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https://www.readbyqxmd.com/read/29624860/hepatic-encephalopathy-diagnosis-and-management
#1
Piero Amodio
Hepatic encephalopathy (HE) is a peculiar kind of brain dysfunction caused by liver insufficiency and/or portal-systemic shunting. It is related to gut-derived substances. It is a relevant cause of morbidity and hospitalisation for patients with cirrhosis. The prognosis of HE is important in terms of survival and re-hospitalisation. It is related to impaired quality of life, falls and poor driving, presents a relevant burden for caregivers and health services, and may negatively impacts on patient's job and income...
April 6, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/29602484/-blue-rubber-bleb-naevus-syndrome-involving-the-pleura
#2
P H Aussedat, S Laroumagne, H Dutau, P Astoul
Bean's syndrome ('blue rubber bleb nevus syndrome') is a rare disease characterized by venous malformations involving various organs. Most often these lesions are localized to the skin and the digestive system. Gastro-intestinal bleeding is the most frequent presentation. Though other organs can be affected, chest localizations are infrequent and pleural localization is exceptional. We report the case of an asbestos-exposed patient with Bean's syndrome with characteristic skin lesions, smoker, hospitalized for the investigation of a hemorrhagic pleural effusion...
March 28, 2018: Revue des Maladies Respiratoires
https://www.readbyqxmd.com/read/29560669/ectopic-variceal-bleeding-due-to-portosystemic-shunt-via-dilated-mesenteric-veins-and-a-varicous-left-ovarian-vein-case-report-and-literature-review-of-ectopic-varices
#3
REVIEW
Mathieu Struyve, Geert Robaeys
Ectopic varices are dilated portosystemic venous collaterals located outside of the gastro-esophageal region. Whereas they are common endoscopic findings in patients with portal hypertension, ectopic variceal bleeding is rather rare and accounts for only 1 to 5 % of all variceal bleedings. The rectum and the duodenum are the most common sites for ectopic varices, but they can be present along the whole intestinal tract and neighborhood. At present, there is no consensus well established on diagnostic workup for ectopic variceal bleeding and their therapeutic strategies...
July 2017: Acta Gastro-enterologica Belgica
https://www.readbyqxmd.com/read/29522647/preventability-of-serious-thromboembolic-and-bleeding-events-related-to-the-use-of-oral-anticoagulants-a-prospective-study
#4
Anne-Laure Sennesael, Anne-Sophie Larock, Bérangère Devalet, Valérie Mathieux, Franck Verschuren, Xavier Muschart, Olivia Dalleur, Jean-Michel Dogné, Anne Spinewine
AIMS: To determine the preventability of serious adverse drug reactions (ADRs) related to the use of direct oral anticoagulants (DOACs), and to explore contributing factors to preventable ADRs. Results were compared with vitamin K antagonists (VKAs). METHODS: We conducted a prospective observational study in the emergency departments of two teaching hospitals from July 2015 to January 2016. Patients admitted with a thrombotic or bleeding event while under DOAC or VKA were included...
March 9, 2018: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29513174/ectopic-variceal-bleeding-due-to-portosystemic-shunt-via-dilated-mesenteric-veins-and-a-varicous-left-ovarian-vein-case-report-and-literature-review-of-ectopic-varices
#5
M Struyve, G Robaeys
Ectopic varices are dilated portosystemic venous collaterals located outside of the gastro-esophageal region. Whereas they are common endoscopic findings in patients with portal hypertension, ectopic variceal bleeding is rather rare and accounts for only 1 to 5 % of all variceal bleedings. The rectum and the duodenum are the most common sites for ectopic varices, but they can be present along the whole intestinal tract and neighborhood. At present, there is no consensus well established on diagnostic workup for ectopic variceal bleeding and their therapeutic strategies...
July 2017: Acta Gastro-enterologica Belgica
https://www.readbyqxmd.com/read/29482717/a-randomised-double-blind-placebo-controlled-phase-2-trial-of-adjunctive-aspirin-for-tuberculous-meningitis-in-hiv-uninfected-adults
#6
Nguyen Th Mai, Nicholas Dobbs, Nguyen Hoan Phu, Romain A Colas, Le Tp Thao, Nguyen Tt Thuong, Ho Dt Nghia, Nguyen Hh Hanh, Nguyen T Hang, A Dorothee Heemskerk, Jeremy N Day, Lucy Ly, Do DA Thu, Laura Merson, Evelyne Kestelyn, Marcel Wolbers, Ronald Geskus, David Summers, Nguyen Vv Chau, Jesmond Dalli, Guy E Thwaites
Adjunctive dexamethasone reduces mortality from tuberculous meningitis (TBM) but not disability, which is associated with brain infarction. We hypothesised that aspirin prevents TBM-related brain infarction through its anti-thrombotic, anti-inflammatory, and pro-resolution properties. We conducted a randomised controlled trial in HIV-uninfected adults with TBM of daily aspirin 81 mg or 1000 mg, or placebo, added to the first 60 days of anti-tuberculosis drugs and dexamethasone (NCT02237365). The primary safety endpoint was gastro-intestinal or cerebral bleeding by 60 days; the primary efficacy endpoint was new brain infarction confirmed by magnetic resonance imaging or death by 60 days...
February 27, 2018: ELife
https://www.readbyqxmd.com/read/29347814/-customization-of-hormonal-contraception
#7
Vincenzo DE Leo, Antonio Cianci, Costantino DI Carlo, Valentina Cappelli, Franca Fruzzetti
In the last few years new oral contraceptives have been marketed showing a better safety profile for women. They are the result of important changes made to the old compounds. As far as the estrogenic component, with the aim of decreasing side effects, the dose of ethinyl estradiol has been reduced and synthetic estrogens have been replaced by natural estradiol, further improving the safety profile. Also the progestin component in the last years has been changed in terms of dose, endocrine and metabolic characteristics...
February 2018: Minerva Ginecologica
https://www.readbyqxmd.com/read/29288116/a-study-on-outcome-of-binding-pancreaticogastrostomy-following-pancreaticoduodenectomy-a-prospective-observational-study
#8
Dronacharya Routh, Nishant Pathak, C S Naidu, A K Singh, P P Rao, Priya Ranjan
INTRODUCTION: The type of anastomosis of the pancreas following pancreaticoduodenectomy is often attributed to the reason for pancreatic leak. Results of various randomized trials comparing pancreaticojejunostomy and pancreaticogastrostomy are conflicting one suggesting advantage over the other and vice versa. In this study we intend to critically analyze a novel technique of binding pancreaticogastrostomy following pancreaticoduodenectomy. AIMS AND OBJECTIVES: The aim of this study is to see the outcome of binding pancreaticogastrostomy by evaluating the technical aspects of binding PG and study the incidence of post-operative complications...
February 2018: International Journal of Surgery
https://www.readbyqxmd.com/read/29287924/the-effect-of-a-concomitant-renal-injury-on-the-outcome-of-colonic-trauma
#9
G V Oosthuizen, R Weale, V Y Kong, J L Bruce, R J Urry, G L Laing, D L Clarke
BACKGROUND: The management of colon injuries has steadily evolved over the course of the last half century. So too has the management of renal trauma. It is not clear from the literature as to whether concomitant colon and renal injuries carry increased risk of morbidity and mortality, and whether this combination of injuries necessitates a specifically tailored management approach. METHODS: A retrospective review was carried out for the period January 2012 to December 2016...
December 6, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29175535/application-of-prognostic-scores-in-the-stopah-trial-discriminant-function-is-no-longer-the-optimal-scoring-system-in-alcoholic-hepatitis
#10
Ewan H Forrest, Stephen R Atkinson, Paul Richardson, Steven Masson, Stephen Ryder, Mark R Thursz, Michael Allison
BACKGROUND & AIMS: 'Static' prognostic models in alcoholic hepatitis, using data from a single time point, include the discriminant function (DF), Glasgow alcoholic hepatitis score (GAHS), the age, serum bilirubin, international normalized ratio and serum creatinine (ABIC) score and the model of end-stage liver disease (MELD). 'Dynamic' scores, incorporating evolution of bilirubin at seven days, include the Lille score. The aim of this study was to assess these scores' performance in patients from the STOPAH trial...
March 2018: Journal of Hepatology
https://www.readbyqxmd.com/read/29148292/cholestatic-liver-injury-as-a-side-effect-of-dabigatran-and-the-use-of-coagulation-tests-in-dabigatran-intoxication-and-after-reversal-by-idarucizumab-in-bleeding-and-sepsis
#11
Willemijn J Comuth, Anne-Mette Haase, Linda Ø Henriksen, Jerzy Malczynski, Daan van de Kerkhof, Anna-Marie B Münster
Idarucizumab, an antidote specific for dabigatran, became available recently. Dabigatran is not associated with increased risk of hepatotoxicity in comparison with warfarin, but it is seen as a rare side-effect. Cases of cholestatic liver injury due to dabigatran have not been reported previously. We present a case of severe gastro-intestinal bleeding with underlying dabigatran intoxication in a patient with renal failure and the effect of reversal of dabigatran using idaruzicumab on coagulation assays. International normalized ratio (INR) and activated partial thromboplastin time (APTT) results were elevated in a setting of sepsis, possibly due to liver failure...
February 2018: Scandinavian Journal of Clinical and Laboratory Investigation
https://www.readbyqxmd.com/read/29095860/red-cell-distribution-width-as-a-novel-marker-for-predicting-high-risk-from-upper-gastro-intestinal-bleeding-patients
#12
Kyeong Ryong Lee, Sang O Park, Sin Young Kim, Dae Young Hong, Jong Won Kim, Kwang Je Baek, Dong Hyuk Shin, Young Hwan Lee
BACKGROUND: In upper gastrointestinal bleeding (UGIB) patients, early risk stratification allows appropriate therapy that may be helpful for reducing morbidity and mortality. OBJECTIVES: to evaluate the efficacy of red-cell distribution width (RDW) for prediction of high-risk in UGIB patients. METHODS: We conducted a clinical retrospective observational study based on data for UGIB patients from 2012 to 2013. The primary outcome was the high-risk UGIB, defined as those who required urgent intervention and/or 30-days mortality...
2017: PloS One
https://www.readbyqxmd.com/read/29023527/dose-escalated-radiotherapy-for-unresectable-or-locally-recurrent-pancreatic-cancer-dose-volume-analysis-toxicity-and-outcome-of-28-consecutive-patients
#13
Sebastian Zschaeck, Bibiana Blümke, Peter Wust, David Kaul, Marcus Bahra, Hanno Riess, Fritz Klein, Marianne Sinn, Uwe Pelzer, Volker Budach, Pirus Ghadjar
PURPOSE: The role of radiotherapy for unresectable pancreatic cancer is controversial. A benefit of additional radiotherapy is supported by some observations. A dose-effect relationship was recently found by dose escalation employing image guided and intensity modulated radiotherapy. METHODS: We retrospectively evaluated 28 consecutive patients, all with history of extensive prior therapies for unresectable locally advanced/ recurrent pancreatic cancer (LAPC/LRPC)...
2017: PloS One
https://www.readbyqxmd.com/read/28918911/mortality-of-severe-septic-patients-between-physician-s-high-and-low-care-volumes
#14
Chun-Yao Lin, Jo-Chi Tseng, Chih-Yu Huang, Chien-Ming Chu, Huang-Pin Wu
BACKGROUND: Patients with severe sepsis frequently require intensive care unit (ICU) admission and different ICU care models may influence their outcomes. The mortality of severe septic patients between physician's high and low care volume remains unclear. METHODS: We analyzed the data from a three-year prospective observation study, which was performed in an adult medical ICU of Chung Gung Memorial Hospital, Keelung. The data included initial bundle therapies based on the Surviving Sepsis Campaign (SSC) guidelines for patients with severe sepsis...
August 2017: Biomedical Journal
https://www.readbyqxmd.com/read/28905803/diagnosis-and-treatment-of-gastroesophageal-reflux-disease-complicated-by-barrett-s-esophagus
#15
Andriy Stasyshyn
The aim of the study was to evaluate the effectiveness of a diagnostic and therapeutic algorithm for gastroesophageal reflux disease complicated by Barrett's esophagus in 46 patients. MATERIALS AND METHODS: A diagnostic and therapeutic algorithm for complicated GERD was developed. To describe the changes in the esophagus with reflux esophagitis, the Los Angeles classification was used. Intestinal metaplasia of the epithelium in the lower third of the esophagus was assessed using videoendoscopy, chromoscopy, and biopsy...
August 31, 2017: Polski Przeglad Chirurgiczny
https://www.readbyqxmd.com/read/28851249/bacterial-pneumonia-in-patients-with-liver-cirrhosis-with-or-without-hiv-co-infection-a-possible-definition-of-antibiotic-prophylaxis-associated-pneumonia-apap
#16
Gianluca Cuomo, Giuseppina Brancaccio, Gianfranca Stornaiuolo, Daniela Manno, Giuseppe L Gaeta, Cristina Mussini, Massimo Puoti, Giovanni B Gaeta
Introducion: Bacterial infections frequently complicate liver cirrhosis. The aim of this study was to identify risk factors and clinical impact of bacterial pneumonia in patients with cirrhosis. MATERIALS AND METHODS: Bacterial infection prevalence study: consecutive patients with cirrhosis were enroled over a six-month period in 13 Italian centres. Pneumonia and other infections were diagnosed by standard methods. Pneumonia study: cirrhotic patients with pneumonia were enroled for an additional six-month period and HIV-positive patients were included...
February 2018: Infectious Diseases
https://www.readbyqxmd.com/read/28818320/-use-of-a-delphi-survey-to-assess-the-hospital-economic-impact-of-innovative-products-the-example-of-idarucizumab-a-dabigatran-specific-reversal-agent
#17
N Jamet, A P Thivilliers, P Paubel, D Chevalier, S Bourguignon, Y Bézie
OBJECTIVES: The economic impact of therapeutic innovations on the hospital patient management cannot be easily estimated. The objective of this study is to illustrate the use of a Delphi survey as a support tool to identify the changes following the use of idarucizumab in dabigatran-treated patients with uncontrolled/life-threatening bleeding or who required emergency surgery/urgent procedures. METHODS: The Delphi questionnaires have been administrated to 8 emergency physicians or anesthetists from 6 different hospital centers...
November 2017: Annales Pharmaceutiques Françaises
https://www.readbyqxmd.com/read/28816341/clinical-impact-of-major-bleeding-in-patients-with-venous-thromboembolism-treated-with-factor-xa-inhibitors-or-vitamin-k-antagonists-an-individual-patient-data-meta-analysis
#18
Suzanne M Bleker, Marjolein P A Brekelmans, Elise S Eerenberg, Alexander T Cohen, Saskia Middeldorp, Gary Raskob, Harry R Büller
Factor Xa (fXa)-inhibitors are as effective and safer than vitamin-K-antagonists (VKA) in the treatment of venous thromboembolism (VTE). We previously classified the severity of clinical presentation and course of all major bleeding events from the EINSTEIN, AMPLIFY and HOKUSAI-VTE trials separately. The current aim was to combine these findings in order to increase precision, assess a class effect and analyse presentation and course for different types of bleeding, i. e. intracranial, gastro-intestinal, and other...
October 5, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28756907/universal-screening-for-alcohol-misuse-in-acute-medical-admissions-is-feasible-and-identifies-patients-at-high-risk-of-liver-disease
#19
Greta Westwood, Paul Meredith, Susan Atkins, Peter Greengross, Paul E Schmidt, Richard J Aspinall
BACKGROUND & AIMS: Many people who die from alcohol related liver disease (ARLD) have a history of recurrent admissions to hospital, representing potential missed opportunities for intervention. Universal screening for alcohol misuse has been advocated but it is not known if this is achievable or effective at detecting individuals at high risk of ARLD. METHODS: We systematically screened all admissions to the Acute Medical Unit (AMU) of a large acute hospital using an electronic data capture system in real time...
September 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28698005/meckel-s-diverticulum-in-the-adult
#20
J Lequet, B Menahem, A Alves, A Fohlen, A Mulliri
Meckel's diverticulum (MD) is the most common gastro-intestinal congenital malformation (approximately 2% in the overall population). The lifetime risk of related complications is estimated at 4%. These include gastro-intestinal bleeding, obstruction or diverticular inflammation. Diagnosis is difficult and rarely made, and imaging, especially in the case of complicated disease, is often not helpful; however exploratory laparoscopy is an important diagnostic tool. The probability of onset of complication decreases with age, and the diagnosis of MD in the adult is therefore often incidental...
September 2017: Journal of Visceral Surgery
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