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Variceal hemorrhage

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https://www.readbyqxmd.com/read/27880982/safety-and-efficacy-of-ruxolitinib-in-splanchnic-vein-thrombosis-associated-with-myeloproliferative-neoplasms
#1
Lisa Pieri, Chiara Paoli, Umberto Arena, Fabio Marra, Fabio Mori, Mery Zucchini, Stefano Colagrande, Alessandro Castellani, Arianna Masciulli, Vittorio Rosti, Valerio De Stefano, Silvia Betti, Guido Finazzi, Maria Luisa Ferrari, Elisa Rumi, Marco Ruggeri, Ilaria Nichele, Paola Guglielmelli, Rajmonda Fjerza, Carmela Mannarelli, Tiziana Fanelli, Lucia Merli, Giuditta Corbizi Fattori, Margherita Massa, Giuseppe Cimino, Alessandro Rambaldi, Giovanni Barosi, Mario Cazzola, Tiziano Barbui, Alessandro M Vannucchi
Splanchnic vein thrombosis (SVT) is one of the vascular complications of myeloproliferative neoplasms (MPN). We designed a phase 2 clinical trial to evaluate safety and efficacy of ruxolitinib in reducing splenomegaly and improving disease-related symptoms in patients with MPN-associated SVT. Patients, diagnosed with myelofibrosis in 12 cases, polycythemia vera in 5 and essential thrombocythemia in 4, received ruxolitinib for 24 weeks in the core study period. Spleen volume was assessed by magnetic resonance imaging (MRI) and splanchnic vein circulation by echo-Doppler analysis...
November 23, 2016: American Journal of Hematology
https://www.readbyqxmd.com/read/27843428/a-rare-case-of-gastric-variceal-hemorrhage-secondary-to-infiltrative-b-cell-lymphoma
#2
Adrienne Lenhart, Juan Fernandez-Castillo, Keith Mullins, Reena Salgia
Portal hypertension commonly arises in the setting of advanced liver cirrhosis and is the consequence of increased resistance within the portal vasculature. Less commonly, left-sided noncirrhotic portal hypertension can develop in a patient secondary to isolated obstruction of the splenic vein. We present a rare case of left-sided portal hypertension and isolated gastric varices in a patient with large B-cell lymphoma, who was treated with splenic artery embolization. The patient is a 73-year-old male with no previous history of liver disease, who presented with coffee ground emesis and melena...
September 2016: Case Reports in Gastroenterology
https://www.readbyqxmd.com/read/27829605/jejunal-varices-after-choledochojejunostomy-treated-with-laparotomic-transcatheter-variceal-embolization
#3
Nobuo Waguri, Rie Azumi, Kazuhito Sugimura, Yoshihisa Arao, Shunzo Ikarashi, Norihiro Sakai, Masahiro Ogawa, Akihiko Osaki, Munehiro Sato, Tsuneo Aiba, Osamu Yoneyama, Koichi Furukawa, Kentarou Igarashi
Portal hypertension induces collateral shunt formation between the portal and systemic circulation, decompressing the elevated portal pressure. Ectopic varices outside of the gastroesophageal region, such as jejunal varices, are rare conditions. This report describes the successful embolization of ruptured jejunal varices resulting from an extrahepatic portal obstruction. A 62-year-old man was admitted to our hospital with recurrent massive gastrointestinal bleeding. Fourteen months earlier, he had undergone a choledochojejunostomy and pancreatic cystojejunostomy for bile duct stenosis with an enlarged pancreatic pseudocyst due to severe chronic pancreatitis...
2016: Nihon Shokakibyo Gakkai Zasshi, the Japanese Journal of Gastro-enterology
https://www.readbyqxmd.com/read/27807564/downhill-esophageal-varices-associated-with-central-venous-catheter-related-thrombosis-managed-with-endoscopic-and-surgical-therapy
#4
Joshua C Berkowitz, Sushma Bhusal, Deepak Desai, Maurice A Cerulli, Sumant Inamdar
Downhill esophageal varices are a rare cause of upper gastrointestinal hemorrhage. We present a case of downhill variceal bleeding due to superior vena cava thrombosis resulting from a prior central venous catheter. The patient was managed with endoscopic band ligation and later with surgical axillary vein to right atrium bypass grafting. Successful long-term resolution of varices was achieved at 1 year of follow-up. This is the longest follow-up described for combined endoscopic and surgical management in the existing literature for catheter-associated downhill varices...
August 2016: ACG Case Reports Journal
https://www.readbyqxmd.com/read/27779613/child-turcotte-pugh-class-is-best-at-stratifying-risk-in-variceal-hemorrhage-analysis-of-a-us-multicenter-prospective-study
#5
Brett E Fortune, Guadalupe Garcia-Tsao, Maria Ciarleglio, Yanhong Deng, Michael B Fallon, Samuel Sigal, Naga P Chalasani, Joseph K Lim, Adrian Reuben, Hugo E Vargas, Gary Abrams, Michele D Lewis, Tarek Hassanein, James F Trotter, Arun J Sanyal, Kimberly L Beavers, Daniel Ganger, Paul J Thuluvath, Norman D Grace, Roberto J Groszmann
GOALS/BACKGROUND: Data on acute variceal hemorrhage (AVH) in the United States is limited and the best method to stratify risk is not clear. Taking advantage of a prospective US cohort study, we aimed to (1) describe clinical outcomes of AVH and their predictors; (2) compare predictors of 6-week mortality. STUDY: Prospective 15-center US cohort of patients with cirrhosis presenting with endoscopically proven AVH, all of whom received antibiotics, vapreotide (a somatostain analog) infusion and endoscopic band ligation...
October 24, 2016: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/27776486/bleeding-downhill-esophageal-varices-associated-with-benign-superior-vena-cava-obstruction-case-report-and-literature-review
#6
Michael Loudin, Sharon Anderson, Barry Schlansky
BACKGROUND: Proximal or 'downhill' esophageal varices are a rare cause of upper gastrointestinal hemorrhage. Unlike the much more common distal esophageal varices, which are most commonly a result of portal hypertension, downhill esophageal varices result from vascular obstruction of the superior vena cava (SVC). While SVC obstruction is most commonly secondary to malignant causes, our review of the literature suggests that benign causes of SVC obstruction are the most common cause actual bleeding from downhill varices...
October 24, 2016: BMC Gastroenterology
https://www.readbyqxmd.com/read/27721730/hepatic-angiosarcoma-associated-with-esophageal-variceal-hemorrhage
#7
Zensho Ito, Mikio Kajihara, Yasunobu Kobayashi, Tomoya Kanai, Yoshihiro Matsumoto, Kazuki Takakura, Toyokazu Yukawa, Toshifumi Ohkusa, Seita Koyama, Hiroo Imazu, Hiroshi Arakawa, Mitsuru Ohata, Shigeo Koido
Primary hepatic angiosarcoma is a very rare malignancy with a poor prognosis. Because patients present with no specific symptoms, the cancer can grow undetected and most cases are diagnosed too late for resection. We present the case of a 78-year-old Japanese man admitted to our hospital with massive hematemesis and melena. A total gastrectomy had previously been performed on the patient to treat gastric cancer. Endoscopic injection sclerotherapy was performed to control the bleeding from varices over the anastomosis...
May 2016: Case Reports in Gastroenterology
https://www.readbyqxmd.com/read/27708520/predictors-of-hospital-re-admissions-among-hispanics-with-hepatitis-c-related-cirrhosis
#8
Pradeep R Atla, Muhammad Y Sheikh, Firdose Gill, Rabindra Kundu, Jayanta Choudhury
BACKGROUND: Hospital re-admissions in decompensated cirrhosis are associated with worse patient outcomes. Hispanics have a disproportionately high prevalence of hepatitis C virus (HCV)-related morbidity and mortality. The goal of this study was to evaluate the factors affecting re-admission rates among Hispanics with HCV-related cirrhosis. METHODS: A total of 292 consecutive HCV-related cirrhosis admissions (Hispanics 189, non-Hispanics 103) from January 2009 to December 2012 were retrospectively reviewed; 132 were cirrhosis-related re-admissions...
October 2016: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
https://www.readbyqxmd.com/read/27706547/-percutaneous-paraumbilical-embolization-of-bleeding-rectal-varices-due-to-portal-hypertension
#9
T Stuber, B Schmitz, H J Brambs
Introduction: Portal hypertension may lead to severe esophageal or rectal variceal bleeding. Case report: We present a case of a 67-year-old patient presenting with recurrent rectal variceal bleeding who was non-responsive to endoscopic treatment. We are reporting on an interventional therapeutic approach found in interdisciplinary consensus. Discussion: Endoscopy, surgery or TIPS (transjugular intrahepatic portosystemic shunt) can be performed in patients with gastrointestinal bleeding due to portal hypertension in liver cirrhosis...
October 5, 2016: Zeitschrift Für Gastroenterologie
https://www.readbyqxmd.com/read/27706545/rescue-therapy-of-a-refractory-rectal-variceal-bleeding-in%C3%A2-a-cirrhotic-patient-by-linton-nachlas-tube-and-tips-implantation-in-combination-with-variceal-embolization
#10
M Buechter, J M Theysohn, A Kahraman, P Manka, G Gerken, A Canbay, A Dechêne
Background: Transjugular intrahepatic portosystemic shunt (TIPS) is considered the gold standard for treatment of gastrointestinal variceal bleeding refractory to endoscopic therapy in patients with portal hypertension. Clinically relevant hemorrhage from rectal varices is less frequent than from other sources, and the therapeutic role of TIPS is still ambiguous. Case report: A 57-year-old female patient was referred to us in December 2015 with severe signs of decompensated alcohol-induced liver cirrhosis. During hospitalization, she presented with recurrent hematochezia from rectal varices following electrosurgical snare removal of a rectal adenoma...
October 5, 2016: Zeitschrift Für Gastroenterologie
https://www.readbyqxmd.com/read/27706456/evaluation-of-primary-prophylaxis-with-propranolol-and-elastic-band-ligation-in-variceal-bleeding-in-cirrhotic-children-and-adolescents
#11
Júlio Rocha Pimenta, Alexandre Rodrigues Ferreira, Paulo Fernando Souto Bittencourt, Camilo Brandão de Resende, Eleonora Druve Tavares Fagundes, Isabela Maria Lopes da Silva
Background: The efficacy of nonselective β-blocker and endoscopic procedures, such as endoscopic variceal ligation, as primary prophylaxis of variceal hemorrhage in cirrhotic adults was demonstrated by numerous controlled trials, but in pediatric population, few are the number of studies. Objective: The objective of this study is to evaluate the primary prophylaxis with β-blocker in cirrhotic children and adolescents with portal hypertension. Methods: This is a cohort study encompassing 26 cirrhotic patients...
October 2016: Arquivos de Gastroenterologia
https://www.readbyqxmd.com/read/27661550/-management-of-pediatric-patients-with-esophageal-varices
#12
Sofía Verdaguer D, Juan Cristóbal Gana A
BACKGROUND: There is a paucity of good quality research about the diagnosis of esophageal varices and the prophylaxis and treatment of variceal bleeding in pediatric patients with portal hypertension There is little consensus and practically no evidence-based approach about the management of these patients. AIM: To describe the behavior and preferences of pediatric gastroenterologists in Chile in the management of portal hypertension in children. MATERIAL AND METHODS: An online survey was sent to Chilean pediatric gastroenterologists, with questions evaluating the physicians’ approaches to screening of esophageal varices in children with portal hypertension, and their preferred methods of prophylaxis and initial management of variceal bleeding...
July 2016: Revista Médica de Chile
https://www.readbyqxmd.com/read/27661203/laparoscopic-treatment-of-presinusoidal-schistosomal-portal-hypertension-associated-with-postoperative-endoscopic-treatment-results-of-a-new-approach
#13
Renata P Colaneri, Fabrício F Coelho, Roberto de Cleva, Paulo Herman
AIM: To propose a laparoscopic treatment for schistosomal portal hypertension. METHODS: Ten patients with schistosomiasis and portal hypertension, with previous gastrointestinal hemorrhage from esophageal varices rupture, were evaluated. Patients were subjected to a laparoscopic procedure, with ligature of splenic artery and left gastric vein. Upper gastrointestinal endoscopy was performed on the 30th postoperative day, when esophageal varices diameter was measured and band ligature performed...
September 22, 2016: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
https://www.readbyqxmd.com/read/27659187/a-case-report-of-simultaneous-orthotopic-liver-transplantation-and-jejunectomy
#14
Guoyong Chen, Sidong Wei, Zhongwu Zou, Jianjun Sun, Gaofeng Tang, Jianbin Chen, Shaotang Zhou
BACKGROUND: Liver transplantation (LT) accompanied by jejunectomy to treat patients with acute or chronic hepatic cirrhosis with thrombosis in the portal system is extremely rare. CASE PRESENTATION: A 47-year-old man presented with hematemesis and melena, and a diagnosis of decompensated cirrhosis, chronic portal vein thrombosis (PVT) and secondary gastro-esophageal variceal hemorrhage was made. Coagulants were administered, but portal vein thrombi occurred rapidly, and gastrointestinal bleeding recurred shortly thereafter...
2016: BMC Surgery
https://www.readbyqxmd.com/read/27638992/mesenteric-vein-thrombosis-can-be-safely-treated-with-anticoagulation-but-is-associated-with-significant-sequelae-of-portal-hypertension
#15
Thomas S Maldonado, Sheila N Blumberg, Sharvil U Sheth, Gabriel Perreault, Mikel Sadek, Todd Berland, Mark A Adelman, Caron B Rockman
BACKGROUND: Mesenteric venous thrombosis (MVT) is a relatively uncommon but potentially lethal condition associated with bowel ischemia and infarction. The natural history and long-term outcomes are poorly understood and under-reported. METHODS: A single-institution retrospective review of noncirrhotic patients diagnosed with MVT from 1999 to 2015 was performed using International Classification of Diseases, Ninth Revision and radiology codes. Patients were excluded if no radiographic imaging was available for review...
October 2016: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/27595456/gastrointestinal-bleeding-from-vascular-malformations-is-octreotide-effective-to-rescue-difficult-to-treat-patients
#16
Andrea Iannone, Mariabeatrice Principi, Michele Barone, Giuseppe Losurdo, Enzo Ierardi, Alfredo Di Leo
Gastrointestinal vascular malformations are responsible for 2-8% of all cases of bleeding and 30-40% of all obscure hemorrhages, being the most frequent cause of occult bleeding in older people. The aim of this review was to provide an up-to-date report about the use of octreotide in bleeding from both hereditary and acquired vascular malformations of the gastrointestinal tract. A systematic literature search was performed, using the keywords "gastrointestinal vascular malformation", "octreotide", "angiodysplasia", "portal hypertensive gastropathy", "gastric antral vascular ectasia", and "hereditary vascular malformations"...
September 2016: Clinics and Research in Hepatology and Gastroenterology
https://www.readbyqxmd.com/read/27583858/occurrence-of-infective-endocarditis-following-endoscopic-variceal-ligation-therapy-a-case-report
#17
Xuan Zhang, Xiaoli Liu, Meifang Yang, Huihui Dong, Lichen Xv, Lanjuan Li
BACKGROUND: Endoscopic variceal ligation (EVL) is the endoscopic treatment of acute esophageal variceal hemorrhage, however, prophylaxis antibiotic during EVL is controversial. METHODS: We reported a 60-year-old man with diabetes, liver cirrhosis and hepatocellular carcinoma who received EVL for esophageal variceal haemorrhage. RESULTS: On the second day after EVL, the patient developed fever and chills. A week after EVL, the blood cultures were viridans streptococcus positive, and echocardiogram showed a vegetation on the cardiac valve...
August 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27568650/laparoscopic-azygoportal-disconnection-with-and-without-splenectomy-for-portal-hypertension
#18
Dou-Sheng Bai, Jian-Jun Qian, Ping Chen, Bing-Lan Xia, Sheng-Jie Jin, Si-Qin Zuo, Guo-Qing Jiang
INTRODUCTION: Laparoscopic splenectomy and azygoportal disconnection (LSD) has been reported to be safe, feasible, and minimally invasive for cirrhotic patients with portal hypertension. There is still controversy as to whether it is necessary to perform synchronous splenectomy for patients with moderate hypersplenism who undergo azygoportal disconnection for esophagogastric variceal hemorrhage (EGVB). METHODS: We retrospectively evaluated the outcomes in 51 cirrhotic patients with EGVB and moderate hypersplenism (PLT ≥50 × 10(9)/L) who underwent LSD (n = 28) or laparoscopic azygoportal disconnection (LD) (n = 23) between January 2014 and October 2015...
August 25, 2016: International Journal of Surgery
https://www.readbyqxmd.com/read/27559696/simvastatin-attenuates-liver-injury-in-rodents-with-biliary-cirrhosis-submitted-to-hemorrhage-resuscitation
#19
Cintia Zimmermann Meireles, Marcos Pasarin, Juan Jose Lozano, Héctor García-Calderó, Jordi Gracia-Sancho, Juan Carlos García-Pagán, Jaime Bosch, Juan G Abraldes
Liver function deterioration is a major cause of death in variceal bleeding. The effects of bleeding on intrahepatic microvascular dysfunction, which contributes to liver injury in cirrhosis, are largely unknown. The aims of this study were to evaluate the impact of hemorrhage/resuscitation (H/R) on cirrhotic microcirculation, and whether simvastatin, a drug that improves liver microcirculation, has hepatoprotective effects. The study was performed in three groups of rats: controls, rats with biliary cirrhosis (CBDL) and CBDL rats pre-treated with 3 doses (5 mg*Kg-1*day-1) of simvastatin...
August 24, 2016: Shock
https://www.readbyqxmd.com/read/27534406/association-between-weekend-admission-and-mortality-for-upper-gastrointestinal-hemorrhage-an-observational-study-and-meta-analysis
#20
Erin Renae Weeda, Brandon Scott Nicoll, Craig Ian Coleman, Anna Sharovetskaya, William Leslie Baker
Higher in-hospital mortality for weekend vs. weekday admissions has been described. We performed a retrospective study and accompanying meta-analysis to examine the association between weekend admission for upper gastrointestinal hemorrhage (UGIH) and in-hospital mortality. We identified adult admissions to United States (US) hospitals for acute variceal and nonvariceal UGIH between 1/2010 and 12/2012 from the National Inpatient Sample (NIS). We used multivariable logistic regression to compare the odds of in-hospital mortality (adjusting for hospital- and patient-level factors) for weekend vs...
August 17, 2016: Internal and Emergency Medicine
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