ABSTRACT
Currently, endoscopic injection sclerotherapy(EIS) is the most widely used method for treating and eradicating acutely bleeding esophageal varices in repeated sessions, but may be associated with some undesirable local and systemic complications. (continue...)
Subject(s)
Esophageal and Gastric Varices , Esophagus , Hemorrhage , Hemostasis , Ligation , Sclerotherapy , Varicose VeinsABSTRACT
A prospective randomised trial was performed to assess the diagnostic accuracy according to the time interval and the efficacy of endoscopic injection of hypertonic saline-epinephrine(HS- E)solution, consisting of 3.5% sodium chloride with 0.0045% epinephrine, for actively bleeding peptic ulcers, exposed vessel or blood clot on ulcer bed, or Mallory-Weiss tear. Over 24 month, emergency endoscopy in 180 patients admitted for upper gastrointestinal hemorrhage identified 51 patients with nonvariceal hemorrhage. The causes of bleeding were; gastric ulcer in 32; duodenal ulcer in 13; gastric cancer in 4; Mallory-Weiss tear in 2. With this method, the hemostatic effect was permanent in 40 cases(84.3%), temporary in 9 cases(11.8%), and failed in 2 cases(3.9%). By applying this method, the rate of emergency operation for patients with bleeding from the upper gastrointestinal tract was significantly reduced from 20.0% (8/40)to 3.9%(2/51)(p<0.05). Emergency endoscopy in acute UGI bleeding increases the accuracy of detection of actual bleeding sites(p<0.05), but if the endoscopic procedure was performed within 48 hours, the hemostatic rate was not affected(p<0.05). We concluded that hypertonic saline-epinephrine injection method could provide a simple maneuver with reasonable cost, high safety, and satisfactory hemostatic efficacy in the treatment of nonvariceal upper gastrointestinal bleeding.
Subject(s)
Humans , Duodenal Ulcer , Emergencies , Endoscopy , Epinephrine , Gastrointestinal Hemorrhage , Hemorrhage , Hemostasis , Mallory-Weiss Syndrome , Peptic Ulcer , Prospective Studies , Sodium Chloride , Stomach Neoplasms , Stomach Ulcer , Ulcer , Upper Gastrointestinal TractABSTRACT
BACKGROUND: Mild iron deficiency anemia is known to be asymptomatic in most of the cases. In view of this, we studied response of the mild anemics to the maximal exercise loading test to learn whether or not they respond similarly to the normals. METHODS: The maximal exercise loading tests by Bruce's protocol were carried out in 22 female asymptomatic anemics with hemoglobin level of between 10.0gm/dL and less than 12.0gm/dL, and the results were compared with those of 44 non-anemic matched controls with mean hemoglobin level of 13.1gm/dL. The ages in both groups were in their 30's to 40's, and even the anemics were otherwise normal clinically and on various laboratory tests. RESULTS: There were no significant difference between two groups in VO2 max, HR max, VCO2 max and VE max and their derivatives including VT/VC and VE/MVV. CONCLUSIONS: Our results indicate that in patients with mild iron deficiency anemia, the cardiorespiratory response to maximal exercise loading is not different from the normals, and suggest that oxygen transport to tissues is not affected even at maximal exercise. probably by adaptive compensatory mechanism.