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1.
Anticancer Res ; 41(7): 3667-3672, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34230165

RESUMO

BACKGROUND: In the oral and maxillofacial area, granulomatosis with polyangiitis (GPA) can lead to extended tissue destruction. CASE REPORT: This is a case report of a life-threatening local complication resulting from a large osseous defect in the cranial base with consecutive massive bleeding from the right internal carotid artery. Intraoperative examination and diagnostic imaging led to neuroradiological interventional treatment by embolization, and in neurosurgical and further reconstructive surgical treatment by the oral and maxillofacial surgeons. The purpose of this case report was to draw attention to the possibly life-threatening local complications of GPA and to discuss the importance of early intervention. CONCLUSION: As a prevention strategy, regular examinations including three-dimensional radiographic diagnostic imaging are important for the early detection of complications and the possible involvement of important structures.


Assuntos
Artéria Carótida Interna/patologia , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/patologia , Hemorragia/etiologia , Hemorragia/patologia , Hemorragia/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade
2.
Blood Adv ; 5(14): 2813-2816, 2021 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-34269797

RESUMO

Acquired von Willebrand disease (aVWD) is a rare disorder associated with a reduction in von Willebrand factor (VWF) activity, leading to increased bleeding risk. Monoclonal gammopathy of undetermined significance (MGUS) is the most common cause of lymphoproliferative disorder-associated aVWD and is caused by accelerated clearance of circulating VWF. Standard VWF replacement protocols for congenital VWD based on intermittent bolus dosing are typically less effective for aVWD because of antibody-mediated clearance. Intermittent bolus dosing of VWF concentrates often leads to inadequate peak response and profoundly shortened VWF half-life in aVWD. Intravenous immune globulin (IVIG) has demonstrated efficacy in aVWD; however, treatment effect is delayed up to 4 days, limiting its efficacy in acutely bleeding patients. We report the successful use of continuous-infusion VWF concentrate (with or without concomitant IVIG) in 3 patients with MGUS-associated aVWD who had demonstrated an inadequate response to bolus dosing. VWF concentrate doses required in this cohort were higher than typical doses for bleeding treatment in congenital VWD. This report illustrates that continuous-infusion VWF concentrate administration with or without intravenous immunoglobulin rapidly achieves target ristocetin cofactor activity and provides adequate hemostasis in aVWD associated with immunoglobulin G MGUS.


Assuntos
Doenças de von Willebrand , Fator de von Willebrand , Hemorragia/tratamento farmacológico , Hemorragia/etiologia , Hemostasia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Doenças de von Willebrand/tratamento farmacológico
3.
Int J Mol Sci ; 22(12)2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34208666

RESUMO

Post-traumatic epilepsy (PTE) and neurocognitive deficits are devastating sequelae of head injuries that are common in adolescents. Investigating desperately needed treatments is hindered by the difficulties in inducing PTE in rodents and the lack of established immature rat models of pediatric PTE. Hemorrhage is a significant risk factor for PTE, but compared to humans, rats are less prone to bleeding because of their rapid blood coagulation system. In this study, we promoted bleeding in the controlled cortical impact (CCI) closed-head injury model with a 20 min pre-impact 600 IU/kg intraperitoneal heparin injection in postnatal day 35 (P35) periadolescent rats, given the preponderance of such injuries in this age group. Temporo-parietal CCI was performed post-heparin (HTBI group) or post-saline (TBI group). Controls were subjected to sham procedures following heparin or saline administration. Continuous long-term EEG monitoring was performed for 3 months post-CCI. Sensorimotor testing, the Morris water maze, and a modified active avoidance test were conducted between P80 and P100. Glial fibrillary acidic protein (GFAP) levels and neuronal damage were also assessed. Compared to TBI rats, HTBI rats had persistently higher EEG spiking and increased hippocampal GFAP levels (p < 0.05). No sensorimotor deficits were detected in any group. Compared to controls, both HTBI and TBI groups had a long-term hippocampal neuronal loss (p < 0.05), as well as contextual and visuospatial learning deficits (p < 0.05). The hippocampal astrogliosis and EEG spiking detected in all rats subjected to our hemorrhage-promoting procedure suggest the emergence of hyperexcitable networks and pave the way to a periadolescent PTE rat model.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/fisiopatologia , Suscetibilidade a Doenças , Hemorragia/etiologia , Fatores Etários , Animais , Biomarcadores , Biópsia , Lesões Encefálicas Traumáticas/diagnóstico , Modelos Animais de Doenças , Eletroencefalografia , Proteína Glial Fibrilar Ácida/metabolismo , Hemorragia/diagnóstico , Imuno-Histoquímica , Aprendizagem em Labirinto , Neurônios/metabolismo , Ratos
4.
Medicine (Baltimore) ; 100(26): e26316, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190149

RESUMO

INTRODUCTION: Severe hemorrhagic cystitis (HC) is still a common complication after allogeneic hematopoietic stem cell transplantation, which affects the quality of life of patients, and may even cause kidney failure. This study reports the clinical effect of adjuvant treatment of adipose-derived mesenchymal stem cells (ADSCs) on severe refractory HC after of reduced intensity conditioning haplotype high-dose peripheral blood hematopoietic stem cell transplantation (RIC-PBSCT) in one case. PATIENT CONCERNS: A 53-year-old female patient with acute myeloid leukemia (FLT3-ITD) at high risk received RIC-PBSCT. The patient was relieved with complete donor chimerism of 99.01%, and normal hemogram. However, the patient developed frequent urination, urgency, and dysuria with gross hematuria with blood clots and difficult urinating, especially at night and early in the morning. There were obvious hyperemia and bleeding points in the mucosa of the posterior wall of the bladder. DIAGNOSIS: The patient was diagnosed as delayed HC of degree IV. INTERVENTIONS AND OUTCOMES: The patient was treated with antiviral drugs, urine alkalization, and diuretic drugs for more than 1 month, but no significant effect was obtained. Thus, the patient was then given ADSCs (1 × 106 kg per kg of body weight, infused once a week for a total of 3 infusions). Symptoms of frequent urination, urgency, and dysuria that happened during the first infusion were improved, and blood clots in the urine were also reduced. After the third infusion, HC symptoms disappeared, the red blood cells were normal, and there was no fever, chills, low infusion blood pressure, or rash. The patient's HC was cured. During follow-up, HC recurrence was not observed. CONCLUSION: ADSCs adjuvant treatment of relapsed and refractory severe HC is safe and reliable with good clinical efficacy. It shows certain clinical application value, which however requires more clinical cases to further verify this.


Assuntos
Tecido Adiposo/citologia , Cistite/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hemorragia/terapia , Transplante de Células-Tronco Mesenquimais , Condicionamento Pré-Transplante/efeitos adversos , Terapia Combinada , Cistite/etiologia , Feminino , Hematúria/etiologia , Hemorragia/etiologia , Humanos , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/terapia , Pessoa de Meia-Idade , Fatores de Risco , Transtornos Urinários/etiologia
5.
Kidney Blood Press Res ; 46(3): 310-322, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34077930

RESUMO

INTRODUCTION: Kidney biopsy remains the gold standard for the diagnosis of most renal diseases. A major obstacle to performing a biopsy is safety concerns. However, many safety measures are not evidence based and therefore vary widely between centers. We sought to determine the rate and timing of kidney biopsy complications in our center, to compare the complication rate between native and transplant kidney biopsies, to evaluate the feasibility of performing kidney biopsies as an outpatient procedure and the value of a postbiopsy ultrasound before discharge, and to identify risk factors for complications. METHODS: We performed a single-center, retrospective, observational study at the Division of Nephrology of the University Hospital Zurich including all patients who underwent renal biopsy between January 2005 and December 2017. Major bleeding (primary outcome) and any other bleeding or nonbleeding complications (secondary outcomes) were compared between native and transplant kidney biopsies and between inpatient and outpatient procedures and correlated with clinical factors possibly affecting bleeding risk. RESULTS: Overall, 2,239 biopsies were performed in 1,468 patients, 732 as inpatient and 1,507 as outpatient procedures. Major bleeding was observed in 28 (3.8%) inpatient and in 15 (1.0%) outpatient procedures, totaling to 43 (1.9%) of all biopsies. Major bleeding requiring intervention amounted to 1.0% (0.5% of outpatient procedures). Rate of major bleeding was similar between native and transplant kidneys. 13/15 (87%) bleeding episodes in planned outpatient procedures were detected during the 4-h surveillance period. Risk factors for bleeding were aspirin use, low eGFR, anemia, cirrhosis, and amyloidosis. Routine postbiopsy ultrasound did not change management. CONCLUSIONS: Kidney biopsy is an overall safe procedure and can be performed as an outpatient procedure in most patients with an observation period as short as 4 h. The value of routine postbiopsy ultrasound is questionable.


Assuntos
Biópsia , Nefropatias/diagnóstico , Rim/patologia , Adulto , Idoso , Biópsia/efeitos adversos , Feminino , Hemorragia/etiologia , Humanos , Nefropatias/patologia , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Estudos Retrospectivos
6.
J Int Med Res ; 49(6): 3000605211025344, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34190616

RESUMO

Neurofibromatosis type 1 (NF1) is an autosomal dominant disease characterized by neuorocutaneous lesions and multisystem involvement. Other notable features of NF1 include vasculopathy in the form of stenosis, occlusion, aneurysm, pseudoaneurysm, arteriovenous deformity, and rupture, which are difficult to manage and can have fatal outcomes. We describe two cases of extensive and progressive brachial artery hemorrhage following blunt trauma in patients with NF1. Management of these patients included combined endovascular and surgical treatment based on the patients' condition. The patients had a poor prognosis because of uncontrolled bleeding. While one patient died, the other survived, but the involved arm was amputated. Endovascular treatment is a widely used, popular, minimally invasive, and safe method to control the bleeding associated with NF1. However, this treatment can be challenging at times. Close collaboration between an interventional radiologist and surgeon is necessary for optimal treatment and careful follow-up for this condition.


Assuntos
Aneurisma , Neurofibromatose 1 , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/cirurgia , Hemorragia/etiologia , Humanos , Neurofibromatose 1/complicações , Neurofibromatose 1/cirurgia
7.
Curr Opin Anaesthesiol ; 34(4): 537-543, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34074885

RESUMO

PURPOSE OF REVIEW: Major trauma remains one of the leading causes of death worldwide with traumatic brain injury and uncontrolled traumatic bleeding as the main determinants of fatal outcome. Interestingly, the therapeutic approach to trauma-associated bleeding and coagulopathy shows differences between geographic regions, that are reflected in different guidelines and protocols. RECENT FINDINGS: This article summarizes main principles in coagulation diagnostics and compares different strategies for treatment of massive hemorrhage after trauma in different regions of the world. How would a bleeding trauma patient be managed if they got hit by the bus in the United States, United Kingdom, Germany, Switzerland, Austria, Denmark, Australia, or in Japan? SUMMARY: There are multiple coexistent treatment standards for trauma-induced coagulopathy in different countries and different trauma centers. Most of them initially follow a protocol-based approach and subsequently focus on predefined clinical and laboratory targets.


Assuntos
Transtornos da Coagulação Sanguínea , Ferimentos e Lesões , Austrália , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/terapia , Alemanha , Objetivos , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Japão , Reino Unido
8.
Curr Opin Anaesthesiol ; 34(4): 507-513, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34074887

RESUMO

PURPOSE OF REVIEW: Posttraumatic bleeding following major trauma is life threatening for the patient and remains a major global health issue. Bleeding after major trauma is worsened by trauma-induced coagulopathy (TIC). TIC consists of acute trauma coagulopathy and resuscitation coagulopathy. The early diagnosis and management of prehospital TIC management are challenging. RECENT FINDINGS: Concepts for early diagnosis and management of civilian prehospital TIC management are evolving. The feasibility of prehospital blood component as well as coagulation factor transfusion has been proven. SUMMARY: Due to different national guidelines and regulations of blood component therapies there is a wide heterogeneity in concepts of prehospital damage control resuscitation. Tranexamic acid administration is widely accepted, whereas the transfusion of whole blood, blood components, or coagulations factors needs further examination in the civilian setting.


Assuntos
Transtornos da Coagulação Sanguínea , Serviços Médicos de Emergência , Ferimentos e Lesões , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/terapia , Transfusão de Componentes Sanguíneos , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Ressuscitação , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia
9.
Curr Opin Anaesthesiol ; 34(4): 514-520, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34091461

RESUMO

PURPOSE OF REVIEW: Recent advances in the understanding of the pathophysiological processes associated with traumatic haemorrhage and trauma-induced coagulopathy (TIC) have resulted in improved outcomes for seriously injured trauma patients. However, a significant number of trauma patients still die from haemorrhage. This article reviews the role of fibrinogen in normal haemostasis, the effect of trauma and TIC on fibrinogen levels and current evidence for fibrinogen replacement in the management of traumatic haemorrhage. RECENT FINDINGS: Fibrinogen is usually the first factor to reach critically low levels in traumatic haemorrhage and hypofibrinogenaemia after severe trauma is associated with increased risk of massive transfusion and death. It is postulated that the early replacement of fibrinogen in severely injured trauma patients can improve outcomes. There is, however, a paucity of evidence to support this, and in addition, there is little evidence to support or refute the effects of cryoprecipitate or fibrinogen concentrate for fibrinogen replacement. SUMMARY: The important role fibrinogen plays in haemostasis and effective clot formation is clear. A number of pilot trials have investigated different strategies for fibrinogen replacement in severe trauma. These trials have formed the basis of several large-scale phase III trials, which, cumulatively will provide a firm evidence base to harmonise worldwide clinical management of severely injured trauma patients with major haemorrhage.


Assuntos
Transtornos da Coagulação Sanguínea , Hemostáticos , Ferimentos e Lesões , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/etiologia , Transfusão de Sangue , Fibrinogênio/uso terapêutico , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Ferimentos e Lesões/complicações
10.
BMJ Case Rep ; 14(6)2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34130979

RESUMO

Diffuse alveolar haemorrhage (DAH) is known to occur from several infectious and non-infectious aetiologies. Among the infectious aetiologies, Haemophilus influenzae, an organism known to cause community-acquired pneumonia, has not been reported in association with DAH prior to this case. On the other hand, vaping, an evolving epidemic concern, has been linked to various types of lung injury, including DAH. However, DAH related to vaping is only limited to several case reports. Our case describes H. influenzae pneumonia with DAH in a patient known to have vaped until the night prior to elective lobectomy for lung cancer and developed DAH within 24 hours of hospitalisation. He subsequently recovered with treatment. DAH requires immediate recognition, and healthcare providers need to be aware that neither haemoptysis nor decrease in haemoglobin level is necessarily associated. Prior to diagnosis, empirical treatment with intravenous steroids and antibiotics can be life-saving.


Assuntos
Pneumopatias , Vaping , Haemophilus influenzae , Hemorragia/etiologia , Humanos , Masculino , Alvéolos Pulmonares
11.
J Autoimmun ; 122: 102685, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34174723

RESUMO

The involvement of viruses and SARS-CoV-2 in autoimmune diseases is well known. The recent demonstration that ChAdOx1 nCoV-19 Covid-19 (AstraZeneca) vaccine (ChA) favors the production of anti-platelet factor 4 (anti-PF4) antibodies, blood clots, and thrombocytopenia raises the question of whether other anti-CoViD-19 vaccines favor the same patterns of events. We assessed the frequency of severe adverse events (SAEs) documented in the EudraVigilance European database up to April 16, 2021 related to thrombocytopenia, bleeding, and blood clots in recipients of ChA compared to that of recipients of the BNT162b2 Covid-19 (Pfizer/BioNTech) vaccine (BNT). ChA administration was associated with a much higher frequency of SAEs in each AE Reaction Group as compared with that elicited by BNT. When considering AEs caused by thrombocytopenia, bleeding and blood clots, we observed 33 and 151 SAEs/1 million doses in BNT and ChA recipients, respectively. When considering patients with AEs related to cerebral/splanchnic venous thrombosis, and/or thrombocytopenia, we documented 4 and 30 SAEs and 0.4 and 4.8 deaths/1 million doses for BNT and ChA recipients, respectively. The highest risk following ChA vaccination is in young people and, likely, women of reproductive age, as suggested by hypothesized scenarios. In conclusion, the immune reaction promoted by ChA vaccine may lead to not only thrombocytopenia and cerebral/splanchnic venous thrombosis but also other thrombotic and thromboembolic SAEs. These events are not favored by BNT vaccine. Our study may help in the evaluation of the benefit/risk profile of the ChA vaccine considering the epidemic curve present in a country.


Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Hemorragia/etiologia , Trombose/etiologia , Adolescente , Adulto , Europa (Continente) , Feminino , Hemorragia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Trombocitopenia/epidemiologia , Trombocitopenia/etiologia , Trombose/epidemiologia , Adulto Jovem
12.
BMJ Case Rep ; 14(6)2021 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-34155024

RESUMO

A 40-year-old man developed granulomatosis with polyangiitis (GPA) following a mild case of COVID-19. Initially, he experienced mild migrating joint pain for 2 months prior to testing positive for SARS-CoV-2 but dramatically worsened following resolution of his infection. The pain continued to progress until he suddenly develope haemoptysis, prompting him to present to a local hospital. The diagnosis of diffuse alveolar haemorrhage secondary to GPA was confirmed with labs, imaging and histopathology. Precipitous deterioration of GPA with concurrent COVID-19 infection indicates a possible temporal relationship. Since the onset of the pandemic, SARS-CoV-2 has been anecdotally associated with the development of various connective tissue disorders. The overlapping clinical presentations and similar appearance on lung imaging present clinicians with a diagnostic challenge. This underscores the importance of having a high index of suspicion of autoimmune diagnoses in patients who present with new or worsening findings following a COVID-19 infection.


Assuntos
COVID-19 , Granulomatose com Poliangiite , Pneumopatias , Adulto , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/diagnóstico , Hemorragia/etiologia , Humanos , Pneumopatias/diagnóstico por imagem , Pneumopatias/etiologia , Masculino , SARS-CoV-2
13.
EuroIntervention ; 17(3): 189-191, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34167937
14.
Int J Mol Sci ; 22(11)2021 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-34072606

RESUMO

The purpose of this study was to determine if asiatic acid may act efficiently in the model of cyclophosphamide (CYP)-induced cystitis in rats. We performed experiments after administration of CYP (single dose 200 mg/kg, intraperitoneally), asiatic acid (30 mg/kg/day for 14 consecutive days, by oral gavage), or CYP plus asiatic acid, during which conscious cystometry, measurements of urothelium thickness and bladder edema, as well as selected biomarkers analyses were conducted. In rats that received asiatic acid together with CYP, a drop in bladder basal pressure, detrusor overactivity index, non-voiding contraction amplitude, non-voiding contraction frequency, and the area under the pressure curve were observed, when compared to the CYP group. Furthermore, a significant increase in threshold pressure, voided volume, intercontraction interval, bladder compliance, and volume threshold to elicit NVC were found in that group accordingly. Administration of the asiatic acid successfully restored concentrations of biomarkers both in bladder urothelium (BDNF, CGRP, OCT-3, IL-1ß, IL-6, NGF, nitrotyrosine, malondialdehyde, TNF-α, SV2A, SNAP23, SNAP25, PAC-1, ORM1, occludin, IGFBP-3, HB-EGF, T-H protein, Z01, and HPX) and detrusor muscle (Rho kinase and VAChT) in CYP-treated rats. Finally, asiatic acid significantly decreased urothelium thickness and bladder oedema. Asiatic acid proved to be a potent and effective drug in the rat model of CYP-induced cystitis.


Assuntos
Antineoplásicos Alquilantes/efeitos adversos , Ciclofosfamida/efeitos adversos , Cistite/tratamento farmacológico , Cistite/etiologia , Hemorragia/tratamento farmacológico , Hemorragia/etiologia , Triterpenos Pentacíclicos/farmacologia , Animais , Biomarcadores , Modelos Animais de Doenças , Ratos , Urotélio/efeitos dos fármacos , Urotélio/metabolismo , Urotélio/patologia
15.
J Endovasc Ther ; 28(4): 614-622, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34018880

RESUMO

PURPOSE: Uncontrolled pelvic hemorrhage from trauma is associated with mortality rates above 30%. The ability of an intervention to reduce blood loss from pelvic trauma is paramount to its success. The objective of this study was to determine if computed tomography volumetric analysis could be used to quantify blood loss in a porcine endovascular pelvic hemorrhage model. MATERIALS AND METHODS: Yorkshire swine under general anesthesia underwent balloon dilation and rupture of the profunda femoris artery, which was confirmed by digital subtraction angiography. Computed tomography angiography and postprocessing segmentation were performed to quantify pelvic hemorrhage volume at 5 and 30 minutes after injury. Continuous hemodynamic and iliofemoral flow data were obtained. Baseline and postinjury hemoglobin, hematocrit and lactate were collected. RESULTS: Of 6 animals enrolled, 5 survived the 30-minute post-injury period. One animal died at 15 minutes. Median volume of pelvic hemorrhage was 141±106 cm3 at 5 minutes and 302±79 cm3 at 30 minutes with a 114% median increase in hematoma volume over 25 minutes (p=0.040). There was a significant decrease in mean arterial pressure (107 to 71 mm Hg, p=0.030) and iliofemoral flow (561 to 122 mL/min, p=0.014) at 30 minutes postinjury, but no significant changes in hemoglobin, hematocrit, or heart rate. CONCLUSION: Computed tomography volumetric analysis can be used to quantify rate and volume of blood loss in a porcine endovascular pelvic hemorrhage model. Future studies can incorporate this approach when evaluating the effect of hemorrhage control interventions associated with pelvic fractures.


Assuntos
Hemorragia , Ossos Pélvicos , Angiografia Digital , Animais , Tomografia Computadorizada de Feixe Cônico , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Suínos , Resultado do Tratamento
16.
Curr Opin Anaesthesiol ; 34(4): 530-536, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34039847

RESUMO

PURPOSE OF REVIEW: Severe bleeding events, which require blood transfusions, are a challenge faced by many critical care physicians on a daily basis. Current transfusion guidelines generally recommend rather strict transfusion thresholds and strategies, which can appear opposing to a patient in need for urgent transfusion at first sight. Moreover, applied guidelines are lacking evidence and specificity for the typical ICU patient population and its comorbidities. Transfusion decisions, which are pivotal for clinical outcome, are often unsatisfactorily based on hemoglobin levels only. RECENT FINDINGS: Recent publications generally support previous studies that a strict transfusion regimen is superior to a liberal one for the majority of cases. Newly developed and easily feasible techniques are currently in clinical trials and have the potential to become a valuable supplementation to hemoglobin-guided decision-making. In addition to the choice of the ideal transfusion strategy, physiological status and comorbidities were found to have a major impact on the outcome of severe bleedings in the ICU. SUMMARY: The body of evidence for ICU-specific transfusion guidelines is scarce. Critical care physicians should properly evaluate their patient's comorbidities and consider extended point-of-care testing for transfusion decisions in indistinct anemic situations. A strict transfusion strategy should, however, be applied whenever possible.


Assuntos
Anemia , Transfusão de Eritrócitos , Hemoglobinas/análise , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Unidades de Terapia Intensiva
17.
Medicine (Baltimore) ; 100(21): e26077, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032739

RESUMO

BACKGROUND: Nonacog alfa (recombinant factor IX [FIX]) is approved in China for the control and prevention of bleeding events in patients with hemophilia B. This was the first study to assess prophylaxis and on-demand therapy with recombinant FIX replacement in a real-world setting in China. This study aimed to evaluate the safety and efficacy of nonacog alfa in Chinese patients with hemophilia B. METHODS: In this open-label, multicenter study (clinicaltrials.gov identifier NCT02336178), patients received on-demand or prophylactic treatment with intravenous nonacog alfa for approximately 6 months or 50 exposure days, whichever occurred first. The primary safety outcome was medically important events (i.e., development of FIX inhibitors, allergic reactions, and thrombotic events). Key secondary efficacy outcomes included the annualized bleeding rate for on-demand treatment and prophylaxis, response to on-demand treatment, the number of infusions per bleeding event, and the number of breakthrough bleeding events within 48 hours of prophylaxis. RESULTS: Seventy male patients (mean [standard deviation] age 7.8 [7.2] years) were enrolled (on-demand, n = 37; prophylaxis, n = 57 [24 patients were included in both groups]). Thirty-eight (54%) patients had up to 50 FIX exposure days before the study. The only medically important event was a transient low-titer FIX inhibitor (incidence 1.4%, 95% confidence interval, 0-7.7). The mean annualized bleeding rate was 26.3 for on-demand treatment and 6.5 for prophylaxis. A mean (standard deviation) of 1.5 (1.7) nonacog alfa infusions were given per bleeding episode; 78.8% of episodes resolved with 1 infusion. Response was "excellent" or "good" for 88% of the on-demand infusions. Twenty-three bleeding events (n = 11 patients) occurred within 48 hours of 2032 prophylaxis doses (1.13%). CONCLUSION: In the real-world setting, nonacog alfa is safe and effective for on-demand treatment and for prophylaxis for patients with hemophilia B in China.


Assuntos
Terapia de Reposição de Enzimas/efeitos adversos , Fator IX/efeitos adversos , Hemofilia B/tratamento farmacológico , Hemorragia/epidemiologia , Adolescente , Criança , Pré-Escolar , China , Terapia de Reposição de Enzimas/métodos , Fator IX/administração & dosagem , Hemofilia B/complicações , Hemorragia/etiologia , Hemorragia/prevenção & controle , Humanos , Lactente , Infusões Intravenosas , Masculino , Estudos Prospectivos , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Resultado do Tratamento
18.
Medicine (Baltimore) ; 100(21): e26142, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032764

RESUMO

RATIONALE: A seminal vesicle cyst is a benign lesion of the seminal vesicle that is usually asymptomatic. However, when a giant seminal vesicle cyst ruptures and bleeds, it can cause obvious clinical symptoms. To our knowledge, no single giant seminal vesicle cyst with hemorrhage has been reported in current studies, and surgery is the primary method to treat seminal vesicle hemorrhage with obvious symptoms. PATIENT CONCERNS: A 31-year-old man presented with urination pain but without obvious urination frequency and urgency, dysuria, and discomfort. Rectal palpation in the chest-knee position revealed a hard mass palpable in the upper right with a smooth surface and mild tenderness, and the upper edge of the mass could not be palpated. DIAGNOSIS: The results of the B-mode ultrasound indicated a mixed echogenic lump between the bladder and prostate, with a size of 81 × 76 mm. The computer tomography scan showed an "S" tubular lump in the right side of the pelvic cavity. The mass has a computer tomography value of 58 to 70 HU, and uneven reinforcement can be observed. On the basis of the results of the magnetic resonance imaging of the urinary bladder, the lump has T1 and T2 signals of equal lengths. INTERVENTIONS: The patient was diagnosed with a huge right seminal vesicle cyst with hemorrhage and was treated via laparoscopic surgery. OUTCOMES: The patient recovered quickly after the operation, and the symptoms of urination pain were significantly improved. LESSONS: Seminal vesicle hemorrhage is clinically rare, and laparoscopic treatment is an effective and safe surgical method for the treatment of seminal vesicle cysts.


Assuntos
Cistos/complicações , Cistos/cirurgia , Hemorragia/etiologia , Laparoscopia , Glândulas Seminais/cirurgia , Adulto , Cistos/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Hemorragia/cirurgia , Humanos , Masculino , Dor/etiologia , Ruptura Espontânea/complicações , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia , Glândulas Seminais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia , Micção
19.
Acta Biomed ; 92(S1): e2021043, 2021 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-33944848

RESUMO

BACKGROUND: The giant haemorrhagic bursitis of the hip joint is a rare clinical condition that requires evidence-based guidelines for adequate diagnosis and management. Usually, this pathology requires conservative treatment; however, when abnormal size or clinical symptoms of compression of the surrounding noble structures are reported, an accurate differential diagnosis is required, in order to exclude other malignant conditions that can be included into differential diagnosis, and a surgical approach should be considered. The purpose of this work is to provide an appropriate description of the diagnostic and therapeutic path, providing an accurate analysis of the possible differential diagnoses. METHODS: We report 2 cases of symptomatic haemorrhagic bursitis of the hip joint, confirmed by histological investigation. In both cases, the patients complained a peripheral nerve deficit of a single limb: one patient presented paresthesia of lateral femoral cutaneous nerve while the second peripheral edema due to compression of the proximal venous and lymphatic circulation. RESULTS: Both cases were successfully managed by complete surgical excision of the mass, with no  recurrence. There were no major complications, but in first case the nerve deficit was permanent. CONCLUSIONS: Giant hemorrhagic trochanteric bursitis is a rare condition, but it should be included in the differential diagnosis of soft tissue masses arising from the hip joint. Due to the rarity of this entity, a cautious exclusion process of all plausible differential diagnosis must be undertaken, in order to not miss the possibility of soft-tissue tumors, primarily malignant high-grade sarcomas.


Assuntos
Bursite , Sarcoma , Bursite/diagnóstico , Hemorragia/diagnóstico , Hemorragia/etiologia , Articulação do Quadril/diagnóstico por imagem , Humanos , Recidiva Local de Neoplasia , Sarcoma/diagnóstico
20.
BMJ Case Rep ; 14(5)2021 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-34039544

RESUMO

An 81-year-old patient presented with fever and lethargy for 3 weeks. There were no other signs or symptoms of infection. Detailed history revealed a fall onto his right flank, prior to the start of fever. All microbiological, autoimmune and oncological investigations were negative. CT scan of chest, abdomen and pelvis showed haemorrhage in a previously diagnosed simple adrenal cyst. The cyst was non-functioning. The patient continued to spike fever in the following 4 weeks, otherwise remained stable. The patient was managed conservatively as haemoglobin level was stable. Repeated scan showed signs of improvement. He was discharged after 5 weeks. He remained afebrile and asymptomatic at the planned endocrinology outpatient follow-up after 8 weeks.


Assuntos
Cistos , Hemorragia , Idoso de 80 Anos ou mais , Dor no Peito , Cistos/complicações , Cistos/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Masculino , Tomografia Computadorizada por Raios X
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