Appendicitis after endoscopic band ligation for massive ileocecal hemorrhage.

A 68-year-old man was admitted with hematochezia. Emergency computed tomography showed multiple diverticula throughout the colon. Initial colonoscopy on day 2 showed no active bleeding, but massive hematochezia on day 3 led to the performance of an emergency endoscopy. Substantial bleeding in the ileocecal area obscured the visual field, making it challenging to view the area around the bleeding site. Two endoscopic band ligations (EBLs) were applied at the suspected bleeding sites. Hemostasis was achieved without active bleeding after EBL. However, the patient developed lower right abdominal pain and fever (39.4°C) on day 6. Urgent computed tomography revealed appendiceal inflammation, necessitating emergency open ileocecal resection for acute appendicitis. Pathological examination confirmed acute phlegmonous appendicitis, with EBLs noted at the appendiceal orifice and on the anal side. This case illustrates the efficacy of EBL in managing colonic diverticular bleeding. However, it also highlights the risk of appendicitis due to EBL in cases of ileocecal hemorrhage exacerbated by poor visibility due to substantial bleeding. Endoscopists need to consider this rare but important complication when performing EBL in similar situations.

Antepartum hemorrhage due to placenta previa with autologous transfusion: A case report.

INTRODUCTION AND IMPORTANCE: Bleeding during pregnancy or during childbirth can cause significant morbidity and mortality for the mother and baby, this can be overcome by performing a caesarean section (C-section) and blood transfusions. Although blood transfusions can save lives, there is a risk such as transfusion reactions, transmission of infection, and anaphylaxis. Giving autologous blood transfusion can reduce the risk of these events. This case report aims to investigate the advantages of autologous blood transfusion in managing the patient's hemodynamic status compared to homologous blood transfusion. CASE PRESENTATION: A 21-year-old female (G2P1A0) with antepartum hemorrhage (APH) due to placenta previa underwent emergency C-section with intrauterine device installation and hysterectomy. The patient received an autologous transfusion to improving the hematocrits and hemoglobin within 30 min. Autologous transfusion provided routine postoperative hemodynamics, electrolytes, and blood stability. However, it could not completely replace homologous transfusion. CLINICAL DISCUSSION: Autologous transfusion reduces transfusion response, infection risk, and immunosuppression. Consequently, it reduces the need for allogenic blood supplies and enables safer transfusion for people with rare blood types and various auto-antibodies. CONCLUSION: Autologous transfusions may provide better outcomes in C-section surgery for APH patients due to placenta previa. Thus, we recommend the use of autologous over homologous transfusion. Further research is required to compare them to a large population.

Venous thromboembolism in women with hormone-dependent breast cancer. To continue or discontinue hormonal treatment? Insights from the RIETE registry.

INTRODUCTION: Hormone therapy (HT) for breast cancer is associated with an increased risk of venous thromboembolism (VTE). This study examines the effects of continuing versus discontinuing HT on VTE recurrence, major bleeding, and mortality, after an acute VTE event. METHODS: Using data in the RIETE-registry from March 2001 through September 2021, we calculated incidence rates and rate-ratios (RR) for VTE events in patients on- and off HT. Cox regression models assessed the impact of HT continuation. RESULTS: Among 479 women with breast cancer on HT who developed VTE (pulmonary embolism 279, isolated deep vein thrombosis 200), 350 (73 %) continued HT. These women were slightly older (70 ± 13 vs. 67 ± 16 years) than those discontinuing HT, with no significant differences in other baseline characteristics. Over a median follow-up of 294 days, 25 (5.2 %) developed VTE recurrences, 18 (3.7 %) had major bleeding, and 73 (15.2 %) died. Rates of VTE recurrence did not differ significantly between groups (RR: 1.28, 95 % CI 0.44-3.75), except in the first three months post-VTE, where a higher rate was observed in those continuing HT (6.02/100 patients-year vs. no events). On multivariable analysis, HT continuation showed no association with VTE recurrences after adjusting for other thromboembolic risk factors (adjusted hazard ratio [aHR] 1.49, 95 % CI 0.5-4.45). CONCLUSION: Continuing HT after a VTE event in women with breast cancer does not generally affect the long-term risk of VTE recurrences but is associated with a higher risk in the first three months. These findings highlight the need for careful monitoring during this period.

Virtual reality training for postpartum uterine balloon insertion - a multi-center randomized controlled trial.

BACKGROUND: Virtual reality provides users a unique opportunity to learn through a fully immersive platform that may be beneficial in postgraduate medical education. OBJECTIVE: The primary objective of the study was to assess the feasibility of virtual reality in the training of obstetrics and gynecology residents in the insertion of a postpartum balloon for management of postpartum hemorrhage. STUDY DESIGN: A multi-center randomized control trial involving obstetric residents (n=40) from two tertiary level perinatal centers - The National Maternity Hospital & The Rotunda, Dublin, Ireland from July 3rd to July 6th 2023. Participants were randomly assigned to an intervention group (n=21) and a control group (n=19). All participants filled in a pre-study survey assessing knowledge, experience in postpartum hemorrhage management, confidence levels, experience of virtual reality and thoughts on its use in medical education. The intervention group received a virtual reality immersive tutorial whilst the control group received no teaching. The decision not to offer the control group any teaching was to reflect the current situation in our hospitals where there is no regular formal teaching on insertion of postpartum balloon prior to night or weekend duty on the labor ward. The use of VR in this scenario provides residents with a new opportunity for accessible simulation training. Both groups were then tested on insertion of a postpartum uterine balloon in a model pelvis. Residents were timed and insertion technique was objectively marked, in line with manufacturer guidelines. Following insertion on the model, participants completed a survey including assessment of knowledge, confidence levels, satisfaction, side effects & benefits of virtual reality. The primary outcome was a structured objective assessment of the residents on the insertion technique of the balloon in a pelvic model. Secondary outcomes were time taken to complete the task, knowledge and confidence levels and any side effects of virtual reality. We calculated descriptive statistics such as frequency and percentage for categorical data. The paired t-test was used to compare mean scores before and after the intervention, both for the multiple choice questionnaire and confidence levels. Statistical significance was defined as a p-value of <0.05. RESULTS: The intervention group scored significantly better in the objective technique assessment post learning experience compared to the control group (9.29/10 vs 7.26/10, P<0.001). The median time for task completion in the intervention group was significantly less than that of the control group (3minutes vs 4 minutes, P=0.012) and resident confidence improved more in the intervention VR group (0.42 vs 0.62, P<0.001). Both groups scored better in the multiple-choice questionnaire post learning experience, however there was no significant difference between them. CONCLUSION: Virtual reality is beneficial to residents for teaching insertion of a postpartum balloon, in terms of technique, time taken and confidence levels.

Tinzaparin, an alternative to subcutaneous unfractionated heparin, in patients with severe and end-stage renal impairment: a retrospective observational single-center study.

BACKGROUND: Tinzaparin could be easier to manage than unfractionated heparin, in patients with severe renal impairment. However, clinical and pharmacological data regarding its use in such patients are lacking. The aims of this study were to determine, in patients with eGFR<30 mL.min-1: tinzaparin pharmacokinetics (PK) parameters, using a population PK approach and bleeding and thrombotic complications. METHODS: We performed a retrospective observational single-center study, including in-patients with eGFR< 30 mL.min-1, receiving prophylactic (4500 IU.day-1) or therapeutic (175 IU.kg-1.day-1) tinzaparin. Measured anti-Xa levels were analyzed using a non-linear mixed effects modelling approach. Individual predicted tinzaparin exposure markers at steady state were calculated for each patient and dosing regimen. The PK was also evaluated through Monte-Carlo simulations, based on the final covariate model parameter estimates. RESULTS: Over a 22-month period, 802 tinzaparin treatment periods in 623 patients were analysed: two-thirds received a prophylactic dose, 66% had an eGFR<20 mL.min-1, and 25% were on renal replacement therapy. In patients for whom anti-Xa measurements were performed (n=199, 746 values), PK parameters, profiles and Cmax were comparable to those in patients without renal impairment or in healthy volunteers. In the whole population, major bleeding occurred in 2.4% and 3.5% of patients receiving prophylactic and therapeutic doses, over a median 9- and 7-days treatment period, respectively. No patients had thrombotic complication. CONCLUSION: Tinzaparin PK parameters and profiles were not affected by renal impairment. This suggests that tinzaparin, at therapeutic or prophylactic dose, could be an alternative to unfractionated heparin in hospitalized patients with severe renal impairment.

Renal protection after hemorrhagic shock in rats: Possible involvement of SUMOylation.

Hemorrhagic shock (HS), a leading cause of preventable death, is characterized by severe blood loss and inadequate tissue perfusion. Reoxygenation of ischemic tissues exacerbates organ damage through ischemia-reperfusion injury. SUMOylation has been shown to protect neurons after stroke and is upregulated in response to cellular stress. However, the role of SUMOylation in organ protection after HS is unknown. This study aimed to investigate SUMOylation-mediated organ protection following HS. Male Wistar rats were subjected to HS (blood pressure of 40 ± 2 mmHg, for 90 min) followed by reperfusion. Blood, kidney, and liver samples were collected at various time points after reperfusion to assess organ damage and investigate the profile of SUMO1 and SUMO2/3 conjugation. In addition, human kidney cells (HK-2), treated with the SUMOylation inhibitor TAK-981 or overexpressing SUMO proteins, were subjected to oxygen and glucose deprivation to investigate the role of SUMOylation in hypoxia/reoxygenation injury. The animals presented progressive multiorgan dysfunction, except for the renal system, which showed improvement over time. Compared to the liver, the kidneys displayed distinct patterns in terms of oxidative stress, apoptosis activation, and tissue damage. The global level of SUMO2/3 in renal tissue was also distinct, suggesting a differential role. Pharmacological inhibition of SUMOylation reduced cell viability after hypoxia-reoxygenation damage, while overexpression of SUMO1 or SUMO2 protected the cells. These findings suggest that SUMOylation might play a critical role in cellular protection during ischemia-reperfusion injury in the kidneys, a role not observed in the liver. This difference potentially explains the renal resilience observed in HS animals when compared to other systems.

Maternal mortality due to obstetric hemorrhage by surgical injury during cesarean section: A nationwide study.

INTRODUCTION: Obstetric hemorrhage remains a largely preventable cause of maternal mortality globally. The contribution of uterine atony to hemorrhage-related maternal mortality has decreased in France, while the contribution of other causes of obstetric hemorrhage such as surgical injury during cesarean has been reported to increase. However, little evidence exists regarding the risk factors and care processes of women who died from this cause of hemorrhage. Therefore, we aimed to describe the clinical profile, underlying mechanisms, and preventability factors among women who died from obstetric hemorrhage by surgical injury during cesarean section. MATERIAL AND METHODS: Nationwide analysis of all hemorrhage-related maternal deaths by surgical injury during cesarean in France identified by the nationwide permanent enhanced maternal mortality surveillance system (ENCMM) between 2007 and 2018. We described the characteristics of the women, delivery hospitals, circumstances of hemorrhage, features of obstetric and resuscitation/transfusion care, and main preventability factors. RESULTS: Between 2007 and 2018, hemorrhage-related maternal mortality in France decreased from 1.6/100 000 live births (95% CI 1.1-2.2) (39/2 472 650) in 2007-2009 to 0.8/100 000 live births (95% CI 0.5-1.3) (19/2 311 783) in 2016-2018. Hemorrhage-related maternal mortality ratio due to surgical injury during cesarean increased from 0.08 (95% CI 0.01-0.3) (2/2 472 650) to 0.2 (95% CI 0.07-0.5) (5/2 311 783) per 100 000 live births. Among the 18 women who died from surgical injury during cesarean over the 12-year study period, we report a high prevalence of obesity (67%, 12/18), previous cesarean (72%, 13/18), and second-stage cesareans (56%, 10/18). In 22% (4/18), cesarean section was performed in a hospital providing <1000 births annually, with no blood bank (39%, 7/18) or no adult intensive care (44%, 8/18) on-site. Overall preventability of deaths was 94% (17/18). Main preventability factors were related to delay in hemorrhage diagnosis (77%, 14/18) due to late recognition of abnormal parameters (33%, 6/18) and late bedside ultrasound (56%, 10/18), and delay in management due to insufficient surgical skills (56%, 10/18). CONCLUSIONS: In France, surgical injury during cesarean section is an increasing, largely preventable contributor to hemorrhage-related maternal mortality, as other causes of fatal hemorrhage have become less frequent. The profile of these women showed a high prevalence of obesity, previous cesarean, second-stage cesarean, and delivery in hospitals with limited medical and surgical resources, which suggests explanatory mechanisms for the fatal outcome and opportunities for prevention.

Predicting early rebleeding and mortality after endoscopic hemostasis of esophagogastric varices: Diagnostic performance of aspartate aminotransferase-to-platelet ratio index and model for end-stage liver disease-Na score.

BACKGROUND: Endoscopic variceal ligation and sclerotherapy are recommended for esophagogastric variceal bleeding (EGVB) in cirrhosis but can be complicated by early rebleeding and death. This study aimed to identify noninvasive markers accurately predicting early rebleeding and mortality after endoscopic hemostasis for EGVB. METHODS: Among 116 patients with endoscopically confirmed EGVB and endoscopic hemostasis, various noninvasive markers were calculated, and their predictive accuracy was compared by receiver-operating characteristic curve analysis. Endpoints included 5-day rebleeding, 5-day mortality, 6-week rebleeding, and 6-week mortality. RESULTS: The median age was 63 years. Child-Pugh class B and C patients accounted for 40.5% and 34.5%, respectively. Only the aspartate aminotransferase-to-platelet ratio index (APRI) significantly predicted 5-day rebleeding, with an area under the curve (AUC) of 0.777 (95% confidence interval [CI]: 0.537-1). The model for end-stage liver disease-Na (MELD-Na) score showed good predictive accuracy for 5-day mortality (AUC: 0.839, 95% CI: 0.681-0.997), 6-week rebleeding (AUC: 0.797, 95% CI: 0.663-0.932), and 6-week mortality (AUC: 0.888, 95% CI: 0.797-0.979). CONCLUSIONS: Patients with cirrhosis with a high APRI and MELD-Na score were at high risk of early rebleeding and death after EGVB. Allocating appropriate monitoring and care for those patients is necessary.

Pediatric WNT medulloblastoma predisposition in intraoperative blood loss: a retrospective observational cohort study.

Introduction: Molecular subgroups influence the vascular architecture within medulloblastomas, particularly the wingless (WNT) subgroup, which contributes to its propensity for primary tumor hemorrhage. Whether this mechanism affects intraoperative blood loss remains unknown. This study aimed to assess the association between WNT medulloblastoma and the predisposition for blood loss. Methods: This was a retrospective observational study using data from a neuro-oncology center comprising molecular data on patients treated between December 31, 2014, and April 30, 2023. Differences between WNT and other subgroups in the risk of primary outcome-intraoperative blood loss were assessed using multivariable-adjusted linear regression. Results: Of the 148 patients included in the analysis, 18 patients (12.2%) had WNT, 42 (28.4%) had sonic hedgehog (SHH) TP53-wildtype, 7 (4.7%) had SHH TP53-mutant, and 81 (54.7%) were non-WNT/ non-SHH. The WNT subgroup more frequently underwent primary intratumoral hemorrhage (22% vs. 3.8%; p = 0.011). The median intraoperative blood loss was 400.00 (interquartile range [IQR] 250, 500) mL for WNT and 300.00 [200, 400] mL for the other subgroups (p = 0.136), with an adjusted ß of 135.264 (95% confidence intervals [CI], 11.701-258.827; p = 0.032). Similar results were observed in both midline and noninfiltrative margin medulloblastoma. Discussion: WNT medulloblastoma is typically associated with primary intratumoral hemorrhage and intraoperative blood loss. The validity of determining the surgical approach based on predicted molecular subtypes from imaging data is questionable. However, attempting to engage in risk communication with patients in a molecular-specific way is worthwhile to validate.

POBS-Card, a new score of severe bleeding after cardiac surgery: Construction and external validation.

Objective: Bleeding after cardiac surgery leads to poor outcomes. The objective of the study was to build the PeriOperative Bleeding Score in Cardiac surgery (POBS-Card) to predict bleeding after cardiac surgery. Methods: We conducted a retrospective cohort study in 2 academic hospitals (2016-2019). Inclusion criteria were adult patients after cardiac surgery under cardiopulmonary bypass. Exclusion criteria were heart transplantation, assistance, aortic dissection, and preoperative hemostasis diseases. Bleeding was defined by the universal definition for perioperative bleeding score ≥2. POBS-Card score was built using multivariate regression (derivation cohort, one center). The performance diagnosis was assessed using the area under the curve in a validation cohort (2 centers) and compared with other scores. Results: In total, 1704 patients were included in the derivation cohort, 344 (20%) with bleeding. Preoperative factors were body mass index <25 kg/m2 (odds ratio [OR], 1.48 [1.14-1.93]), type of surgery (redo: OR, 1.76 [1.07-2.82]; combined: OR, 1.81 [1.19-2.74]; ascendant aorta: OR, 1.56 [1.02-2.38]), ongoing antiplatelet therapy (single: OR, 1.50 [1.09-2.05]; double: OR, 2.00 [1.15-3.37]), activated thromboplastin time ratio >1.2 (OR, 1.44 [1.03-1.99]), prothrombin ratio <60% (OR, 1.91 [1.21-2.97]), platelet count <150 g/L (OR, 1.74 [1.17-2.57]), and fibrinogen <3 g/L (OR, 1.33 [1.02-1.73]). In the validation cohort of 597 patients, the area under the curve was 0.645 [0.605-0.683] and was superior to other scores (WILL-BLEED, Papworth, TRUST, TRACK). A threshold >14 predicted bleeding with a sensitivity of 50% and a specificity of 73%. Conclusions: POBS-Card score was superior to other scores in predicting severe bleeding after cardiac surgery. Performances remained modest, questioning the place of these scores in the perioperative strategy of bleeding-sparing.

An unusual etiology of subarachnoid hemorrhage, basilar artery perforator aneurysms, in Macao: Three case reports and review of literature.

BACKGROUND: Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications. Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage. Conversely, basilar artery perforator aneurysms (BAPAs) are a rare etiology. There is no consensus on the optimal management of ruptured BAPAs in the acute setting. CASE SUMMARY: We present a case series of 3 patients with ruptured BAPAs who were treated at our institution. Two patients had a modified Fisher grade of I, and one had a grade of IV on initial presentation. The aneurysms were detected by computed tomography angiography in two cases and conventional angiography in one case. The 3 patients underwent endovascular treatment with Guglielmi detachable coils. Post-treatment, the patients had good clinical outcomes, and follow-up brain computed tomography scans showed reduced subarachnoid hemorrhage without any new hemorrhage. However, one patient experienced a cerebral infarction 2 months later and eventually succumbed to the condition. The other 2 patients showed progressive recovery, and no aneurysm recurrence was observed at the 2-year follow-up. CONCLUSION: Endovascular treatment may be a preferable approach for managing ruptured BAPAs compared with surgical intervention or conservative management. Early detection and prompt treatment is important to achieve favorable patient outcomes.

The Association Between the Location of Subarachnoid Hemorrhage and the Occurrence of Takotsubo Cardiomyopathy: A Systematic Review and Meta-analysis.

Takotsubo cardiomyopathy (TCM) is a syndrome characterized by transient regional cardiac dysfunction of the left ventricle. The goal of this review is to better understand the relationship between the anatomic locations of subarachnoid hemorrhages (SAHs) and the development of TCM as identified through a review of cohort studies. From inception to December 2023, we systematically explored major electronic medical information sources to identify cases of TCM that developed after SAHs. The six selected studies included in the meta-analysis suggest a modest but statistically significant increase in the odds of the events in the posterior circulation group compared to the anterior circulation group, with a combined odds ratio (OR) estimate of around 1.45-1.46. The fixed effect model gives an overall OR of 1.45 with a 95% confidence interval (CI) of 1.01 to 2.10, z = 2.01, p = 0.0442, while the random effects model yields a slightly higher OR of 1.46 with the same 95% CI, z = 2.03, p = 0.0425. There is a tendency for SAH occurrence in the posterior cerebral circulation to cause SAH-related TCM more frequently than in the anterior cerebral circulation.

Jejunal Angiodysplasia as an Unusual Cause of Hemorrhage After Hepaticojejunostomy.

Ectopic variceal bleeding is a rare cause of postoperative hemorrhage following hepaticojejunostomy and should be differentiated from other causes such as pseudoaneurysms or ulcers. Uncommon complications post-hepaticojejunostomy demand scrupulous attention, and this case report reveals a seldom-documented scenario of jejunal angiodysplasia as an elusive cause of postoperative bleeding. Through a comprehensive examination of the patient's clinical trajectory, diagnostic challenges, and subsequent management, this report contributes to the expanding knowledge base on atypical vascular complications in surgical settings.

Successful Intrasaccular Microcoil Embolization of a Lower Segment Pulmonary Artery Aneurysm in a Patient With Behcet's Disease.

Behcet's disease (BD) is an uncommon, long-term inflammatory condition characterized by recurring ulcers in the mouth and genital area, uveitis, and various systemic issues. One of the particularly rare but severe complications of this disease is the formation of pulmonary artery aneurysms (PAAs). Although these aneurysms are uncommon, they can lead to dangerous pulmonary hemorrhages (PHs), which are often fatal, requiring prompt diagnosis and intervention. We present a case of lower segment PAA in an 18-year-old patient with recently diagnosed BD, presenting with life-threatening PH and managed successfully with microcoil embolization of the aneurysm and immunosuppressive (IS) medications, achieving stable remission without complications.

Comparison of the Clinical Outcomes Between Reperfusion and Non-Reperfusion Therapy in Elderly Patients with Acute Ischemic Stroke.

Purpose: To investigate the benefit (90-day mRS score) and rate of major complications (early symptomatic intracranial hemorrhage-SICH) after reperfusion therapy (RT) (including intravenous thrombolysis -IVT and mechanical thrombectomy -MT) in patients over 80 years with acute ischemic stroke (AIS). Patients and Methods: AIS patients aged over 80 admitted to Huizhou Central People's Hospital from September 2018 to 2023 were included in this study. Data on SICH, NIHSS, and mRS were analyzed. A good prognosis was defined as a mRS ≤ 2 or recovery to pre-stroke status at 90 days. Results: Of 209 patients, 80 received non-RT, 100 received IVT and 29 underwent MT. The non-RT group had the lowest baseline NIHSS while the MT group had the highest (non-RT 6.0 vs IVT 12.0 vs MT 18.0, P <0.001). Higher NIHSS was associated with increased SICH risk (OR 1.083, P=0.032), while RT was not (OR 5.194, P=0.129). The overall SICH rate in the RT group was higher but not significantly different after stratification by stroke severity. Poor prognosis was associated with higher admission NIHSS, stroke due to large artery atherosclerosis (LAA) combined with cardioembolism (CE), and stroke-associated pneumonia (SAP) (OR 0.902, P<0.001; OR 0.297, P=0.029; OR 0.103, P<0.001, respectively). The RT group showed a greater reduction in NIHSS (delta NIHSS) than the non-RT group (non-RT 2.0 vs IVT 4.0 vs MT 6.0, P<0.005). For severe AIS, the IVT group had a better prognosis at 90 days (non-RT 0% vs IVT 38.2%, P=0.039). No 90-day mortality difference was found between groups after stratification. Conclusion: Stroke severity, rather than RT, is an independent risk factor for SICH in AIS patients over 80. RT in severe stroke patients improves NIHSS at 90 days, suggesting RT is safe and effective in this demographic. Further studies with larger samples are required to confirm these findings.

Purely Endoscopic Evacuation of Intracranial Hematomas.

Cerebral hemorrhage is a frequent disease and one of the main causes of disabilities. Even in the case of cerebral hemorrhage, if there were a treatment that would improve the functional prognosis, the benefits would be immeasurable. Although there are limited reports with a high level of evidence in past studies, it has been found that surgery can be effective if a large amount of hematoma can be removed in a minimally invasive manner. Also, it has become clear that the control of bleeding becomes a problem when surgery is performed within 2 days after the onset of stroke and that the therapeutic time window might be longer. In Japan, since the introduction of the transparent sheath by Nishihara et al., endoscopic hematoma removal has been widely performed and has become the standard surgical procedure. The three basic equipment needed for this surgery are a rigid scope, a suction coagulator, and a transparent sheath. The key point of the surgery is to search for hematomas and bleeding points through a transparent sheath and coagulate the bleeding vessels. In this chapter, we will introduce surgical techniques using these devices, but it is important to carefully decide on surgical options by considering your own technique, the condition of each patient, and the devices available in the area.

High blood glucose variability may predict poor outcomes in patients with spontaneous cerebellar hemorrhage undergoing surgical operation: a retrospective study.

BACKGROUND: Elevated blood glucose (BG) variability has been reported as an independent risk factor for poor prognosis in a variety of diseases. This study aimed to investigate the association between BG variability and clinical outcomes in patients with spontaneous cerebellar hemorrhage (SCH) undergoing surgical operation. METHODS: This retrospective cohort study of the consecutive patients admitted to the department of Neurosurgery, the Affiliated Hospital of Qingdao University between January 2014 and June 2022 with the diagnosis of SCH underwent surgical intervention. BG analysis was continuously and routinely performed. BG variability was represented by the standard deviation (SD) of the serial measurements within the first 7 days. The general characteristics, imageological information, blood glucose level, and surgical information were reviewed and compared through medical records. RESULTS: A total of 115 patients (65 male and 50 female) were enrolled. Out of all 115 patients, the overall clinical outcomes according to the modified Rankin Scale (mRS) were poor (mRS 3-6) in 31 patients (26.96%) and good (mRS 0-2) in 84 patients (73.04%). Twelve of the 115 patients died during hospitalization, and the mortality rate was 10.43%. Multivariate logistic regression analysis showed that SD of BG (odds ratio (OR), 4.717; 95% confidence interval (CI), 1.054-21.115; P = 0.043), GCS (OR, 0.563; 95% CI, 0.330-0.958; P = 0.034), and hematoma volume (OR, 1.395; 95% CI, 1.118-1.748; P = 0.003) were significant predictors. The area under the ROC curve of SD of BG was 0.911 (95% CI, 0.850-0.973; P < 0.001) with a sensitivity and specificity of 90.3% and 83.3%, respectively, and the cut-off value was 1.736. CONCLUSIONS: High BG Variability is independently correlated with the 6-month poor outcomes in patients with SCH undergoing surgical operation.

Unilateral Alveolar Hemorrhage: A Rare Pulmonary Complication in Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune disease that presents a broad spectrum of clinical manifestations. Alveolar hemorrhage in SLE is rare and has a poor prognosis. We present the case of a patient with a diagnosis of SLE and lupus nephropathy on hemodialysis who presented criteria for alveolar hemorrhage with unilateral involvement, with clinical improvement after the administration of steroid boluses. The uncommon presentation of unilateral pulmonary involvement and the importance of making an adequate protocol for ruling out differential diagnoses are highlighted.