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Jia Zhu, Xingshun Qi, Haonan Yu, Chunping Su, Xiaozhong Guo
BACKGROUND AND AIM: Endoscopic therapy is the cornerstone choice for the management of varices and variceal hemorrhage. The aim of the present systematic review and meta-analysis was to evaluate the efficacy of acid suppression in patients treated with endoscopic therapy for gastroesophageal varices. METHODS: All eligible studies were searched via the PubMed, EMBASE, and Cochrane Library databases. Incidence of bleeding, mortality, ulcers, chest pain, and dysphagia after endoscopic therapy and length of stay were analyzed...
March 22, 2018: Expert Review of Gastroenterology & Hepatology
Sam Schulman, Peter L Gross, Bruce Ritchie, Susan Nahirniak, Yulia Lin, Lani Lieberman, Marc Carrier, Mark A Crowther, Indy Ghosh, Alejandro Lazo-Langner, Michelle Zondag
Oral factor Xa inhibitors are increasingly used for anticoagulation, but there is no approved reversal agent. Prothrombin complex concentrate (PCC) for the management of Xa-inhibitor-associated bleeding has been described in small case series and one cohort study. Patients on apixaban or rivaroxaban, suffering a major bleed, were treated at nine Canadian hospitals as per existing hospital protocol with a fixed dose of PCC 2,000 units and subsequently recruited for a 30-day follow-up. The treating physician evaluated the haemostatic effectiveness as observed during the first day as good, moderate or poor/none, using an assessment guide...
March 21, 2018: Thrombosis and Haemostasis
Ilaria Cavallari, Giuseppe Patti
Platelets and the coagulation cascade play key roles in initiation, amplification, and perpetuation of acute coronary syndromes (ACS). In the past few years, there has been great progress in ACS antithrombotic treatment with the introduction of novel anticoagulants (fondaparinux and bivalirudin), more potent P2Y12 inhibitors (prasugrel and ticagrelor) and protease-activated receptor antagonists (vorapaxar). Nonetheless, patients with ACS frequently have recurrent ischemic events despite the use of currently recommended dual antiplatelet therapy, revascularization procedures as appropriate, and other evidence-based secondary preventive measures...
March 21, 2018: Internal and Emergency Medicine
Siavash Piran, Caroline Gabriel, Sam Schulman
Direct oral factor Xa (FXa) inhibitors are widely used for anticoagulation but a targeted antidote is not available. Four-factor prothrombin complex concentrate (4FPCC) has been shown in observational studies to support hemostasis in most patients with major bleeding related to FXa inhibitors with an acceptable rate of thromboembolic events. However, the effectiveness of 4FPCC for reversal of FXa inhibitors prior to emergency surgery or invasive procedures is unclear. A retrospective chart review was performed in patients that received 4FPCC at Hamilton General Hospital from 2015 to 2017...
March 21, 2018: Journal of Thrombosis and Thrombolysis
Ander Regueiro, Ignacio Cruz-Gonzalez, Armando Bethencourt, Luis Nombela-Franco, Jean Champagne, Luis Asmarats, Pilar Jiménez-Quevedo, Tania Rodriguez-Gabella, Juan Carlos Rama-Merchan, Rishi Puri, Gilles O'Hara, Josep Rodés-Cabau
PURPOSE: We aimed to evaluate the late clinical outcomes of percutaneous LAA closure in patients with atrial fibrillation (AF) and contraindication to oral anticoagulation. METHODS: Consecutive AF patients with contraindications to oral anticoagulation who underwent successful LAA closure between December 2008 and March 2013 at four centers were included. RESULTS: A total of 101 patients (median age 76 [IQR 69-80] years, 48% women, mean CHA2 DS2 -VASc 5 ± 2; HAS-BLED 4 ± 1) were included...
March 21, 2018: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Xin Xue, Lisheng Jiang, Erich Duenninger, Manuela Muenzel, Shaofeng Guan, Adam Fazakas, Fanzhou Cheng, Juergen Illnitzky, Thorsten Keil, Jiangtao Yu
The prevalence of chronic kidney disease (CKD) is high in patients with atrial fibrillation (AF). Left atrial appendage closure (LAAC) has been recognized as an efficient alternative to oral anticoagulation for the prevention of thromboembolic events in patients with non-valvular AF (NVAF); however, the long-term safety and efficacy of LAAC in patients with CKD remain unclear. This study was designed to provide data regarding the safety and efficacy of LAAC in NVAF patients with CKD. A real-world analysis of the safety and efficacy of LAAC was performed on a cohort of 300 NVAF patients with or without CKD who underwent LAAC using the Watchman (WM) device at our center...
March 22, 2018: Heart and Vessels
Andrew T Hale, Kelly Pekala, Benjamin Theobald, Katherine Kelly, Michael Wolf, John C Wellons, Truc Le, Chevis N Shannon
PURPOSE: In traumatic brain injury (TBI), hyperglycemia and hypothermia are thought to be associated with poor outcomes, but have not been systematically studied in children. Thus, our aim was to evaluate whether serum glucose and temperature at admission, among other clinical variables, were associated with need for post hospital-discharge seizure medication in children diagnosed with TBI. METHODS: We performed a retrospective study of 1814 children who were diagnosed with TBI at a tertiary pediatric hospital...
March 21, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
M Roessler, N Eulitz
The scope of emergency calls for emergency medical services staffed by an emergency physician (EMS-EP) includes calls to patients with life-limiting diseases. Symptom exacerbation as well as psychosocial overburdening of caring relatives are the most frequent reasons for activation of an EMS-EP. Pain crises, acute dyspnea, massive bleeding and/or an impending or overt cardiac arrest are the most frequent symptom exacerbations. Under the conditions of a prehospital emergency physician mission, particular challenges are the evaluation of the overall situation, the prognosis and the presumed will of the patient...
March 21, 2018: Der Anaesthesist
Seong Hee Kim, Chan Hee Jin, In Taek Hwang, Jun Sook Park, Jung Hwan Shin, Dae Woon Kim, Yong Soo Seo, Jee Nah Sohn, Yun Seok Yang
Objective: The present study aimed to determine the differences in outcomes between natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy (NAVH) and conventional laparoscopy-assisted vaginal hysterectomy (LAVH). Methods: We retrospectively reviewed the charts of patients who between July 2012 and September 2015, were diagnosed as having benign uterine disease such as uterine myoma, endometriosis, or adenomyosis and managed via NAVH or LAVH in a single-center (Eulji University Hospital)...
March 2018: Obstetrics & Gynecology Science
Jung Yeon Park, Hyo Jeong Ahn, Ba Raem Yoo, Kyu Ri Hwang, Taek Sang Lee, Hye Won Jeon, Sun Min Kim, Byoung Jae Kim
Objective: This study was conducted to determine the effectiveness and safety of medical treatment with sublingual misoprostol (MS) in the 1st trimester miscarriage under the approval by Health Insurance Review and Assessment Service (HIRA) for off-label usage by the single medical center in Korea. Methods: A retrospective cohort study was performed in one institution between April 2013 and June 2016. Ninety-one patients diagnosed with miscarriage before 14 weeks of gestation and wanted to try medical treatment were included...
March 2018: Obstetrics & Gynecology Science
Geum Seon Sohn, SiHyun Cho, Yong Man Kim, Chi-Heum Cho, Mee-Ran Kim, Sa Ra Lee
Uterine fibroids (leiomyomas or myomas), benign monoclonal tumors, are the most common benign tumors in women. Heavy or prolonged menstrual bleeding, abnormal uterine bleeding, resultant anemia, pelvic pain, infertility, and/or recurrent pregnancy loss are generally associated with uterine fibroids. Although curative treatment of this tumor relies on surgical therapies, medical treatments are considered the first-line treatment to preserve fertility and avoid or delay surgery. The aim of this review is to provide available and emerging medical treatment options for symptomatic uterine fibroids...
March 2018: Obstetrics & Gynecology Science
Elisabetta Balestro, Paolo Solidoro, Piercarlo Parigi, Massimo Boffini, Alessandro Lucianetti, Federico Rea
Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal disease that can only be cured by lung transplantation. Pharmacological agents play a role in preserving lung function and prolonging survival until a suitable donor organ becomes available. However, data on the effects of newer antifibrotic therapies on lung transplantation outcomes in IPF patients are lacking. The nine patients included in this case series were treated with nintedanib 150 mg twice daily for 3-30 (mean 13 ± 9) months before lung transplant surgery...
May 2018: Respirology Case Reports
Jumpei Ogura, Yasushi Adachi, Koji Yasumoto, Akiharu Okamura, Hirofumi Nonogaki, Kazuyo Kakui, Koji Yamanoi, Koh Suginami, Takashi Koyama, Susumu Ikehara
Large-cell neuroendocrine carcinoma (LCNEC) of the endometrium is an extremely rare, high-grade malignant tumor. We herein report a case of a rapidly growing LCNEC arising in the endometrium. A 52-year-old woman was referred to Toyooka Hospital (Tooyoka, Japan) due to genital bleeding in February 2016. There had been no abnormalities on a regular gynecological and physical examination 3 months prior to the consultation. Imaging (computed tomography and magnetic resonance imaging) and a pelvic examination revealed a tumor sized 16...
April 2018: Molecular and Clinical Oncology
Tagore Sunkara, Megan E Caughey, Vinaya Gaduputi
Melanosis of the stomach and duodenum is a rare entity and a striking finding diagnosed by upper gastrointestinal endoscopy. Here, we describe the case of an 83-year-old female, with a complicated medical history, who was referred to gastroenterologist to assess bleeding risk. From the endoscopy, it was determined that she had both melanosis gastri and duodeni. Although both are rare, gastric melanosis appears to be even more unusual than duodenal melanosis, with only a few reported cases documented in the literature thus far...
2018: Gastroenterology and Hepatology From Bed to Bench
David Glineur, Marc Hendrikx, Dainis Krievins, Peteris Stradins, Bernhard Voss, Thomas Waldow, Luc Haenen, Martin Oberhoffer, Caroline M Ritchie
Background: Obtaining hemostasis during cardiovascular procedures can be a challenge, particularly around areas with a complex geometry or that are difficult to access. While several topical hemostats are currently on the market, most have caveats that limit their use in certain clinical scenarios such as pulsatile arterial bleeding. The aim of this study was to assess the effectiveness and safety of Veriset™ hemostatic patch in treating cardiovascular bleeding. Methods: Patients (N=90) scheduled for cardiac or vascular surgery at 12 European institutions were randomized 1:1 to treatment with either Veriset™ hemostatic patch (investigational device) or TachoSil® (control)...
2018: Medical Devices: Evidence and Research
Wei Zhang, Qiao-Zheng Wang, Xiao-Wei Chen, Hong-Shan Zhong, Xi-Tong Zhang, Xu-Dong Chen, Ke Xu
AIM: To investigate 30-year treatment outcomes associated with Budd-Chiari syndrome (BCS) at a tertiary hospital in China. METHODS: A total of 256 patients diagnosed with primary BCS at our tertiary hospital between November 1983 and September 2013 were followed and retrospectively studied. Cumulative survival rates and cumulative mortality rates of major causes were calculated by Kaplan-Meier analysis, and the independent predictors of survival were identified using a Cox regression model...
March 14, 2018: World Journal of Gastroenterology: WJG
Sonali Sethi, Satyajit Godhi, Sunil Kumar Puri
Gastric duplication cysts are rare and mostly present in the first year of life. In adulthood presentation is in the form of obstruction, ulceration, bleeding, fistulization etc. Malignancy is extremely rare with only 12 cases reported to date. We came across a gastric duplication cyst with papillary adenocarcinoma in a 63 year old man. He underwent cyst excision with radical subtotal gastrectomy. The awareness of such a condition made it possible for us to have a suspicion of malignancy preoperatively based on imaging and thus a radical surgery was performed...
March 2018: Indian Journal of Surgical Oncology
Purushottam Chavan, Sreelekha Ray, Suma Sheshadri, Rajshekar Halkud
An adult male presented to us with a recurrent, large bleeding tumour in the neck. We describe our approach to the patient, whose tumour was labelled as an atypical glomus on final histopathology. They are relatively uncommon in the head neck, and this case report with literature review is expected to add to our knowledge.
March 2018: Indian Journal of Surgical Oncology
Manish Raturi, Shamee Shastry, Mohandoss Murugesan, Poornima B Baliga, Kalyana Chakravarthy
BACKGROUND: Conventional coagulation screening tests such as Prothrombin time, International normalized ratio (INR) and activated partial thromboplastin time are often used to predict bleeding in various clinical situations. We aimed to observe the effect of Fresh-frozen plasma (FFP) on these parameters. Methods: Patients' demographics, pre- and post-transfusion coagulation parameters were noted to assess the level of correction. The magnitude of improvement in INR was determined using the formula given by Holland and Brooks...
January 2018: Asian Journal of Transfusion Science
Kristin A Williams, Sara Mithani, Ghazal Sadeghi, Leena Palomo
BACKGROUND: This randomized, single-blinded, controlled study compares the effectiveness of two modes of delivering the same set of oral hygiene instructions: those loaded on a computer-assisted teaching format versus those given personally by a self-care instructor. METHODS: 60 participants with mild to moderate periodontitis were randomized to either the computer-teaching format or the self-care instructor. Plaque score and bleeding indices were assessed at baseline and at 4 week re-evaluation to compare the instructional modalities...
January 10, 2018: Dent J (Basel)
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