ABSTRACT
Colonoscopy is frequently used for lower GI tract screening tests. Although rare, splenic injury may develop in the high-risk patients on anticoagulants or antiplatelet agents. A 78-year-old female visited our hospital complaining of chest pain. She had taken antihyperlipidemic and antiplatelet agent with hyperlipidemia and 20%-stenosis in the left anterior descending artery. She was taken polypectomy after colonoscopy 4 years ago. The next day, after a follow-up colonoscopy for polypectomy, she complained epigastric and left upper abdominal discomfort. Pain intensity was not high, but next day, epigastric pain was increased, so coronary angiography was performed 2 days later using anticoagulants. Coronary angiography showed 40~50%-stenosis in the left anterior descending artery. Another antiplatelet agent was added. After 72 hours on colonoscopy, her pain was localized upper left abdominal area. Abdominal CT showed intracapsular bleeding in the spleen with a small amount of hemoperitoneum in the pelvis. Since her vital signs were stable, she was treated with conservative management. Her pain improved and discharged. One month later, she was taken Abdominal CT. CT showed the size of intracapsular fluid collection in the spleen was increased, but the whole fluid collection was liquidized. 2 weeks later, follow-up sonography showed the size of fluid collection conspicuously was reduced. The case reported herein is a splenic Injury after Colonoscopy in patient on antiplatelet agents.
Subject(s)
Aged , Female , Humans , Anticoagulants , Arteries , Chest Pain , Colonoscopy , Coronary Angiography , Follow-Up Studies , Hemoperitoneum , Hemorrhage , Hyperlipidemias , Lower Gastrointestinal Tract , Mass Screening , Pelvis , Platelet Aggregation Inhibitors , Spleen , Tomography, X-Ray Computed , Vital SignsABSTRACT
BACKGROUND: The delivery of proper diabetes care and preventive services is essential for diabetic patients in family practice. However, there are few studies on preventive service practice. This study aimed to survey the delivery of preventive services among diabetic patients in an outpatient department of family medicine in a general hospital. METHODS: We reviewed all of the electronic medical records and charts of patients with a recent diagnosis code of type II diabetes mellitus in an outpatient department of family medicine at Asan Medical Center from January 1, 2001, to December 31, 2002, encompassing documentation of laboratory tests, treatment, and cancer screening. RESULTS: This study included 124 patients with diabetes. Blood pressure measurement, fundus examination, and nutritional counseling were performed in 96.7%, 80.6%, and 50% of subjects, respectively. Lipid profiles and urine microalbumin were checked in 91.1% and 58.2%, respectively. Anti-platelet and anti-smoking agents were prescribed in 17.7% and 13.2%, respectively. In males, the rate of cancer screening for stomach and colon were 55.9 and 53.2%, respectively. In females, the rate of cancer screening for stomach, colon, breast, and cervix were 45.5, 51.6, 43.2, and 38.6%, respectively. CONCLUSION: Diabetic care related services were delivered more often than those of preventive services, such as cancer screening and prescription of anti-smoking or anti-platelet agents. Efforts to improve the delivery of preventive services are needed among diabetic patients in family practice.
Subject(s)
Female , Humans , Male , Blood Pressure , Breast , Cervix Uteri , Colon , Counseling , Diabetes Mellitus , Diagnosis , Early Detection of Cancer , Electronic Health Records , Family Practice , Hospitals, General , Outpatients , Prescriptions , StomachABSTRACT
Piretanide, 4-phenoxy-3-(pyrrolidinyl)-5-sulphamoyl benzoic acid, apart from being an efficient diuretic, enhances endogenous plasma fibrinolytic activity after a single dose of 6 mg administered by oral route. After ingestion of the drug, acceleration of fibrinolytic acitivity became manifest within 1 h, reached its peak in 3 h and was associated with a fall in fibrinogen and diminished urokinase excretion. Piretanide did not cause lysis of fibrin in vitro. Primary platelet aggregation, induced by adenosine-diphosphate, was inhibited by piretanide. In in vitro experiments piretanide led to effective inhibition of adenosine-diphosphate-induced platelet aggregation with complete inhibition at 5 mM concentration. Piretanide led to a highly significant decrease of platelet factor-4 release.