Endoscopic injection treatment of gastrointestinal bleeding in hemophiliacs.

The aims of this prospective study were to determine the patterns of gastrointestinal (GI) bleeding in hemophiliacs and to assess the hemostatic effect of injection therapy with alcohol. During a 5-year period (1990-1994) 89 hemophiliacs were admitted to our department with acute GI bleeding. Among these patients duodenal ulcer was found endoscopically to be the most common (42.7%) cause of hemorrhage; gastric ulcer was the source of the bleeding in only three patients (3.4%). A group of 46 patients met the criteria of active or recent bleeding and underwent injection therapy with alcohol. The injected bleeding lesions were duodenal ulcer in 32 patients, duodenal erosion in 2, gastric ulcer in 3, and other gastric lesions (Mallory-Weiss tear, Dieulafoy lesion, stomal ulcer, erosions) in 9 patients. Initial hemostasis was achieved in 100% and permanent hemostasis in 82.6%. Rebleeding was observed in eight patients (17.4%), with five of them successfully treated by reinjections. Three patients (6.5%) required emergency surgery. The mortality rate in the group of injected patients was 2.2%. One patient died of stroke on day 10 after partial gastrectomy. All injected patients were given replacement therapy with factor VIII or IX for 2 days (29 patients) or 7 to 14 days (17 patients). Analysis of the hemostatic effect achieved in these two subgroups indicate that short-term replacement therapy (2 days) may be sufficient to ensure adequate hemostasis in hemophiliacs. The results of the present study indicate that injection therapy with alcohol is an effective, safe, proved method to control GI bleeding in hemophiliacs.

[Use of human anti-Pseudomonas immunoglobulins in treatment of children with burns]. / Zastosowanie ludzkiej immunoglobuliny przeciwko Pseudomonas w leczeniu oparzonych dzieci.

This studies included 15 children with burns involving 10-55% of the whole body surface, treated at the two surgical departments in Poland. All patients have been given 0.5 mL of a 15% solution of anti-Pseudomonas immunoglobulin in a deep i.m. injections for 3 consecutive days. Immunoglobulin has generally been well tolerated, except short fever attacks. Human anti-Pseudomonas immunoglobulin prepared in the institute of Haematology and Transfusion in Warsaw prevented infections with P. aeruginosa in 12 burned children. There have been no cases of bacteremia produced by P. aeruginosa in 15 treated children with burns. The obtained results indicate efficacy of such therapy in burned children.

Modern oxygen carriers: state of art 1990.

Three major components of blood with clearly defined functions are: 1) red cells 2) plasma volume 3) coagulation factors At the present time artificial or synthetic coagulation factors are not available. Plasma volume expanders are well known in clinical practice. The main subject of this paper is the complex area of red cell substitutes with particular reference to the oxygen carrying capacity. The history of blood oxygen carrying capacity is briefly presented with particular reference to contributions by G. S. Adair, C. Bohr, M. Perutz and R. R. Benesch. 3 oxygen carrying developments are discussed in detail: 1) perfluorocarbons 2) artificial red cells 3) stroma-free haemoglobin solution Perfluorocarbons were used as carriers of oxygen in experiments and clinical practice. Before their wide clinical application a number of potential problems must be solved. In selected patients (coronary angioplasty, cerebral thrombosis, cardiopulmonary by-pass) perfluorocarbons (Fluosol D-A) could be considered as beneficial. Artificial red cells (neohaemocytes) are available in some centres in which progress of micro-technology appears to lead to encapsulation of purified human haemoglobin. These preparations should receive more attention. Finally stroma-free haemoglobin solution was the subject of our own research for several years. Our preparation met the requirements of the blood substitute, but had the short half-life in the circulation. Recent advances in chemistry in some centres resulted in the modification of hb molecule and linking with P-5-P. The modified poly hb solution is an ideal oxygen delivering fluid.

[Results of using polyvalent Pseudomonas aeruginosa vaccine in children with burns by various medical centers]. / Wyniki stosowania wielowaznej szczepionki przeciwko paleczce ropy blekitnej u oparzonych dzieci w róznych osrodkach leczniczych kraju.

Polyvalent Pseudomonas aeruginosa vaccine, prepared at the Institute of Hematology from 10 hospital strains isolated from burn wounds, was administered to 32 children with extensive and deep burns. The vaccine was well tolerated. The vaccine produced a high degree of the immunity against Pseudomonas aeruginosa infection. Agglutinin serum titre increased significantly. Vaccination either prevented or inhibited the infection of burn wounds with Pseudomonas aeruginosa in all immunized children. The symptoms of Pseudomonas aeruginosa infection usually disappeared following one or two vaccinations. Bacteriemia caused by P. aeruginosa was not observed in 31 out of 32 children. In the remaining child transient bacteriemia was noted. No septicemia caused by P. aeruginosa was seen. Due to the high efficiency of the polyvalent P. aeruginosa vaccine all burned children with burns exceeding 10% of the total body surface should by vaccinated to prevent the life-threatening infections with Pseudomonas aeruginosa.

[Thrombocytopenia in a patient with hemophilia and HIV infection treated with intravenous immunoglobulin and splenectomy]. / Maloplytkowosc u chorego na hemofilie z zakazeniem HIV leczona dozylnie immunoglobulina i splenektomia.

In a patient with haemophilia B who had developed immune thrombocytopenia following HIV infection, high doses of intravenous immunoglobulin were administered. The therapy brought about only a temporary rise in platelet counts. No beneficial effects were also obtained during a 3-month treatment with corticosteroids. Since there was no response to the conservative therapy, the patient was splenectomized under the cover of factor IX concentrate and the surgical procedure resulted in a complete remission of the thrombocytopenia.

Extrahepatic portal hypertension: long-term results of surgical treatment.

Long-term results of surgical treatment were analysed in 42 patients with extrahepatic portal hypertension treated in the Department of Surgery, Institute of Haematology in Warsaw in the period 1971-1987. In all, 71 operations were carried out, and 20 patients were treated by endoscopic sclerotherapy of oesophageal varices. Recurrence of haemorrhage was found in 6 out of 11 patients 54% after venous shunting, in 13 out of 17 patients (76%) after treatment by ligation of oesophageal varices and in 32 out of 35 patients (91%) after splenectomy. Following repeated sclerotherapy of oesophageal varices, recurrence of haemorrhage occurred in 3 out of 20 patients (15%). During 17 years four deaths occurred (10%) none of which was due to haemorrhage from oesophageal varices. The authors conclude that the method of repeated sclerotherapy is presently the most effective way of preventing haemorrhage from oesophageal varices and consider this form of management as the treatment of choice in patients with extrahepatic portal hypertension.

[Comparison of the results of sclerotherapy of esophageal varices using a rigid esophagoscope and fiber-optics esophagoscope]. / Porównanie wyników leczenia obliteracyjnego zylaków przelyku z zastosowaniem ezofagoskopu sztywnego i ezofagofiberoskopu.

The authors compared the results of 20 emergency and 100 elective varicosclerotisations with rigid esophagoscope and the same number of obliterations with the use of esophagofiberoscope. Haemorrhage was stopped in 90% of patients injected through the rigid esophagoscope and in 80% of patients in whom esophagofiberoscope was used. Hospital mortality rate in patients with bleeding esophageal warices was 25% in both groups. Complications were seen in 4.2% of procedures carried out with the rigid esophagoscope, and 5.8% of obliterations with esophagofiberoscope. The authors recommend rigid esophagoscope for emergency sclerotherapy and for the initial 2-3 series of injections in patients with large varices. Esophagofiberoscope is prefered in case of repeated, elective varicosclerotisations, first injections and recurrence of esophageal varices following obliterative therapy.

Emergency and elective sclerotherapy of oesophageal varices.

Endoscopic injection sclerotherapy of oesophageal varices was performed in 71 patients: 50 with intrahepatic and 21 with extrahepatic block. In summary 330 procedures were done: 220 under general anaesthesia using the Negus rigid oesophagoscope and 110 with diazepam as premedication using a flexible, fibreoptic endoscope. Definitive control of variceal haemorrhage was achieved in 30 of 34 emergency admissions (88%). The hospital mortality in acute variceal bleeding was 26.5%. Elective, repeated sclerotherapy was performed in 60 patients. In 43 patients complete obliteration of varices or their marked reduction were observed. Rebleeding occurred in 23% and major complications in 17% of patients. The overall one year survival rate was 82%. We consider sclerotherapy as a method of choice in bleeding oesophageal varices uncontrollable by vasopressin and balloon tamponade. It also represents a valuable method of preventing rebleeding particularly in patients with a high operative risk.

Evaluation of early postsplenectomy complications.

This study was done to define the incidence of early postsplenectomy complications and is based upon 688 splenectomies--mainly in malignant and nonmalignant hematologic conditions--performed during the period 1952 to 1986. In 354 patients, early postoperative complications were observed, among whom wound and pulmonary infections were most common. A fatal outcome was noted in 32 patients for a mortality rate of 4.7 per cent. The incidence of early complications after splenectomy is higher than after most other surgical procedures within the abdominal cavity and depends upon the underlying diseases which lead to splenectomy. Deficient immunologic defense mechanisms may be a significant factor in the development of early complications in patients after splenectomy.

Hazards of thrombolytic therapy in deep vein thrombosis.

From 1965 to 1985, 64 deep vein thrombosis (DVT) patients were treated with streptokinase (SK). In 26 cases 'high-dose SK' (IV 100,000 units/h for 4 days) was used and in 38 patients a 'low-dose SK' regime (IV 250,000 units every 12 h for 4 days) was employed. The clinical signs of DVT subsided in 78 per cent of treated patients within 30 days of completing SK treatment. A repeat phlebography was performed immediately after SK therapy in 29 patients (45 per cent) and a total recanalization or partial thrombolysis was achieved in 80 per cent of the studied cases. In 15 patients minor and major haemorrhagic complications occurred. There were five fatalities, all in the high-dose SK group (three intracranial haemorrhages and two major bleeds). Three patients developed pulmonary embolism and none of them died. The post-treatment clinical and phlebographic evaluation did not reveal any significant difference between the two methods of SK administration, but more haemorrhagic complications (P less than 0.02, chi=5.50825) occurred in the high-dose SK patients. This report emphasizes the risk of bleeding complications during thrombolytic therapy. If SK is to be used, therefore, careful selection of patients and meticulous monitoring are mandatory.