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Objective:To investigate the predictive value of albumin-bilirubin score combined with Glasgow-Blatchfordscale(GBS) in the short-term prognosis of patients with acute upper gastrointestinal hemorrhage.Methods:Eighty-one patients with acute upper gastrointestinal hemorrhage who were treated in JingzhouHospital Affiliated to Yangtze University from May 2020 to May 2022 were selected as the research subjects, according to the prognosis of patients within 30 d, they were divided into poor prognosis group (35 cases) and fair prognosis group (46 cases). Clinical data were collected and the levels of albumin (ALB), creatinine (Cr), hemoglobin (Hb), total bilirubin (TBIL), urea nitrogen (BUN) and the scores of ALBI, GBS were compared between the two groups. The independent risk factors of short-term prognosis in patients with acute upper gastrointestinal hemorrhage were analyzed by Logistic multivariate regression analysis. The predictive value of ALBI score and GBS score for short-term prognosis of acute upper gastrointestinal hemorrhage was evaluated. Receiver operating characteristic (ROC) curve were drawn, and the area under the curve was calculated and compared.Results:There were no significant differences in baseline data such as gender, heart rate, systolic blood pressure, smoking history, drinking history, drug use, syncope, mental changesand comorbidities between the two groups ( P>0.05). The age in the poor prognosis group was higher than that in the fair prognosis group: (65.60 ± 7.90) years vs. (62.60 ± 7.50) years, there was statistical difference ( P<0.05). The levels of BUN, TBIL and GBS scores in the poor prognosis group were higher than those in the fair prognosis group: (9.86 ± 2.94) mmol/L vs.(8.56 ± 2.66) mmol/L, (20.70 ± 12.31) μmol/L vs. (11.71 ± 8.11) μmol/L, (10.77 ± 1.59) scores vs. (7.91 ± 1.91) scores; the levels of Hb, Cr, ALB and ALBI scores were lower than those in the fair prognosis group: (74.97 ± 16.47) g/L vs.(84.01 ± 19.44) g/L, (65.72 ± 12.08) μmol/L vs. (70.37 ± 11.52) μmol/L, (25.67 ± 4.30) g/L vs. (32.62 ± 5.07) g/L, (0.75 ± 0.47) scores vs. (1.37 ± 0.43) scores, there were statistical differences ( P<0.05). Logistic regression analysis showed that ALB, TBIL and ALBI, GSB scores were independent risk factors for death within 30 din patients with acute upper gastrointestinal hemorrhage ( P<0.05). ROC curve analysis showed that the area under the curve of ALBI score and GBS score were 0.922 and 0.875, while the area under the curve of combined was 0.958, the sensitivity was 94.29%, and the specificity was 84.78%, which were significantly higher than predicted alone ( Z = 1.87, 2.44; P<0.05). Conclusions:ALBI score combined with GBS has good predictive value for short-term prognosis in patients with acute upper gastrointestinal hemorrhage.
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Huangtu Decoction, first recorded in Essentials from the Golden Cabinet(Jin Kui Yao Lue) from ZHANG Zhong-jing in Han dynasty, is used to treat distal bleeding. It is mainly treated for the syndrome of failing to control blood with spleen-yang deficiency. The connotation of distal bleeding is more extensive, including not only upper gastrointestinal bleeding in the traditional sense such as peptic ulcer bleeding, gastrointestinal tumors, gastric mucosal lesions, vascular dysplasia, esophagogastric variceal bleeding, and pancreatic and biliary tract injury, but also other anorectal diseases such as part colon and rectal cancer swelling or polyps, hemorrhoids, and anal fissure and other parts of bleeding such as epistaxis, thrombocytopenia, functional uterine bleeding, threatened abortion, and unexplained hematuria. Distal bleeding also involves syndromes of failing to keep part deficient and cold fluids in interior, such as nocturia, enuresis, clear nose, sweating, cold tears, and leucorrhea, and excessive gastrointestinal bleeding caused by anti-plate and anticoagulant drugs, unexplained positive in the fecal occult blood test, and other modern clinical new problems. The indications of Huangtu Decoction include not only lower blood, defecation before blood, distant blood, hematemesis, epistaxis, and other diseases in traditional Chinese medicine, but also three types of clinical manifestations including bleeding, deficiency syndrome, and stagnant heat syndrome. In the clinic, Huangtu Decoction can be used to treat acute upper gastrointestinal bleeding, acute coronary syndrome complicated with acute upper gastrointestinal bleeding, bleeding events caused by excessive antiplatelet and anticoagulant drugs, unexplained positive in the fecal occult blood test, gastrointestinal tumor with bleeding, thrombocytopenia, and other acute and critical diseases. The dosage of Cooking Stove Earthkey, Rehmanniae Radix, and Asini Corii Colla in Huangtu Decoction is the key to hemostasis.
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Humans , Gastrointestinal Hemorrhage/drug therapy , Acute Coronary Syndrome , Epistaxis , Esophageal and Gastric Varices , Anticoagulants , Thrombocytopenia , Critical CareABSTRACT
Acute esophageal necrosis (AEN), also known as "black esophagus," is an entity characterized by the circumferential black appearance of esophageal mucosa, usually associated with hypoperfusion and gastric outlet obstruction. This entity has a reported prevalence of up to 0.2%, affecting predominantly elderly men with multiple comorbidities. Most cases resolve with conservative treatment with no need of surgical intervention. However, the overall prognosis is poor, with mortality reaching one-third of cases due to the patient's underlying illness. In this article we present three cases of patients with AEN.
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Humans , Male , Middle Aged , Aged , Aged, 80 and over , Esophageal Diseases , Necrosis , Gastrointestinal Hemorrhage , IschemiaABSTRACT
Acute esophageal necrosis (AEN), also known as "black esophagus," is an entity characterized by the circumferential black appearance of esophageal mucosa, usually associated with hypoperfusion and gastric outlet obstruction. This entity has a reported prevalence of up to 0.2%, affecting predominantly elderly men with multiple comorbidities. Most cases resolve with conservative treatment with no need of surgical intervention. However, the overall prognosis is poor, with mortality reaching one-third of cases due to the patient's underlying illness. In this article we present three cases of patients with AEN.
Subject(s)
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Esophageal Diseases/pathology , Necrosis , Endoscopy, Gastrointestinal , Gastrointestinal HemorrhageABSTRACT
Resumen Introducción: Con la escala de Glasgow-Blatchford (EG-B) se califica mediante datos clínicos, el riesgo de resangrado después de hemorragia del tubo digestivo alto (HTDA); y con las escalas de Forrest y Dagradi, mediante endoscopia. Objetivo: Evaluar la capacidad de la EG-B para identificar riesgo de resangrado a 30 días después de una HTDA; el estándar de oro de comparación fue la endoscopia. Método: Se analizaron 129 expedientes de pacientes con HTDA y endoscopia. Se cuantificaron las escalas de Glasgow-Blatchford, Forrest y Dagradi; se calculó sensibilidad, especificidad y área bajo la curva ROC (ABC-ROC) del riesgo de resangrado reportado por EG-B. Resultados: La EG-B identificó a 53 pacientes con riesgo bajo de resangrado (41.09 %) y 76 con riesgo alto (58.91 %). Con la endoscopia se identificó a 107 pacientes con hemorragia no variceal (82.94 %), 98 con riesgo bajo (89.9 %) y 11 con riesgo alto (10.09 %); además, 22 pacientes con hemorragia variceal (17.05 %), 12 con riesgo bajo (54.54 %) y 10 con riesgo alto (45.45 %). La EG-B mostró sensibilidad de 0.857, especificidad de 0.462 y ABC-ROC de 0.660. Conclusiones: La EG-B es sencilla, objetiva y útil para identificar riesgo de resangrado después de HTDA; se sugiere como herramienta de triaje en urgencias.
Abstract Introduction: The Glasgow-Blatchford scale (GBS) classifies the risk of re-bleeding after upper gastrointestinal bleeding (UGIB) using clinical data, whereas the Forrest and Dagradi scales do it by endoscopy. Objective: To assess GBSs ability to identify re-bleeding risk within 30 days of an UGIB, using endoscopy as the gold standard for comparison. Method: 129 medical records of patients with UGIB and endoscopy were analyzed. The Glasgow-Blatchford, Forrest and Dagradi scales were quantified; sensitivity, specificity and area under the ROC curve (AUC-ROC) of GBS-reported re-bleeding risk were calculated. Results: GBS identified 53 patients with low re-bleeding risk (41.09 %) and 76 with high risk (58.91 %). Endoscopy identified 107 patients with non-variceal bleeding (82.94 %): 98 with low risk (89.9 %) and 11 with high risk (10.09 %); in addition, it identified 22 patients with variceal hemorrhage (17.05 %): 12 with low risk (54.54 %) and 10 with high risk (45.45 %). GBS showed a sensitivity of 0.857, specificity of 0.462 and an AUC-ROC of 0.660. Conclusions: GBS is simple, objective and useful to identify the risk of re-bleeding after UGIB; it is suggested as a triage tool in the emergency department.
Subject(s)
Humans , Male , Female , Middle Aged , Esophageal and Gastric Varices/diagnosis , Triage/methods , Endoscopy, Gastrointestinal/standards , Gastrointestinal Hemorrhage/diagnosis , Recurrence , Sensitivity and Specificity , Risk Assessment/methods , Area Under CurveABSTRACT
Objective To evaluate the feasibility and clinical outcomes of interventional treatment of Budd-Chiari syndrome (BCS) associated with simultaneous upper gastrointestinal hemorrhage.Methods The clinical data of 32 patients of BCS with upper gastrointestinal hemorrhage from October 2015 to April 2008 in First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.Variceal embolization and inferior vena cave (IVC) and/or hepatic veins (HV) angioplasty were performed simultaneously.Perioperative complications were observed.Portal vein pressures were measured through catheterization preand post-operation.Restenosis of IVC and HV,upper gastrointestinal hemorrhage were observed on followup.Results Percutaneous transluminal balloon angioplasty were successfully carried out in all patients:16 patients with IVC and 17 patients with HV stenosis underwent angioplasty without stent placement.Portography indicated one esophageal and gastric varices in 17 patients and two in 15 patients.All the varices were embolized successfully.The portal vein pressure reduced from (35.7±2.9) cmH2O to (31.2±2.5) cmH2O (P ＜ 0.05,1 cmH2O =0.098 kPa).Portal vein pressure reduced from (35.8± 3.0) cmH2O to (30.7±2.3) cmH2O in HV type BCS post-operation,and reduce from (35.6±3.0) cmH2O to (31.8±2.6) cmH2O in HV and IVC involved type,which indicated that portal vein pressure decreased more obviously after HV recanalization.On follow-up for 3 to 32 months (mean 11.7 ±7.8 months),7 patients with IVC and 5 patients with HV stenosis developed restenosis.Transluminal balloon angioplasty was performed.No upper gastrointestinal hemorrhage occurred during the follow-up period.Conclusion One-stage interventional treatment of BCS with upper gastrointestinal hemorrhage was safe and effective,and had satisfactory mediumlong term outcomes.
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Objective To investigate the CT and MR imaging features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage.Methods A total of 36 patients diag-nosed with hepatic ischemia/necrosis by both medical imaging and clinical diagnosis shortly after hepato-splenic surgery and upper gastrointestinal hemorrhage were collected,including 9 patients with liver cancer resection,5 patients with liver cancer ablation(microwave ablation/radiofrequency ablation,argon-helium knife,alcohol injection),1 1 patients with spleen resection,and 11 patients with upper gastrointestinal bleeding.Conventional liver CT and/or MR plain and dynamic enhancement scan were performed to com-prehensively analyze the morphology and density/signal performance of the lesions.Results(1)Number of lesions:AU cases had multiple lesions.(2)Distribution of lesions:scattered in the liver lobes,clustered or regional distribution,mainly in the periphery of the liver.(3)Size of lesions:the boundary of the nodu-lar lesion was clear.and the single maximum diameter Was 1.0-1.5 ca.It can be fused into a wedge-shaped patch or a segmental/sub-segmental large patch with a slight mass effect.(4)CT density or MR sig-nal characteristics:CT plain scan showed slightly low density;MR plain scan showed slightly low signal on T1 WI,high signal on T2WI,slightly high signal on DWI and no lipid/fat on dual phase imaging;24 out of 36 cases(66.7％)showed no enhancement,while some lesions showed thin ring enhancement on the edge;emboli were found in the main and/or branches of portal vein(21/36 cases,58.3％).(5)In the short-term review(minimum 5 days),the lesions became smaller or disappeared,and the local liver volume be-came smaller or the surface was depressed.Conclusions Hepatic ischemia/necrosis OCCURS after hepato-splenic surgery and upper gastrointestinal hemorrhage.The imaging manifestations are multiple nodular or flaky hypovascular foci,and the short-term review shows a markedly improvement.It needs to be differentia-ted from infection and metastasis of malignant tumors after operation.
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Objective@#To investigate the CT and MR imaging features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage.@*Methods@#A total of 36 patients diagnosed with hepatic ischemia/necrosis by both medical imaging and clinical diagnosis shortly after hepatosplenic surgery and upper gastrointestinal hemorrhage were collected, including 9 patients with liver cancer resection, 5 patients with liver cancer ablation (microwave ablation/radiofrequency ablation, argon-helium knife, alcohol injection), 11 patients with spleen resection, and 11 patients with upper gastrointestinal bleeding. Conventional liver CT and / or MR plain and dynamic enhancement scan were performed to comprehensively analyze the morphology and density/signal performance of the lesions.@*Results@#(1) Number of lesions: All cases had multiple lesions. (2) Distribution of lesions: scattered in the liver lobes, clustered or regional distribution, mainly in the periphery of the liver. (3) Size of lesions: the boundary of the nodular lesion was clear, and the single maximum diameter was 1.0-1.5 cm. It can be fused into a wedge-shaped patch or a segmental/sub-segmental large patch with a slight mass effect. (4) CT density or MR signal characteristics: CT plain scan showed slightly low density; MR plain scan showed slightly low signal on T1WI, high signal on T2WI, slightly high signal on DWI and no lipid/fat on dual phase imaging; 24 out of 36 cases (66.7%) showed no enhancement, while some lesions showed thin ring enhancement on the edge; emboli were found in the main and/or branches of portal vein (21/36 cases, 58.3%). (5) In the short-term review (minimum 5 days), the lesions became smaller or disappeared, and the local liver volume became smaller or the surface was depressed.@*Conclusions@#Hepatic ischemia/necrosis occurs after hepatosplenic surgery and upper gastrointestinal hemorrhage. The imaging manifestations are multiple nodular or flaky hypovascular foci, and the short-term review shows a markedly improvement. It needs to be differentiated from infection and metastasis of malignant tumors after operation.
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Introducción: la hemorragia digestiva alta constituye un problema de salud frecuente en todo el mundo y es una de las urgencias que determina gran número de ingresos en los servicios de Cirugía General en nuestro medio, por lo que reviste gran importancia clínica y sanitaria. Objetivo: determinar la utilidad de las escalas de Rockall y Baylor modificado para pronosticar resangrado en pacientes con hemorragia digestiva alta. Método: se realizó un estudio observacional descriptivo prospectivo, incluyendo a los pacientes ingresados por hemorragia digestiva alta por úlcera péptica en el Hospital Enrique Cabrera, desde el 1ro. de enero del 2012 hasta el 30 de septiembre del 2015. Resultados: de 300 pacientes ingresados por hemorragia digestiva alta por úlcera péptica, se tomó una muestra de 71 enfermos. El tratamiento endoscópico se realizó a todos los pacientes, y el tratamiento quirúrgico en 8,4 por ciento. Nueve pacientes presentaron resangrado (12,7 por ciento). Las escalas de Rockall y Baylor modificado presentaron una especificidad de 82 por ciento y 86 por ciento, respectivamente con baja sensibilidad en ambos casos a pesar de esto la escala de Rockall es la de mayor sensibilidad. Conclusiones: las dos escalas fueron altamente específicas, pero la de Rockall fue más sensible para identificar los pacientes con riesgo alto de resangrado(AU)
Introduction: Upper gastrointestinal hemorrhage is a common health problem worldwide and one of the emergencies determining a huge number of admissions into general surgery services in our scenario, it is therefore of great clinical and sanitary importance. Objective: To determine the usefulness of the modified Rockall and Baylor scores in predicting rebleeding in patients with upper gastrointestinal hemorrhage. Method: A prospective, descriptive, observational study was carried out, including patients admitted for upper gastrointestinal hemorrhage due to peptic ulcer in Enrique Cabrera, from January 1st, 2015 to September 30, 2015. Results: Among the 300 patients admitted for upper digestive hemorrhage due to peptic ulcer, we took a sample of 71 patients. All patients were performed endoscopic treatment, while 8.4 percent were performed surgical treatment. Nine patients presented with rebleeding (12.7 percent). The modified Rockall and Baylor scores showed a specificity of 82 percent and 86 percent, respectively, with low sensitivity in both cases. Despite this, the Rockall score is the one with the highest sensitivity. Conclusions: The two score were highly specific, but the Rockall score was more sensitive for identifying patients at high risk of rebleeding(AU)
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Humans , Peptic Ulcer/surgery , Endoscopy/methods , Hemorrhage/therapy , Epidemiology, Descriptive , Prospective Studies , Observational StudyABSTRACT
Objective:To investigate the curative efficacy and safety of Kangfuxin liquid in treating patients of upper gastrointestinal hemorrhage caused by non-steroid drugs treated with somatostatin.Methods:90 patients with upper gastrointestinal hemorrhage caused by non-steroid drugs meeting the inclusion criteria were collected as observational objects to be randomly divided into the control group and the observation group with 45 cases in each group.Besides conventional treatments,the control group was given somatostatin,while the observation group was given Kangfuxin liquid in combination with somatostatin.Then,the curative efficiency,hemostatic time,recurrent bleeding rate,levels of serum inflammatory factors and adverse reactions were observed and compared.Results:Assessment of curative efficacy showed that the total therapeutic efficiency ratio in the observation group was statistically higher than that in the control group(95.6％ vs 82.2％,P＜0.05).In comparison with the control group,the hemostatic time in the observation group was statistically shorter[(1.4±0.5)d vs (2.6±0.7)d,P＜0.05],while the recurrent bleeding rate in the two groups was statistically same(4.4％ vs 11.1％,P＞0.05).As to inflammatory factors,the observation group had statistically lower levels of serum TNF-α and IL-6 than those in the control group [(5.46±0.93)ng/L vs (8.37± 1.08)ng/L,(19.37±3.43)ng/L vs (38.22±8.14)ng/L,both P＜0.05].During the treatment,there was no case of severe adverse reactions.And the incidences of adverse reactions in the observation group and the control group were statistically same (22.2％ vs 15.6％,P＞0.05).Conclusion:Besides treatment of somatostatin,adjuvant therapy of Kangfuxin liquid has well application effect in patients of upper gastrointestinal hemorrhage caused by non-steroid drugs.And it can significantly increase curative efficacy,shorten hemostatic time,alleviate inflammatory reaction with minor adverse reactions.
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Objective To evaluate the application value of percutaneous transsplenic varices embolization(PTSVE)in the treatment of upper gastrointestinal hemorrhage in patients with schistosomiasis cirrhosis. Methods Sixteen schistosomiasis cir-rhosis patients(12 males and 4 females)with portal hypertension complicated with esophageal and upper gastrointestinal hemor-rhage were selected as the investigation subjects,all the patients had been treated by esophageal vein ligation and sclerothera-py,but with bleeding again post-operation. The patients were treated by PTSVE under the guidance of X-ray fluoroscopy. The success rate of PTSVE and the rate of complications were observed. In addition,the patients received PTSVE were reexamined with abdominal CT one month post-operation,and the degrees of varices were compared before and after PTSVE. Results Four-teen cases(87.50%)were successfully treated with PTSVE. Two cases(12.50%)failed,and one case had an abdominal bleed-ing 1 week post-operation. The abdominal CT showed the degrees of esophageal varices(P < 0.001),esophageal vein(P <0.001)and gastric varices(P < 0.001)were significantly decreased in the patients who received PTSVE one month after the op-eration. Conclusions PTSVE is a safe and effective method in the treatment of upper gastrointestinal hemorrhage in the pa-tients with schistosomiasis cirrhosis. PTSVE is especially suitable for the patients with severe liver cirrhosis,significantly bor-dered liver split,and bared main portal vein and even the branches.
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Objective To compare the clinical curative effect between transjugular intrahepatic portosystemic stent-shunt (TIPS) and TIPS together with gastric coronary vein embolization (GCVE) in treating cirrhosis portal hypertension (PHT) associated with upper gastrointestinal hemorrhage (UGH),and to discuss the necessity,feasibility and clinical curative effect of TIPS plus GCVE.Methods The clinical data of 38 PHT patients with UGH,who were admitted to authors' hospital during the period from April 2010 to May 2012,were retrospectively analyzed.Only TIPS was employed in 15 patients (group A),and TIPS plus GCVE was adopted in 23 patients (group B).Before and after operation,the indexes,hemodynamics of portal vein and spleen,the morphology of spleen,and the degree of gastrointestinal varices were determined and analyzed.The patients were followed up to observe the occurrence of postoperative complications.Results In both groups,the postoperative portal vein pressure showed an obvious reduction with accelerated velocity of flow,and the splenic venous congestion index was decreased,these changes were statistically significant when compared with the preoperative ones (P＜0.05),and which was more obvious in group B than in group A (P＜0.05).After the treatment,the esophagogastric varices (EGV) was obviously improved,the improvement rates of group B and group A were 94.7％ and 66.6％ respectively,the emergency hemostasis rates of group B and group A were 100％ and 75.0％ respectively,The rates of re-bleeding were 4.3％ and 28.5％ respectively;the above results of group B were statistically better than those of group A (P＜0.05).No statistically significant differences in liver function indexes existed between preoperative values and postoperative ones in the same group as well as in group comparison (P＞0.05).The differences in the postoperative hepatic encephalopathy (HE) occurrence and in primary patency rate of stent between the two groups were not statistically significant (P＞0.05).In both groups,the re-intervention patency rate was 100％.The incidence rate of HE in patients in whom the distal end of stent was located in the left branch of portal vein was strikingly lower than that in patients in whom the distal end of stent was located in the right branch of portal vein (P＜0.05).Conclusion For the treatment of PHT associated with UGH,TIPS combined with GCVE carries reliable curative effect,this therapy is superior to simple use of TIPS.
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Objective To investigate the causes and preventive measures of upper gastrointestinal bleeding in hyperbaric oxygen therapy for patients with severe closed head injury.MethodsThe clinical data of 24 cases of patients with upper gastrointestinal hemorrhage treated by hyperbaric oxygen therapy in the first people's Hospital of Fuyang District Hangzhou from May 2011 to May 2016 were analyzed, the occurrence time and clinical effect of upper gastrointestinal bleeding were analyzed.ResultsAmong the 24 cases of patients, 14 cases were treated for the first time that overt bleeding, including bleeding from the stomach liquid outflow of blood from 2 cases, gastric outflow 2 cases, hemorrhage after cure again received hyperbaric oxygen therapy 3 times again dominant bleeding 2 cases;6 cases hyperbaric oxygen treatment for third, 7, 10 times brown liquid or bloody fluid from the stomach outflow;4 cases hyperbaric oxygen treatment in patients with second and 3 courses of coffee liquid from the outflow tube, which accounted for 58.3%, 25.0%, 16.7% of the total, retrospectively;8 cases were with good recovery, 10 cases moderate disability, 4 cases severe disability, 2 cases vegetative state, 0 case died, the good recovery rate was 33.3%.ConclusionNot correctly grasp the time of hyperbaric oxygen therapy in the treatment of patients with severe closed craniocerebral injury will cause upper gastrointestinal hemorrhage, correct application of H2 receptor binding agent, developing targeted therapy programme can effectively prevent and treat upper gastrointestinal bleeding, so is worthy of the clinical's full attention.
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Objective We investigated whether cirrhotic patients with upper gastrointestinal hemorrhage should be stratified for antibiotic prophylaxis based on Child-Pugh scores and etiology,to estimate risks of nosocomial infection,six-week re-bleeding,and mortality,and whether antibiotics prophylaxis have equal effects on patients of all Child-Pugh classes and etiologies.Methods A total of 316 hospitalized patients of cirrhosis patients with upper gastrointestinal hemorrhage were analyzed.The patients were classified as antibiotic group and control group,according to the patients whether received antibiotic prophylaxis or not.The two groups were monitored nosocomial infection rates,six-week re-bleeding rates and mortality rates.Results (1) Antibiotic prophylaxis reduces rates of nosocomial infection,six-week re-bleeding.(2)According to the etiology,cirrhosis can be divided into viral cirrhosis (VC) group and alcoholic cirrhosis (AC) group.The nosocomial infection rates and six-week re-bleeding rates of the VC group were lower in the antibiotic group.The nosocomial infection rates and the six-week re-bleeding rates of the AC group were lower in the antibiotic group.(3) According to Child-Pugh classification,patients were divided into Child-Pugh class A,B,C three groups.Child-Pugh class A group:the nosocomial infection rates,six-week re-bleeding rates and mortality rates had no significant difference between the antibiotic group and control group.Child-Pugh class B group:the nosocomial infection rates and six-week re-bleeding rates were lower in the antibiotic group.Child-Pugh class C group:the nosocomial infection rates and six-week re-bleeding rates were lower in the antibiotic group.Conclusion Antibiotic prophylaxis reduces rates of nosocomial infection,six-week re-bleeding in cirrhosis patients with upper gastrointestinal hemorrhage,so the writer suggests short-term antibiotic prophylaxis.Antibiotics prophylaxis have equal effects on cirrhosis patients of different etiologies.While antibiotics prophylaxis have no equal effects on cirrhosis patients of all Child-Pugh classes.The nosocomial infection rates,six-week-rebleeding rates and mortality rates of Child-Pugh class A are low.The recommendation for routine antibiotic prophylaxis for this subgroup requires further evaluation.
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Objective We investigated whether cirrhotic patients with upper gastrointestinal hemorrhage should be stratified for antibiotic prophylaxis based on Child-Pugh scores and etiology,to estimate risks of nosocomial infection,six-week re-bleeding,and mortality,and whether antibiotics prophylaxis have equal effects on patients of all Child-Pugh classes and etiologies.Methods A total of 316 hospitalized patients of cirrhosis patients with upper gastrointestinal hemorrhage were analyzed.The patients were classified as antibiotic group and control group,according to the patients whether received antibiotic prophylaxis or not.The two groups were monitored nosocomial infection rates,six-week re-bleeding rates and mortality rates.Results (1) Antibiotic prophylaxis reduces rates of nosocomial infection,six-week re-bleeding.(2)According to the etiology,cirrhosis can be divided into viral cirrhosis (VC) group and alcoholic cirrhosis (AC) group.The nosocomial infection rates and six-week re-bleeding rates of the VC group were lower in the antibiotic group.The nosocomial infection rates and the six-week re-bleeding rates of the AC group were lower in the antibiotic group.(3) According to Child-Pugh classification,patients were divided into Child-Pugh class A,B,C three groups.Child-Pugh class A group:the nosocomial infection rates,six-week re-bleeding rates and mortality rates had no significant difference between the antibiotic group and control group.Child-Pugh class B group:the nosocomial infection rates and six-week re-bleeding rates were lower in the antibiotic group.Child-Pugh class C group:the nosocomial infection rates and six-week re-bleeding rates were lower in the antibiotic group.Conclusion Antibiotic prophylaxis reduces rates of nosocomial infection,six-week re-bleeding in cirrhosis patients with upper gastrointestinal hemorrhage,so the writer suggests short-term antibiotic prophylaxis.Antibiotics prophylaxis have equal effects on cirrhosis patients of different etiologies.While antibiotics prophylaxis have no equal effects on cirrhosis patients of all Child-Pugh classes.The nosocomial infection rates,six-week-rebleeding rates and mortality rates of Child-Pugh class A are low.The recommendation for routine antibiotic prophylaxis for this subgroup requires further evaluation.
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Objective:To discuss the efficacy of emergency endoscopic hemostasis combined with somatostatin in treatment of upper gastrointestinal hemorrhage.Methods:100 patients with upper gastrointestinal hemorrhage were selected and divided into two groups randomly.The control group (48 cases) was given conventional hemostatic measures.The observation group (52 cases) was given emergency endoscopic hemostasis combined with somatostatin.The efficacy of emergency endoscopic hemostasis combined with somatostatin in treatment of upper gastrointestinal hemorrhage was evaluated by efficacy,the curative success rate and the improvement situation of clinical symptoms.Results:The effective rate was 88.5 ％ in the observation group,and the effective rate was 70.8 ％ in the control group,and the effective rate of observation group was higher than that of the control group (P＜0.05).The success rate for different lesion size was higher in the observation group compared with control group (P＜0.05).According to the success rate,with the increased size of lesion,the hemostasis rate was decreased.The hospitalization,negative fecal occult and haematemesis disappeared time of observation group was shorter than that of the control group (P＜0.05).The postoperative bleeding rate of observation group was lower than that of the control group (P＜0.05).Conclusions:The emergency endoscopic hemostasis combined with somatostatin has a good therapeutic effect on upper gastrointestinal hemorrhage.It can improve the clinical symptoms and shorten the hospitalization time,but its effect is limited on large lesion of upper gastrointestinal hemorrhage.
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BACKGROUND/AIMS: As the elderly population taking antithrombotic therapy (ATT) increases, gastrointestinal (GI) bleeding risk during ATT may likely increase. This study was conducted to evaluate the clinical characteristics of severe upper GI bleeding (UGIB) during ATT. MATERIALS AND METHODS: Among patients on ATT at Gyeongsang National University Hospital between March 2005 and February 2010, those with severe UGIB requiring endoscopic hemostasis were selected for the study. Their medical records were retrospectively reviewed for clinical variables. RESULTS: Among 59,773 patients taking ATT, 125 (0.21%) developed severe UGIB and comprised 12.8% of the overall endoscopic hemostasis cases (125/978) during the same period. The patients with severe UGIB on ATT were older than the ones not on ATT (68.3 vs. 59.9 years, P<0.001). The common indications for ATT were cardiovascular (60.8%, 76/125) and cerebrovascular diseases (25.6%, 32/125). Fifty-nine patients (47.2%) were taking two or more agents, 36 (28.8%) were on aspirin monotherapy, while 22 (17.6%) were taking warfarin alone. Aspirin was involved in 68.8% (86/125) of severe UGIB. According to ATT type, the incidence of severe UGIB was 0.48% with warfarin, 0.38% with aspirin, and 0.33% with clopidogrel. The main causes of severe UGIB were gastric (78, 62.4%) and duodenal ulcers (15, 12.0%). UGIB recurred in 11 cases (8.8%), but all were successfully controlled with repeated hemostasis and there was no mortality. CONCLUSIONS: The frequency of severe UGIB during ATT was 0.21%. Aspirin was the most common agent leading to severe UGIB, but its incidence was highest with warfarin. Gastric ulcer was the most common focus. Endoscopic hemostasis was effective and safe for UGIB during ATT.
Subject(s)
Aged , Humans , Aspirin , Cerebrovascular Disorders , Duodenal Ulcer , Endoscopy , Hemorrhage , Hemostasis , Hemostasis, Endoscopic , Incidence , Medical Records , Mortality , Retrospective Studies , Stomach Ulcer , WarfarinABSTRACT
Objective To study treatment of massive variceal bleeding secondary to localized pancreatitis-associated portal hypertension (MVBPAPH).Methods A retrospective study on the clinical data of patients with MVBPAPH was carried out.Of 24 patients with MVBPAPH,20 had pancreatic pseudocysts.12 were operated after failure of treatment with endovascular intervention for variceal bleeding (including 10 patients with splenectomy and gastric fundus-body peripheral vessels amputation and 2 patients with pancreatic pseudocystogastrostomy).8 patients underwent partial splenic embolization and left gastroepiploic artery embolization.4 patients directly underwent splenectomy and gastric fundus-body peripheral vessels amputation for variceal bleeding.Results Left pleural effusion developed in 5 patients who underwent arterial embolization.Left pleural effusion and lung infection occurred in 2 patients who underwent operation.All patients recovered well and were discharged home.During the follow-up period of 2 to 72 months,no rebleeding occurred in these patients (including 2 patients had passed little interval melena).Gastroscopy re-examination showed that variceal veins were not found in 18 patients.Variceal veins which were detected in the remaining 6 patients were obviously less severe.Conclusion Individualized treatment should be given to patients with MVBPAPH and according to the specific type of pancreatitis and the onset time of any accompanying pseudocyst.
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Objective To explore the curative effects of endoscopic band ligation combined with drug injection in the treatment of hepatic cirrhosis complicated with upper gastrointestinal hemorrhage. Methods 76 patients with hepatic cirrhosis complicated with upper gastrointestinal hemorrhage were divided into 2 groups by random double blind method, with 38 cases in each group. The control group were treated by conservative regimen alone while the experimental group were treated by endoscopic band ligation combined with drug injection, based on the control group. The clinical curative effects, adverse reactions, hemostasis time, hospitalization time , rebleeding , haemodynamics and other indexes before and after the treatment in the 2 groups were compared. Results The total effective rate, rebleeding rate and the incidence of fever in the experimental group were 2.6% and 10.5%, respectively. Compared with those in the control group (71.1%, 21.1%, 28.9%), the differences were statistically significant (P < 0.05). The differences in volume of blood transfusion, hemostasis time , time of improvement of symptoms and hospitalization time between the experimental group and the control group were significant (P < 0.01). The blood flow of portal vein(550.2 ± 143.4)mL and splenic vein (284.3 ± 96.4)mLin the experimental group was significantly less than that in the control group [(628.1 ± 156.0)mL, (332.6 ± 100.3)mL] (P < 0.05). Condusions Endoscopic band ligation combined with drug injection in the treatment of hepatic cirrhosis complicated with upper gastrointestinal hemorrhage is effective and can significantly improve the varicose hemodynamics in patients. The rate of rebleeding is low.
ABSTRACT
Objective To investigate the clinical efficacy of splenectomy combined with coronary-caval shunt in treatment of portal hypertension (PHT).Methods The retrospective descriptive study was conducted.The clinical data of 21 patients with PHT who underwent splenectomy combined with coronary-caval shunt at the First Affiliated Hospital of Xi'an Jiaotong University from January 2001 to December 2015 were collected.Observation indicators included (1) operation situations,changes of pre-and post-operative portal hemodynamics including operation time and volume of intraoperative blood loss,diameter and blood flow velocity of portal vein (PV),gastric coronary vein and superior mesenteric vein (SMV).(2) Clinical indexes in perioperative period (before operation,at postoperative 1 week and 1 month):① blood routine test:the counts of red blood cell (RBC),white blood cell (WBC) and platelet (PLT),② liver function:Child-Pugh score,alanine transaminase (ALT),total bilirubin (TBil),albumin (Alb),extended time of prothrombin time (PT) and international normalized ratio (INR).(3) Follow-up:postoperative 1-,3-,5-year complications [upper gastrointestinal re-bleeding,peritoneal effusion,hepatic encephalopathy,hepatic failure,portal vein thrombosis (PVT) and anastomotic stoma thrombosis].The follow-up using outpatient examination and telephone interview was regularly conducted once every 3 months within postoperative 1 year and once every 6 months after postoperative 1 year up to March 2016 or end of follow-up (death).Measurement data with normal distribution were presented as x ± s.The comparison of different time-point was analyzed by the repeated measures ANOVA and Student t test.Measurement data with sknewed distribution were presented as M (range).Results (1) Operation situations and changes of pre-and post-operative portal hemodynamics:21 patients underwent successful splenectomy combined with coronary-caval shunt,including 19 receiving splenic vein bypass combined with anastomosis of gastric coronary vein and inferior vena cava and 2 receiving anastomosis of gastric coronary vein and inferior vena cava.Operation time,volume of intraoperative blood loss were (187 ± 33)minutes and (233 ± 114)mL.Diameter and blood flow velocity of PV,gastric coronary vein and SMV were (1.39±0.20)cm,(0.66±0.15)cm,(0.74±0.32)cm,(11.2±3.4)cm/s,(6.6± 1.3)cm/s,(7.0 ±2.2)cm/s before operation and (1.36 ±0.22)cm,(0.42 ±0.11)cm,(0.81 ±0.23)cm,(10.4 ± 2.5) cm/s,(8.2 ± 2.5) cm/s,(6.9 ± 2.4) cm/s after operation,respectively,showing no statistically significant difference in the diameter and blood flow velocity of PV and SMV before and after operation (t =0.46,-0.81,0.87,0.14,P ＞ 0.05)and with statistically significant differences in the diameter and blood flow velocity of gastric coronary vein before and after operation (t =5.9 1,-2.60,P ＜ 0.05).(2) Clinical indexes in perioperative period:① routine blood test:the counts of RBC,WBC and PLT were (2.70 ± 0.50) × 1012/L,(2.6 ±2.3) × 109/L,(55 ±28) × 109/L before operation and (3.10 ±0.60) × 1012/L,(2.8 ±2.0) × 109/L,(248 ± 182) × 109/L at postoperative 1 week and (3.70 ±0.20) × 1012/L,(6.2 ± 1.9) × 109/L,(457 ± 184) × 109/L at postoperative 1 month,respectively,with statistically significant differences (F =31.91,11.03,30.74,P ＜ 0.05).There were statistically significant differences in the counts of RBC and PLT between 1 week postoperatively and before operation (t =-2.35,-4.81,P ＜ 0.05) and between 1 month postoperatively and 1 week postoperatively (t =-4.35,-5.65,-3.71,P ＜ 0.05).② Liver function:Child-Pugh score,ALT,TBil,Alb,extended time of PT and INR were 6.3 ± 1.2,(23 ± 17) U/L,(28 ± 18) μmol/L,(31.1 ± 6.8) g/L,(4.8 ±2.1) s,1.40 ± 0.20 before operation and 6.2 ± 0.9,(44 ± 24) U/L,(26 ± 11) μmol/L,(35.0 ± 7.4) g/L,(3.4 ± 2.0) s,1.30 ± 0.20 at postoperative 1 week and 6.0 ± 0.6,(36 ± 22) U/L,(23 ± 8) μmol/L,(34.2 ± 2.2) g/L,(3.7 ± 3.0) s,1.50 ± 0.30 at postoperative 1 month,respectively,showing no statistically significant difference (F =1.97,2.60,1.18,1.45,P ＞0.05).There were statistically significant differences in the ALT and extended time of PT (F =7.97,4.37,P ＜ 0.05) and in the ALT and extended time of PT between 1 week postoperatively and before operation (t =3.23,2.21,P ＜ 0.05).(3) Follow-up:21 patients were followed up for 3-168 months with a median time of 37 months.During follow-up,3 patients were dead.One,1,2 patients were complicated with upper gastrointestinal re-bleeding at postoperative 1,3,5 years and received hemostatic therapy under endoscopy,and then 2 were dead.Three,2 and 2 patients had peritoneal effusion and were improved by symptomatic treatment.One patient had hepatic encephalopathy and hepatic failure at postoperative 5 years and was dead after conservative treatment.PVT and anastomotic stoma thrombosis at postoperative 1,3,5 years were detected in 2,2,1 and 2,1,1 patients,with anticoagulant therapy,and 1 patient received vascular recanalization.Conclusion Coronary-caval shunt is a highly selective portosystemic shunt,it can significantly down regulate the regional pressure while ensure the normal blood flow of liver and decrease the rate of rebleeding,hepatic encephalopathy and thrombosis,meanwhile,it might be a potential therapy in management of PHT.