AIM: To compare the causes and clinical outcome of patients with acute upper gastrointestinal bleeding (AUGB) and a history of gastric surgery to those with AUGB but without a history of gastric surgery in the past.ME...AIM: To compare the causes and clinical outcome of patients with acute upper gastrointestinal bleeding (AUGB) and a history of gastric surgery to those with AUGB but without a history of gastric surgery in the past.METHODS: The causes and clinical outcome were compared between 105 patients with AUGB and a history of gastric surgery, and 608 patients with AUGB but without a history of gastric surgery.RESULTS: Patients who underwent gastric surgery in the past were older (mean age: 68.1±11.7 years vs 62.8±17.8 years, P= 0.001), and the most common cause of bleeding was marginal ulcer in 63 patients (60%). No identifiable source of bleeding could be found in 22 patients (20.9%) compared to 42/608 (6.9%) in patients without a history of gastric surgery (P = 0.003). Endoscopic hemostasis was permanently successful in 26 out of 35 patients (74.3%) with peptic ulcers and active bleeding or non-bleeding visible vessel. Nine patients (8.6%) were operated due to continuing or recurrent bleeding,compared to 23/608 (3.8%) in the group of patients without gastric surgery in the past (P= 0.028). Especially in peptic ulcer bleeding patients, emergency surgery was more common in the group of patients with gastric surgery in the past [9/73 (12.3%) vs 19/360 (5.3%), P = 0.025].Moreover surgically treated patients in the past required more blood transfusion (3.3±4.0 vs 1.5±1.7, P = 0.0001) and longer hospitalization time (8.6±4.0 vs 6.9±4.9 d,P = 0.001) than patients without a history of gastric surgery. Mortality was not different between the two groups [4/105 (3.8%) vs 19/608 (3.1%)].CONCLUSION: Upper gastrointestinal bleeding seems to be more severe in surgically treated patients than in non-operated patients.展开更多
BACKGROUND: Active hemorrhage arising from hepatic injury can be life-threatening and require immediate attention. At present, nonoperative management of abdominal solid organ injuries has become the usual method of c...BACKGROUND: Active hemorrhage arising from hepatic injury can be life-threatening and require immediate attention. At present, nonoperative management of abdominal solid organ injuries has become the usual method of care. The purpose of this study was to determine whether, hemocoagulase injection alone guided by contrast-enhanced ultrasonography (CEUS) could control active bleeding in rabbit liver. METHODS: The livers of 30 rabbits were punctured with an 18-gauge semiautomatic biopsy needle to create an active bleeding liver model, which was confirmed with CEUS. The animals were randomly divided into two groups: a treatment group (n=15) and a control group (n=15). In the treatment group, hemocoagulase was injected into the bleeding site under CEUS guidance. In the control group, the active bleeding site was treated with normal saline. When these treatment procedures had been performed, lactated Ringer's solution was given to both groups to maintain the mean arterial pressure at 70 mmHg for 1 hour. The intraperitoneal blood loss, hematocrit, mean heart rate, and macroscopic and microscopic examinations were analyzed at the end of the study. RESULTS: CEUS showed hypoechoic and anechoic perfusion defects in active bleeding liver models. Macroscopic and microscopic examinations also supported the results. After the hemocoagulase injection, the former bleeding site appeared on CEUS as an area devoid of contrast. The blood loss was lower in the treatment group than in the control group (38.0+/-16.6 ml versus 107.9+/-20.8 ml; t=10.172, P<0.05). The mean hematocrit value and the heart rate were higher in the treatment group than in the control group (hematocrit: 23.9+/-3.8% versus 18.8+/-4.1%; t=3.541, P<0.05; heart rate: 250+/-18 versus 223+/-15; t=4.551, P<0.01). CONCLUSION: Hemocoagulase injection alone under the guidance of CEUS is a simple and quick method to control blood loss in active liver bleeding.展开更多
BACKGROUND Primary aortoduodenal fistula is a rare cause of gastrointestinal(GI)bleeding consisting of abnormal channels between the aorta and GI tract without previous vascular intervention that results in massive in...BACKGROUND Primary aortoduodenal fistula is a rare cause of gastrointestinal(GI)bleeding consisting of abnormal channels between the aorta and GI tract without previous vascular intervention that results in massive intraluminal hemorrhage.CASE SUMMARY A 67-year-old man was hospitalized for coffee ground vomiting,tarry stools,and colic abdominal pain.He was repeatedly admitted for active GI bleeding and hypovolemic shock.Intermittent and spontaneously stopped bleeders were undetectable on multiple GI endoscopy,angiography,computed tomography angiography(CTA),capsule endoscopy,and ^(99)mTc-labeled red blood cell(RBC)scans.The patient received supportive treatment and was discharged without signs of rebleeding.Thereafter,he was re-admitted for bleeder identification.Repeated CTA after a bleed revealed a small aortic aneurysm at the renal level contacting the fourth portion of the duodenum.A ^(99)mTc-labeled RBC singlephoton emission CT(SPECT)/CT scan performed during bleeding symptoms revealed active bleeding at the duodenal level.According to his clinical symptoms(intermittent massive GI bleeding with hypovolemic shock,dizziness,dark red stool,and bloody vomitus)and the abdominal CTA and ^(99)mTc-labeled RBC SPECT/CT results,we suspected a small aneurysm and an aortoduodenal fistula.Subsequent duodenal excision and duodenojejunal anastomosis were performed.A 7-mm saccular aneurysm arising from the anterior wall of the abdominal aorta near the left renal artery was identified.Percutaneous intravascular stenting of the abdominal aorta was performed and his symptoms improved.CONCLUSION Our findings suggest that ^(99)mTc-labeled RBC SPECT/CT scanning can aid the diagnosis of a rare cause of active GI bleeding.展开更多
Reticulocytosls in rats was induced by repetitive bleeding. Both the in vitro and the in vivo studies showed that the detected reductive speed of methemoglobin of the bleeding group was faster than that of the control...Reticulocytosls in rats was induced by repetitive bleeding. Both the in vitro and the in vivo studies showed that the detected reductive speed of methemoglobin of the bleeding group was faster than that of the control group at all time intervals. At the same time, the NADH-cytochrome b5 methemoglobin reductase activity and the molybdenum content in erythrocytes of the bleeding group were significantly increased. Regressional analysis showed that there was a significantly positive correlation between the enzyme activity and the molybdenum content. It is proposed that molybdenum might be required for the enzyme activity展开更多
In this letter we comment on the article by Zhang et al published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2024.We focus specifically on the management of gastric varices(GV),which is a s...In this letter we comment on the article by Zhang et al published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2024.We focus specifically on the management of gastric varices(GV),which is a significant consequence of portal hypertension,is currently advised to include beta-blocker therapy for primary prophylaxis and transjugular intrahepatic portosystemic shunt for secondary prophylaxis or active bleeding.Although it has been studied,direct endoscopic injection of cyanoacrylate glue has limitations,such as the inability to fully characterize GV endoscopically and the potential for distant glue embolism.In order to achieve this,endoscopic ultrasound has been used to support GV characterization,real-time therapy imaging,and Doppler obliteration verification.展开更多
Background: Life-threatening bleeding is a major cause of trauma-related deaths. Stop the Bleed—Active bleeding control (ABC) program in Hyderabad recently showed that lay first responders can be effectively trained....Background: Life-threatening bleeding is a major cause of trauma-related deaths. Stop the Bleed—Active bleeding control (ABC) program in Hyderabad recently showed that lay first responders can be effectively trained. However, the willingness of high school students to train in bleeding control is unknown. We report Stop the Bleed training needs assessment from high schools in India and estimate the potential multiplier effect. Methods: A cross-sectional survey was conducted from 12 randomly selected schools in Hyderabad. The study was to understand current knowledge, skills and willingness to get trained and respond to life-threatening bleeding from injuries. 107 Participants (35 Teachers and 72 students) were purposively selected for telephonic interviews with a structured questionnaire. Results: Response rate was 93% overall. 80% of participants have never been trained in bleeding control. 84% reported willingness to be trained, train others and help bleeding victims. All the teachers reported that stop the bleed training would be useful in high schools. 70.6% of teachers recommended that training could start from middle school (10 to 15 years), 47% preferred the online training mode. Only 20% of participants had prior training in lifesaving first aid and 32% did not know the number of emergency medical services (EMS). Each trained participant has the potential to train 3 to 4 people at the household level and perhaps more at the community level. Conclusion: The surveyed schools in Hyderabad do not have the knowledge, skills, or training curriculum in Stop the Bleed. Students and teachers are willing to be trained and train others, with great potential for a “multiplier-effect” in the community.展开更多
文摘AIM: To compare the causes and clinical outcome of patients with acute upper gastrointestinal bleeding (AUGB) and a history of gastric surgery to those with AUGB but without a history of gastric surgery in the past.METHODS: The causes and clinical outcome were compared between 105 patients with AUGB and a history of gastric surgery, and 608 patients with AUGB but without a history of gastric surgery.RESULTS: Patients who underwent gastric surgery in the past were older (mean age: 68.1±11.7 years vs 62.8±17.8 years, P= 0.001), and the most common cause of bleeding was marginal ulcer in 63 patients (60%). No identifiable source of bleeding could be found in 22 patients (20.9%) compared to 42/608 (6.9%) in patients without a history of gastric surgery (P = 0.003). Endoscopic hemostasis was permanently successful in 26 out of 35 patients (74.3%) with peptic ulcers and active bleeding or non-bleeding visible vessel. Nine patients (8.6%) were operated due to continuing or recurrent bleeding,compared to 23/608 (3.8%) in the group of patients without gastric surgery in the past (P= 0.028). Especially in peptic ulcer bleeding patients, emergency surgery was more common in the group of patients with gastric surgery in the past [9/73 (12.3%) vs 19/360 (5.3%), P = 0.025].Moreover surgically treated patients in the past required more blood transfusion (3.3±4.0 vs 1.5±1.7, P = 0.0001) and longer hospitalization time (8.6±4.0 vs 6.9±4.9 d,P = 0.001) than patients without a history of gastric surgery. Mortality was not different between the two groups [4/105 (3.8%) vs 19/608 (3.1%)].CONCLUSION: Upper gastrointestinal bleeding seems to be more severe in surgically treated patients than in non-operated patients.
文摘BACKGROUND: Active hemorrhage arising from hepatic injury can be life-threatening and require immediate attention. At present, nonoperative management of abdominal solid organ injuries has become the usual method of care. The purpose of this study was to determine whether, hemocoagulase injection alone guided by contrast-enhanced ultrasonography (CEUS) could control active bleeding in rabbit liver. METHODS: The livers of 30 rabbits were punctured with an 18-gauge semiautomatic biopsy needle to create an active bleeding liver model, which was confirmed with CEUS. The animals were randomly divided into two groups: a treatment group (n=15) and a control group (n=15). In the treatment group, hemocoagulase was injected into the bleeding site under CEUS guidance. In the control group, the active bleeding site was treated with normal saline. When these treatment procedures had been performed, lactated Ringer's solution was given to both groups to maintain the mean arterial pressure at 70 mmHg for 1 hour. The intraperitoneal blood loss, hematocrit, mean heart rate, and macroscopic and microscopic examinations were analyzed at the end of the study. RESULTS: CEUS showed hypoechoic and anechoic perfusion defects in active bleeding liver models. Macroscopic and microscopic examinations also supported the results. After the hemocoagulase injection, the former bleeding site appeared on CEUS as an area devoid of contrast. The blood loss was lower in the treatment group than in the control group (38.0+/-16.6 ml versus 107.9+/-20.8 ml; t=10.172, P<0.05). The mean hematocrit value and the heart rate were higher in the treatment group than in the control group (hematocrit: 23.9+/-3.8% versus 18.8+/-4.1%; t=3.541, P<0.05; heart rate: 250+/-18 versus 223+/-15; t=4.551, P<0.01). CONCLUSION: Hemocoagulase injection alone under the guidance of CEUS is a simple and quick method to control blood loss in active liver bleeding.
文摘BACKGROUND Primary aortoduodenal fistula is a rare cause of gastrointestinal(GI)bleeding consisting of abnormal channels between the aorta and GI tract without previous vascular intervention that results in massive intraluminal hemorrhage.CASE SUMMARY A 67-year-old man was hospitalized for coffee ground vomiting,tarry stools,and colic abdominal pain.He was repeatedly admitted for active GI bleeding and hypovolemic shock.Intermittent and spontaneously stopped bleeders were undetectable on multiple GI endoscopy,angiography,computed tomography angiography(CTA),capsule endoscopy,and ^(99)mTc-labeled red blood cell(RBC)scans.The patient received supportive treatment and was discharged without signs of rebleeding.Thereafter,he was re-admitted for bleeder identification.Repeated CTA after a bleed revealed a small aortic aneurysm at the renal level contacting the fourth portion of the duodenum.A ^(99)mTc-labeled RBC singlephoton emission CT(SPECT)/CT scan performed during bleeding symptoms revealed active bleeding at the duodenal level.According to his clinical symptoms(intermittent massive GI bleeding with hypovolemic shock,dizziness,dark red stool,and bloody vomitus)and the abdominal CTA and ^(99)mTc-labeled RBC SPECT/CT results,we suspected a small aneurysm and an aortoduodenal fistula.Subsequent duodenal excision and duodenojejunal anastomosis were performed.A 7-mm saccular aneurysm arising from the anterior wall of the abdominal aorta near the left renal artery was identified.Percutaneous intravascular stenting of the abdominal aorta was performed and his symptoms improved.CONCLUSION Our findings suggest that ^(99)mTc-labeled RBC SPECT/CT scanning can aid the diagnosis of a rare cause of active GI bleeding.
文摘Reticulocytosls in rats was induced by repetitive bleeding. Both the in vitro and the in vivo studies showed that the detected reductive speed of methemoglobin of the bleeding group was faster than that of the control group at all time intervals. At the same time, the NADH-cytochrome b5 methemoglobin reductase activity and the molybdenum content in erythrocytes of the bleeding group were significantly increased. Regressional analysis showed that there was a significantly positive correlation between the enzyme activity and the molybdenum content. It is proposed that molybdenum might be required for the enzyme activity
文摘In this letter we comment on the article by Zhang et al published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2024.We focus specifically on the management of gastric varices(GV),which is a significant consequence of portal hypertension,is currently advised to include beta-blocker therapy for primary prophylaxis and transjugular intrahepatic portosystemic shunt for secondary prophylaxis or active bleeding.Although it has been studied,direct endoscopic injection of cyanoacrylate glue has limitations,such as the inability to fully characterize GV endoscopically and the potential for distant glue embolism.In order to achieve this,endoscopic ultrasound has been used to support GV characterization,real-time therapy imaging,and Doppler obliteration verification.
文摘Background: Life-threatening bleeding is a major cause of trauma-related deaths. Stop the Bleed—Active bleeding control (ABC) program in Hyderabad recently showed that lay first responders can be effectively trained. However, the willingness of high school students to train in bleeding control is unknown. We report Stop the Bleed training needs assessment from high schools in India and estimate the potential multiplier effect. Methods: A cross-sectional survey was conducted from 12 randomly selected schools in Hyderabad. The study was to understand current knowledge, skills and willingness to get trained and respond to life-threatening bleeding from injuries. 107 Participants (35 Teachers and 72 students) were purposively selected for telephonic interviews with a structured questionnaire. Results: Response rate was 93% overall. 80% of participants have never been trained in bleeding control. 84% reported willingness to be trained, train others and help bleeding victims. All the teachers reported that stop the bleed training would be useful in high schools. 70.6% of teachers recommended that training could start from middle school (10 to 15 years), 47% preferred the online training mode. Only 20% of participants had prior training in lifesaving first aid and 32% did not know the number of emergency medical services (EMS). Each trained participant has the potential to train 3 to 4 people at the household level and perhaps more at the community level. Conclusion: The surveyed schools in Hyderabad do not have the knowledge, skills, or training curriculum in Stop the Bleed. Students and teachers are willing to be trained and train others, with great potential for a “multiplier-effect” in the community.
