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1.
Pan Afr Med J ; 33: 113, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489091

RESUMO

Meckel's diverticulum (MD) is a remnant of omphalomesenteric channel. It is often asymptomatic but it can be responsible for various clinical complications and variable clinical status especially in children. We conducted a retrospective study on complications of MD among children hospitalized in the division of Paediatric Surgery at the University Hospital Hassan II, Fez, Morocco. The study aimed to describe the clinical, radiological and therapeutic features of MD. The study was conducted over a period of 10 years (January 2009 - December 2018) and involved 18 children (15 boys and 3 girls) aged 1 day - 15 years (with an average age of 5 years) who had undergone surgery for complications of MD. Acute intussusception and intestinal occlusion were the most frequent complications. Other complications included: infection of the MD (1 case) and digestive hemorrhage (2 cases). Two rare types of neonatal Meckel's diverticulum were described (neonatal occlusion and fistula associated with omphalocele). In no case, abdominal X-ray without treatment, ultrasound and CT scan showed MD. Scintigraphy was performed in 2 patients with hematochezia and it helped to make the diagnosis of MD in one case. Three patients underwent laparoscopic surgery with resection of the MD and intestinal anastomosis with laparoscopy. The other patients underwent laparotomy. Ileostomy was performed in one case, followed by secondary recovery. Patient's outcome was good, except for one case of anastomotic leakage. Anatomopathological examination showed two cases of heterotopia.


Assuntos
Anastomose Cirúrgica/métodos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparoscopia/métodos , Divertículo Ileal/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Lactente , Recém-Nascido , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intussuscepção/epidemiologia , Intussuscepção/etiologia , Intussuscepção/cirurgia , Laparotomia/métodos , Masculino , Divertículo Ileal/diagnóstico , Divertículo Ileal/cirurgia , Marrocos , Estudos Retrospectivos
3.
Medicine (Baltimore) ; 98(28): e16312, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305417

RESUMO

Gastrointestinal bleeding (GIB) is a common complication that occurs after stroke, and GIB may negatively affect patient prognosis. In this study, we aimed to examine:(1) the risk factors of GIB in acute cerebral infarction patients;(2) association between GIB and 1-year mortality in patients with acute cerebral infarction.Patients with acute cerebral infarction were divided into 2 groups based on the occurrence of GIB during acute stroke stage. Patient characteristics, clinical presentation, stroke risk factors, comorbidities, laboratory data, medication, and outcomes were investigated to analyze the associations between the variables and the probability of having GIB. In addition, patients in the study were matched individually by age, gender. A 1:1 matched case-control method and conditional logistic regression models for single and multiple factors were used to assess the risk factors of GIB in acute cerebral infarction patients.Clinical data of patients with acute cerebral infarction were reviewed and analyzed during the years 2015 and 2016. Finally, 1662 patients with acute cerebral infarction were included in this study, of whom 139 (8.5%) patients had GIB at admission. Multivariate logistic regression analysis revealed that the independent risk factors for GIB in patients with acute cerebral infarction were advanced age (OR = 1.030, P = .009), low Glasgow Coma Scale (GSC) score (OR = 0.850, P = .014), infection (OR = 4.693, P < .001), high NIHSS score (OR = 1.114, P = .001), and posterior circulation infarction (OR = 4.981, P = .010). The case-control study ultimately included 136 case-control pairs. Stepwise conditional regression analyses revealed that the independent risk factors for GIB in patients with acute cerebral infarction were low Glasgow Coma Scale (GSC) score (RR = 0.645, P = .011), infection (RR = 15.326, P = .001), and posterior circulation infarction (RR = 6.129, P = .045). The group with GIB had a higher rate of mortality and disability level (mRS grade ≥ 4) than the group without GIB (P < .001) within 1 year after stroke. In addition, independent risk factors of death within 1 year after stroke in patients were GIB (OR = 6.096, P < .001), infection (OR = 4.493, P < .001), mRS grade ≥ 4 (OR = 4.129, P < .001), and coronary heart disease (OR = 3.718, P = .001).GIB is a common complication after ischemic stroke. These identified factors may help clinicians identify risks of GIB before it develops. GIB is associated with increased risk of 1-year mortality and poor functional outcome in acute cerebral infarction patients.


Assuntos
Isquemia Encefálica/epidemiologia , Hemorragia Gastrointestinal/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Isquemia Encefálica/complicações , Estudos de Casos e Controles , Avaliação da Deficiência , Feminino , Hemorragia Gastrointestinal/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações
4.
Khirurgiia (Mosk) ; (5): 31-37, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31169816

RESUMO

AIM: To identify risk factors of adverse outcomes in patients with nonvariceal upper gastrointestinal bleeding. MATERIAL AND METHODS: Epidemiological observational analytical longitudinal retrospective cohort study included 312 patients who were hospitalized in the Clinical Hospital #40 of Yekaterinburg in 2014-2016. The main inclusion criterion was nonvariceal upper gastrointestinal bleeding. RESULTS: In-hospital mortality was 31 (9.9%) of 312 patients. Multivariate analysis confirmed the following risk factors of mortality: severity of blood loss (OR 22.70, 95% CI 5.08-102.00); open surgery (OR 15.20, 95% CI 2.71-74.80); M. Charlson comorbidity index (OR 2.15, 95% CI 1.34-3.43); risk of recurrent bleeding according to T. Rockall scale (OR 1.76, 95% CI 1.18-2.64). CONCLUSION: Independent risk factors of adverse outcomes in patients with nonvariceal upper gastrointestinal bleeding are severe hemorrhagic shock, open surgery, high M. Charlson comorbidity index and risk of recurrent bleeding according to T. Rockall scale.


Assuntos
Hemorragia Gastrointestinal/epidemiologia , Comorbidade , Varizes Esofágicas e Gástricas/epidemiologia , Hemorragia Gastrointestinal/mortalidade , Mortalidade Hospitalar , Humanos , Estudos Longitudinais , Recidiva , Estudos Retrospectivos , Fatores de Risco , Federação Russa/epidemiologia , Prevenção Secundária/estatística & dados numéricos , Choque Hemorrágico/epidemiologia , Choque Hemorrágico/mortalidade
5.
J Card Surg ; 34(6): 453-462, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31058372

RESUMO

BACKGROUND: This study explores novel preimplantation risk factors associated with gastrointestinal bleeding (GIB) after continuous-flow left ventricular assist device (CF-LVAD) implantation. CF-LVAD therapy implantation for patients with advanced heart failure is associated with a 20% to 40% incidence of GIB. METHODS: This study includes patients receiving CF-LVAD at a quaternary medical center from 2006 to 2014 (n = 254). The primary endpoint was GIB within 12 months after implantation; the secondary outcome was 3-year all-cause mortality. The Student t test or the χ2 test compared continuous or categorical variables. Competing risks analysis calculated the cumulative incidence of GIB postimplantation. Cox proportional hazards model was used for univariate/multivariate models predicting GIB. RESULTS: Sixty-four patients had GIB, with incidence rates at 1, 3, and 12 months of 11.8%, 19.3%, and 25.2%, respectively. Endoscopy revealed no identified source of bleeding in 41%; 33% of lesions were localized in the upper gastrointestinal tract, with the bulk (39%) categorized as vascular. Patients with prior gastrointestinal abnormalities (n = 98) had a greater risk of GIB post-CF-LVAD (HR 1.85 [1.11-3.09]; P = 0.02) than those with normal gastrointestinal evaluation results (n = 45) and those without preimplantation gastrointestinal evaluation (n = 111). Baseline blood urea nitrogen, chronic obstructive pulmonary disease, and prior percutaneous coronary intervention were statistically associated with post-CF-LVAD GIB. The presence of GIB within 12 months of CF-LVAD implantation was associated with an increased risk of 3-year all-cause mortality (HR 2.57 [1.57-4.15]; P < 0.01). CONCLUSIONS: First-year GIB is associated with increased mortality post-CF-LVAD. We advocate a closer examination of several GIB risk factors when evaluating CF-LVAD candidates.


Assuntos
Hemorragia Gastrointestinal/etiologia , Insuficiência Cardíaca/terapia , Coração Auxiliar/efeitos adversos , Idoso , Nitrogênio da Ureia Sanguínea , Feminino , Hemorragia Gastrointestinal/epidemiologia , Insuficiência Cardíaca/mortalidade , Ventrículos do Coração , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Doença Pulmonar Obstrutiva Crônica , Fatores de Risco , Fatores de Tempo
6.
Gastroenterology ; 157(2): 403-412.e5, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31054846

RESUMO

BACKGROUND & AIMS: Antiplatelets and anticoagulants are associated with increased upper gastrointestinal bleeding. We evaluated whether proton pump inhibitor therapy could reduce this risk. METHODS: We performed a 3 × 2 partial factorial double-blind trial of 17,598 participants with stable cardiovascular disease and peripheral artery disease. Participants were randomly assigned to groups given pantoprazole 40 mg daily or placebo, as well as rivaroxaban 2.5 mg twice daily with aspirin 100 mg once daily, rivaroxaban 5 mg twice daily, or aspirin 100 mg alone. The primary outcome was time to first upper gastrointestinal event, defined as a composite of overt bleeding, upper gastrointestinal bleeding from a gastroduodenal lesion or of unknown origin, occult bleeding, symptomatic gastroduodenal ulcer or ≥5 erosions, upper gastrointestinal obstruction, or perforation. RESULTS: There was no significant difference in upper gastrointestinal events between the pantoprazole group (102 of 8791 events) and the placebo group (116 of 8807 events) (hazard ratio, 0.88; 95% confidence interval [CI], 0.67-1.15). Pantoprazole significantly reduced bleeding of gastroduodenal lesions (hazard ratio, 0.52; 95% confidence interval, 0.28-0.94; P = .03); this reduction was greater when we used a post-hoc definition of bleeding gastroduodenal lesion (hazard ratio, 0.45; 95% confidence interval, 0.27-0.74), although the number needed to treat still was high (n = 982; 95% confidence interval, 609-2528). CONCLUSIONS: In a randomized placebo-controlled trial, we found that routine use of proton pump inhibitors in patients receiving low-dose anticoagulation and/or aspirin for stable cardiovascular disease does not reduce upper gastrointestinal events, but may reduce bleeding from gastroduodenal lesions. ClinicalTrials.gov ID: NCT01776424.


Assuntos
Anticoagulantes/efeitos adversos , Doenças Cardiovasculares/prevenção & controle , Hemorragia Gastrointestinal/prevenção & controle , Pantoprazol/administração & dosagem , Úlcera Péptica/prevenção & controle , Inibidores da Bomba de Prótons/administração & dosagem , Administração Oral , Idoso , Anticoagulantes/administração & dosagem , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/métodos , Feminino , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/induzido quimicamente , Úlcera Péptica/epidemiologia , Rivaroxabana/administração & dosagem , Rivaroxabana/efeitos adversos , Resultado do Tratamento
7.
World J Gastroenterol ; 25(18): 2251-2263, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31143075

RESUMO

BACKGROUND: The role of prophylactic clipping for the prevention of delayed polypectomy bleeding (DPB) remains unclear and conclusions from prior meta-analyses are limited due to the inclusion of variety of resection techniques and polyp sizes. AIM: To conduct a meta-analysis on the effect of clipping on DPB following endoscopic mucosal resection (EMR) of colorectal lesions ≥ 20 mm. METHODS: We performed a search of PubMed and the Cochrane library for studies comparing the effect of clipping vs no clipping on DPB following endoscopic resection. The Cochran Q test and I 2 were used to test for heterogeneity. Pooling was conducted using a random-effects model. RESULTS: Thirteen studies with a total of 7794 polyps were identified, of which data was available on 1701 cases of EMR of lesions ≥ 20 mm. Prophylactic clipping was associated with a lower rate of DPB (1.4%) when compared to no clipping (5.2%) (pooled OR: 0.24, 95%CI: 0.12-0.50, P < 0.001) following EMR of lesions ≥ 20 mm. There was no significant heterogeneity among the studies (I 2 = 0%, P = 0.67). CONLUSION: Prophylactic clipping may reduce DPB following EMR of large colorectal lesions. Future trials are needed to further identify risk factors and stratify high risk cases in order to implement a cost-effective preventive strategy.


Assuntos
Pólipos do Colo/cirurgia , Colonoscopia/métodos , Ressecção Endoscópica de Mucosa/métodos , Hemorragia Gastrointestinal/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Colonoscopia/efeitos adversos , Colonoscopia/instrumentação , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/instrumentação , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Incidência , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Fatores de Tempo
8.
J Coll Physicians Surg Pak ; 29(5): 414-417, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31036108

RESUMO

OBJECTIVE: To compare efficiency of trans-arterial chemo-embolization (TACE) plus high intensity focused ultrasound (HIFU), and TACE alone on patients with primary liver cancer. STUDY DESIGN: A descriptive, analytical study. PLACE AND DURATION OF STUDY: Department of Ultrasound, Daqing Oilfield General Hospital, China, from March 2015 to March 2017. METHODOLOGY: A total of 90 primary liver cancer patients were randomly divided into control group and observation group, 45 cases in each group. Control group was treated with TACE alone, while observation group was treated with HIFU plus TACE. Alpha-fetoprotein (AFP), alanine amino-transferase (ALT), aspartate amino-transferase (AST), total bilirubin (TBIL), and frequency of complications, were compared in the two groups. RESULTS: The total remission rate of observation group was higher than that of control group (p=0.017). At 6 months after treatment, AFP level in observation group was lower than that in control group (p <0.001). There was no statistical difference in liver function indicators of ALT, AST, and TBIL between two groups (p=0.968, 0.944 and 0.973, respectively). The incidence of digestive tract hemorrhage was lower than that in control group (p=0.049). After one year of follow-up, the tumor recurrence rate and tumor metastasis rate in observation group were lower than that of control group (p=0.036 and 0.044, respectively). CONCLUSION: Treatment of primary liver cancer by TACE plus HIFU has a higher overall remission rate, causes little damage to normal liver tissue, can fully kill tumor cells and reduce postoperative local recurrence and metastasis rate with less adverse reactions.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Ablação por Ultrassom Focalizado de Alta Intensidade , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/patologia , Terapia Combinada/métodos , Feminino , Hemorragia Gastrointestinal/epidemiologia , Humanos , Incidência , Neoplasias Hepáticas/patologia , Masculino , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Ultrassonografia/métodos
10.
Can J Gastroenterol Hepatol ; 2019: 1808797, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30881946

RESUMO

Non-cirrhotic portal hypertension (NCPH) comprises a heterogeneous group of liver disorders causing portal hypertension without cirrhosis and carries a high risk of variceal bleeding. Recent guidelines, based largely on patients with viral cirrhosis, suggest low likelihood of high risk varices (HRV) in patients with a liver stiffness measurement (LSM) <20 kPa and platelet count >150 × 109/L. In NCPH, LSM is often higher than healthy controls but lower than matched cirrhotic patients. The aim of this study was to assess whether LSM or other noninvasive assessments of portal hypertension could predict HRV in NCPH patients. Methods. Records of patients with NCPH seen at a single centre between 2007 and 2018 were reviewed retrospectively. Primary outcome measure was presence or absence of HRV at gastroscopy within 12 months of clinical assessment. Association of LSM or other clinical features of portal hypertension (spleen size, platelet count, platelet count/spleen length ratio (PSL), LSM-spleen length/platelet count ratio score (LSP)) with HRV and ability of these variables to predict HRV was analysed. Results. Of 44 patients with NCPH who met inclusion criteria, 34% (15/44) had HRV. In a multivariate model, spleen size and PSL correlated with HRV but platelet count, LSM, and LSP did not (spleen size: ß = 0.35, p = 0.02; OR 1.42, 95% CI 1.06-1.92; PSL: ß = -1.47, p = 0.02; OR 0.23, 95% CI 0.07-0.80). There was no significant difference between spleen size and PSL in predicting HRV (AUROC 0.81 (95% CI 0.66 - 0.91) versus 0.71 (95% CI 0.54 - 0.84), respectively, p = 0.400). Spleen size >17.2cm had sensitivity 78.6% and specificity 64.3% for prediction of HRV. Conclusions. In NCPH patients, spleen size may predict risk of HRV at gastroscopy within 12 months. LSM and platelet count are not useful to assess risk of HRV in NCPH.


Assuntos
Varizes Esofágicas e Gástricas/epidemiologia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/epidemiologia , Gastroscopia/métodos , Hipertensão Portal/complicações , Adulto , Idoso , Técnicas de Imagem por Elasticidade , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/etiologia , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Tamanho do Órgão , Contagem de Plaquetas , Estudos Retrospectivos , Sensibilidade e Especificidade , Baço/patologia
11.
Magy Seb ; 72(1): 3-7, 2019 Mar.
Artigo em Húngaro | MEDLINE | ID: mdl-30869534

RESUMO

INTRODUCTION: Despite significant development in surgical and intensive therapy, esophageal perforation is still a severe, life-threatening condition. Successful therapy depends on several clinical factors, available medical equipments, but most of all on the available expertise and experience. PATIENTS AND METHODS: We retrospectively evaluated patients' data operated at the 1st Department of Surgery at Semmelweis University between 2005 and 2017 due to esophageal perforation of non-malignant origin. RESULTS: During the period above 77 patients were treated. All of them were referred to us from an external institute. 15 patients (19%) arrived in shock. The patients developed perforation in 29 cases spontaneously (38%), in 32 cases (41%) during endoscopy, in 12 cases (16%) due to food bolus impaction, and in 4 cases (5%) following balloon tamponade of esophageal variceal bleeding. Patients were sent to our clinic 2.7 days after the presentation of the symptoms. In 2 patients (2%) drainage, in 6 patients (8%) suture, in 8 patients (12%) funduplication, in 19 patients (28%) esophageal exclusion, and in 33 patients (50%) total esophageal extirpation had to be done. 27 patients (35%) died. Discussion, conclusion: Surgical treatment of esophageal injuries is basically influenced by two factors: observation time before surgery and the presence of sepsis symptoms. We have to perform radical surgery basically due to delay. Waste of time is caused by the non-uniform diagnostic strategy and the delay in the true diagnosis.


Assuntos
Perfuração Esofágica/diagnóstico , Perfuração Esofágica/cirurgia , Esôfago/cirurgia , Adolescente , Adulto , Drenagem , Endoscopia , Perfuração Esofágica/etiologia , Perfuração Esofágica/mortalidade , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/epidemiologia , Esofagectomia/métodos , Feminino , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/epidemiologia , Humanos , Hungria/epidemiologia , Masculino , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
12.
Int J Radiat Oncol Biol Phys ; 104(3): 622-630, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30853423

RESUMO

PURPOSE: There is limited long-term data on outcome and side effects of Cs-131 prostate brachytherapy and minimal patient-reported data on rectal bleeding with any isotope. We aimed to describe the incidence, prevalence, and predictors of late patient-reported rectal bleeding after Cs-131 brachytherapy. METHODS AND MATERIALS: We reviewed a prospectively collected database of 620 men treated with Cs-131 prostate brachytherapy. Of 620 patients, 390 (62.9%) received brachytherapy as monotherapy; the remainder received combination therapy with external beam radiation therapy (EBRT). Patients were administered Expanded Prostate Cancer Index Composite questionnaires preoperatively and postoperatively at each follow-up visit. The primary outcome was late rectal bleeding, defined as rectal bleeding reported at the 6-month follow-up or later. Clinically significant rectal bleeding was defined as occurring more than "rarely," and clinically significant bother from rectal bleeding was defined as considering bleeding more than a "very small problem." Univariate and multivariate Cox regression were performed to identify factors predictive for rectal bleeding. RESULTS: With a median follow-up time of 48 months, the cumulative incidence of clinically significant late rectal bleeding was 12.4%, with 15.2% reporting clinically significant bother from bleeding. At the time of last follow-up, the prevalence of clinically significant rectal bleeding and bother were 4.0% and 4.7%, respectively. On univariate analysis, acute clinically significant rectal bleeding, defined as occurring within the first 6 months (P = .001) and combination therapy with EBRT (P = .001) predicted for clinically significant late rectal bleeding. On multivariate analysis, both EBRT (P = .001; hazard ratio, 2.50; 95% confidence interval, 1.58-3.94) and acute rectal bleeding (P < .001; hazard ratio, 3.11; 95% confidence interval, 1.75-5.53) remained significant predictors for late rectal bleeding. CONCLUSIONS: Prostate brachytherapy with Cs-131 is well tolerated in the long term. Although the incidence of clinically significant patient-reported late rectal bleeding was 12.4%, the prevalence at last follow-up was only 4.0%, suggesting that this problem tends to resolve.


Assuntos
Braquiterapia/efeitos adversos , Radioisótopos de Césio/efeitos adversos , Hemorragia Gastrointestinal/epidemiologia , Qualidade de Vida , Reto , Idoso , Idoso de 80 Anos ou mais , Braquiterapia/métodos , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Prevalência , Estudos Prospectivos , Reto/efeitos da radiação , Análise de Regressão , Fatores de Tempo
13.
World J Gastroenterol ; 25(4): 457-468, 2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-30700942

RESUMO

BACKGROUND: Endoscopic submucosal dissection (ESD) for gastric neoplasms during continuous low-dose aspirin (LDA) administration is generally acceptable according to recent guidelines. This retrospective study aimed to investigate the effect of continuous LDA on the postoperative bleeding after gastric ESD in patients receiving dual antiplatelet therapy (DAPT). AIM: To investigate the feasibility of gastric ESD with continuous LDA in patients with DAPT. METHODS: A total of 597 patients with gastric neoplasms treated with ESD between January 2010 and June 2017 were enrolled. The patients were categorized according to type of antiplatelet therapy (APT). RESULTS: The postoperative bleeding rate was 6.9% (41/597) in all patients. Patients were divided into the following two groups: no APT (n = 443) and APT (n = 154). APT included single-LDA (n = 95) and DAPT (LDA plus clopidogrel, n = 59) subgroups. In the single-LDA and DAPT subgroups, 56 and 39 patients were received continuous LDA, respectively. The bleeding rate with continuous single-LDA (10.7%) was similar to that with discontinuous single-LDA (10.3%) (P > 0.99). Although the bleeding rate with continuous LDA in patients receiving DAPT (23.1%) was higher than that with discontinuous LDA in patients receiving DAPT (5.0%), no significant difference was observed (P = 0.141). CONCLUSION: The bleeding rate with continuous LDA in patients receiving DAPT was not statistically different from that with discontinuous LDA in patients receiving DAPT. Therefore, continuous LDA administration may be acceptable for ESD in patients receiving DAPT, although patients should be carefully monitored for possible bleeding.


Assuntos
Ressecção Endoscópica de Mucosa/efeitos adversos , Hemorragia Gastrointestinal/epidemiologia , Inibidores da Agregação de Plaquetas/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Neoplasias Gástricas/cirurgia , Trombose/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Clopidogrel/administração & dosagem , Clopidogrel/efeitos adversos , Ressecção Endoscópica de Mucosa/métodos , Estudos de Viabilidade , Feminino , Mucosa Gástrica/irrigação sanguínea , Mucosa Gástrica/patologia , Mucosa Gástrica/cirurgia , Hemorragia Gastrointestinal/etiologia , Gastroscopia/efeitos adversos , Gastroscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/normas , Hemorragia Pós-Operatória/etiologia , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/patologia , Resultado do Tratamento
14.
Expert Rev Gastroenterol Hepatol ; 13(3): 263-269, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30791764

RESUMO

BACKGROUND: Upper gastrointestinal hemorrhage (UGH) is a life-threatening complication in patients with cirrhosis; however, data regarding the role of UGH in acute-on-chronic liver failure (ACLF) are limited. METHODS: A prospective, observational cohort study was performed from February 2014 to Mach 2015. RESULTS: UGH was identified in 170 of 492 cirrhotic patients with acute decompensation (AD) at the time of admission. Logistic regression analysis showed that fecal occult blood test positivity was an independent risk factor for UGH in patients with or without ACLF [OR(95%CI): 8.31(4.89-14.10), p < 0.001; and 6.29 (1.48-26.76), p = 0.031]. Other independent risk factors were a history of gastrointestinal bleeding [OR(95% CI): 13.43 (7.17-25.15), p < 0.001], older age [OR(95% CI): 0.98(0.96-0.99), p = 0.003], greater INR level [OR(95% CI): 0.48(0.28-0.81), p = 0.007] in patients without ACLF. Multivariate Cox proportional hazard model analysis indicated that UGH did not increase mortality at different times in cirrhotic patients with acute decompensation. CONCLUSIONS: UGH is a frequent complication in cirrhotic patients with AD, even those with ACLF. Positive fecal occult blood tests and previous GI bleeding were shown to be associated with the risk of UGH. UGH did not significantly increase the risk of mortality in cirrhotic patients with AD or ACLF.


Assuntos
Insuficiência Hepática Crônica Agudizada/epidemiologia , Hemorragia Gastrointestinal/epidemiologia , Cirrose Hepática/epidemiologia , Insuficiência Hepática Crônica Agudizada/diagnóstico , Insuficiência Hepática Crônica Agudizada/mortalidade , Insuficiência Hepática Crônica Agudizada/terapia , Adulto , Idoso , China/epidemiologia , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/terapia , Humanos , Cirrose Hepática/diagnóstico , Cirrose Hepática/mortalidade , Cirrose Hepática/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
15.
World J Surg Oncol ; 17(1): 31, 2019 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-30760274

RESUMO

BACKGROUND: Because conventional prostate biopsy has some limitations, optimal variations of prostate biopsy strategies have emerged to improve the diagnosis rate of prostate cancer. We conducted the systematic review to compare the diagnosis rate and complications of transperineal versus transrectal prostate biopsy. We searched for online publications published through June 27, 2018, in PubMed, Scopus, Web of Science, and Chinese National Knowledge Infrastructure databases. The relative risk and 95% confidence interval were utilized to appraise the diagnosis and complication rate. The condensed relative risk of 11 included studies indicated that transperineal prostate biopsy has the same diagnosis accuracy of transrectal prostate biopsy; however, a significantly lower risk of fever and rectal bleeding was reported for transperineal prostate biopsy. No clue of publication bias could be identified. SHORT CONCLUSION: To conclude, this review indicated that transperineal and transrectal prostate biopsy have the same diagnosis accuracy, but the transperineal approach has a lower risk of fever and rectal bleeding. More studies are warranted to confirm these findings and discover a more effective diagnosis method for prostate cancer.


Assuntos
Biópsia com Agulha de Grande Calibre/métodos , Complicações Pós-Operatórias/epidemiologia , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Biópsia com Agulha de Grande Calibre/efeitos adversos , Febre/epidemiologia , Febre/etiologia , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Períneo/cirurgia , Complicações Pós-Operatórias/etiologia , Prognóstico , Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Reto/irrigação sanguínea , Reto/diagnóstico por imagem , Reto/cirurgia , Ultrassonografia de Intervenção
16.
World J Gastroenterol ; 25(2): 190-204, 2019 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-30670909

RESUMO

Colonoscopy is a widely used method for diagnosing and treating colonic disease. The number of colonoscopies is increasing worldwide, and concerns about associated adverse events are growing. Large-scale studies using big data for post-colonoscopy complications have been reported. A colon perforation is a severe complication with a relatively high mortality rate. The perforation rate, as reported in large studies (≥ 50,000 colonoscopies) published since 2000, ranges from 0.005-0.085%. The trend in the overall perforation rate in the past 15 years has not changed significantly. Bleeding is a more common adverse event than perforation. Recent large studies (≥ 50,000 colonoscopies) have reported post-colonoscopy bleeding occurring in 0.001-0.687% of cases. Most studies about adverse events related to colonoscopy were performed in the West, and relatively few studies have been conducted in the East. The incidence of post-colonoscopy complications increases in elderly patients or patients with inflammatory bowel diseases. It is important to use a unified definition and refined data to overcome the limitations of previous studies. In addition, a structured training program for endoscopists and a systematic national management program are needed to reduce post-colonoscopy complications. In this review, we discuss the current trends in colonoscopy related to adverse events, as well as the challenges to be addressed through future research.


Assuntos
Doenças do Colo/diagnóstico por imagem , Colonoscopia/efeitos adversos , Educação Médica Continuada/tendências , Saúde Global/tendências , Complicações Pós-Operatórias/epidemiologia , Doenças do Colo/epidemiologia , Colonoscopia/educação , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Saúde Global/estatística & dados numéricos , Humanos , Incidência , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/etiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
17.
Transplant Proc ; 51(1): 171-178, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30655149

RESUMO

BACKGROUND: Cirrhosis for biliary atresia (BA) is associated with risk of gastrointestinal bleeding (GB) from gastroesophageal varices due to portal hypertension. Primary prophylaxis of GB is controversial in children who are candidates for liver transplantation (LT). The aim of the study was to define the management of gastroesophageal varices and to identify the benefit of primary prophylaxis for GB in BA children waiting for LT. METHODS: A retrospective single-center study including all BA children listed for LT in 2008-2016. Clinical, endoscopical, and biochemical data were analyzed. RESULTS: Of 82 children, 50 (61%) did not receive primary prophylaxis and did not present any episode of bleeding, 16 (19.5%) underwent primary prophylaxis, and 16 (19.5%) presented spontaneous GB and received secondary prophylaxis. Children without primary prophylaxis and GB were younger than patients with primary prophylaxis and those with GB (7.7 years [range, 4.1-37.9 years] vs 11.2 years [range, 5.1-43 years]; P = .03 vs 10.7 years [range, 6.9-39.9 years], respectively; P = .004). Seventy-five percent of GB occurred in children older than 8 months. Fifteen (93.8%) children with GB presented esophageal varices (grade III = 10 [62.5%]) and 10 (62.5%) required endoscopic treatments, consisting mainly of sclerotherapy. Median time to LT was similar for children with or without bleeding (2 months [range, 0-17.7 months] vs 2.2 months [0-17.9 months], respectively; P = .89). After 45.5 months (range, 13.7-105.5 months) of follow-up, the overall patient survival was 97.6%. At the intention-to-treat analysis, the survival rate was 100% for patients without bleeding episode and 87.5% for children with GB (P = .16). CONCLUSIONS: Despite the risk of GB being not clinically predictable in children with BA waiting for LT, our experience suggests that primary prophylaxis of GB might be unnecessary in children younger than 6 months, while it should be considered in older children. Thus, the occurrence of GB does not delay the timing of transplantation.


Assuntos
Atresia Biliar/complicações , Hemorragia Gastrointestinal/prevenção & controle , Transplante de Fígado , Adolescente , Adulto , Criança , Pré-Escolar , Varizes Esofágicas e Gástricas/complicações , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/complicações , Masculino , Prevenção Primária , Estudos Retrospectivos , Adulto Jovem
18.
Gut Liver ; 13(2): 206-214, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30602219

RESUMO

Background/Aims: Acoustic radiation force impulse (ARFI) elastography predicts the presence of esophageal varices (EVs). We investigated whether an ARFI-based prediction model can assess EV bleeding (EVB) risk in patients with cirrhosis. Methods: The records of 262 patients with cirrhosis who underwent ARFI elastography and endoscopic surveillance at two institutions in 2008 to 2013 were retrospectively reviewed, and ARFI-spleen diameter-to-platelet ratio scores (ASPS) were calculated. Results: The median patient age (165 men, 97 women) was 56 years. The median ARFI velocity, spleen diameter, platelet count, and ASPS were 1.7 m/sec, 10.1 cm, 145×109/L, and 1.16, respectively. During the median 38-month follow-up, 61 patients experienced EVB. Among all patients (179 without EVs and 83 with EVs), the cutoff value that maximized the sum of the sensitivity (73.1%) and specificity (78.4%) (area under receiver operating characteristic curve [AUROC], 0.824) for predicting EVB was 2.60. The cumulative EVB incidence was significantly higher in patients with ASPS ≥2.60 than in those with ASPS <2.60 (p<0.001). Among patients with EVs (n=83), 49 had high-risk EVs (HEVs), and 22 had EVB. The cumulative EVB incidence was significantly higher in HEV patients than in low-risk EV patients (p=0.037). At an ASPS of 4.50 (sensitivity, 66.7%; specificity, 70.6%; AUROC, 0.691), the cumulative EVB incidence was significantly higher in patients with a high ASPS than in those with a low ASPS (p=0.045). A higher ASPS independently predicted EVB (hazard ratio, 4.072; p=0.047). Conclusions: ASPS can assess EVB risk in patients with cirrhosis. Prophylactic management should be considered for patients with HEVs and ASPS ≥4.50.


Assuntos
Técnicas de Imagem por Elasticidade/estatística & dados numéricos , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Hemorragia Gastrointestinal/diagnóstico por imagem , Cirrose Hepática/diagnóstico por imagem , Área Sob a Curva , Técnicas de Imagem por Elasticidade/métodos , Varizes Esofágicas e Gástricas/epidemiologia , Varizes Esofágicas e Gástricas/etiologia , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Incidência , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Baço/diagnóstico por imagem
20.
Fundam Clin Pharmacol ; 33(2): 134-147, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30383903

RESUMO

Prior meta-analyses have shown a higher gastrointestinal risk of nonselective NSAIDs versus placebo and a lower gastrointestinal risk of coxibs versus nonselective NSAIDs. However, the available data about gastrointestinal risk for coxibs versus placebo are scarce. The aim of this study was to review the current evidence on the use of coxibs and to evaluate the risk of gastrointestinal adverse outcomes (GAO) associated with coxibs versus nonexposed. Search was conducted on PubMed and Embase databases. We selected cohort observational, case-control, nested case-control and case-crossover studies that reported the risk of GAO associated with coxibs versus nonexposed as relative risk (RR), odds ratio (OR), hazard ratio (HR) or incidence rate ratio (IRR). It was estimated the pooled RR and the 95% confidence interval (CI) for coxibs both individually and as a whole by the DerSimonian and Laird method. Twenty-eight studies met inclusion criteria. Overall, coxibs were associated with a significant increment in the risk of GAO [RR 1.64 (95% CI 1.44-1.86)]. The analysis by individual drugs showed that etoricoxib [RR 4.85 (95% CI 2.64-8.93)] presented the highest gastrointestinal risk, followed by rofecoxib [RR 2.02 (95% CI 1.56-2.61)] and celecoxib [RR 1.53 (95% CI 1.19-1.97)]. Gastrointestinal risk was also high for the subgroups aged <65 years and low-dose coxibs. The use of coxibs is associated with a statistically significant increased risk of GAO, which would be high even for low-dose coxibs and <65-year-old subgroups. The risk would be higher for etoricoxib than for celecoxib and rofecoxib.


Assuntos
Inibidores de Ciclo-Oxigenase 2/efeitos adversos , Hemorragia Gastrointestinal/induzido quimicamente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Inibidores de Ciclo-Oxigenase 2/administração & dosagem , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Segurança do Paciente , Medição de Risco , Fatores de Risco , Adulto Jovem
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