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upper G.I. bleed

Matthew R Cohn, Ashley E Levack, Nikunj N Trivedi, Jordan C Villa, David S Wellman, John P Lyden, Dean G Lorich, Joseph M Lane
OBJECTIVES: To compare blood loss, delay of surgery, and short term adverse events in (1) patients admitted on warfarin versus non-anticoagulated controls and (2) warfarin patients with day of surgery (DOS) INR of 1.5 or greater versus below 1.5. DESIGN: Retrospective cohort. SETTING: Academic level I trauma center. PATIENTS/PARTICIPANTS: One hundred twenty four patients treated surgically for hip fractures including patients presenting on warfarin (n=62) and matched controls (n=62)...
April 24, 2017: Journal of Orthopaedic Trauma
Bilal H Kirmani, Sion G Jones, S C Malaisrie, Darryl A Chung, Richard Jnn Williams
BACKGROUND: Aortic valve disease is a common condition that is easily treatable with cardiac surgery. This is conventionally performed by opening the sternum longitudinally down the centre ("median sternotomy") and replacing the valve under cardiopulmonary bypass. Median sternotomy is generally well tolerated, but as less invasive options have become available, the efficacy of limited incisions has been called into question. In particular, the effects of reducing the visibility and surgical access has raised safety concerns with regards to the placement of cannulae, venting of the heart, epicardial wire placement, and de-airing of the heart at the end of the procedure...
April 10, 2017: Cochrane Database of Systematic Reviews
A Norgaard, J Stensballe, T H de Lichtenberg, J O White, A Perner, M Wanscher, J Hillingsø, M L Holm, M Mau-Sørensen, H Sillesen, L Kjeldsen, C Bäck, J Nielsen, J Seeberg, M B Hansen, P I Johansson
BACKGROUND AND OBJECTIVES: Traditionally, Denmark has had a high rate of allogeneic red blood cell transfusion caused by a liberal transfusion practice despite the existence of restrictive guidelines. We established a Patient Blood Management programme in a tertiary hospital and report the results of the implementation of evidence-based transfusion practice. MATERIALS AND METHODS: Red blood cell transfusion quality indicators were compared with the evidence-based guideline at hospital and department level...
February 20, 2017: Vox Sanguinis
Annika Reintam Blaser, Joel Starkopf, Waleed Alhazzani, Mette M Berger, Michael P Casaer, Adam M Deane, Sonja Fruhwald, Michael Hiesmayr, Carole Ichai, Stephan M Jakob, Cecilia I Loudet, Manu L N G Malbrain, Juan C Montejo González, Catherine Paugam-Burtz, Martijn Poeze, Jean-Charles Preiser, Pierre Singer, Arthur R H van Zanten, Jan De Waele, Julia Wendon, Jan Wernerman, Tony Whitehouse, Alexander Wilmer, Heleen M Oudemans-van Straaten
PURPOSE: To provide evidence-based guidelines for early enteral nutrition (EEN) during critical illness. METHODS: We aimed to compare EEN vs. early parenteral nutrition (PN) and vs. delayed EN. We defined "early" EN as EN started within 48 h independent of type or amount. We listed, a priori, conditions in which EN is often delayed, and performed systematic reviews in 24 such subtopics. If sufficient evidence was available, we performed meta-analyses; if not, we qualitatively summarized the evidence and based our recommendations on expert opinion...
March 2017: Intensive Care Medicine
O Telci Caklili, H H Mutlu, Y Colak, E Ozturk, D Kosemetin Dover, I Tuncer
Massive upper gastrointestinal bleeding is a life-threatening emergency which needs urgent intervention. Hematological malignancies are very rare causes of this type of bleeding and they usually originate from duodenum. In this case we present a gastric diffuse large B-cell lymphoma (DLBCL) causing massive upper gastrointestinal system bleeding. A 77-year-old male patient was admitted to emergency clinic with hematemesis and hematochezia. In physical examination patient was pale and sweaty; his vitals were unstable with a heart rate of 110 per minute and a blood pressure of 90/50 mmHg...
2016: Case Reports in Gastrointestinal Medicine
Jianzong Wang, Duanming Hu, Wen Tang, Chuanyin Hu, Qin Lu, Juan Li, Jianhong Zhu, Liming Xu, Zhenyu Sui, Mingjie Qian, Shaofeng Wang, Guojian Yin
The goal of this study is to evaluate how to predict high-risk nonvariceal upper gastrointestinal bleeding (NVUGIB) pre-endoscopically. A total of 569 NVUGIB patients between Match 2011 and January 2015 were retrospectively studied. The clinical characteristics and laboratory data were statistically analyzed. The severity of NVUGIB was based on high-risk NVUGIB (Forrest I-IIb), and low-risk NVUGIB (Forrest IIc and III). By logistic regression and receiver-operating characteristic curve, simple risk score systems were derived which predicted patients' risks of potentially needing endoscopic intervention to control bleeding...
June 2016: Medicine (Baltimore)
V G Pishchik, E I Zinchenko, A D Obornev, A I Kovalenko
AIM: To present one of the largest materials of video-assisted thoracoscopic (VATS) anatomic lung resections in Russia. MATERIAL AND METHODS: It is a retrospective analysis of treatment of 246 patients who underwent VATS anatomic lung resection for the period from 2010 to 2014 at the Center for Thoracic Surgery of St. Petersburg Clinical Hospital №122. One surgical team has operated 125 men and 121 women aged from 20 to 85 years (58.8±13.4 years). There were 216 (87...
2016: Khirurgiia
Matteo Fornai, Luca Antonioli, Carolina Pellegrini, Rocchina Colucci, Deborah Sacco, Erika Tirotta, Gianfranco Natale, Alessia Bartalucci, Marina Flaibani, Cecilia Renzulli, Emilia Ghelardi, Corrado Blandizzi, Carmelo Scarpignato
Nonsteroidal anti-inflammatory drugs, besides exerting detrimental effects on the upper digestive tract, can also damage the small and large intestine. Although the underlying mechanisms remain unclear, there is evidence that enteric bacteria play a pivotal role. The present study examined the enteroprotective effects of a delayed-release formulation of rifaximin-EIR (R-EIR, 50mg/kg BID, i.g.), a poorly absorbed antibiotic with a broad spectrum of antibacterial activity, in a rat model of enteropathy induced by indomethacin (IND, 1...
February 2016: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
Ping-I Hsu, Tzung-Jiun Tsai
Low-dose aspirin, commonly defined as 75-325 mg daily, is widely used for cardiovascular (CV) protection. It reduced the risk of CV events and death in patients with coronary and cerebrovascular diseases and has the advantages of both low cost and long duration of antiplatelet action. However, low-dose aspirin therapy is associated with upper gastrointestinal (GI) side effects, which range from dyspepsia (point prevalence: 31%), gastroduodenal erosions (point prevalence: 60%), endoscopic peptic ulcer (3-month incidence: 7%) to symptomatic or complicated ulcers (annual incidence of upper GI bleeding: 0...
2015: Current Pharmaceutical Design
Frederike G I van Vilsteren, Roos E Pouw, Lorenza Alvarez Herrero, Raf Bisschops, Martin Houben, Frans T M Peters, B E Schenk, Bas L A M Weusten, Erik J Schoon, Jacques J G H M Bergman
BACKGROUND: Endoscopic resection is the cornerstone of endoscopic management of esophageal early neoplasia. However, endoscopic resection is a complex technique requiring knowledge and expertise. Our aims were to identify the most important learning points in performing endoscopic resection in a training setting and to provide information on how to improve endoscopic resection technique. METHODS: Six gastroenterologists at centers with multidisciplinary expertise in upper gastrointestinal oncology participated in a structured endoscopic resection training program, consisting of four training days with lectures and hands-on training on live pigs, further one-to-one hands-on training days, and written feedback (by an expert) on videos of unsupervised endoscopic resection procedures...
November 2015: Endoscopy
Michel Aquarius, Fabiënne G M Smeets, Helena W Konijn, Patricia M Stassen, Eric T Keulen, Cees T Van Deursen, Ad A M Masclee, Yolande C Keulemans
BACKGROUND/AIMS: The Glasgow Blatchford Bleeding Score (GBS) has been developed to assess the need for treatment in patients with acute upper gastrointestinal hemorrhage (UGIH) presenting at emergency departments (EDs). We aimed (a) to determine the validity of the GBS and Rockall scoring systems for prediction of need for treatment and (b) to identify the optimal cut-off value of the GBS. METHODS: We carried out a population-based, prospective multicenter study of 520 consecutive patients presenting with acute UGIH at EDs of three hospitals...
September 2015: European Journal of Gastroenterology & Hepatology
Riccardo Gattai, Desire' Pantalone, Maria Luisa Migliaccio, Manuela Bonizzoli, Adriano Peris, Paolo Bechi
INTRODUCTION: Acute upper gastrointestinal bleeding is a common emergency. The ingestion of foreign bodies represents a less frequent cause of bleeding, but it is equally life-threatening, especially if the patient does not report the incident. PRESENTATION OF CASE: We are reporting the case of a 77-year-old patient with a bleeding caused by ingestion of glass fragments with co-existing jejunal diverticula. DISCUSSION: The ingestion of foreign bodies is a rare, mostly accidental event...
2015: International Journal of Surgery Case Reports
Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Elijah Dixon, Chad G Ball, Robert P Myers, Subrata Ghosh, Robert Hilsden, Sander Veldhuyzen van Zanten, Gilaad G Kaplan
AIM: To evaluate the incidence, surgery, mortality, and readmission of upper gastrointestinal bleeding (UGIB) secondary to peptic ulcer disease (PUD). METHODS: Administrative databases identified all hospitalizations for UGIB secondary to PUD in Alberta, Canada from 2004 to 2010 (n = 7079) using the International Classification of Diseases Codes (ICD-10). A subset of the data was validated using endoscopy reports. Positive predictive value and sensitivity with 95% confidence intervals (CI) were calculated...
December 14, 2014: World Journal of Gastroenterology: WJG
C I Mavrodin, G Pariza, V Iordache, C S Pop
Massive bleeding is an unusual complication of pancreatitis. Most patients have chronic pancreatic disorders associated with pancreatic pseudocyst. We present the case of a patient, aged 49 years, known with alcohol-induced chronic pancreatitis, corporeal-caudal pancreatic pseudocyst expanded in the omental bursa, admitted to the emergency room because of hematemesis and melena, the endoscopy revealing, as a source, the erosion through the posterior gastric wall by the pseudocyst. The gastrostomy and haemostasis in situ of the source and the pseudocyst-gastric anastomosis was the solution adopted, with favourable long-term evolution...
June 15, 2014: Journal of Medicine and Life
Ángel Lanas
The studies presented at the recent American Congress of Gastroenterology in the field of non-variceal upper gastrointestinal bleeding (associated or not to NSAIDs or ASA use) have not been numerous but interesting. The key findings are: a) rabeprazole, the only PPI that had few studies in this field, is effective in the prevention of gastric ulcers; b) famotidine could also be effective in the prevention of complications by AAS; c) the new competitive inhibitors of the acid potassium pump are effective (as much as PPIs) on the recurrence of peptic ulcers by ASA; d) early endoscop (<8 h) in non-variceal upper gastrointestinal bleeding seems to offer no better results than those made in the first 24 h; e) endoscopic therapy in Forrest 1a ulcers does not obliterate the bleeding artery in 30% of cases and is the cause of bleeding recurrence; f) alternative therapies with glue or clotting products are being increasingly used in endoscopic therapy of gastrointestinal bleeding; g) liberal administration of blood in the GI bleeding is associated with poor prognosis; h) lesions of the small intestine are frequent cause of gastrointestinal bleeding when upper endoscopy shows no positive stigmata; and i) capsule endoscopy studies have high performance in gastrointestinal bleeding of obscure origin, if performed early in the first two days after the beginning of the bleeding episode...
September 2014: Gastroenterología y Hepatología
Onur Koyuncu, Selim Turhanoglu, Kasım Tuzcu, Murat Karcıoglu, Isil Davarcı, Ercan Akbay, Cengiz Cevik, Cahit Ozer, Daniel I Sessler, Alparslan Turan
BACKGROUND: Carbon monoxide (CO) is a product of burning solid fuel in stoves and smoking. Exposure to CO may provoke postoperative complications. Furthermore, there appears to be an association between COHb concentrations and pain. We thus tested the primary hypothesis that children with high preoperative carboxyhemoglobin (COHb) concentrations have more postoperative complications and pain after tonsillectomies, and secondarily that high-COHb concentrations are associated with more pain and analgesic use...
March 2015: Paediatric Anaesthesia
P Casarotti, C Mendola, G Cammarota, F Della Corte
The anesthetic management of patients affected by myasthenia gravis is usually challenging in elective surgery and even more so in emergency procedures. The difficulties involved are several-fold, ranging from the choice of an appropriate muscle relaxant (i.e. one that enables safe and rapid airway management) to neuromuscular monitoring and normal muscular recovery. Additionally, optimizing patient conditions - either pharmacologically or with plasmapheresis - before intervention is well beyond the realm of possibility...
October 2014: Acta Anaesthesiologica Scandinavica
G Vrakas, M-G Pramateftakis, D Raptis, D Kanellos, I Kanellos
Transcatheter arterial embolization is a valuable, minimally invasive method, used as treatment for upper gastrointestinal bleeding, after failed primary endoscopic approach. It is a safe and effective procedure, but it's use is limited because of relatively high rates of rebleeding and mortality. The aim of this paper is to present a case of severe, massive upper gastrointestinal bleeding deriving from gastric angiodysplasia, which was treated successfully with superselective embolization. The patient recovered from the haemorrhagic shock and avoided emergency surgical intervention...
2012: Journal of Surgical Case Reports
Yen-I Chen, Jonathan Wyse, Alan Barkun, Marc Bardou, Ian Gralnek, Myriam Martel
BACKGROUND: Many aspects in the management of acute upper gastrointestinal bleeding rely on pre-esophagogastroduodenoscopy (EGD) stratification of patients likely to exhibit high-risk stigmata (HRS); however, data predicting the presence of HRS are lacking. OBJECTIVE: To determine clinical and laboratory predictors of HRS at the index EGD in patients presenting with acute upper gastrointestinal bleeding using retrospective data from a validated national database - the Canadian Registry in Upper Gastrointestinal Bleeding and Endoscopy registry...
June 2014: Canadian Journal of Gastroenterology & Hepatology
S A Shutov, S R Karagiulia, K I Danishian, V Iu Zorenko, A V Grzhimolovskiĭ, T Iu Polianskaia, E M Shulutko, G M Galstian
The experience of treatment of 366 patients with haemophilia who were urgently hospitalized in hеmatological Scientific Center over the last 10 years is presented in the article. There were 114 (31.1%) patients with acute diseases of abdominal cavity organs, 150 (41%) patients with bleeding from upper gastrointestinal tract, 102 (27.9%) patients with acute hematomas of retroperitoneal space. Urgent operations were performed in 48 (22.2%) patients who were hospitalized with clinical symptoms of acute abdomen syndrome...
2014: Khirurgiia
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