ABSTRACT
Based on their mode of action, it is reasonable to expect that the combination therapy of aspirin and a vitamin K antagonist (VKA) may be more beneficial in preventing (athero) thrombotic complications in high-risk patients for cardiovascular events. However, there is no consensus about additional aspirin use in the most common indications for VKA or the use of VKAs to be added to the most common aspirin indications. The variation in clinical outcomes and bleeding complications suggests that extrapolating from one indication to another may not be appropriate. So far, decisions about the combined use of aspirin and VKA are individualized in the absence of adequate data. Only in patients with mechanical heart valves the benefits and safety of combining aspirin with VKA therapy seems obvious. In patients with peripheral artery disease no beneficial effect was noted for the combination therapy, perhaps with an exception of those with graft failure. For all other clinical situations, this is unclear and should be avoided.
Subject(s)
Aspirin/administration & dosage , Vitamin K/antagonists & inhibitors , Atherosclerosis/blood , Atherosclerosis/drug therapy , Drug Therapy, Combination , Humans , Platelet Aggregation Inhibitors/administration & dosage , Randomized Controlled Trials as Topic/methodsABSTRACT
Duodenal metastases are a very uncommon and peculiar cause of upper gastrointestinal bleeding. However, they should be considered in a patient presenting with upper gastrointestinal bleeding and a previous history of malignancy. The importance of recognising the unusual presentation of duodenal metastasis has to be emphasised. We describe two patients with upper gastrointestinal bleeding due to duodenal metastases. In the first patient a periampullary bleeding due to a metastasis of a renal cell carcinoma was detected five years after nephrectomy of the right kidney. In the second patient an occult bleeding caused by a duodenal metastasis of a melanoma was diagnosed. The first manifestation of this melanoma was eight years earlier.
Subject(s)
Duodenal Neoplasms/complications , Duodenal Neoplasms/secondary , Gastrointestinal Hemorrhage/etiology , Intestine, Small , Occult Blood , Aged , Carcinoma, Renal Cell/secondary , Humans , Kidney Neoplasms/pathology , Male , Melanoma/secondary , Skin Neoplasms/pathologyABSTRACT
We describe herein a 63-year-old patient with a splenic abscess due to Peptostreptococcus spp., diagnosed with the aid of abdominal computerised tomography and treated with ultra-sound guided percutaneous drainage and antibiotics. The bacteriological characteristics of splenic abscesses are discussed.
Subject(s)
Abscess/microbiology , Gram-Positive Bacterial Infections/complications , Peptostreptococcus , Splenic Diseases/microbiology , Abscess/diagnosis , Abscess/therapy , Gram-Positive Bacterial Infections/diagnostic imaging , Humans , Male , Middle Aged , Splenic Diseases/diagnosis , Splenic Diseases/therapy , Tomography, X-Ray ComputedABSTRACT
A case is presented of a 58-year-old woman developing profound thrombocytopenia within one week after starting treatment with ticlopidine. Ticlopidine was prescribed following coronary artery stenting. The patient recovered rapidly after discontinuation of the drug, suggesting a possible relationship between ticlopidine and thrombocytopenia. Haematological disorders associated with ticlopidine, such as neutropenia, thrombocytopenia and bone marrow aplasia, are rare and usually seen within the first three months of therapy. As the use of ticlopidine increases, clinicians should be aware of haematological complications associated with its use and inform their patients appropriately.
Subject(s)
Platelet Aggregation Inhibitors/adverse effects , Thrombocytopenia/chemically induced , Ticlopidine/adverse effects , Coronary Disease/drug therapy , Female , Follow-Up Studies , Humans , Middle Aged , Platelet Count/drug effects , Thrombocytopenia/blood , Thrombocytopenia/diagnosisABSTRACT
BACKGROUND: Cholestyramine enhances gallbladder emptying and plasma cholecystokinin responses to oral ingestion of a mixed meal. It is not known whether this effect occurs independently of alterations in gastric emptying or maldigestion of nutrients. METHODS: We perfused 15 g of an amino acid meal intraduodenally for 60 min in seven healthy volunteers, once with and once without cholestyramine. Intraduodenal perfusion of saline with or without cholestyramine (6 g/h) was started 60 min before the amino acid meal and continued for 2 h. RESULTS: Cholestyramine markedly enhanced the incremental plasma cholecystokinin response to the meal from 36 +/- 12 to 139 +/- 25 pmol/l x 60 min (P < 0.005), incremental amylase output from 2.4 +/- 0.7 to 5.7 +/- 0.7 kU/h (P < 0.05), and incremental integrated gallbladder contraction from 1948 +/- 235 to 2840 +/- 189% x 60 min (P < 0.05). CONCLUSION: The enhancing effect of cholestyramine on postprandial gallbladder contraction, pancreatic enzyme secretion, and plasma cholecystokinin release is not dependent on gastric emptying rates or appropriate digestion of nutrients.
