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1.
Angiol Sosud Khir ; 26(3): 108-114, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063757

RESUMO

An aorto-oesophageal fistula is a rare but life-threatening pathological condition developing on the background of diseases of the aorta and oesophagus, as well as after surgical interventions on the aorta. The article deals with a clinical case report regarding management of a patient presenting with an aorto-oesophageal fistula resulting from a thoracic artery aneurysm. The main clinical manifestations of the diseases included dysphagia (due to oesophageal obstruction caused by thrombotic masses of the aneurysm) and the occurring gastrointestinal haemorrhage. Comprehensive instrumental diagnosis was performed using roentgen examination of the oesophagus, oesophagoscopy, and contrast-enhanced computed tomography of the chest. The obtained findings made it possible to objectively assess the patient's state, to carry out timely treatment in conditions of a surgical hospital, and to avoid severe complications.


Assuntos
Aneurisma da Aorta Torácica , Doenças da Aorta , Fístula Esofágica , Fístula Vascular , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/diagnóstico , Doenças da Aorta/cirurgia , Fístula Esofágica/diagnóstico , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Fístula Vascular/diagnóstico , Fístula Vascular/etiologia , Fístula Vascular/cirurgia
2.
Am Surg ; 86(9): 1049-1055, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33049164

RESUMO

Dr Dean Warren was born in 1924 and died prematurely from cancer in 1989. He was a man of uncommon intelligence, wit, collegiality, integrity, honesty, and a true leader in American surgery. In 1966, he and his colleagues (Drs Zeppa and Fomon) presented a new concept for surgical shunts to control variceal hemorrhage while maintaining portal perfusion or hepatopetal blood flow. He termed this new shunt the distal splenorenal shunt (DSRS), which was the first selective shunt invented. The DSRS selective shunt was a brilliant improvement over the total shunt concept proposed by Nicolai Eck and was practiced worldwide during the 1980s. In a space of 2 decades, Dr Warren's pioneering work would show that the selective DSRS was superior to total shunts for treatment of portal hypertension, but that endoscopic sclerotherapy was a better first-line treatment for variceal hemorrhage than his own creation. His absolute adherence to the principles he espoused in his presidential address to the Society for Surgery of the Alimentary Tract in 1973 were employed in his research and treatment of patients. This paper details Dr Warren's extraordinary research accomplishments and sets a lesson for us that well-designed clinical trials including randomization are essential in the advancement of the care of surgical patients.


Assuntos
Varizes Esofágicas e Gástricas/história , Hemorragia Gastrointestinal/história , Derivação Esplenorrenal Cirúrgica/história , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , História do Século XX , Humanos , Estados Unidos
3.
Medicine (Baltimore) ; 99(41): e22651, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031327

RESUMO

RATIONALE: Dieulafoy lesion (DL), a rare cause of gastrointestinal bleeding, is easily covered by blood scab formation on the mucous membrane for its small size, which makes it difficult to be identified under endoscope. In clinical practice, it is also very easy to miss gastric mucosa-associated lymphoid tissue (MALT) lymphoma that exhibits atypical early manifestations under gastroendoscope and is difficult to be diagnosed by routine superficial biopsy. Most patients only experience nonspecific dyspepsia symptoms. PATIENT CONCERNS: A 68-year-old man suffering from repeated melena for 6 years arrived at our hospital. The patient had undergone gastroscopy and capsule endoscopy at other hospitals for several times and received symptomatic treatment, but his melena still continued to recur. At our hospital, the capsule endoscopy displayed that there existed large hemorrhage in the stomach, after which a gastrointestinal decompression tube was placed, so the bright red blood was drained. Subsequently, a sunken vascular malformation tissue in the anterior wall of the gastric fundus was observed under emergency endoscope. Pulsating blood flow appeared immediately after biopsy, and over-the-scope clip (OTSC) was quickly applied to stop the bleeding. Near the bleeding point, scar-like tissue that was surrounded by interrupted mucosa was discovered, and biopsy was performed at this site. DIAGNOSIS: The diagnosis of DL and gastric MALT were determined by the digestive endoscopy and biopsy pathology. INTERVENTIONS: With the diagnosis of DL and gastric MALT, the hemorrhagic spot was treated by OTSC. After the patient's condition was stable, anti-Helicobacter pylori treatment was performed. OUTCOMES: After the corresponding treatment, the 6-month follow-up revealed that the lymphoma was not completely cured, but no further bleeding occurred. There was no bleeding in the epigastric region and the patient was in good condition. LESSONS: From endoscopy, it is easy to miss DL. When the hemostatic equipment is fully prepared, biopsy can be performed. After biopsy, pulsatile bleeding is convincing evidence for Dieulafoy disease. OTSC represents an effective and low-risk method for DL and it could replace surgery. Moreover, the mucosa surrounding Dieulafoy disease should be carefully observed to exclude coexisting diseases such as lymphoma or gastric cancer.


Assuntos
Hemorragia Gastrointestinal/etiologia , Linfoma de Zona Marginal Tipo Células B/complicações , Neoplasias Gástricas/complicações , Idoso , Hemorragia Gastrointestinal/terapia , Humanos , Masculino
4.
Nihon Shokakibyo Gakkai Zasshi ; 117(10): 888-895, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33041300

RESUMO

In order to demonstrate the bleeding risk factors of GIST (gastrointestinal stromal tumor), we retrospectively investigated clinicopathological features between hemorrhagic (H group, 24 cases) and nonhemorrhagic GIST (NH group, 30 cases). In addition, we investigated features between the E group (6 cases) necessitating TAE (trans-catheter arterial embolization) and NE group (other 48 cases). Whereas H group partly includes high-risk grade GIST with chronic bleeding, meanwhile the E group (reflecting acute bleeding) is characterized by a highly enhanced mass with ulceration, comprising of smaller low-risk grade GIST. Amongst the 29 cases for forceps biopsy, which were 6 cases (21%) including one of E group, needed be hospitalized for postbiopsy bleeding. Acute bleeding in GIST may not be associated with malignant transformation. Postbiopsy bleeding or massive hemorrhage can also be encountered particularly in highly enhanced GIST with ulceration, even with a small and low-risk grade.


Assuntos
Embolização Terapêutica , Tumores do Estroma Gastrointestinal , Hemorragia Gastrointestinal/etiologia , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/terapia , Humanos , Estudos Retrospectivos
5.
Medicine (Baltimore) ; 99(40): e22583, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019474

RESUMO

INTRODUCTION: Henoch-Schönlein purpura (HSP) is an extremely rare condition in patients with pulmonary tuberculosis, with only a few reported cases. Compared to patients with typical clinical symptoms, it is difficult to make a definitive diagnosis when HSP presents as an initial manifestation in pulmonary tuberculosis patients. Herein, a case of pulmonary tuberculosis that showed HSP at first was reported, and the related literatures were reviewed. PATIENT CONCERNS: A 24-year-old man presented with palpable purpura on the extremities, accompanied by abdominal pain, bloody stools, and knee pain. DIAGNOSES: The patient was diagnosed with pulmonary tuberculosis based on the results of interferon gamma release assays, purified protein derivative test, and computed tomography. INTERVENTIONS: The patient was treated with vitamin C and chlorpheniramine for 2 weeks, and the above-mentioned symptoms were relieved. However, 3 weeks later, the purpura recurred with high-grade fever and chest pain during the inspiratory phase. The patient was then treated with anti-tuberculosis drugs, and the purpura as well as the high fever disappeared. OUTCOMES: The patient recovered well and remained free of symptoms during the follow-up examination. CONCLUSION: Pulmonary tuberculosis presenting with HSP as an initial manifestation is not common. Therefore, it is difficult to clinically diagnose and treat this disease. When an adult patient shows HSP, it is important to consider the possibility of tuberculosis to avoid misdiagnosis and delayed treatment.


Assuntos
Antituberculosos/uso terapêutico , Púrpura de Schoenlein-Henoch/etiologia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Assistência ao Convalescente , Ácido Ascórbico/uso terapêutico , Clorfeniramina/uso terapêutico , Diagnóstico Diferencial , Febre/diagnóstico , Febre/etiologia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Testes de Liberação de Interferon-gama/métodos , Masculino , Púrpura de Schoenlein-Henoch/tratamento farmacológico , Resultado do Tratamento , Tuberculina , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/diagnóstico por imagem , Vitaminas/uso terapêutico , Adulto Jovem
6.
Khirurgiia (Mosk) ; (10): 60-67, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047587

RESUMO

OBJECTIVE: To improve prediction of recurrent bleeding after endoscopic sclerotherapy of esophageal varices. MATERIAL AND METHODS: A prospective, observational, case-control study was performed. Immediate and long-term results of endoscopic sclerotherapy of esophageal varices were studied in 91 patients for the period from 2002 to 2016. Multiple regression analysis with binary response model was applied to analyze the prediction models. RESULTS: Recurrent bleeding occurred in 80.5 (20; 182) days after sclerotherapy (range 0-2557 days). Spearman's correlation analysis revealed a significant relationship between bleeding recurrence and erythrocyte count (R= -0.32), Child-Pugh class of liver cirrhosis (R=0.49), Child-Pugh score (5-15) (R=0.54), content of amino acids, HPro/Pro ratio (R=0.71). Prognostic indicators were selected by stepwise inclusion of predictors. Thus, the final version of regression equation is as follows: Y=exp (-0.17+0.93×Child-Pugh score-106.42×HPro/Pro)/[1+exp(-0.17+0.93×Child-Pugh score-106.42×HPro/Pro)]. High risk of recurrent bleeding from esophageal varices within 1 year after endoscopic sclerotherapy is determined by Y-value >0.5. An accuracy of this model is 89.6%, Se 94.3%, Sp 79.2%, PPV 90.9%, NPV 86.4%, OR 63.3, LR + 4.53, LR - 0.07. CONCLUSION: Thus, the proposed method is highly informative, effective, available and can be widely used in clinical practice.


Assuntos
Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/etiologia , Escleroterapia/efeitos adversos , Estudos de Casos e Controles , Criança , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/tratamento farmacológico , Varizes Esofágicas e Gástricas/cirurgia , Esofagoscopia/efeitos adversos , Esofagoscopia/métodos , Humanos , Prognóstico , Estudos Prospectivos , Recidiva , Medição de Risco , Escleroterapia/métodos
8.
Mil Med Res ; 7(1): 45, 2020 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-32962760

RESUMO

BACKGROUND: Gastrointestinal symptoms are not rare among coronavirus disease 2019 (COVID-19) patients, but there have been no reports regarding convalescent plasma therapy for the recovery of gastrointestinal problems in COVID-19 patients. CASE PRESENTATION: We present two cases of patients with COVID-19-associated recurrent diarrhea and positive fecal occult blood who successfully recovered after a one-time convalescent plasma administration. CONCLUSION: When COVID-19 patients develop recurrent or refractory gastrointestinal symptoms and fail to respond to the available treatment, alternative therapy with convalescent plasma administration may be considered.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Diarreia/terapia , Hemorragia Gastrointestinal/terapia , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Idoso , Infecções por Coronavirus/diagnóstico , Diarreia/etiologia , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Imunização Passiva/métodos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Recidiva , Amostragem , Índice de Gravidade de Doença , Taiwan , Resultado do Tratamento
11.
Emerg Med Clin North Am ; 38(4): 871-889, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981623

RESUMO

Massive gastrointestinal hemorrhage is a life-threatening condition that can result from numerous causes and requires skilled resuscitation to decrease patient morbidity and mortality. Successful resuscitation begins with placement of large-bore intravenous or intraosseous access; early blood product administration; and early consultation with a gastroenterologist, interventional radiologist, and/or surgeon. Activate a massive transfusion protocol when initial red blood cell transfusion does not restore effective perfusion or the patient's shock index is greater than 1.0. Promptly reverse coagulopathies secondary to oral anticoagulant or antiplatelet use. Use thromboelastography or rotational thromboelastometry to guide further transfusions. Secure a definitive airway and minimize aspiration.


Assuntos
Hemorragia Gastrointestinal/terapia , Manuseio das Vias Aéreas , Antibacterianos/uso terapêutico , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticoagulantes/efeitos adversos , Antifibrinolíticos/uso terapêutico , Oclusão com Balão , Fatores de Coagulação Sanguínea/administração & dosagem , Transfusão de Sangue/métodos , Cateteres , Serviço Hospitalar de Emergência , Fator Xa/administração & dosagem , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Humanos , Infusões Intraósseas , Infusões Intravenosas , Anamnese , Exame Físico , Inibidores da Bomba de Prótons/uso terapêutico , Proteínas Recombinantes/administração & dosagem , Ressuscitação , Tromboelastografia , Vasoconstritores/uso terapêutico
12.
Medicine (Baltimore) ; 99(39): e22471, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991485

RESUMO

RATIONALE: Patients with long term bed rest in intensive care unit after neurosurgery could experience splanchnic hypoperfusion. These patients have several other medical conditions that exacerbate splanchnic hypoperfusion during treatment and the splanchnic hypoperfusion could result in "stress-induced intestinal necrosis", which could cause massive hematochezia. We report here the experience of life-threatening hematochezia in 3 patients who underwent brain surgery in our institution. PATIENTS CONCERNS: One female patient (72-year-old) and 2 male patients (58- and 35-year-old) were admitted to our institution because of traumatic intracerebral hemorrhage, subarachnoid hemorrhage due to a ruptured anterior communicating artery, and subarachnoid hemorrhage with unknown cause respectively. All patients underwent emergency brain surgery for diagnosis and treatment. After surgery, they all experienced long-term bed rest in intensive care unit. Hematochezia occurred on postoperative day 15, 17, and 49, respectively. DIAGNOSES: All of the patients were assessed by abdomen/pelvis computed tomography and underwent a colonoscopy. INTERVENTIONS: The female patient underwent embolization through pelvic arteriography and epinephrine injection through colonoscopy, but a total colectomy and ileostomy was performed due to refractory hematochezia. 58-year-old male patient had a laparoscopic ileostomy for the bowel rest. The other patient underwent nil per os and conservative treatment for 2 weeks. OUTCOMES: The female patient was discharged without further treatment plan, 58-year-old male patient survived after laparoscopic ileostomy, while the other patient survived after 2 weeks of nil per os. LESSON: Abdominal symptoms, such as hematochezia, should be actively managed in neurosurgical patients who are undergoing long-term bed rest in an intensive care unit under physiologically stressful medical conditions.


Assuntos
Repouso em Cama/efeitos adversos , Hemorragia Gastrointestinal/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Adulto , Idoso , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios X
14.
Am J Gastroenterol ; 115(10): 1609-1616, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32796176

RESUMO

INTRODUCTION: Although current literature has addressed gastrointestinal presentations including nausea, vomiting, diarrhea, abnormal liver chemistries, and hyperlipasemia as possible coronavirus disease 2019 (COVID-19) manifestations, the risk and type of gastrointestinal bleeding (GIB) in this population is not well characterized. METHODS: This is a matched case-control (1:2) study with 41 cases of GIB (31 upper and 10 lower) in patients with COVID-19 and 82 matched controls of patients with COVID-19 without GIB. The primary objective was to characterize bleeding etiologies, and our secondary aim was to discuss outcomes and therapeutic approaches. RESULTS: There was no difference in the presenting symptoms of the cases and controls, and no difference in severity of COVID-19 manifestations (P > 0.05) was observed. Ten (32%) patients with upper GIB underwent esophagogastroduodenoscopy and 5 (50%) patients with lower GIBs underwent flexible sigmoidoscopy or colonoscopy. The most common upper and lower GIB etiologies were gastric or duodenal ulcers (80%) and rectal ulcers related to rectal tubes (60%), respectively. Four of the esophagogastroduodenoscopies resulted in therapeutic interventions, and the 3 patients with rectal ulcers were referred to colorectal surgery for rectal packing. Successful hemostasis was achieved in all 7 cases that required interventions. Transfusion requirements between patients who underwent endoscopic therapy and those who were conservatively managed were not significantly different. Anticoagulation and rectal tube usage trended toward being a risk factor for GIB, although it did not reach statistical significance. DISCUSSION: In COVID-19 patients with GIB, compared with matched controls of COVID-19 patients without GIB, there seemed to be no difference in initial presenting symptoms. Of those with upper and lower GIB, the most common etiology was peptic ulcer disease and rectal ulcers from rectal tubes, respectively. Conservative management seems to be a reasonable initial approach in managing these complex cases, but larger studies are needed to guide management.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Hemorragia Gastrointestinal/epidemiologia , Úlcera Péptica/epidemiologia , Pneumonia Viral/complicações , Doenças Retais/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Transfusão de Sangue/estatística & dados numéricos , Estudos de Casos e Controles , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Endoscopia/estatística & dados numéricos , Enema/efeitos adversos , Enema/instrumentação , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Úlcera Péptica/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Doenças Retais/etiologia , Doenças Retais/terapia , Fatores de Risco
15.
Medicine (Baltimore) ; 99(30): e21312, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791719

RESUMO

Bleeding complications of acute coronary syndromes (ACS) after percutaneous coronary intervention (PCI) are strongly associated with adverse patient outcomes, and gastrointestinal bleeding (GIB) is the most common major bleeding event, especially in the early post-PCI period. Current guidelines recommend routinely conducting bleeding risk assessments. The existing tools are mainly used to evaluate the overall bleeding risk and guide the adjustment of antithrombotic strategies after 1 year. However, there are no specific tools for GIB risk assessment.Between January 2015 and June 2015, 4943 ACS patients underwent PCI were consecutively enrolled in the derivation cohort. GIB, cardiovascular, and cerebrovascular events were recorded within 1 year of follow-up. A validation cohort including 1000 patients who met the same inclusion and exclusion criteria was also established by propensity-score matching baseline characteristics. Multivariable cox proportional-hazards regression model was used to derive a risk-scoring system, and predictive variables were selected. A risk score nomogram based on the risk prediction model was created to estimate the 1-year risk of GIB.In this study, we found that the usage of clopidogrel (hazard ratio, HR: 2.52, 95% confidence intervals, CI: 1.573-4.021) and glycoprotein IIb/IIIa receptor inhibitors (HR: 1.863, 95% CI: 1.226-2.829), history of peptic ulcers (HR: 3.601, 95% CI: 1.226-2.829) or tumor (HR: 4.884, 95% CI: 1.226-2.829), and cardiac insufficiency (HR: 11.513, 95% CI: 7.282-18.202), renal insufficiency (HR: 2.010, 95% CI: 1.350-2.993), and prolonged activated partial thromboplastin time (HR: 4.639, 95% CI: 2.146-10.032) were independent risk factors for GIB 1 year after PCI. Based on these 7 factors, a nomogram and scoring system was established. The area under curve of risk score was 0.824 in the deviation cohort and 0.810 in the verification cohort. In both cohorts, the GIB score was significantly better than that of 3 classical bleeding scores (all P < .05).This score could well predict the risk of GIB within 1 year after PCI and could be used to guide antithrombotic strategies.


Assuntos
Síndrome Coronariana Aguda/complicações , Hemorragia Gastrointestinal/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Síndrome Coronariana Aguda/terapia , Idoso , Regras de Decisão Clínica , Clopidogrel/efeitos adversos , Clopidogrel/uso terapêutico , Estudos de Coortes , Feminino , Hemorragia Gastrointestinal/diagnóstico , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial , Úlcera Péptica/complicações , Inibidores da Agregação de Plaquetas/efeitos adversos , Inibidores da Agregação de Plaquetas/uso terapêutico , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Insuficiência Renal/complicações , Projetos de Pesquisa/normas , Medição de Risco
17.
Korean J Intern Med ; 35(5): 1027-1030, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32664710

RESUMO

Following the coronavirus disease 2019 outbreak in China, more than 10,765 patients tested positive for severe acute respiratory syndrome coronavirus 2 from February 18, 2020 to April 30, 2020 in South Korea. Performing emergency endoscopy is extremely challenging from the clinicians' viewpoint during the viral outbreak. There are no available guidelines for emergency endoscopy in tertiary hospitals during this pandemic. We set up an algorithm as a guide for emergency endoscopy in patients presenting to the emergency room with bleeding, foreign body, or impending cholangitis. From February 18, 2020 to April 30, 2020 of outbreak, 130 patients underwent emergency endoscopy in our center. Owing to the simple and streamlined algorithm for performing emergency endoscopy, no endoscopy-related infection to other patients or medical workers was reported in our center.


Assuntos
Algoritmos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência , Endoscopia , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Colangite/diagnóstico , Colangite/etiologia , Colangite/terapia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Corpos Estranhos/diagnóstico , Corpos Estranhos/etiologia , Corpos Estranhos/terapia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , República da Coreia , Estudos Retrospectivos , Centros de Atenção Terciária
18.
Acta Gastroenterol Belg ; 83(2): 245-248, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32603042

RESUMO

Objective: To analyze the risk factors for upper gastrointestinal bleeding (UGIB) in patients with ST-segment elevation myocardial infarction (STEMI) during double antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). Methods: A total of 388 patients treated from January 2015 to September 2017 due to STEMI were selected. Thirty-two cases of UGIB occurring during DAPT after PCI were included as a UGIB group, and another 356 cases without UGIB were set as a control group. Age, gender, body mass index, smoking, drinking, history of previous diseases (hypertension, diabetes and digestive tract diseases), infection of Helicobacter pylori (Hp), combined use of other drugs (statins, NSAIDs, ß receptor blockers, PPI, H2RA and dabigatran etexilate), as well as serum levels of creatinine (Cr), alanine transaminase (ALT) and C-reactive protein (CRP) were compared. The risk factors for UGIB were subjected to univariate and logistic regression analyses. Results: Compared with the control group, the UGIB group had significantly longer hospital stay, and higher proportion of discontinuation of antithrombotic drugs and mortality rate (P<0.05). Logistic regression analysis showed that age (P=0.002), smoking (P=0.000), Hp infection (P=0.020), history of digestive tract diseases (P=0.030) and renal insufficiency (P=0.041) were independent risk factors for UGIB, and use of PPI (P=0.028) was a protective factor for UGIB. Conclusions: Old age, smoking, Hp infection, history of digestive tract diseases and renal insufficiency are risk factors for UGIB caused by PCI combined with DAPT in patients with STEMI. Proper use of PPI thereafter can reduce the incidence rate of UGIB.


Assuntos
Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Hemorragia Gastrointestinal/etiologia , Humanos , Modelos Logísticos , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação de Plaquetas , Fatores de Risco
19.
Acta Gastroenterol Belg ; 83(2): 265-270, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32603045

RESUMO

Background and aims: Lower Gastrointestinal Bleeding (LGIB) is one of the leading causes of ER visits. Colonoscopy is indicated in all patients with LGIB, yet the time frame for performing colonoscopy remains unclear. Whether or not urgent endoscopic evaluation improves outcomes of LGIB has been questioned. We therefore aimed to examine the success of urgent colonoscopy in identifying the source of LGIB. Patients and methods: A retrospective study was conducted in which timing of colonoscopy was divided into urgent (performed within the first 24 hours of presentation) and delayed (performed following 24 hours of hospitalization). Data on clinical presentation, investigations and endoscopic findings was collected. Risk ratios were calculated and regression analysis was used to examine associations and identify predictors of endoscopic success. Result: A total of 183 patients underwent colonoscopies. 55.4% of colonoscopies were performed within 24 hours of presentation. A source of LGIB was identified in 55.7% of first attempt colonoscopies. Endoscopic intervention was required in 10.9% of cases and rebleeding occurred in 24.6%, of which 6.5% required hospital re-admission. 2.7% required emergency colectomy and the calculated mortality rate was 1%. Risk ratios comparing urgent to delayed colonoscopy for source of LGIB identification, colectomy and mortality were 1.01, 4.8 and 1.2, respectively. Age and timing of colonoscopy appeared to be predictive of colectomy on regression analysis. Conclusions: Urgent colonoscopy for LGIB did not improve the rate of identification of the source of bleeding, colectomy rate or mortality rate and was predictive of the need for emergency colectomy.


Assuntos
Colonoscopia , Hemorragia Gastrointestinal , Doença Aguda , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hospitalização , Humanos , Estudos Retrospectivos
20.
J. negat. no posit. results ; 5(7): 702-720, jul. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-194131

RESUMO

OBJETIVO: Reflejar nuestra frustración al perder un paciente, no porque su infrecuente patología sea de por sí muy grave, sino por el acumulo sobreañadido de otros motivos diagnósticos, y terapéuticos en un entorno hospitalario de epidemia Covid-19. MÉTODO: Primero describimos el proceso diagnóstico, terapéutico y evolutivo (27 febrero al 25 marzo 2020) de un varón de 73 años portador de una fístula aorto-entérica secundaria a un bypass aorto-bifemoral, implantado doce años antes en otro hospital. Después presentamos nuestra experiencia (1978-2020) en este tipo de situaciones, y finalmente realizamos una revisión de la literatura (1953-2020) al respecto. RESULTADOS: A) Caso clínico: ausencia de diagnóstico precoz, fracaso de la técnica operatoria elegida, importantes complicaciones postoperatorias (hemorragia, infarto cerebral y neumonía bilateral por coronavirus) que finalizo en exitus. B) Experiencia personal: cuatro casos (incluido el referido). C) Revisión de la literatura: tres revisiones sistemáticas: 564 casos (1953-1993); 386 casos en 58 publicaciones (1991-2006), 823 pacientes en 216 publicaciones (1995-2015) y 20 casos en 14 publicaciones (2016-2020). CONCLUSIÓN: Si en situaciones normales una fístula aorto-entérica es una condición que amenaza seriamente la vida del paciente (hemorragia y/o infección), no debe extrañar que en situaciones excepcionales esa situación de gravedad se incremente. No obstante, de estas malas experiencias estamos obligados a sacar enseñanzas que beneficien a otros en el futuro


OBJECTIVE: To reflect our frustration when losing a patient, not because their infrequent pathology is in itself very serious, but because of the accumulation of other diagnostic and therapeutic reasons in a hospital environment of the Covid-19 epidemic. METHOD: First we describe the diagnostic, therapeutic and evolutionary process (February 27 to March 25, 2020) of a 73-year-old male with an aorto-enteric fistula secondary to an aorto-bifemoral bypass, implanted twelve years earlier in another hospital. Then we present our experience (1978-2020) in this type of situation, and finally we carried out a review of the literature (1953-2020) in this regard. RESULTS: A) Clinical case: absence of early diagnosis, failure of the chosen operative technique, significant postoperative complications (hemorrhage, cerebral infarction and bilateral coronavirus pneumonia) that ended in death. B) Personal experience: four cases (including the referred one). C) Literature review: three systematic reviews: 564 cases (1953-1993); 386 cases in 58 publications (1991-2006), 823 patients in 216 publications (1995-2015) and 20 cases in 14 publications (2016-2020). CONCLUSION: If in normal situations an aorto-enteric fistula is a condition that seriously threatens the patient's life (hemorrhage and / or infection), it should not be surprising that in exceptional situations this serious situation increases. However, from these bad experiences we are obliged to draw lessons that will benefit others in the future


Assuntos
Humanos , Masculino , Idoso , Fístula Intestinal/complicações , Fístula/complicações , Aorta/lesões , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Complicações Pós-Operatórias , Hemorragia Gastrointestinal/etiologia , Dispositivos de Oclusão Vascular
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