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low gastrointestinal bleeding

Emanuele Rondonotti, Cristiano Spada, Samuel Adler, Andrea May, Edward J Despott, Anastasios Koulaouzidis, Simon Panter, Dirk Domagk, Ignacio Fernandez-Urien, Gabriel Rahmi, Maria Elena Riccioni, Jeanin E van Hooft, Cesare Hassan, Marco Pennazio
SMALL-BOWEL CAPSULE ENDOSCOPY (SBCE): 1: ESGE recommends that prior to SBCE patients ingest a purgative (2 L of polyethylene glycol [PEG]) for better visualization.Strong recommendation, high quality evidence.However, the optimal timing for taking purgatives is yet to be established. 2: ESGE recommends that SBCE should be performed as an outpatient procedure if possible, since completion rates are higher in outpatients than in inpatients.Strong recommendation, moderate quality evidence...
March 14, 2018: Endoscopy
Sajith C Senadeera, Simon V Vun, Nicholas Butterfield, Tim W Eglinton, Frank A Frizelle
BACKGROUND: Lower gastrointestinal bleeding (LGIB) is a common acute general surgical condition that is typically self-limiting; however in refractory cases it can necessitate life-saving intervention. When bleeding is refractory, super-selective embolization (SSE) becomes an important management strategy. This study aims to evaluate outcomes of this procedure at our institution and identify predictors of clinical success. METHODS: A retrospective analysis of patients with positive computed tomography angiograms for LGIB at a tertiary centre between December 2007 and May 2017...
March 14, 2018: ANZ Journal of Surgery
Shu-Ruei Wu, Hsiao-Ching Kuo, Wei-Chun Huang, Yung-Feng Huang, Yee-Hsuan Chiou, Yu-Hsiang Chang, Bao-Ren Nong
INTRODUCTION: Immune thrombocytopenia (ITP) is an immune-mediated disease; it has been reported to be associated with several diseases. The data on ITP in patients with hepatitis B, tuberculosis, or thyroid diseases are relatively scarce. In addition, these diseases are not rare in Taiwan, together with hepatitis C and Helicobacter pylori which are also related to ITP. METHODS AND MATERIALS: We identified 1223 ITP patients and characterized these patients between 2000 and 2013 from the National Health Insurance Research Database...
March 2, 2018: Thrombosis Research
Maja Hellfritzsch, Lotte Rasmussen, Jesper Hallas, Anton Pottegård
INTRODUCTION: Knowledge on adverse effects (AEs) related to non-vitamin K antagonist oral anticoagulants (NOACs) in real-world populations is sparse. OBJECTIVE: Our objective was to identify signals of potential AEs in patients with atrial fibrillation (AF) initiating NOAC treatment using a hypothesis-free screening approach. METHODS: Using the nationwide Danish registries, we identified patients with AF initiating dabigatran, rivaroxaban, or apixaban between 2011 and 2015 (n = 50,627)...
March 1, 2018: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
Yitao He, Zhili Cai, Siling Zeng, Siyan Chen, Bingshan Tang, Yubing Liang, Xin Chang, Yi Guo
OBJECTIVE: To evaluate the effect of fluoxetine on three-year recurrence rate of acute ischemic stroke. PATIENTS AND METHODS: 404 enrolled patients with acute ischemic stroke were randomly divided into control and treatment groups, and underwent conventional secondary preventive therapy for ischemic stroke. In addition, the treatment group was administered fluoxetine (20 mg daily for 90 days). A three-year follow-up was performed, and indicators related to risk factors of stroke were assessed at day 90 of follow-up...
February 26, 2018: Clinical Neurology and Neurosurgery
Xiuju Shi, Shuxia Yu, Fenyan Wang, Qi Zhao, Hongwei Xu, Bin Li
RATIONALE: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors involving the gastrointestinal tract. A small percentage of GISTs may cause acute gastrointestinal bleeding, which requires urgent surgical intervention. PATIENT CONCERNS: In this case report, we present a 62-year-old male patient with who was hospitalized due to acute bleeding. DIAGNOSES: The patient was diagnosed as GIST with low risk. INTERVENTIONS: The patient was treated endoscopically with polidocanol sclerotherapy...
March 2018: Medicine (Baltimore)
Adam L Edwards, Paul Fitzmorris, Salpy V Pamboukian, James F George, C M Wilcox, Shajan Peter
Gastrointestinal bleeding (GIB) is common in patients with continuous-flow left ventricular assist devices (CF-LVADs) possibly because of changes in blood flow. We aimed to test the hypothesis that a low pulsatility index (PI) is associated with an increased hazard of overt GIB in patients with CF-LVADs. We conducted a retrospective cohort study of patients who had a HeartMate II (HMII) CF-LVAD implanted at our center. The study end-point was the first overt GIB causing or occurring during a hospitalization between 6 days and 6 months after HMII implantation...
February 27, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Ira Roshan Afshar, Mo Seyed Sadr, Lisa L Strate, Myriam Martel, Charles Menard, Alan N Barkun
Objective: The use of early colonoscopy in the management of acute lower gastrointestinal bleeding (LGIB) is controversial, with disparate evidence. We aim to formally characterize the utility of early colonoscopy (within 24 h) in managing acute LGIB. Design: A systematic literature search to August 2016 identified fully published and abstracts of randomized controlled trials (RCTs) and observational studies assessing early colonoscopy in acute LGIB. Single-arm studies were also included to define incidence...
2018: Therapeutic Advances in Gastroenterology
Tonmoy Ghosh, Shaikh Anowarul Fattah, Khan A Wahid
Wireless capsule endoscopy (WCE) is the most advanced technology to visualize whole gastrointestinal (GI) tract in a non-invasive way. But the major disadvantage here, it takes long reviewing time, which is very laborious as continuous manual intervention is necessary. In order to reduce the burden of the clinician, in this paper, an automatic bleeding detection method for WCE video is proposed based on the color histogram of block statistics, namely CHOBS. A single pixel in WCE image may be distorted due to the capsule motion in the GI tract...
2018: IEEE Journal of Translational Engineering in Health and Medicine
Ke-Ling Wang, Shu-Fang Ma, Ling-Yu Pang, Meng-Na Zhang, Lin-Yan Hu, Meng-Jia Liu, Li-Ping Zou
RATIONALE: Blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterized by multiple venous malformations. The gastrointestinal bleeding and secondary iron deficiency anemia are the most common complications. There are currently no effective treatments for BRBNS. Here, we report a case of successful treatment with a small dose of sirolimus of a BRBN patient with a de novo gene mutation. PATIENT CONCERNS: A 12-year-old female was admitted to our hospital with multiple hemangiomas for 12 years...
February 2018: Medicine (Baltimore)
Erik N Sorensen, Hannah J Voorhees, Lynn M Dees, Si M Pham, Zachary N Kon, Bartley P Griffith, Erika D Feller
There are no evidence-based guidelines for antithrombotic therapy in left ventricular assist device patients. We evaluated the efficacy of a multi-agent, test-guided protocol, which remained consistent throughout our use of the Heartware HVAD. Thrombelastography and PFA-100 guide antiplatelet titration. Goals are normal kaolin thrombelastography maximum amplitude and prolonged PFA-100. We analyzed incidence and rates of nonprocedural bleeding, stroke, and pump thrombosis for all 81 primary Heartware left ventricular assist devices implanted since 2011...
February 15, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Ersin Ozaslan, Metin Ozkan, Irfan Cicin, Mustafa Benekli, Murat Kocer, Mukremin Uysal, Berna Oksuzoglu, Abdurrahman Isikdogan, Erdem Cubukcu, Emin T Elkiran, Faysal Dane, Mehmet Aliustaoglu, Alper Sevinc, Aziz Karaoglu, Arife Ulas, Gamze Gokoz-Dogu
We compared the efficacy and safety of low-molecular-weight heparins (LMWHs) in patients with cancer who are at low risk of venous thromboembolism (VTE). Patients were treated by medical oncologists in Turkey at 15 sites, where they were enrolled and followed up for a period of 12 months. Due to the study design, there was no specific treatment protocol for LMWH. Primary end points were efficacy and the time to change in VTE status. Of the included 250 patients, 239 (95.6%), 176 (70.4%), 130 (52.0%), and 91 (36...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
Rashad Zayat, Mohamed Shoaib, Mohammad Amen Khattab, Usaama Ahmad, Andreas Goetzenich, Christian Stoppe, Ann Christina Foldenauer, Ajay Moza, Heike Schnoering, Rüdiger Autschbach, Lachmandath Tewarie
OBJECTIVES: Haemolysis during left ventricular assist device support is associated with thrombosis. In this retrospective study, we analysed whether low-level haemolysis (LLH) as defined by simultaneously elevated lactate dehydrogenase (LDH) and free haemoglobin (fHb) levels had an impact on thromboembolic and bleeding events and on von Willebrand factor levels in HeartMate II patients. METHODS: After exclusion of patients with LDH >700 U/l and fHb >40 mg/dl at hospital discharge, 79 HeartMate II patients were included...
February 12, 2018: Interactive Cardiovascular and Thoracic Surgery
Ann C Gaffey, Carol W Chen, Jennifer J Chung, Jason Han, Christian A Bermudez, Joyce Wald, Pavan Atluri
BACKGROUND: Continuous-flow left ventricular assist devices (CF-LVAD) have become the standard of care for patients with end stage heart failure. Device reliability has increased, bringing the potential for VAD, compared to transplant, into debate. However, complications continue to limit VADs as first line therapy. Bleeding is a major morbidity. A debate exists as to the difference in bleeding profile between the major centrifugal and axial flow devices. We hypothesized that there would be similar adverse bleeding event profiles between the 2 major CF-LVADs...
February 13, 2018: Journal of Cardiothoracic Surgery
Shannon M Grabosch, Osman M Shariff, C William Helm
BACKGROUND: This is an updated version of the original Cochrane review published in 2014, Issue 4. Cervical intraepithelial neoplasia (CIN) precedes the development of invasive carcinoma of the cervix. Current treatment of CIN is quite effective, but there is morbidity for the patient related to pain, bleeding, infection, cervical stenosis and premature birth in a subsequent pregnancy. Effective treatment with medications, rather than surgery, would be beneficial. OBJECTIVES: To evaluate the effectiveness and safety of non-steroidal anti-inflammatory agents (NSAIDs), including cyclooxygenase-2 (COX-2) inhibitors, to induce regression and prevent the progression of CIN...
February 12, 2018: Cochrane Database of Systematic Reviews
Luiz Cláudio Rodrigues Pereira da Silva, Valerio Todaro, Flávia Almada do Carmo, Flavia Serra Frattani, Valeria Pereira de Sousa, Carlos Rangel Rodrigues, Plínio Cunha Sathler, Lucio Mendes Cabral
Fucoidan-loaded nanoparticles emerge as great candidates to oral anticoagulant therapy, due to increasing of bioavailability and circulation time of this natural anticoagulant. Crosslink between chitosan chains are performed using glutaraldehyde to confer higher gastric pH resistance to nanoparticle matrices. In this work, chitosan-fucoidan nanoparticles, without (NpCF) and with glutaraldehyde crosslink (NpCF 1% and NpCF 2%), were prepared to evaluate their anticoagulant, antithrombotic and hemorrhagic profile...
February 9, 2018: Nanotechnology
Nicholas Moore, James M Scheiman
Over-the-counter (OTC) analgesics are routinely used worldwide for self-management of various painful conditions. Despite this, there has been little in-depth review of the safety of non-aspirin analgesics at OTC doses. This paper reviews the available literature on the gastrointestinal (GI) and hepatic safety of non-aspirin OTC analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs; ibuprofen, ketoprofen, diclofenac, and naproxen) and acetaminophen; safety in overdose is also reviewed. Each non-aspirin OTC analgesic has a distinct adverse event (AE) profile, with GI AE rates for OTC dosing in one study ranging from 37% for diclofenac to 7...
February 8, 2018: Postgraduate Medicine
Kazumichi Kawakubo, Kei Yane, Kazunori Eto, Hirotoshi Ishiwatari, Nobuyuki Ehira, Shin Haba, Ryusuke Matsumoto, Keisuke Shinada, Hiroaki Yamato, Taiki Kudo, Manabu Onodera, Toshinori Okuda, Yoko Taya-Abe, Shuhei Kawahata, Kimitoshi Kubo, Yoshimasa Kubota, Masaki Kuwatani, Hiroshi Kawakami, Akio Katanuma, Michihiro Ono, Tsuyoshi Hayashi, Minoru Uebayashi, Naoya Sakamto
Background/Aims: Although the risk of bleeding after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is low, the safety of EUS-FNA in patients prescribed antithrombotic agents is unclear. Therefore, this study evaluated the incidence of bleeding after EUS-FNA in those patients. Methods: Between September 2012 and September 2015, patients who were prescribed antithrombotic agents underwent EUS-FNA at 13 institutions in Japan were prospectively enrolled in the study...
February 8, 2018: Gut and Liver
Emma Cb Wall, Katherine Mb Ajdukiewicz, Hanna Bergman, Robert S Heyderman, Paul Garner
BACKGROUND: Every day children and adults die from acute community-acquired bacterial meningitis, particularly in low-income countries, and survivors risk deafness, epilepsy and neurological disabilities. Osmotic therapies may attract extra-vascular fluid and reduce cerebral oedema, and thus reduce death and improve neurological outcomes.This is an update of a Cochrane Review first published in 2013. OBJECTIVES: To evaluate the effects of osmotic therapies added to antibiotics for acute bacterial meningitis in children and adults on mortality, deafness and neurological disability...
February 6, 2018: Cochrane Database of Systematic Reviews
Jordan E Axelrad, Alberto Pinsino, Pauline N Trinh, Anusorn Thanataveerat, Christian Brooks, Ryan T Demmer, Lisa Effner, Grant Parkis, Barbara Cagliostro, Jiho Han, A Reshad Garan, Veli Topkara, Koji Takeda, Hiroo Takayama, Yoshifumi Naka, Ivonne Ramirez, Reuben Garcia-Carrasquillo, Paolo C Colombo, Tamas Gonda, Melana Yuzefpolskaya
BACKGROUND: Gastrointestinal bleeding (GIB) is a frequent cause of re-admission in patients with continuous-flow left ventricular assist devices (CF-LVADs) and is associated with multiple endoscopic procedures and high resource utilization. Our aim was to determine the diagnostic and therapeutic yield of endoscopy and to develop a more cost-effective approach for the management of GIB in CF-LVAD recipients. METHODS: We retrospectively reviewed 428 patients implanted with a CF-LVAD between 2009 and 2016 at the Columbia University Medical Center and identified those hospitalized for GIB...
December 20, 2017: Journal of Heart and Lung Transplantation
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