[Acute cytomegalovirus infection-associated hemophagocytic syndrome in a patient treated with azathioprine]. / Azathioprin adása mellett kialakult haemophagocytosis szindrómával szövodött akut cytomegalovirus-fertozés.

The authors present the case of a 21-year-old woman with ulcerative colitis. Azathioprine treatment was complicated with pancytopenia and septic shock. Acute cytomegalovirus infection related to the immunosuppressive therapy, resulting in hemophagocytosis syndrome and neutropenic fever was diagnosed. Recovery was achieved by the administration of parenteral ganciclovir, broad spectrum antibiotic and complex intensive care.

Pantoprazole before Endoscopy in Patients with Gastroduodenal Ulcer Bleeding: Does the duration of Infusion and Ulcer Location Influence the Effects?

The aim of this study was to investigate the effect of preemptive pantoprazole infusion on early endoscopic findings in patients with acute ulcer bleeding. Records of 333 patients admitted with acute ulcer bleeding were analyzed. Ulcer bleeders were given either 80 mg bolus of pantoprazole followed by continuous infusion of 8 mg per hour or saline infusion until endoscopy. In 93 patients saline infusion whereas in 240 patients bolus plus infusion of pantoprazole was administrated with mean (±SD) durations of 5.45 ± 12.9 hours and 6.9 ± 13.2 hours, respectively (P = 0.29). Actively bleeding ulcers were detected in 46/240 (19.2%) of cases in the pantoprazole group as compared with 23/93 (24.7%) in the saline infusion group (P = 0.26). Different durations of pantoprazole infusion (0-4 hours, >4 hours, and >6 hours) had no significant effect on endoscopic and clinical outcome parameters in duodenal ulcer bleeders. Gastric ulcer bleeders on pantoprazole infusion longer than 4 and 6 hours before endoscopy had actively bleeding ulcers in 4.3% and 5% compared to the 19.5% active bleeding rate in the saline group (P = 0.02 and P = 0.04). Preemptive infusion of high-dose pantoprazole longer than 4 hours before endoscopy decreased the ratio of active bleeding only in gastric but not in duodenal ulcer patients.

Management of peptic ulcer bleeding in different case volume workplaces: results of a nationwide inquiry in hungary.

The aim of this study was to conduct a national survey to evaluate the recent endoscopic treatment and drug therapy of peptic ulcer bleeding (PUB) patients and to compare practices in high and low case volume Hungarian workplaces. A total of 62 gastroenterology units participated in the six-month study. A total of 3033 PUB cases and a mean of 8.15 ± 3.9 PUB cases per month per unit were reported. In the 23 high case volume units (HCV), there was a mean of 12.9 ± 5.4 PUB cases/month, whereas in the 39 low case volume units (LCV), a mean of 5.3 ± 2.9 PUB cases/month were treated during the study period. In HCV units, endoscopic therapies for Forrest Ia, Ib, and IIa ulcers were significantly more often used than in LCV units (86% versus 68%; P = 0.001). Among patients with stigmata of recent haemorrhage (Forrest I, II), bolus + continuous infusion PPI was given significantly more frequently in HCV than in LCV units (49.6% versus 33.2%; P = 0.001). Mortality in HCV units was less than in LCV units (2.7% versus 4.3%; P = 0.023). The penetration of evidence-based recommendations for PUB management is stronger in HCV units resulting lower mortality.

[The value of routine second-look endoscopy in the management of acute gastroduodenal ulcer bleeding]. / A tervezett ellenôrzô endoszkópia értéke az akut gastroduodenalis fekélyvérzés ellátásában.

UNLABELLED: The role of routine second-look endoscopy in the management of patients with acute peptic ulcer bleeding is controversial. A more precise identification of higher risk patient group, based on both clinical and endoscopic criteria, is needed to determine whether there are high-risk patients who may benefit from this management strategy. AIM: Or aim was to find out whether scheduled second-look endoscopy has any beneficial effect in the clinical outcome. METHODS: Both endoscopic and clinical data were analyzed in 274 acute gastroduodenal ulcer bleeding patients. The need for repeated endoscopic haemostatic intervention was used as a measure to evaluate the potential beneficial effect of the second look endoscopy. Patients were categorized according to the Forrest classification detected during the emergency endoscopy. RESULTS: In the subgroup of actively bleeding patients (Forrest Ia, Ib) a second endoscopic haemostasis was performed in 23.8% of cases. In the patient subgroup with visible vessel ulcers (Forrest IIa) and in those with adherent clot covered ulcers (Forrest IIb) the needs for a repeated haemostasis were 13.0% and 13.3% respectively. Despite the not statistically significant differences, remarkable clinical impact was noted favoring scheduled second look endoscopy in patients with initially active ulcer bleeding. CONCLUSION: In the light of the retrospective study results it may be concluded that the scheduled second look endoscopy strategy offers a beneficial clinical outcome for selected patients estimated to be a very high risk of re-bleeding following the initial endoscopic therapy for active bleeding.

[Treatment of extra-esophageal variceal bleeding with cyanoacrylate]. / Extraoesophagealis varixvérzés kezelése cyanoacrylattal.

BACKGROUND AND AIMS: Endoscopic obliteration of bleeding extra-esophageal varices using N-butyl-2-cyanoacrylate (Histoacryl) has been validated by several authors. The aim of the present paper is to describe the intravariceal injection technique using cyanoacrylate and to present the own results and complications observed in conjunction with the haemostatic treatment. PATIENTS AND METHODS: A total of 11 intravariceal injection treatments of N-butil-2-cyanoacrylate were performed in 8 patients (3 males, 5 females, mean age 65.5 years) with extra-esophageal variceal bleeding. In 7 cases the bleeding varices were located in the gastric fundus and in one case the varix was found in the duodenum. Variceal bleeders under subintensive care were treated early electively with 1:1 ratio cyanoacrylate-lipiodol intravariceal injection solutions. The injection needle was inserted trough a standard endoscope. RESULTS: Early haemostasis was achieved in all patients (11/11) and no early rebleeding occurred. In one case because of repeated episodes of late recurrent bleedings 3 more injection treatments were performed. In another case several hours after the injection a transitional cerebral ischemic attack developed. Injection needle sticking occurred during one treatment. There was no mortality due to acute bleeding while two patients died because of hepatic failure during the follow up period. CONCLUSIONS: Endoscopic injection of diluted cyanoacrylate and lipiodol appears to be an effective and safe treatment method of the extra-esophageal variceal bleeding. Injection treatment in an early elective fashion can be performed with the standard sclerotherapy equipment.