Application effect of emergency medical service in patients with acute upper gastrointestinal hemorrhage / 中国基层医药

Objective To discuss the effect of emergency integrated green channel for patients with upper gastrointestinal hemorrhage. Methods From January 2014 to August 2016,182 patients with acute upper gastrointes-tinal hemorrhage were selected in the research. Eighty - four patients with acute upper gastrointestinal hemorrhage before the emergency integrated green channel established in Zhoushan Hospital were selected as control group,while 98 patients with acute upper gastrointestinal hemorrhage after the emergency integrated green channel established in Zhoushan Hospital were selected as research group. The control group received conventional emergency treatment, while the research group received emergency medical service. The average hemostasis time,mean volume of blood transfusion,average hospitalization period,average hospital cost,the operability,recurrence rate of bleeding and mortality rate were compared between the two groups. Results The average hemostasis time,average blood transfusion volume, average hospitalization time and average hospitalization expense in the study group were (4. 52 ± 1. 24)h,(352. 37 ± 17. 35)mL,(6. 02 ± 0. 89) d,(5346. 84 ± 338. 76) yuan,respectively,which in the control group were (9. 43 ± 2. 04)h,(512. 72 ± 15. 3)mL,(9. 24 ± 1. 16)d and (7012. 38 ± 422. 12)yuan,respectively,there were statistically significant differences between two groups(t = 19. 921,65. 542,21. 160,29. 517,all P < 0. 05). The operative rate, recurrence rate and mortality rate in the study group were 2. 04％ (2 / 98),3. 06％ (3 / 98) and 2. 04％ (2 / 98), respectively,which were significantly lower than those in the control group [8. 33％ (7 / 84),9. 52％ (8 / 84) and 5. 96％ (4 / 84)], the differences were statistically significant ( χ2 = 71. 202,67. 455,74. 195, all P < 0. 01). Conclusion Application of emergency medical service in patients with acute upper gastrointestinal hemorrhage not only can control bleeding effectively,decrease blood transfusion,hospitalization period and hospital cost,but also can reduce operability,recurrence rate of bleeding and mortality rate,which can serve as an emergency treatment plan applying to clinic.

Sangrado del intestino delgado: enfoque y tratamiento / Small Bowel Bleeding: Approach and Treatment

Resumen Actualmente, se pueden identificar lesiones del intestino delgado que antes eran inaccesibles. La principal herramienta diagnóstica es la videocápsula endoscópica por el alto valor predictivo negativo. Con los avances en los métodos endoscópicos, la clasificación del sangrado gastrointestinal ha cambiado. Es así como la definición del sangrado oscuro, que antes incluía al originado en el intestino delgado, se ha relegado cuando su origen no se puede identificar tras la realización de una esofagogastroduodenoscopia, colonoscopia y estudios del tracto digestivo medio, tales como videocápsula endoscópica, enteroscopia de empuje, enteroscopia profunda, enteroscopia intraoperatoria, enterorresonancia, enterotomografía, angiografía y gammagrafía.

Abstract Intestinal lesions that were previously inaccessible can now be identified. The most important new diagnostic tool is the endoscopic videocapsule because of its high negative predictive value. With advances in endoscopic methods, the classification of gastrointestinal bleeding has changed so that definition of occult and obscure bleeding that previously included bleeding originating in the small intestine has been relegated to cases for which the origin cannot be identified after performing esophagogastroduodenoscopy, colonoscopy and studies of the middle digestive tract such as endoscopic videocapsule, push enteroscopy, deep enteroscopy , intraoperative enteroscopy, MRI enterography, CT enterography, angiography and scintigraphy.

Factors determining the clinical outcome of acute variceal bleed in cirrhotic patients.

Variceal bleed is a severe complication of portal hypertension. We studied the predictors of failure to control variceal bleed and re-bleed in patients with cirrhosis. We reviewed the case records of 382 consecutive patients admitted with variceal bleed from January 2001 to December 2005. Diagnosis of cirrhosis was made on clinical, laboratory, and radiological parameters. Acute variceal bleeding, failure to control bleed, and re-bleeding were defined according to Baveno III consensus report. Failure to control bleed was observed in 39 (10.2%) patients while in hospital re-bleed occurred in 49 (12.8%) patients. Thirty-four patients died. Diabetes was present in 148 (39%) patients. On multivariate logistic regression analysis, predictors of failure to control bleed were presence of diabetes mellitus and active bleeding at the time of endoscopy; predictors of in-hospital re-bleed were diabetes mellitus and serum bilirubin >3 mg/dL. Diabetes mellitus, active bleeding at endoscopy and bilirubin >3 mg/dL are bad prognostic factors for initial control of variceal bleed, and recurrent bleed in patients with cirrhosis.

A Case of Amyloidosis with Recurrent Intestinal Bleeding / 대한소화기내시경학회지

Amyloidosis is characterized by deposition of amyloid in the intercellular space and vascular wall. Amyloid deposition provokes dysfunction of the accumulated organ and causes variable clinical symptoms that depend on the involved organ. Although intestinal bleeding may occur with amyloidosis, it is relatively rare as a presenting symptom or as the sole manifestation of the disease. We experienced a case of recurrent intestinal bleeding in a 68-year-old female patient with lambda type primary amyloidosis. A colonoscopy revealed the presence of multiple large circular ulcers in the transverse colon and nonspecific submucosal hemorrhage and edema at the rectum. An endoscopic biopsy established the diagnosis of amyloidosis. A case of recurrent intestinal bleeding in a patient with primary amyloidosis is presented, with a review of the literature.

Hemangioma of Small Intestine in Children Causing Recurrent Gastrointestinal Hemorrhage:3 Cases Report and Literature Review / 实用儿科临床杂志

Objective To summarize the clinical characteristics and diagnosis and treatment of hemangioma of small intestine in children.Methods Location,pathology,clinical manifestation,diagnosis and treatment of 3 cases from our hospital and 44 cases reported in our courtry with hemangioma of the small bowel were analyzed from 1994 to 2004.Results These tumors locating in jejunum,ileum,duodenum as well as parts small intestine were 31.9%,42.6%,4.2% and 21.3%,respectively.Solitary and multiple tumors were 29.8% and 70.2% separately.The histopatholical report of 10 cases revealed that capillary,cavernous,mixed type hemangioma and hematolymphangioma were 2,6,1 and 1 cases,respectively.Thirty nine children presented with recurrent black stool.Five patients manifest in the form of intussusception.One child passed a bloody stool so massive as to cause shock.Small-bowel obstruction occurred in 5 cases.The hemoglobin of 38 patients were lower than 90 g/L.The incidence of preoperative diagnosis was only 10.6%.All of patients were performed operation.Conclusions The frequent locations of hemangioma of small intestine are in ileum and jejunum,and multiple tumors are common.The diseases are characterized as recurrent hematochezia with painlessness.Preoperative diagnosis of a small bowel hemangioma can be very difficult.The segments of small bowel with hemangioma resection are the most method of the treatment.

A Case of Intestinal Hemorrhage in Patient with Primary Amyloidosis / 대한소화기내시경학회지

Although intestinal bleeding is known to occur in amyloidosis, it is rare as a presenting symptom or sole manifestation of the disease. We experienced a case of intestinal hemor-rhage in a 64-year old female patient with primary amyloidosis, kappa type. Antral muco-sal erosions were discovered and one shallow healing ulcer at the angle. Colonoscopy revealed multiple purplish nodules in the sigmoid colon and descending colon, as well as a large shallow ulcer with blood clots in the sigmoid colon which was suspected to be the intestinal hemorrhage site. Endoscopic biopsy established amyloidosis. Polarizing microscopy after Congo red staining and immunohistochemical staining identified primary amyloid, kappa type. A case of intestinal hemorrhage in patients with primary amyloidosis is presented and the literature is reviewed.

Analysis of the etiology and diagnosis of 54 cases of small intestinal hemorrhage / 重庆医科大学学报

Objective:To analyze and discuss etiology and diagnosis of small intestinal hemorrhage.Methods:Fifty-four cases, who had small intestinal hemorrhage and had been admitted in our hospital from 1980.1 to 2003.12,were analyzed according to etiology and diagnosis.Results:Small intestinal tumors were found in 35 cases(64.81%),among which most were malignant (68.57%),angiodysplasia in 10 cases (18.52%),Crohn's disease,infective disease and diverticula in 9 cases (16.67%).The positive rates of intraoperative colonoscopy,angiography,radionucleide scanning,endoscopy,intestinal tract X-ray as well as ultrasound were 6/6(100%),4/5(80%),5/6(83.33%),8/37(21.62%),6/24(25.00%) and 10/29(34.48%) respectively.Conclusion:Tumor is the most common cause of small intestinal hemorrhage and angiodysplasia often cause small intestinal massive bleeding.Besides intraoperative colonoscopy,angiography and radionucleide scanning special diagnostic methods.B ultrasound is helpful for diagnosis of small intestinal hemorrhage.