Clinical efficacy and safety of simultaneous integrated boost intensity-modulated radiotherapy to the tumor center in the first course radiotherapy for bulky cervical cancer with massive bleeding / 中华放射肿瘤学杂志

Objective To evaluate the clinical efficacy and safety of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) to the tumor center in the treatment of bulky cervical cancer with massive bleeding in the first course radiotherapy.Methods Twenty-one cases with bulky cervical cancer complicated with massive vaginal bleeding were enrolled.At the first three times of external irradiation,a high dose radiotherapy (15 Gy/3 fractions) was delivered to the tumor center (the region retracted 2 cm from the periphery of cervical mass),followed by conventional irradiation (2 Gy/fraction) in the posterior course.Conventional dose irradiation (46 Gy/23 fractions) was given to the tumor periphery and pelvic lymphatic drainage area throughout the whole course.Concurrent chemotherapy by cisplatin at a dose of 25 mg/m2 was delivered weekly.After the external irradiation,intracavitary radiotherapy was given (20 Gy/4 fractions).Results Within 24 h after the first course radiotherapy,the volume of vaginal bleeding was significantly decreased by 50％ and the bleeding was almost stopped within one week.The hemostasis rate was 100％.Conclusions SIB-IMRT into the center of bulky cervical cancer is an efficacious treatment of massive vaginal bleeding.

Prediction of massive transfusion in trauma patients in the surgical intensive care units (THAI-SICU study) / 中华创伤杂志(英文版)

PURPOSE@#After damage control surgery, trauma patients are transferred to intensive care units to restore the physiology. During this period, massive transfusion might be required for ongoing bleeding and coagulopathy. This research aimed to identify predictors of massive blood transfusion in the surgical intensive care units (SICUs).@*METHODS@#This is an analysis of the THAI-SICU study which was a prospective cohort that was done in the 9-university-based SICUs in Thailand. The study included only patients admitted due to trauma mechanisms. Massive transfusion was defined as received ≥10 units of packed red blood cells on the first day of admission. Patient characteristics and physiologic data were analyzed to identify the potential factors. A multivariable regression was then performed to identify the significant model.@*RESULTS@#Three hundred and seventy patients were enrolled. Sixteen patients (5%) received massive transfusion in the SICUs. The factors that significantly predicted massive transfusion were an initial sequential organ failure assessment (SOFA) ≥9 (risk difference (RD) 0.13, 95% confidence interval (CI): 0.03-0.22, p = 0.01); intra-operative blood loss ≥ 4900 mL (RD 0.33, 95% CI: 0.04-0.62, p = 0.02) and intra-operative blood transfusion ≥ 10 units (RD 0.45, 95% CI: 0.06 to 0.84, p = 0.02). The probability to have massive transfusion was 0.976 in patients who had these 3 factors.@*CONCLUSION@#Massive blood transfusion in the SICUs occurred in 5%. An initial SOFA ≥9, intra-operative blood loss ≥4900 mL, and intra-operative blood transfusion ≥10 units were the significant factors to predict massive transfusion in the SICUs.

Unexpected Massive Bleeding during Liver Transplantation in Patients with Budd-Chiari Syndrome: A case report / 대한마취과학회지

Budd-Chiari syndrome (BCS) is a heterogenous group of disorders characterized by obstruction of hepatic venous outflow. Severe liver cirrhosis and limited cardiac reserve in patients with BCS makes them less tolerant to liver transplantation. We experienced two cases of massive bleeding during living donor liver transplantation in patients with BCS. Blood products and fluids were rapidly infused with a rapid infusion system, final infusion volume in these two patients were 177 L and 193 L, and the use of Cell Savers allowed for the patient's blood products to be saved. The patients were managed successfully and recovered uneventfully with advanced monitoring, including monitoring of their jugular venous oxygen saturation and continuous cardiac output. Therefore, rapid infusion systems and Cell Savers, along with advanced monitoring, are necessary in the event of massive bleeding during liver transplantation.

Massive Bleeding from Multiple Jejunal Diverticulosis

Jejunoileal diverticulosis is formed by herniation of mucosa and submucosa through the muscular layer of the bowel wall. The condition usually consists of multiple diverticula at the mesenteric border, in contrast to the true congenital Meckel's diverticulum. Small bowel diverticulum is a rare disease that can give rise to unexpected problems such as malabsorption, perforation, diverticulitis, obstruction and bleeding. Since the reported complication rate is low, uncomplicated small bowel diverticula are generally recommended to be left untreated. Bleeding from a diverticulum is often sudden and massive. We report herein a case of a 43-yearold women who presented with massive bleeding from multiple jejunal diverticula. She had been admitted to hospital one day previously with the chief complaint of severe whole abdominal pain which was aggravated progressively. On physical examination, she showed an acute, ill appearance. The abdomen was slightly distended and tender with rebound tenderness. On the abdomen CT, the jejunal wall was thickened and the mesenteric lymph nodes were enlarged. An emergency laparotomy was performed. Multiple jejunal diverticula, distributed from 20 to 100 cm distal to the ligament of Treitz, were found, along with massive bleeding from diverticulosis. A segment of the jejunum containing all diverticula was resected and end to end anastomosis was performed. Due to the relative rarity of these lesions and their complications, diagnosis is often difficult and delayed. Awareness of their tendency to cause nonspecific abdominal symptoms and serious complications may lead to earlier diagnosis and timely treatment.

Tardive hemorrhoea cause of osteofascial compartment syndrome after trauma / 中国矫形外科杂志

[Objective]To analyze the reason for osteofascial compartment syndrome caused by tardive massive bleeding and to discuss the first-aid measure to treat continuing bleeding in operation.[Method]There were 5 cases in this study.Two osteofascial compartment syndrome with tardive haematoma were caused by secondary disturbances of blood coagulation.One iliopsoas muscle haematoma was caused by over-dose of warfarin(WARF).Vitamine K was applied to anti-warfarin and depressed haematoma by ultrasonic guiding puncturation aider a pause of warfarin.The other one suffered from continuing bleeding after a depression operation on right femoral bone haematoma.The bleeding could not be stopped until carbasus obturation and a supplementary of lood coagulation factor.The carbasus were taken out 36 hours later.Three traumatic pseudoaneurysm rupture happened to superior gluteal artec,arteriae tibialis posterior and deep femoral artery separately.The bleeding artery was ligated and removed the body of the blood tumor in these three cases.In addition,arterial embolism was applied in two of them before operation.[Result]No recurrence happened to the case with iliopsoas muscle haematoma after 16 weeks as a result of absorption and degeneration.As the patient with right femoral bone haematoma referred,the bleeding stopped after treated by carbasus obturation.The wound was closed 36 hours after the operation.A satisfactory sensory recovery,pulsation of dorsal pedal artery and arteria tibialis posterior were found.Rebleeding was found in 3 weeks after the wound closed.The pathobiology inspection of bone and muscle tissue around the fracture site showed osteoma sarcomatosum in right femoral bone.The author gave the patient to the operation of high amputation.No rebleeding,nervous symptoms caused by compression,limbs necrosis and ischemic contracture was found after 3 patients suffering from traumatic pseudoaneurysm rapture with followed-up from 8 month to 3 years.[Conclusion]Hemorrhea caused by secondary disturbances of blood coagulation or pseudoaneurysm can lead to osteofascial compartment syndrome.Embolism of the bleeding artery before removal of the aneurysm and haematoma can reduce bleeding in operation.It is the best choice for the doctor to stop operation immediately and stop bleeding by effective carbasus obturation.

A Case of Nonspecific Ulcer of the Terminal Ileum Associated with Massive Bleeding / 소아과

Nonspecific ulcer of the small bowel is rare in children. Nonspecific ulcer of the colon or small bowel is clinically and pathologically recognized as a disease related to intestinal Behcet's disease. Differentiation of nonspecific ulcers from Behcet's ulcer by pathologic findings is often impossible and the clinical course is similar. A 13-year-old boy was admitted due to massive lower gastrointestinal bleeding with an intractable tongue ulcer. Colonoscopic findings revealed a well demarcated deep ulcer on the terminal ileum. The patient was treated with steroids and sulfasalazine and the response was favorable. We report a case of nonspecific ulcer of terminal ileum with massive rectal bleeding in a 13-year-old boy.

A Case of Ischemic Colitis with Massive Bleeding / 대한소화기내시경학회지

Ischemic colitis generally develops in the elderly patients with concomitant cardiovascular condition, diabetes mellitus, and renal insufficiency. This disease predominently occurs in the left colon, particularly splenic flexure and sigmoid colon. The most frequent symptoms include abdominal pain, diarrhea, alteration in bowel functions and hematochezia. Blood loss is usually minimal in most patients. Herein, we report a case of ischemic colitis which developed on ascending colon with massive bleeding. A 48-year-old man was admitted because of massive lower gastrointestinal bleeding for 7 days. He has underwent hemodialysis for thirteen years. Colonoscopy showed a circular ulcer on the ascending colon with partial stenosis and mass-like oozing lesion distal to the stenotic area. We performed right hemi-colectomy. Grossly, colon showed shallow ulceration and congested ileocecal valve coated with hemorrhage. Microscopically, ulcer bed showed thickened and fibrotic submucosa which had nearly obliterated atherosclerotic vessels.

Massive Bleeding from Jejunal Diverticulosis with an Angiodysplasia in a Patient with End Stage Renal Disease

Small bowel diverticulum, although not common and usually asymptomatic, can give rise to unexpected problems such as malabsorption, perforation, obstruction and bleeding. Bleeding from a diverticulum is often sudden and massive, therefore requiring emergency operation. We report herein a case of a 75-year-old man who presented with massive bleeding from multiple jejunal diverticula. He had been diagnosed with hypertensive end stage renal disease and treated with hemodialysis since 14 years previously. He was admitted with both hematemesis and hematochezia, and treated conservatively at first. However, bleeding continued and the anemia did not improve despite blood transfusions. An gastroduodenofiberscope and selected angiography revealed no bleeding focus. An emergency laparotomy was performed and multiple jejunal diverticula, distributed from 15 to 60cm distal to the ligament of Treitz, were found. A segment of the jejunum containing all diverticula was resected and end to end anastomosis was performed. A histologic examination revealed some dilated blood vessels in the submucosa of the diverticulum, which was compatible with the findings of the angiodysplasia. Based on these findings, we suggest that angiodysplasia was the cause of bleeding from the jejunal diverticula in this case.

The diagnosis and treatment of acute lower gastrointestinal massive bleeding / 临床外科杂志

Objective To investigate the methods of diagnosis and treatment of acute lower gastrointestinal massive bleeding. Methods Retrospective analysis was made on diagnozing and treating of 21 patients with acute lower gastrointestinal massive bleeding Results Within a total of 21 cases,bleeding was controlled by conservative treatment in 6 cases(28.6%),supermesenteric angiography showe positive findings in 92.8% and the interventional therapy was applied successfully in 84.6%. no recurrence was observed after Ⅰ month to 4 year follow up. Conclusions Patients with acute lower gastrointestinal massive bleeding should be treated firstly by conservatie method,uncontrollable bleeding should be evaluated by selective supermesenteric angiography;after the bleeding artery was recongnized by angiography,the intervention embolotherapy should be taken;the patients whose angiography are negative and bleeding cannot be controlled should be operatded