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Significant Bleeding (significant + bleeding)
Selected AbstractsAegyptin displays high-affinity for the von Willebrand factor binding site (RGQOGVMGF) in collagen and inhibits carotid thrombus formation in vivoFEBS JOURNAL, Issue 2 2010Eric Calvo Aegyptin is a 30 kDa mosquito salivary gland protein that binds to collagen and inhibits platelet aggregation. We have studied the biophysical properties of aegyptin and its mechanism of action. Light-scattering plot showed that aegyptin has an elongated monomeric form, which explains the apparent molecular mass of 110 kDa estimated by gel-filtration chromatography. Surface plasmon resonance identified the sequence RGQOGVMGF (where O is hydroxyproline) that mediates collagen interaction with von Willebrand factor (vWF) as a high-affinity binding site for aegyptin, with a KD of approximately 5 nm. Additionally, aegyptin interacts with the linear peptide RGQPGVMGF and heat-denatured collagen, indicating that the triple helix and hydroxyproline are not a prerequisite for binding. However, aegyptin does not interact with scrambled RGQPGVMGF peptide. Aegyptin also recognizes the peptides (GPO)10 and GFOGER with low affinity (,m range), which respectively represent glycoprotein VI and integrin ,2,1 binding sites in collagen. Truncated forms of aegyptin were engineered, and the C-terminus fragment was shown to interact with collagen and to attenuate platelet aggregation. In addition, aegyptin prevents laser-induced carotid thrombus formation in the presence of Rose Bengal in vivo, without significant bleeding in rats. In conclusion, aegyptin interacts with distinct binding sites in collagen, and is useful tool to inhibit platelet,collagen interaction in vitro and in vivo. Structured digital abstract ,,MINT-7299280, MINT-7299290: Collagen (uniprotkb:P02461) binds (MI:0407) to Aegyptin (uniprotkb:O01949) by enzyme linked immunosorbent assay (MI:0411) ,,MINT-7298991, MINT-7299153, MINT-7299208: Collagen (uniprotkb:P02452) binds (MI:0407) to Aegyptin (uniprotkb:O01949) by surface plasmon resonance (MI:0107) ,,MINT-7299266: Collagen (uniprotkb:P02452) binds (MI:0407) to Aegyptin (uniprotkb:O01949) by fluorescence microscopy (MI:0416) ,,MINT-7299256: Collagen (uniprotkb:P02452) binds (MI:0407) to Aegyptin (uniprotkb:O01949) by solid phase assay (MI:0892) [source] Diagnosis, clinical features and molecular assessment of the dysfibrinogenaemiasHAEMOPHILIA, Issue 5 2008M. HILL Summary., Hereditary dysfibrinogenaemia is characterized by the presence of functionally abnormal plasma fibrinogen. Dysfibrinogenaemia is a heterogeneous disorder associated with different mutations throughout the three genes that code for the fibrinogen sub-units, affecting many different aspects of fibrinogen/fibrin activity. Dysfibrinogenaemia may be discovered during the investigation of individuals who present with bleeding or thombosis, or may be found in individuals during routine coagulation screening. More specialized coagulation tests may confirm the diagnosis of dysfibrinogenaemia but do not reliably distinguish between the different fibrinogen variants and are not usually useful in predicting bleeding or thrombotic risk. Advances in molecular diagnostics have facilitated the investigation of the molecular causes of fibrinogen disorders. Several ,hot spot' areas have been identified where mutations causing a high proportion of cases of dysfibrinogenaemia are found (A,Arg16 and ,Arg275). Molecular diagnostics have also shown that many fibrinogen variants share the same causative mutation. There is a discrepancy between the quality of the molecular and functional data available for each mutation and the clinical information on individuals and their family members. However, there are accumulating data that the ,hot spot' mutations accounting for 60,80% of cases of dysfibringenaemia are not associated with a significant bleeding or thrombosis in the absence of other risk factors. Rapid screening for these mutations may provide reassurance for patients in the presurgical setting. [source] Application of unsedated transnasal esophagogastroduodenoscopy in the diagnosis of hypopharyngeal cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2009Cheng-Ping Wang MD Abstract Background This study evaluates the efficacy of unsedated transnasal esophagogastroduodenoscopy (EGD) in the diagnosis of hypopharyngeal cancer and screening of esophageal lesions. Methods Twenty-seven patients with newly diagnosed hypopharyngeal cancer were evaluated by transnasal EGD without conscious sedation. Results Twenty-two hypopharyngeal cancers arose from the pyriform sinus, and the other 5 tumors were from the posterior hypopharyngeal wall. Seventeen tumors were classified as T3-T4. Twenty-four hypopharyngeal tumors were pathologically proved malignancy by this technique. Regarding simultaneous esophageal lesions, esophageal dysplasia was noted in 4 patients and esophageal cancer occurred in 6 patients. The procedures were performed without difficulty except in 1 patient with huge posterior wall tumor. The mean procedure time was 22 minutes. All patients tolerated the procedure well, without significant bleeding or respiratory distress during examination. Conclusion Unsedated transnasal EGD is a safe, tolerable, and accurate endoscopic technique for diagnosis of hypopharyngeal cancer and screening of simultaneous esophageal cancer. © 2008 Wiley Periodicals, Inc. Head Neck, 2009 [source] Application of cardiopulmonary bypass for resection of renal cell carcinoma and adrenocortical carcinoma extending into the right atriumINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2006TATSUMASA OCHI Aim:, The application of cardiopulmonary bypass to atrial involvement represents an important advance that has improved the safety and technical efficacy of a difficult surgical undertaking. Our experiences of the management of extended thrombi into the right atrium in patients with retroperitoneal malignancy using a cardiopulmonary bypass were discussed. Methods:, Data were reviewed for five patients (two men and three women; mean age, 60.4 years; range, 49,79 years) with retroperitoneal tumors displaying intracardiac tumor extension. Tumors originated in the right kidney in four patients, and in left adrenal gland in one patient. Cardiopulmonary bypass was used in all cases. Results:, Mean total blood loss was 6059 mL. Mean operative time was 14.7 h. No intra- or postoperative complications due to surgical technique were encountered, and no significant bleeding occurred during incision of the inferior vena cava or after removal of tumor thrombus. The follow-up period ranged from 3 to 20 months with a mean of 12.6 months. Of the five patients, three died of metastatic diseases, one died of liver dysfunction and one remains disease free as of 18 months postoperatively. Conclusions:, Our experience indicates that this procedure can be safely used for atrial involvement. Although superior long-term survival cannot be shown yet, favorable early results and a lack of perioperative complications were identified. [source] Repair of Complete Atrioventricular Septal Defect with Tetralogy of Fallot:JOURNAL OF CARDIAC SURGERY, Issue 2 2004Literature Review, Our Experience Materials and Methods: Between January 1990 and January 2002, 17 consecutive children with CAVSD-TOF underwent complete correction. Nine patients (53%) underwent previous palliation. Mean age at repair was 2.9 ± 1.9 years. Mean gradient across the right ventricular outflow tract was 63 ± 16 mmHg. All children underwent closure of septal defect with a one-patch technique, employing autologous pericardial patch. Maximal tissue was preserved for LAVV reconstruction by making these incisions along the RV aspect of the ventricular septal crest. LAVV annuloplasty was performed in 10 (59%) patients. Six patients (35%) required a transannular patch. Results: Three (17.6%) hospital deaths occurred in this series. Causes of death included progressive heart failure in two patients and multiple organ failure in the other patient. Two patients required mediastinal exploration due to significant bleeding. Dysrhythmias were identified in 4 of 11 patients undergoing a right ventriculotomy versus none of the patients undergoing a transatrial transpulmonary approach (p = ns). The mean intensive care unit stay was 3.2 ± 2.4 days. Two patients required late reoperation due to severe LAVV regurgitation at 8.5 and 21 months, respectively, after the intracardiac complete repair. The mean follow-up time was 36 ± 34 months. All patients survived and are in NYHA functional class I or II. The LAVV regurgitation grade at follow-up was significantly lower than soon after operation, 1.1 ± 0.4 versus 1.7 ± 0.5 (p = 0.002). At follow-up, the mean gradient across the right ventricular outflow tract was 17 ± 6 mmHg, significantly lower than preoperatively (p < 0.001). Conclusions: Complete repair in patients with CAVSD-TOF seems to offer acceptable early and mid-term outcome in terms of mortality, morbidity, and reoperation rate. Palliation prior to complete repair may be reserved in specific cases presenting small pulmonary arteries or severely cyanotic neonates. The RVOT should be managed in the same fashion as for isolated TOF; however, a transatrial transpulmonary approach is our approach of choice. (J Card Surg 2004;19:175-183) [source] Transatrial Access to the Normal Pericardial Space For Local Cardiac Therapy: Preclinical Safety Testing with Aspirin and Pulmonary Artery HypertensionJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2001TODD C. PULERWITZ M.D. The reliability, rapidity, and safety of nonsurgical, transatrial pericardial access for local cardiac therapy have been demonstrated in healthy animals. Since many patients take aspirin or have increased right-sided pressures, we evaluated the procedure's safety under these conditions. Transatrial pericardial access was performed in anesthetized pigs following aspirin administration (162 mg po, n = 6) or during experimental pulmonary artery hypertension (n = 4 different animals) and required only 3 minutes following guide catheter positioning. Platelet aggregability testing with arachidonic acid confirmed aspirin effectiveness. Mean pericardial fluid hematocrit was 0.1 ± 0.1% after 2 days of aspirin therapy and 1.9 ± 1.1% at sacrifice 24 hours later (NS). Mean pericardial fluid hematocrit was 1.0 ± 0.5% after 45 minutes of pulmonary artery hypertension and 4.3 ± 0.8% at sacrifice 30 minutes later (NS). Histologic analysis in both groups revealed a small thrombus and localized inflammation at the site of puncture. Neither aspirin use nor pulmonary artery hypertension causes significant bleeding into the pericardial space following transatrial access and thus does not preclude this route for local cardiac drug delivery. [source] The effects of supraphysiological doses of corticosteroids in hypotensive liver failureLIVER INTERNATIONAL, Issue 2 2003Rachael Harry Abstract: Background: In septic shock, supraphysiological doses of corticosteroids reduce norepinephrine requirements. We reviewed our experience of this treatment in hypotensive liver failure. Methods: We retrospectively analysed 20 patients with liver failure who were treated with supraphysiological doses of hydrocortisone because of norepinephrine dependence. We compared their norepinephrine requirements, outcome, microbiology and incidence of gastrointestinal bleeding to an historical control group treated with norepinephrine but not corticosteroids. Results: After 48 h of steroid treatment, the median norepinephrine dose was reduced (0.14 µg/kg/min to 0.08 µg/kg/min; P < 0.05) while the blood pressure over the same period of time did not change significantly (67.3 mm Hg to 70 mm Hg). Duration of ITU stay was longer in the steroid treated group (13.5 days vs 3 days; P < 0.05) but survival was similar in both groups. There were 23 episodes of positive bacterial cultures after norepinephrine was started in the steroid treated group, compared with 18 episodes in the control group. More of the positive cultures were due to resistant organisms in the steroid treated group (65% vs 17% in the control group; P < 0.002). There was no significant bleeding due to gastrointestinal inflammation in either group. Conclusions: Supraphysiological doses of corticosteroids reduce norepinephrine requirements in hypotensive liver failure. They do not improve survival but may extend time to find a suitable donor in those awaiting urgent liver transplantation. [source] The feasibility of pain treatment at home after adenoidectomy with ketoprofen tablets in small childrenPEDIATRIC ANESTHESIA, Issue 5 2000Hannu Kokki MD In this study, we investigated the feasibility of pain treatment using ketoprofen 25 mg tablets (5 mg·kg,1·day,1) at home in children after daycase adenoidectomy. We also determined the adverse events and the incidence of postoperative bleeding during the first week after surgery. Initially, we studied 611 children aged 1,9 years. The study design was prospective, longitudinal, and open. The final data consisted of 555 (91%) children, and 522 children who received ketoprofen at home. The parents administered four (1,10, median with 10th and 90th percentiles) ketoprofen tablets to their children during the first week. A total of 20% of the parents experienced problems in administering tablets, and problems were three times more common in children under 48 months compared to older children. The main problems were swallowing difficulties and the unpleasant taste of the tablet. Neither serious adverse events, nor clinically significant bleeding occurred. Ketoprofen at the dose of 5 mg·kg,1·day,1 proved to be a safe analgesic in children for short-term use after adenoidectomy. [source] Lateral Thyrotomy for Excision of Laryngeal ParagangliomasTHE LARYNGOSCOPE, Issue 1 2006Seth M. Brown MD Abstract Laryngeal paragangliomas, although rare, are lesions that warrant appropriate diagnosis and treatment secondary to their location and high risk of bleeding when violated. This article describes a method to workup patients with solid submucosal lesions of the larynx to diagnose a paraganglioma without a biopsy. When recognized preoperatively, a lateral approach to removal can be performed, decreasing the risk of significant bleeding and the need for tracheotomy or permanent laryngostoma. This article also adds two more cases to the reported literature of 75. [source] | ||||||||||