BACKGROUND Hemostatic powders have been used as primary or salvage therapy to control gastrointestinal bleeding in a number of scenarios.PuraStat®is a novel,selfassembling peptide gel that has properties that dif...BACKGROUND Hemostatic powders have been used as primary or salvage therapy to control gastrointestinal bleeding in a number of scenarios.PuraStat®is a novel,selfassembling peptide gel that has properties that differ from hemostatic powders.It is transparent,can be used in narrow spaces and combined with other modalities.Also,it is pre-filled in a syringe ready to use and easy to handle and deliver.PuraStat®has been shown to be effective and safe in treating gastrointestinal bleeding lesions.But,its role as a hemostatic agent in all bleeding indications remains to be clarified.AIM To evaluate PuraStat®efficacy and its applications,feasibility and safety in treating gastrointestinal bleeding lesions.METHODS We performed a retrospective single-centre analysis of all consecutive patients with gastrointestinal bleeding,that required endoscopic treatment and where PuraStat®was applied,from June 2020 to October 2022.Demographics,biochemical,endoscopic,endoscopist assessment and outcome data were collected.We analysed the whole cohort and the subgroup with upper gastrointestinal bleeding.The primary outcome was to evaluate the efficacy of PuraStat®at achieving initial hemostasis.The patients were followed-up for 30 days after the episode of bleeding.RESULTS In total 45 patients were included,and 17/45(37.8%)females.The mean age was 65.8 years.Charlson score was>2 in 27/45(60%)and 26/45(57.8%)required transfusion.The procedures were gastroscopy(77.8%),colonoscopy(15.5%),endoscopic retrograde cholangiopancreatography(4.4%)and enteroscopy(2.2%).The most common bleeding lesion was peptic ulcer(33.3%).PuraStat®was used alone in 36%of the cases.One hundred percent achieved initial hemostasis and no complications were documented.There were no significant differences between the use of PuraStat®alone or in combination in terms of re-bleeding(P=0.64)or mortality(P=0.69).In 46.6%of cases,the reason for applying PuraStat®was as addition to standard of care,in 35.5%as an alternative because standard of care was not possible and in 17.8%as a rescue therapy.CONCLUSION PuraStat®is an effective therapy for multiple etiologies and is considered very easy to use in the majority.Its role as front line agent should be considered in the future.展开更多
Background:Thrombocytopenia is a possible risk factor for bleeding after band ligation of esophageal varices.However,elevated von Willebrand factor(VWF)in cirrhosis improves platelet function and could decrease this r...Background:Thrombocytopenia is a possible risk factor for bleeding after band ligation of esophageal varices.However,elevated von Willebrand factor(VWF)in cirrhosis improves platelet function and could decrease this risk.Our objective was to assess platelet function in patients with cirrhosis undergoing esophageal variceal ligation(EVL).Methods:The assessment consisted of platelet count,antigen and activity of VWF and VWF-cleaving protease ADAMTS-13 activity,and a platelet adhesion and aggregation test simulating vascular flow in vivo(Impact-RR)prior to EVL.Results:Totally 111 patients were divided into three groups according to platelet count:(1)<50×109/L(n=38,34.2%);(2)50×109/L to 100×109/L(n=47,42.3%);and(3)>100×109/L(n=26,23.4%).No statistically significant difference was found in the aggregate size of platelets[group 1:41.0(31.8–67.3)μm 2;group 2:47.0(33.8–71.3)μm 2;and group 3:47.0(34.0–66.0)μm 2;P=0.60]and no significant correlation was found between aggregate size and platelet count(Spearman r=0.07;P=0.47).Surface coverage was 4.1%(2.8%–6.7%),8.5%(4.0%–10.0%),and 9.0%(7.1%–12.0%)(P<0.001)in groups 1,2 and 3,respectively and correlated with platelet count(Spearman r=0.39;P<0.0001).There was no significant difference between groups in VWF or ADAMTS-13.Post-EVL bleeding occurred in six(5.4%)patients(n=2 in group 1,n=1 in group 2,and n=3 in group 3;P=0.32).Patients with bleeding had higher MELD scores[15.0(11.3–20.3)versus 12.0(10.0–15.0);P=0.025],but no difference was demonstrated for platelet function parameters.Conclusion:Platelet function is preserved even in the presence of thrombocytopenia,including in the patients with post-EVL bleeding.展开更多
Primary biliary cirrhosis is a slowly progressive cholestatic autoimmune liver disease that mainly affects middle-aged women with an estimated prevalence ranging from 6.7 to 402 cases per million. Hereditary hemorrhag...Primary biliary cirrhosis is a slowly progressive cholestatic autoimmune liver disease that mainly affects middle-aged women with an estimated prevalence ranging from 6.7 to 402 cases per million. Hereditary hemorrhagic telangiectasia, or Rendu-Osler-Weber disease, is an autosomal dominant disorder characterized by angiodysplastic lesions (telangiectases and arteriovenous malformations) that can affect many organs, including liver, with a prevalence of 1-2 cases per 10000. We describe the coexistence, for the first time to our knowledge, of these two rare diseases in a 50-year old Caucasian woman. In this setting, the relevance of an accurate medical history, the role of liver histology and the characterization of liver involvement through dynamic imaging techniques can be emphasized.展开更多
Objective： To investigate the clinical features and treatment strategy of dissymmetric bilateral frontal contusion, and to summarize our experience in treating these patients by minimally invasive surgery. Methods：...Objective： To investigate the clinical features and treatment strategy of dissymmetric bilateral frontal contusion, and to summarize our experience in treating these patients by minimally invasive surgery. Methods： Over the past 3 years, we have treated a total of 31 patients with dissymmetric bilateral frontal contusion using endoscopy-assisted unilateral cerebral falx incision. ~ ~ther 30 patients treated by routine bilateral approaches within the same period were taken as control. Results： Seventeen cases （54.8%） in the unilateral operation group survived and were in good condition, 8 （25.8%） had moderate disability, 4 （12.9%） had severe disability, 1 （3.2%） was in vegetative state, and 1 （3.2%） died. Compared with the control group, the Glasgow Out- come Scale score was not significantly different in the uni-lateral operation group, but the operation time, blood trans- fusion volume, the length of hospital stay, the incidences of mental disorder and olfactory nerve injury were greatly reduced in the unilateral operation group. Conclusions： Endoscopy-assisted unilateral cerebral falx incision can shorten the operation time, reduce surgical trauma and complications in treatment of patients with dissymmetric bilateral frontal contusion. It can obviously diminish the chance of delayed intracerebral hematoma and subsequently minimize the incidences of subfalcial and centrencephalic herniation.展开更多
文摘BACKGROUND Hemostatic powders have been used as primary or salvage therapy to control gastrointestinal bleeding in a number of scenarios.PuraStat®is a novel,selfassembling peptide gel that has properties that differ from hemostatic powders.It is transparent,can be used in narrow spaces and combined with other modalities.Also,it is pre-filled in a syringe ready to use and easy to handle and deliver.PuraStat®has been shown to be effective and safe in treating gastrointestinal bleeding lesions.But,its role as a hemostatic agent in all bleeding indications remains to be clarified.AIM To evaluate PuraStat®efficacy and its applications,feasibility and safety in treating gastrointestinal bleeding lesions.METHODS We performed a retrospective single-centre analysis of all consecutive patients with gastrointestinal bleeding,that required endoscopic treatment and where PuraStat®was applied,from June 2020 to October 2022.Demographics,biochemical,endoscopic,endoscopist assessment and outcome data were collected.We analysed the whole cohort and the subgroup with upper gastrointestinal bleeding.The primary outcome was to evaluate the efficacy of PuraStat®at achieving initial hemostasis.The patients were followed-up for 30 days after the episode of bleeding.RESULTS In total 45 patients were included,and 17/45(37.8%)females.The mean age was 65.8 years.Charlson score was>2 in 27/45(60%)and 26/45(57.8%)required transfusion.The procedures were gastroscopy(77.8%),colonoscopy(15.5%),endoscopic retrograde cholangiopancreatography(4.4%)and enteroscopy(2.2%).The most common bleeding lesion was peptic ulcer(33.3%).PuraStat®was used alone in 36%of the cases.One hundred percent achieved initial hemostasis and no complications were documented.There were no significant differences between the use of PuraStat®alone or in combination in terms of re-bleeding(P=0.64)or mortality(P=0.69).In 46.6%of cases,the reason for applying PuraStat®was as addition to standard of care,in 35.5%as an alternative because standard of care was not possible and in 17.8%as a rescue therapy.CONCLUSION PuraStat®is an effective therapy for multiple etiologies and is considered very easy to use in the majority.Its role as front line agent should be considered in the future.
文摘Background:Thrombocytopenia is a possible risk factor for bleeding after band ligation of esophageal varices.However,elevated von Willebrand factor(VWF)in cirrhosis improves platelet function and could decrease this risk.Our objective was to assess platelet function in patients with cirrhosis undergoing esophageal variceal ligation(EVL).Methods:The assessment consisted of platelet count,antigen and activity of VWF and VWF-cleaving protease ADAMTS-13 activity,and a platelet adhesion and aggregation test simulating vascular flow in vivo(Impact-RR)prior to EVL.Results:Totally 111 patients were divided into three groups according to platelet count:(1)<50×109/L(n=38,34.2%);(2)50×109/L to 100×109/L(n=47,42.3%);and(3)>100×109/L(n=26,23.4%).No statistically significant difference was found in the aggregate size of platelets[group 1:41.0(31.8–67.3)μm 2;group 2:47.0(33.8–71.3)μm 2;and group 3:47.0(34.0–66.0)μm 2;P=0.60]and no significant correlation was found between aggregate size and platelet count(Spearman r=0.07;P=0.47).Surface coverage was 4.1%(2.8%–6.7%),8.5%(4.0%–10.0%),and 9.0%(7.1%–12.0%)(P<0.001)in groups 1,2 and 3,respectively and correlated with platelet count(Spearman r=0.39;P<0.0001).There was no significant difference between groups in VWF or ADAMTS-13.Post-EVL bleeding occurred in six(5.4%)patients(n=2 in group 1,n=1 in group 2,and n=3 in group 3;P=0.32).Patients with bleeding had higher MELD scores[15.0(11.3–20.3)versus 12.0(10.0–15.0);P=0.025],but no difference was demonstrated for platelet function parameters.Conclusion:Platelet function is preserved even in the presence of thrombocytopenia,including in the patients with post-EVL bleeding.
文摘Primary biliary cirrhosis is a slowly progressive cholestatic autoimmune liver disease that mainly affects middle-aged women with an estimated prevalence ranging from 6.7 to 402 cases per million. Hereditary hemorrhagic telangiectasia, or Rendu-Osler-Weber disease, is an autosomal dominant disorder characterized by angiodysplastic lesions (telangiectases and arteriovenous malformations) that can affect many organs, including liver, with a prevalence of 1-2 cases per 10000. We describe the coexistence, for the first time to our knowledge, of these two rare diseases in a 50-year old Caucasian woman. In this setting, the relevance of an accurate medical history, the role of liver histology and the characterization of liver involvement through dynamic imaging techniques can be emphasized.
文摘Objective： To investigate the clinical features and treatment strategy of dissymmetric bilateral frontal contusion, and to summarize our experience in treating these patients by minimally invasive surgery. Methods： Over the past 3 years, we have treated a total of 31 patients with dissymmetric bilateral frontal contusion using endoscopy-assisted unilateral cerebral falx incision. ~ ~ther 30 patients treated by routine bilateral approaches within the same period were taken as control. Results： Seventeen cases （54.8%） in the unilateral operation group survived and were in good condition, 8 （25.8%） had moderate disability, 4 （12.9%） had severe disability, 1 （3.2%） was in vegetative state, and 1 （3.2%） died. Compared with the control group, the Glasgow Out- come Scale score was not significantly different in the uni-lateral operation group, but the operation time, blood trans- fusion volume, the length of hospital stay, the incidences of mental disorder and olfactory nerve injury were greatly reduced in the unilateral operation group. Conclusions： Endoscopy-assisted unilateral cerebral falx incision can shorten the operation time, reduce surgical trauma and complications in treatment of patients with dissymmetric bilateral frontal contusion. It can obviously diminish the chance of delayed intracerebral hematoma and subsequently minimize the incidences of subfalcial and centrencephalic herniation.
