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Recurrent Bleeding (recurrent + bleeding)

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Medical Sciences	100%

Selected Abstracts

The Colorado Haemophilia Paediatric Joint Physical Examination Scale: normal values and interrater reliability

HAEMOPHILIA, Issue 1 2007
M. R. HACKER
Summary., ,Persons with haemophilia often experience their first joint haemorrhage in early childhood. Recurrent bleeding into a joint may lead to significant morbidity, specifically haemophilic arthropathy. Early identification of the onset and progression of joint damage is critical to preserving joint structure and function. Physical examination is the most feasible approach to monitor joint health. Our group developed the Colorado Haemophilia Paediatric Joint Physical Examination Scale to identify earlier signs of joint degeneration and incorporate developmentally appropriate tasks for assessing joint function in young children. This study's objectives were to establish normal ranges for this scale and assess interrater reliability. The ankles, knees and elbows of 72 healthy boys aged 1 through 7 years were evaluated by a physical therapist to establish normal ranges. Exactly 10 boys in each age category from 2 to 7 years were evaluated by a second physical therapist to determine interrater reliability. The original scale was modified to account for the finding that mild angulation in the weight-bearing joints is developmentally normal. The interrater reliability of the scale ranged from fair to good, underscoring the need for physical therapists to have specific training in the orthopaedic assessment of very young children and the measurement error inherent in the goniometer. Modifications to axial alignment scoring will allow the scale to distinguish healthy joints from those suffering frequent haemarthroses. [source]

Endoscopic band ligation could decrease recurrent bleeding in Mallory,Weiss syndrome as compared to haemostasis by hemoclips plus epinephrine

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2009
S. LECLEIRE
Summary Background, Mallory,Weiss syndrome (MWS) with active bleeding at endoscopy may require endoscopic haemostasis the modalities of which are not well-defined. Aim, To compare the efficacy of endoscopic band ligation vs. hemoclip plus epinephrine (adrenaline) in bleeding MWS. Methods, From 2001 to 2008, 218 consecutive patients with a MWS at endoscopy were hospitalized in our Gastrointestinal Bleeding Unit. In 56 patients (26%), an endoscopic haemostasis was required because of active bleeding. Band ligation was performed in 29 patients (Banding group), while hemoclip application plus epinephrine injection was performed in 27 patients (H&E group). Treatment efficacy and early recurrent bleeding were retrospectively compared between the two groups. Results, Primary endoscopic haemostasis was achieved in all patients. Recurrent bleeding occurred in 0% in Banding group vs. 18% in H&E group (P = 0.02). The use of hemoclips plus epinephrine (OR = 3; 95% CI = 1.15,15.8) and active bleeding at endoscopy (OR = 1.9; 95% CI = 1.04,5.2) were independent predictive factors of early recurrent bleeding. Conclusions, Haemostasis by hemoclips plus epinephrine was an independent predictive factor of rebleeding. This result suggests that band ligation could be the first choice endoscopic treatment for bleeding MWS, but requires further prospective assessment. [source]

Clinical and endoscopic characteristics of acute haemorrhagic rectal ulcer, and endoscopic haemostatic treatment: a retrospective study of 95 patients

COLORECTAL DISEASE, Issue 10Online 2010
Y. Motomura
Abstract Aim, Acute haemorrhagic rectal ulcer (AHRU) is characterized by sudden onset of painless and massive rectal bleeding in elderly bedridden patients who have serious illness. Endoscopic diagnosis and management of AHRU is, however, still controversial. We retrospectively investigated 95 AHRU patients to elucidate the clinical characteristics, endoscopic findings and haemostatic strategies. Method, Between January 1999 and March 2007, 95 patients were diagnosed with AHRU in our hospital. Medical records and colonoscopy files were reviewed. Clinical features, colonoscopic findings, haemostatic treatment and outcome of the patients were evaluated. Results, Eighty per cent of the patients were bedridden at the onset. The most frequent underlying disorder was cerebrovascular disease (36.8%). Hypoalbuminaemia (< 3.5 g/dl) was seen in 92.6% of the patients. Endoscopic findings of AHRU were classified as circumferential ulcer (41.1%), linear or nearly round small ulcer(s) (44.2%), circumferential and small ulcer(s) (7.4%) and Dieulafoy-like ulcer (7.4%). Primary endoscopic haemostatic treatment was performed in 45.3% of cases. Recurrent bleeding occurred in 24.2% of patients. Permanent haemostasis was achieved by secondary endoscopic treatment in 82.6% of re-bleeding patients. Conclusion, Understanding the typical clinical and endoscopic findings and careful endoscopic examination are important for the accurate diagnosis of AHRU, and endoscopic haemostatic therapy may be effective for bleeding patients. [source]

Pseudoxanthoma elasticum with recurrent gastric hemorrhage managed by endoscopic mechanical hemostasis

DIGESTIVE ENDOSCOPY, Issue 2 2004
Hitoshi Nishiyama
A 24-year-old-woman was admitted to our hospital for further examination of recurrent upper gastrointestinal tract hemorrhage. The characteristic xanthomatous papular rash, retinal angioid streaks, and stenosis of cardiac coronary artery confirmed the diagnosis of pseudoxanthoma elasticum. Upper gastrointestinal endoscopy revealed vascular dilation in the gastric body to fornix. The vessel showing conspicuous dilation covered with the discolored mucosa was suspected as the source of the bleeding. The vessel was identified as a dilated vein located in the submucosa by endoscopic ultrasonography and pulsed-wave Doppler ultrasonography. Abdominal angiography demonstrated aneurysmal dilation in the splenic artery, but not in the gastric artery. Endoscopic band ligation was chosen as an initial treatment for the prevention of recurrent bleeding. The procedure seemed to be successful, but rebleeding occurred on the next day, which was again treated with hemostatic clipping. There have been no further episodes of gastrointestinal hemorrhage during the 15-month follow up. [source]

Endoscopic band ligation for postpolypectomy gastric bleeding

DIGESTIVE ENDOSCOPY, Issue 2 2003
RYOSAKU TOMIYAMA
We report a case of a patient in whom endoscopic band ligation was achieved for postpolypectomy gastric bleeding. A 76-year-old man visited our hospital because of anemia. Endoscopy revealed a gastric polyp, approximately 12 mm in diameter, on the lesser curvature in the distal gastric body. The polyp was considered to be the source of chronic anemia and was therefore removed by using standard careful snare-cautery polypectomy technique. Four days later, follow-up endoscopy was performed to evaluate the postpolypectomy site, and an active bleeding postpolypectomy ulcer was identified. Initial attempts to achieve hemostasis with ethanol injection were unsuccessful. Immediate hemostasis was obtained with a subsequent endoscopic band ligation device. There has been no recurrent bleeding. Endoscopic band ligation might be a good treatment modality for the treatment of a postpolypectomy gastric bleeding lesion. [source]

Successful Endoscopic Band Ligation for Treatment of Postpolypectomy Hemorrhage

DIGESTIVE ENDOSCOPY, Issue 4 2000
Yohei Mizuta
We describe a case of large pedunculated tubulovillous adenoma of the stomach associated with postpolypectomy hemorrhage, which was successfully treated by endoscopic band ligation. The case study involved a 60-year-old Japanese woman with a pedunculated polyp with a slightly lobular surface, measuring 25 mm in diameter. It was detected on the posterior wall of the middle body of the gastric remnant. The lesion was diagnosed as a tubulovillous adenoma by a biopsy specimen and treated by endoscopic polypectomy using the detachable snare to prevent postpolypectomy hemorrhage. There was no episode of immediate postpolypectomy hemorrhage, but hematemesis occured 18 h after the excision. Endoscopic examination of the stomach showed the mark left by bleeding on the cutting surface and the absence of the detachable snare. Endoscopic intervention by rubber band ligation was performed to prevent the recurrent bleeding. Complete hemostasis was obtained and no serious complications occured. [source]

Haemosuccus pancreaticus: diagnostic and therapeutic challenges

HPB, Issue 4 2009
Velayutham Vimalraj
Abstract Background:, Haemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal bleeding. The objective of our study was to highlight the challenges in the diagnosis and management of HP. Methods:, The records of 31 patients with HP diagnosed between January 1997 and June 2008 were reviewed retrospectively. Results:, Mean patient age was 34 years (11,55 years). Twelve patients had chronic alcoholic pancreatitis, 16 had tropical pancreatitis, two had acute pancreatitis and one had idiopathic pancreatitis. Selective arterial embolization was attempted in 22 of 26 (84%) patients and was successful in 11 of the 22 (50%). Twenty of 31 (64%) patients required surgery to control bleeding after the failure of arterial embolization in 11 and in an emergent setting in nine patients. Procedures included distal pancreatectomy and splenectomy, central pancreatectomy, intracystic ligation of the blood vessel, and aneurysmal ligation and bypass graft in 11, two, six and one patients, respectively. There were no deaths. Length of follow-up ranged from 6 months to 10 years. Conclusions:, Upper gastrointestinal bleeding in a patient with a history of chronic pancreatitis could be caused by HP. Diagnosis is based on investigations that should be performed in all patients, preferably during a period of active bleeding. These include upper digestive endoscopy, contrast-enhanced computed tomography (CECT) and selective arteriography of the coeliac trunk and superior mesenteric artery. Contrast-enhanced CT had a high positive yield comparable with that of selective angiography in our series. Therapeutic options consist of selective embolization and surgery. Endovascular treatment can control unstable haemodynamics and can be sufficient in some cases. However, in patients with persistent unstable haemodynamics, recurrent bleeding or failed embolization, surgery is required. [source]

Endoscopic band ligation could decrease recurrent bleeding in Mallory,Weiss syndrome as compared to haemostasis by hemoclips plus epinephrine

Helicobacter pylori eradication therapy vs. antisecretory non-eradication therapy for the prevention of recurrent bleeding from peptic ulcer

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2004
J. P. Gisbert
Summary Aim :,To perform a meta-analysis comparing the efficacy of Helicobacter pylori eradication therapy vs. antisecretory non-eradication therapy for the prevention of recurrent bleeding from peptic ulcer. Methods :,A search was made of the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and several congresses for controlled clinical trials comparing the efficacy of H. pylori eradication therapy vs. antisecretory non-eradication therapy for the prevention of peptic ulcer re-bleeding. Studies with all patients taking non-steroidal anti-inflammatory drugs were excluded. Extraction and quality assessment of the studies were performed by two reviewers. Results :,In the first meta-analysis, the mean percentage of re-bleeding in the H. pylori eradication therapy group was 4.5%, compared with 23.7% in the non-eradication therapy group without long-term antisecretory therapy [odds ratio, 0.18; 95% confidence interval (CI), 0.09,0.37; ,number needed to treat' (NNT), 5; 95% CI, 4,8]. In the second meta-analysis, the re-bleeding rate in the H. pylori eradication therapy group was 1.6%, compared with 5.6% in the non-eradication therapy group with maintenance antisecretory therapy (odds ratio, 0.25; 95% CI, 0.08,0.76; NNT, 20; 95% CI, 12,100). When only patients with successful H. pylori eradication were included, the re-bleeding rate was 1%. Conclusions :,The treatment of H. pylori infection is more effective than antisecretory non-eradication therapy (with or without long-term maintenance antisecretory treatment) in the prevention of recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori, and eradication therapy should be prescribed to infected patients. [source]

Cure of gastric antral vascular ectasia by liver transplantation despite persistent portal hypertension: A clue for pathogenesis

LIVER TRANSPLANTATION, Issue 8 2002
Catherine Vincent
Gastric antral vascular ectasia (GAVE) is a rare cause of chronic bleeding in cirrhotic patients. It has been suggested that these gastric lesions might be related to portal hypertension, hepatic insufficiency, or both parameters. We report two cases of cirrhotic patients in whom GAVE was the source of recurrent bleeding. These patients also had complete portal vein thrombosis. Liver transplantation was performed and an end-to-end cavoportal anastomosis was performed, leaving patients with persistent portal hypertension after surgery. We observed complete disappearance of the antral lesions several weeks after transplantation, which shows that the GAVE is not related to portal hypertension but is rather a direct consequence of liver failure. Possible pathophysiologic mechanisms are discussed. [source]

Patients' preferences in the evaluation of postmenopausal bleeding

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2007
A Timmermans
Objective, To assess patients' preferences for diagnostic management of postmenopausal bleeding (PMB). Design, A structured interview. Setting, A teaching hospital with office hysteroscopy facilities. Population, Thirty-nine women with PMB and with a completed work-up including an office hysteroscopy. Methods, A structured interview was taken from 39 women who had had an office hysteroscopy in the diagnostic work-up for PMB. Women were informed about the probability of endometrial carcinoma versus benign disease and about advantages and disadvantages of different diagnostic strategies, i.e. expectant management after ultrasound or complete diagnostic work-up, including invasive procedures. Main outcome measures, Women were informed about the probability of endometrial carcinoma versus benign disease and about advantages and disadvantages of different diagnostic strategies, i.e., expectant management after ultrasound or complete diagnostic work-up including invasive procedures. Women were asked to make a trade-off between different options. Results, Most women wanted to be 100% certain that carcinoma could be ruled out. Only 5% of the women were willing to accept more than 5% risk of false reassurance. If the risk of recurrent bleeding due to benign disease exceeded 25%, the majority of women would prefer immediate diagnosis and treatment of benign lesions. Conclusion, Women with PMB are prepared to undergo hysteroscopy to rule out any risk on cancer. This finding implicates that the measurement of endometrial thickness with transvaginal ultrasound as a first-line test in the assessment of PMB should be reconsidered. [source]

Hyperbaric oxygen therapy for radiation-induced haemorrhagic cystitis

BJU INTERNATIONAL, Issue 1 2005
Amos Neheman
OBJECTIVE To assess the efficacy of hyperbaric oxygen (HBO) for treating haemorrhagic cystitis. PATIENTS AND METHODS From February 1997 to April 2004, seven patients with radiation-induced haemorrhagic cystitis were treated with HBO; they received a mean (range) of 30 (18,57) HBO treatments and the follow-up was 24 (3,53) months. RESULTS The haematuria resolved completely in all seven patients shortly after treatment; one had an improvement but died from complications relating to cancer shortly after completing treatment, and two had recurrence of gross haematuria. They were re-treated with HBO until the haematuria resolved. CONCLUSIONS Radiation-induced haemorrhagic cystitis can be treated successfully with HBO primarily or after failure of standard regimens. This method was well tolerated even in patients debilitated by advanced cancer and blood loss. Long-term remission is possible in most patients, and re-treatment effectively manages recurrent bleeding. [source]

Oral or intravenous proton pump inhibitor in patients with peptic ulcer bleeding after successful endoscopic epinephrine injection

BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 3 2009
Jai-Jen Tsai
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT? , Endoscopic therapy significantly reduces recurrent bleeding, surgery and mortality in patients with bleeding peptic ulcers. , Intravenous (i.v.) proton pump inhibitors (PPIs) have been found to be effective as adjuvant pharmacotherapy in preventing rebleeding in these patients. , It remains undetermined whether oral and i.v. regular-dose PPIs are equally effective. WHAT THIS STUDY ADDS? , Oral rabeprazole and i.v. regular-dose omeprazole are comparable in preventing rebleeding in patients with high-risk bleeding peptic ulcers after successful endoscopic injection with epinephrine. AIMS We aimed to assess the clinical effectiveness of oral vs. intravenous (i.v.) regular-dose proton pump inhibitor (PPI) after endoscopic injection of epinephrine in patients with peptic ulcer bleeding. METHODS Peptic ulcer patients with active bleeding, nonbleeding visible vessels, or adherent clots were enrolled after successful endoscopic haemostasis achieved by epinephrine injection. They were randomized to receive either oral rabeprazole (RAB group, 20 mg twice daily for 3 days) or i.v. omeprazole (OME group, 40 mg i.v. infusion every 12 h for 3 days). Subsequently, the enrolled patients receive oral PPI for 2 months (rabeprazole 20 mg or esomeprazole 40 mg once daily). The primary end-point was recurrent bleeding up to 14 days. The hospital stay, blood transfusion, surgery and mortality within 14 days were compared as well. RESULTS A total of 156 patients were enrolled, with 78 patients randomly allocated in each group. The two groups were well matched for factors affecting the clinical outcomes. Primary end-points (recurrent bleeding up to 14 days) were reached in 12 patients (15.4%) in the OME group and 13 patients (16.7%) in the RAB group [95% confidence interval (CI) of difference ,12.82, 10.22]. All the rebleeding events occurred within 3 days of enrolment. The two groups were not different in hospital stay, volume of blood transfusion, surgery or mortality rate (1.3% of the OME group and 2.6% of the RAB group died, 95% CI of difference ,5.6, 3.0). CONCLUSIONS Oral rabeprazole and i.v. regular-dose omeprazole are equally effective in preventing rebleeding in patients with high-risk bleeding peptic ulcers after successful endoscopic injection with epinephrine. [source]

Doppler guided haemorrhoidal arterial ligation with recto-anal-repair (RAR) for the treatment of advanced haemorrhoidal disease

COLORECTAL DISEASE, Issue 10Online 2010
P. Walega
Abstract Objective, A modification of Doppler guided haemorrhoidal artery ligation (DGHAL) to include the addition of recto-anal repair is reported. Preliminary results of function and safety of third and fourth degree haemorrhoidals are given. Method, Thirty patients underwent DGHAL combined with recto-anal-repair (RAR). Each had rectal examination, anorectal manometry and Quality of Life assessment before and 3 months after the procedure. Results, Twenty-nine patients were included in the final analysis. There were three (10.34%) patients of intra-operative and one (3.45%) of postoperative bleeding. Three months after RAR (17.24%) patients with minor residual mucosal prolapse were detected, three (10.34%) patients reported residual symptoms. There was no case of recurrent bleeding. Anal manometry at 3 months after RAR was significantly lower than before the procedure (P < 0.05). One (3.45%) patient reported occasional soiling 3 months after RAR. Conclusion, Recto-anal-repair is safe in treating third and fourth degree haemorrhoids with no major complications and low rate of residual disease. [source]