Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.561
Filtrar
1.
Wiad Lek ; 74(2): 202-206, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33813472

RESUMO

OBJECTIVE: The aim: To determine clinical and endoscopical features of gastroduodenal hemorrhages in elderly patients with concomitant cardio-vascular pathology in a way by studying, main indicators of the immune system for drawing up further tactics. PATIENTS AND METHODS: Material and methods: The study included 609 patients with ulcerative gastroduodenal bleeding, complicated by cardio-vascular system pathology in 2017-2019 years. The observed patients were distributed into the groups: I - patients, who received treatment according to the standard system of cardiovascular pathology treatment (n=541), II - "double" therapy (n=68). Control group consists of 20 relatively healthy patients were similar to the research group. RESULTS: Results: Blood lost of a big amount and massive blood lost were noticed in 113 (18.56%±1.58) and 121 (19.87%±1.62) patients respectively. Active bleeding (F I) was revealed in 38 patients (6.24%±0.98), a high risk of hemorrhage relapse was determined in 486 patients (79.80%±1.63). Signs of recent hemorrhage were absent in 85 patients (13.96%±1.40). A high level of pro-inflammatory cytokines IL-6, TNF-α and a low activity of the anti-inflammatory mediator IL-10 define the process activity, their long-term circulation in patients with ulcerative hemorrhages of the gastro-intestinal tract are associated with unfavorable prognosis. In 5 cases conditionally-radical surgical interventions were performed. Palliative surgery - 3 patients (р>0.05). CONCLUSION: Conclusions: The patients of second group ("double therapy") with big and massive blood loss was 2.7 times higher than similar indices in patients of the first group (standard therapy). The patients who received "double therapy" had 3.3 times more active hemorrhage percentage than the patients who received standard therapy (р<0.05).


Assuntos
Hemorragia Gastrointestinal , Úlcera , Idoso , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Prognóstico , Recidiva
2.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509873

RESUMO

Acute upper gastrointestinal (UGI) bleeding is one of the most frequent presentations to a surgical emergency. Most of them respond to initial resuscitation, and a definite diagnosis is established as soon as possible, thereby helping the clinician in management. We present the diagnostic challenges that we faced with a 70-year-old man who presented with UGI bleed. He initially responded to resuscitation, but later deteriorated and became haemodynamically unstable. The source of the UGI bleed on evaluation was found to be pseudoaneurysm of the gastroduodenal artery (PsGDA) and treated successfully by coil embolisation. The cause of the PsGDA was diverticulum arising from the first part of duodenum with changes of diverticulitis. Diverticulum originating from the first part of the duodenum is seldom reported. Moreover, diverticulitis involving this part and causing PsGDA has not been reported so far.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Diverticulite/diagnóstico por imagem , Duodenopatias/diagnóstico por imagem , Hemorragia Gastrointestinal/terapia , Artéria Hepática , Idoso , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Angiografia Digital , Antibacterianos/uso terapêutico , Diverticulite/complicações , Diverticulite/tratamento farmacológico , Duodenopatias/complicações , Duodenopatias/tratamento farmacológico , Embolização Terapêutica , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Tomografia Computadorizada por Raios X
4.
Z Gastroenterol ; 59(1): 43-49, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33429449

RESUMO

Non-cirrhotic portal vein thrombosis (PVT) in patients with antiphospholipid syndrome (APS) is a rare complication, and the management has to be determined individually based on the extent and severity of the presentation. We report on a 37-year-old male patient with non-cirrhotic chronic PVT related to a severe thrombophilia, comprising APS, antithrombin-, factor V- and factor X-deficiency. Three years after the initial diagnosis of non-cirrhotic PVT, the patient presented with severe hemorrhagic shock related to acute bleeding from esophageal varices, requiring an emergency transjugular intrahepatic portosystemic stent shunt (TIPSS). TIPSS was revised after a recurrent bleeding episode due to insufficient reduction of the portal pressure. Additionally, embolization of the dilated V. coronaria ventriculi led to the regression of esophageal varices but resulted simultaneously in a left-sided portal hypertension (LSPH) with development of stomach wall and perisplenic varices. After a third episode of acute esophageal varices bleeding, a surgical distal splenorenal shunt (Warren shunt) was performed to reduce the LSPH. Despite anticoagulation with low molecular weight heparin and antithrombin substitution, endoluminal thrombosis led to a complete Warren shunt occlusion, aggravating the severe splenomegaly and pancytopenia. Finally, a partial spleen embolization (PSE) was performed. In the postinterventional course, leukocyte and platelet counts increased rapidly and the patient showed no further bleeding episodes. Overall, this complex course demonstrates the need for individual assessment of multimodal treatment options in non-cirrhotic portal hypertension. This young patient required triple modality porto-systemic pressure reduction (TIPSS, Warren shunt, PSE) and involved finely balanced anticoagulation and bleeding control.


Assuntos
Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/etiologia , Hipertensão Portal/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Trombofilia , Trombose Venosa , Adulto , Varizes Esofágicas e Gástricas/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Humanos , Hipertensão Portal/diagnóstico , Masculino , Equipe de Assistência ao Paciente , Veia Porta/fisiopatologia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Stents
5.
J Vasc Interv Radiol ; 32(2): 282-291.e1, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33485506

RESUMO

PURPOSE: To compare the safety and clinical outcomes of combined transjugular intrahepatic portosystemic shunt (TIPS) plus variceal obliteration to those of TIPS alone for the treatment of gastric varices (GVs). MATERIALS AND METHODS: A single-center, retrospective study of 40 patients with bleeding or high-risk GVs between 2008 and 2019 was performed. The patients were treated with combined therapy (n = 18) or TIPS alone (n = 22). There were no significant differences in age, sex, model for end-stage liver disease score, or GV type between the groups. The primary outcomes were the rates of GV eradication and rebleeding. The secondary outcomes included portal hypertensive complications and hepatic encephalopathy. RESULTS: The mean follow-up period was 15.4 months for the combined therapy group and 22.9 months for the TIPS group (P = .32). After combined therapy, there was a higher rate of GV eradication (92% vs 47%, P = .01) and a trend toward a lower rate of GV rebleeding (0% vs 23%, P = .056). The estimated rebleeding rates were 0% versus 5% at 3 months, 0% versus 11% at 6 months, 0% versus 18% at 1 year, and 0% versus 38% at 2 years after combined therapy and TIPS, respectively (P = .077). There was no difference in ascites (13% vs 11%, P = .63), hepatic encephalopathy (47% vs 55%, P = .44), or esophageal variceal bleeding (0% vs 0%, P > .999) after the procedure between the groups. CONCLUSIONS: The GV eradication rate is significantly higher after combined therapy, with no associated increase in portal hypertensive complications. This translates to a clinically meaningful trend toward a reduction in GV rebleeding. The value of a combined treatment strategy should be prospectively studied in a larger cohort to determine the optimal management of GVs.


Assuntos
Embolização Terapêutica , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Derivação Portossistêmica Transjugular Intra-Hepática , Escleroterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Embolização Terapêutica/efeitos adversos , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/etiologia , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Recidiva , Estudos Retrospectivos , Escleroterapia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
6.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495179

RESUMO

We present an unusual case of an acutely unwell patient with an upper gastrointestinal bleed whose resuscitation efforts were delayed by the discovery of his, similarly, acutely unwell pet on the medical high dependency unit. We highlight the challenges this provided the clinical team and focus on the issues relating to patient safety, consent and multidisciplinary action which may be more relevant to daily clinical practice.


Assuntos
Transfusão de Sangue , Hemorragia Gastrointestinal/terapia , Gastroscopia , Pesar , Animais de Estimação , Animais , Galinhas , Humanos , Masculino , Competência Mental , Pessoa de Meia-Idade , Preferência do Paciente , Assistência Centrada no Paciente
9.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(12): 1149-1154, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33353268

RESUMO

Anastomotic bleeding is a common complication after colorectal surgery, mainly manifesting as continuous or intermittent bloody stool. The risk factors for anastomotic bleeding mainly include suboptimal surgical skill, surgical methods (such as laparoscopic anastomosis), close distance between the tumor and the anal margin, benign colorectal diseases, anastomotic leakage after colorectal surgery, severe pelvic and abdominal infections, and the patient's own condition, etc. Anastomotic bleeding can be prevented by standardized operation and intraoperative endoscopic examination. Anastomotic bleeding is mostly a self-limited disease, which can be cured by conservative treatments such as fluid resuscitation, blood transfusion and endoscopic treatment. When serious anastomotic bleeding threatens the life of patients, surgical treatment should be taken into consideration decisively.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório , Hemorragia Gastrointestinal/prevenção & controle , Laparoscopia , Fístula Anastomótica/etiologia , Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Laparoscopia/efeitos adversos , Reto/cirurgia , Fatores de Risco
10.
Rev Gastroenterol Peru ; 40(3): 219-223, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33181807

RESUMO

INTRODUCTION: During the COVID-19 pandemic, endoscopic procedures are associated with a high risk of SARS-CoV-2 infection. However, in cases of upper gastrointestinal bleeding (UGIB), priority should be given to an early endoscopy. OBJECTIVE: The main objective was to compare the time since arrival at the hospital and the performance of the endoscopy between both groups. MATERIALS AND METHODS: We performed a retrospective study. Data contains information of patients who attended to the hospital with UGIB and underwent an endoscopy between October 19th, 2019 and June 6th, 2020. Patients were divided into 2 phases: pre-pandemic and pandemic. The time between arrival at the hospital and the performance of the endoscopy in both phases were compared as well as other indicators such hospital stay and in-hospital mortality. RESULTS: With information from 219 patients, the median age was 69 years. 154 and 65 endoscopies were performed in pre-pandemic and pandemic phase, respectively. The time between arrival at the hospital and the performance of the endoscopy was significantly longer during the pandemic (10.00 vs. 13.08 hours, p-value = 0.019). Nevertheless, there were no significant differences in hospital stay or mortality. CONCLUSION: The management of patients with UGIB during the COVID-19 pandemic is complex and requires the application of clinical judgment to decide the best timing to perform an endoscopy without affecting patient care.


Assuntos
Infecções por Coronavirus , Endoscopia Gastrointestinal/tendências , Hemorragia Gastrointestinal/diagnóstico por imagem , Pandemias , Pneumonia Viral , Padrões de Prática Médica/tendências , Tempo para o Tratamento/tendências , Trato Gastrointestinal Superior/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Infecções por Coronavirus/prevenção & controle , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/terapia , Mortalidade Hospitalar/tendências , Humanos , Controle de Infecções/métodos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Peru , Pneumonia Viral/prevenção & controle , Estudos Retrospectivos
11.
Nihon Shokakibyo Gakkai Zasshi ; 117(11): 985-991, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33177261

RESUMO

An 86-year-old man was transferred to the Tokyo Medical University Hospital because of a temporary loss of consciousness and melena. We performed upper gastrointestinal endoscopy, which revealed Mallory-Weiss syndrome caused by a strong vomiting reflex. After an examination, he complained of abdominal pain, and his blood pressure decreased. Abdominal contrast-enhanced computed tomography showed fresh intra-abdominal hemorrhage. We performed transcatheter arterial embolization by using N-butyl-2-cyanoacrylate to control the bleeding from the right gastroepiploic artery. Intra-abdominal hemorrhage after upper gastrointestinal endoscopy is rare, and we report this case with the literature review.


Assuntos
Embolização Terapêutica , Embucrilato , Síndrome de Mallory-Weiss , Idoso de 80 Anos ou mais , Endoscopia do Sistema Digestório , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Hemoperitônio , Humanos , Masculino
12.
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
13.
Cochrane Database Syst Rev ; 10: CD000553, 2020 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-33089892

RESUMO

BACKGROUND: People with liver cirrhosis who have had one episode of variceal bleeding are at risk for repeated episodes of bleeding. Endoscopic intervention and portosystemic shunts are used to prevent further bleeding, but there is no consensus as to which approach is preferable. OBJECTIVES: To compare the benefits and harms of shunts (surgical shunts (total shunt (TS), distal splenorenal shunt (DSRS), or transjugular intrahepatic portosystemic shunt (TIPS)) versus endoscopic intervention (endoscopic sclerotherapy or banding, or both) with or without medical treatment (non-selective beta blockers or nitrates, or both) for prevention of variceal rebleeding in people with liver cirrhosis. SEARCH METHODS: We searched the CHBG Controlled Trials Register; CENTRAL, in the Cochrane Library; MEDLINE Ovid; Embase Ovid; LILACS (Bireme); Science Citation Index - Expanded (Web of Science); and Conference Proceedings Citation Index - Science (Web of Science); as well as conference proceedings and the references of trials identified until 22 June 2020. We contacted study investigators and industry researchers. SELECTION CRITERIA: Randomised clinical trials comparing shunts versus endoscopic interventions with or without medical treatment in people with cirrhosis who had recovered from a variceal haemorrhage. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. When possible, we collected data to allow intention-to-treat analysis. For each outcome, we estimated a meta-analysed estimate of treatment effect across trials (risk ratio for binary outcomes). We used random-effects model meta-analysis as our main analysis and as a means of presenting results. We reported differences in means for continuous outcomes without a meta-analytic estimate due to high variability in their assessment among all trials. We assessed the certainty of evidence using GRADE. MAIN RESULTS: We identified 27 randomised trials with 1828 participants. Three trials assessed TSs, five assessed DSRSs, and 19 trials assessed TIPSs. The endoscopic intervention was sclerotherapy in 16 trials, band ligation in eight trials, and a combination of band ligation and either sclerotherapy or glue injection in three trials. In eight trials, endoscopy was combined with beta blockers (in one trial plus isosorbide mononitrate). We judged all trials to be at high risk of bias. We assessed the certainty of evidence for all the outcome review results as very low (i.e. the true effects of the results are likely to be substantially different from the results of estimated effects). The very low evidence grading is due to the overall high risk of bias for all trials, and to imprecision and publication bias for some outcomes. Therefore, we are very uncertain whether portosystemic shunts versus endoscopy interventions with or without medical treatment have effects on all-cause mortality (RR 0.99, 95% CI 0.86 to 1.13; 1828 participants; 27 trials), on rebleeding (RR 0.40, 95% CI 0.33 to 0.50; 1769 participants; 26 trials), on mortality due to rebleeding (RR 0.51, 95% CI 0.34 to 0.76; 1779 participants; 26 trials), and on occurrence of hepatic encephalopathy, both acute (RR 1.60, 95% CI 1.33 to 1.92; 1649 participants; 24 trials) and chronic (RR 2.51, 95% CI 1.38 to 4.55; 956 participants; 13 trials). No data were available regarding health-related quality of life. Analysing each modality of portosystemic shunts individually (i.e. TS, DSRS, and TIPS) versus endoscopic interventions with or without medical treatment, we are very uncertain if each type of shunt has effect on all-cause mortality: TS, RR 0.46, 95% CI 0.19 to 1.13; 164 participants; 3 trials; DSRS, RR 0.93, 95% CI 0.65 to 1.33; 352 participants; 4 trials; and TIPS, RR 1.10, 95% CI 0.92 to 1.31; 1312 participants; 19 trial; on rebleeding: TS, RR 0.28, 95% CI 0.14 to 0.56; 127 participants; 2 trials; DSRS, RR 0.26, 95% CI 0.11 to 0.65; 330 participants; 5 trials; and TIPS, RR 0.44, 95% CI 0.36 to 0.55; 1312 participants; 19 trials; on mortality due to rebleeding: TS, RR 0.25, 95% CI 0.06 to 0.96; 164 participants; 3 trials; DSRS, RR 0.31, 95% CI 0.13 to 0.74; 352 participants; 5 trials; and TIPS, RR 0.65, 95% CI 0.40 to 1.04; 1263 participants; 18 trials; on acute hepatic encephalopathy: TS, RR 1.66, 95% CI 0.70 to 3.92; 115 participants; 2 trials; DSRS, RR 1.70, 95% CI 0.94 to 3.08; 287 participants; 4 trials, TIPS, RR 1.61, 95% CI 1.29 to 1.99; 1247 participants; 18 trials; and chronic hepatic encephalopathy: TS, Fisher's exact test P = 0.11; 69 participants; 1 trial; DSRS, RR 4.87, 95% CI 1.46 to 16.23; 170 participants; 2 trials; and TIPS, RR 1.88, 95% CI 0.93 to 3.80; 717 participants; 10 trials. The proportion of participants with shunt occlusion or dysfunction was overall 37% (95% CI 33% to 40%). It was 3% (95% CI 0.8% to 10%) following TS, 7% (95% CI 3% to 13%) following DSRS, and 47.1% (95% CI 43% to 51%) following TIPS. Shunt dysfunction in trials utilising polytetrafluoroethylene-covered stents was 17% (95% CI 11% to 24%). Length of inpatient hospital stay and cost were not comparable across trials. Funding was unclear in 16 trials; 11 trials were funded by government, local hospitals, or universities. AUTHORS' CONCLUSIONS: Evidence on whether portosystemic shunts versus endoscopy interventions with or without medical treatment in people with cirrhosis and previous hypertensive portal bleeding have little or no effect on all-cause mortality is very uncertain. Evidence on whether portosystemic shunts may reduce bleeding and mortality due to bleeding while increasing hepatic encephalopathy is also very uncertain. We need properly conducted trials to assess effects of these interventions not only on assessed outcomes, but also on quality of life, costs, and length of hospital stay.


Assuntos
Endoscopia/métodos , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Cirrose Hepática/complicações , Derivação Portossistêmica Cirúrgica/métodos , Viés , Causas de Morte , Varizes Esofágicas e Gástricas/prevenção & controle , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/prevenção & controle , Encefalopatia Hepática/epidemiologia , Encefalopatia Hepática/etiologia , Humanos , Análise de Intenção de Tratamento , Derivação Portossistêmica Cirúrgica/efeitos adversos , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Prevenção Secundária , Derivação Esplenorrenal Cirúrgica/efeitos adversos
15.
Zhonghua Wai Ke Za Zhi ; 58(10): 808-812, 2020 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-32993269

RESUMO

Esophagogastric variceal bleeding (EVB) is the most dangerous complication of cirrhotic portal hypertension.With the continuous emergence of research findings on EVB, multiple disciplinary team, including internal medicine department, surgery department, intervention therapy department, radiology department, has become a new mode for the prevention and treatment of EVB. This article first reviewed the classification of esophageal varices and gastric varices, and then reviewed the recent research findings of EVB from three aspects: primary prophylaxis, active variceal bleeding treatment, and secondary prophylaxis.The aim was to provide new ideas for the individualized prevention and treatment of EVB.


Assuntos
Varizes Esofágicas e Gástricas , Hemorragia Gastrointestinal/terapia , Hipertensão Portal , Cirrose Hepática/complicações , Varizes Esofágicas e Gástricas/classificação , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/prevenção & controle , Humanos , Hipertensão Portal/etiologia , Hipertensão Portal/terapia
16.
BMC Gastroenterol ; 20(1): 318, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993509

RESUMO

BACKGROUND: SARS-CoV-2 is highly infectious and has been a significant public health threat. Despite typical manifestations of illness are dominated by respiratory symptom, some patients have concurrent gastrointestinal manifestations, including nausea, diarrhea, and vomiting. Massive gastrointestinal bleeding, however, has rarely been reported. CASE PRESENTATION: We herein described a case of severe SARS-CoV-2 infected patient with several risk factors for poor prognosis, including male, hypertension, old age, mixed bacterial infection and multilobular infiltration on radiological imaging. After improvement of respiratory status, the onset of gastrointestinal bleeding occurred, probably resulting from direct viral invasion as evidenced by the positive findings for SARS-CoV-2 in the repeat stool specimens. Although aggressive resuscitation was administered, hematochezia was uncontrolled. The patient rapidly deteriorated, suffered from cardiac arrest, and expired. CONCLUSIONS: Digestive symptoms could be severe in SARS-CoV-2 infected patients, especially for the high-risk individuals with predisposing conditions. A more thorough protocol for preventing cross-infection through faecal-oral transmission should be implemented in the process of patient care and infection control.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Hemorragia Gastrointestinal/virologia , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Idoso de 80 Anos ou mais , Infecções por Coronavirus/terapia , Evolução Fatal , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Humanos , Masculino , Pandemias , Pneumonia Viral/terapia , Fatores de Risco
17.
Medicine (Baltimore) ; 99(39): e22298, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991434

RESUMO

RATIONALE: There are many treatments for chronic hemorrhagic radiation colorectal inflammation, but only a few treatments are supported by high-quality research evidence. Studies have shown that the occurrence and development of radiation proctitis are closely associated with the intestinal flora. Animal studies have indicated that faecal microbiota transplantation (FMT) can improve radiation enteropathy in a mouse model. PATIENT CONCERNS: A 45-year-old female patient suffered from recurrent hematochezia and diarrhea for half a year after radiotherapy and underwent recurrent transfusion treatments. Colonoscopy showed obvious congestion of the sigmoid colon and rectal mucosa, a smooth surface, and bleeding that was easily induced by touch, which are consistent with radiation proctitis. The pathological findings revealed chronic mucosal inflammation. The magnetic resonance imaging examination of the pelvic cavity with a plain scan and enhancement showed changes after radiotherapy and chemotherapy, and no obvious tumor recurrence or metastasis was found. The laboratory examinations excluded pathogen infection. DIAGNOSES: Based on the history and examinations, the final diagnosis of this patient was chronic hemorrhagic radiation proctitis. INTERVENTIONS: The patient was treated with a total of 4 individual courses of FMT. OUTCOMES: After the six-month follow-up, her hematochezia, abdominal pain and diarrhea were relieved. Furthermore, 16S rRNA sequencing of the feces showed that the intestinal bacterial composition of the patient obviously changed after FMT and became similar to that of the donors. LESSONS: This case report shows that FMT can relieve the symptoms of hematochezia and diarrhea by changing the bacterial community structure in patients with chronic hemorrhagic radiation proctitis.


Assuntos
Transplante de Microbiota Fecal/métodos , Hemorragia Gastrointestinal/terapia , Proctite/etiologia , Lesões por Radiação/complicações , Assistência ao Convalescente , Doença Crônica , Colonoscopia/métodos , Diarreia/etiologia , Fezes/microbiologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Proctite/diagnóstico , Proctite/patologia , RNA Ribossômico 16S/genética , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/patologia , Doadores de Tecidos , Resultado do Tratamento
18.
Vnitr Lek ; 66(4): 32-41, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32972182

RESUMO

Liver cirrhosis is the most common reason of clinically significant portal hypertension in the western countries. Portal vein or hepatic veins thrombosis is less common. Variceal bleeding is the most severe life threatening complication of portal hypertension. Appropriate treatment includes initial general management, fluid replacement and hemosubstitution, antibiotic prophylaxis, vasoactive medication and endoscopic treatment. Transjugular intrahepatic portosystemic shunt (TIPS) is standard option in case of first line treatment failure. Dedicated esophageal metal stent or balloon tamponade could be used as a bridge to the TIPS or in case of TIPS contraindication. Non selective beta-blockers and endoscopic therapy are used in primary and secondary prophylaxis.


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal , Derivação Portossistêmica Transjugular Intra-Hepática , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Hipertensão Portal/complicações , Cirrose Hepática/complicações
19.
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
20.
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
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...