 (44.2%) women. All patients underwent MRI or CT angiography of cerebral vessels; in 47 (54.6%) patients, cerebral aneurysm was confirmed by selective cerebral angiography. The size of the aneurysms ranged from miliary (3.0 mm to giant sizes 25.0-30.0 mm). RESULTS: The clinical picture of patients with ruptured arterial aneurysms was associated with the prevalence of subarachnoid hemorrhage, the location and volume of formed intracerebral hematomas in patients in the pre-hemorrhagic period with unruptured aneurysms - with the location and size of arterial aneurysms. One of the serious complications that arose during operations was intraoperative rupture (15.1%) of the aneurysmal sac at different stages of operations. The worst results with mortality up to 4.17% were observed in patients with ruptured arterial aneurysms, on the HH scale III, IV and 7-8, 9-10 points on the Glasgow scale. In cases where direct access to the aneurysm is difficult, it is advisable to perform subpial microresection of the altered medulla around the aneurysm. This allows you to avoid traumatic damage to the walls of the aneurysm and the development of spasm of arterial vessels. In order to avoid aneurysm rupture when isolating the aneurysm neck, it is advisable to temporarily apply special removable (temporary) clips to the proximal and distal segments of the supporting vessel of the aneurysm. After it was possible to isolate the neck of the aneurysm, a special clip was applied and, if possible, the patency and integrity of the vessel carrying the aneurysm and its branches were preserved. To determine the absence of blood flow in the aneurysm and assess the patency of arterial vessels, it is recommended to use intraoperative microvascular doplefography. CONCLUSION: The results of surgical treatment for ruptured aneurysms depended on the preoperative condition of the patients. Microsurgical clipping of arterial aneurysms effectively prevents the risk of recurrent subarachnoid hemorrhage. The absence of complications in patients during surgery and the early postoperative period does not guarantee the possibility of developing delayed complications that may require repeated operations.

Hepatosplenic schistosomiasis, treatment outcomes and associated factors among adult patients treated at public hospitals in the Harari Region of Ethiopia: retrospective cross-sectional study.

Schistosomiasis is one of the neglected tropical diseases that pose a significant burden in developing countries, particularly in sub-Saharan Africa. Hepatosplenic schistosomiasis (HSS) is a substantial cause of morbidity and mortality. This study aimed to determine clinical patterns, outcomes and factors associated with HSS in the Harari Region of Ethiopia. An institutional-based retrospective cross-sectional study was conducted among 93 adult patients diagnosed with HSS at public hospitals in the Harari Region from December 2018 to November 2022. Data were extracted from medical records using a standardized data extraction tool. EpiData version 4.2 and SPSS version 26.0 were used for data entry and analysis. Fisher's exact test was used to identify the association between dependent and independent variables, and statistical significance was declared at p<0.05. In the current study, HSS-related mortality was recorded in 7.5% of patients. Recurrent episodes of upper gastrointestinal (GI) bleeding (p=0.04), hypotension (p=0.02), altered mental status at admission (p=0.009) and antibiotic use for the treatment of spontaneous bacterial peritonitis (p=0.04) were significant factors associated with HSS-related mortality. The study found that treatment outcomes of HSS patients were strongly associated with recurrent upper GI bleeding, hypotension, altered mental status and antibiotic use for spontaneous bacterial peritonitis treatment. The use of antibiotics for spontaneous bacterial peritonitis treatment was strongly associated with the treatment outcome of patients with HSS and was unique to our study. Adequate recording of patient data, improving chart keeping, integration of preventive and curative programs, improvement of the diagnostic tools, comprehensive treatment guidelines, early diagnosis and treatment are strongly recommended. Rigorous prospective studies that can fully reflect cause-and-effect relationships are crucial to fill fundamental evidence gaps.

Knee Arthroplasty for Ankylosis in a Patient with Severe Hemophilia A

Abstract Hemophilic arthropathy is a common complication of hemophilia A and can lead to chronic synovitis, joint damage, and eventually ankylosis. We present a case report of a 39-year-old male patient with a history of recurrent hemorrhages into the joints. He had a history of traumatic injury to both upper limbs and lower limbs. The patient was on bed rest for 6 months. Subsequently, he developed ankylosis of both elbows in 30° of flexion and ankylosis of the right (Right) knee in 40° of flexion with tricompartmental arthritis of the left knee joint. Radiologically, the left knee joint showed reduced joint space with tricompartmental arthritis. The patient was managed by the tumor prosthesis for the Rt knee. He was advised for management of the elbow joints for which he was not willing. Postoperatively, he was allowed knee range of motion exercises and walking with a walker for 4 weeks followed by a stick for 1 month. At 6-month follow-up, he was able to walk effortlessly without support. The Knee Society Score improved from 47 preoperatively to 75 at 6-month follow-up.