Our knowledge of the local hemostatic factors capable of playing a role in certain intraocular hemorrhages is reviewed as a background to therapy with agents active in hemostasis. Common to hyphemas and subretinal hemorrhages are some conditions which are apt to disturb hemostasis and result in recurrent bleeding. They are: 1) Dilution of blood by aqueous humor or subretinal exudative fluid followed by the formation of hemostatic plugs which are prone to spontaneous lysis; 2) Contiguity of certain structures, such as the iris and the choroid, which are extremely rich in fibrinolytic activators favoring premature dissolution of the hemostatic plug and thereby recurrent bleeding; and 3) Presumptive high local concentration of fibrin degradation products (FDP), which have an anticoagulant action and would counteract hemostasis in the event of rebleeding. Based on these observations, the use of fibrinolytic inhibitors for the treatment of hyphema and subretinal hemorrhages seems warranted. Hemostatic mechanisms in intraocular hemorrhages and their treatment with various agents are discussed.

Antifibrinolytic Agents↗

PubMedDate not supplied

Low fibrinolytic activity in the walls of veins in patients with thrombosis.

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Fibrinolysis↗

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Concomitant radiochemotherapy in unresectable carcinoma of the exocrine pancreas: cost-effectiveness analysis.

One of the principal therapeutic options in unresectable carcinoma of exocrine pancreas is concomitant radiochemotherapy. However, in current scientific literature cost analyses of this therapeutic modality are lacking. A payer-oriented cost-effectiveness analysis of concomitant radiochemotherapy was carried out. Outcomes and differences in costs relatively to two different therapeutic strategies were compared retrospectively: biliary drainage + observation (group 1); biliary drainage + concomitant radiochemotherapy (group 2). Cost-effectiveness was assessed based on the analysis of incremental cost of benefit in terms of survival in group 2. As incremental cost of group 2 was considered that of radiochemotherapy, costs of diagnosis and staging being similar in the two groups. The unit of measurement used was $/Lys (LYS = years of life saved). For estimates of cost-effectiveness in different clinical situations, a sensitivity analysis was carried out. The incremental cost of standard concomitant radiochemotherapy was shown to be $4,755. Incremental costs relatively to the situations of minimum and maximum treatment were shown to be $4,410 and $8,375, respectively. Median survival was 4.5 and 10 months in group 1 and 2 respectively (logrank: p = 0.0046). The benefit in terms of survival achieved by concomitant radiochemotherapy was shown to be 5.5 months equal to 0.46 years. Therefore, in the standard situation, the treatment cost-effectiveness can be estimated in: $4,755/0.46 years = $10,337/LYS, that is, the cost of a year of life saved was shown to be $10,337. Results of sensitivity analysis showed that cost-effectiveness can be estimated in the range $7,603 and $25,379/LYS. In conclusion, concomitant radiochemotherapy in patients with unresectable pancreatic carcinoma is able to improve the quality of life through the relief of related symptoms as well as median survival (10 vs 4.5 months). Costs of these benefits, even if considering better survival only, based on this analysis, were shown to be acceptable.

Adult↗

PubMedDate not supplied

[Cardiac rhythm in the newborn infant. A contribution to the definition of normality].

The definition of normal cardiac rhythm in newborn is still uncertain. Authors studied thirty healthy newborns by standard and dynamic ECG; results were compared and discussed.

Circadian Rhythm↗

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[ECG monitoring in full-term infants. Analysis of the rhythm and variability of heart rate].

BACKGROUND: Heart Rate (HR) and Heart Rate Variability (HRV) depend on the neural control to the heart. HRV can be measured from 24-hours function. Little information is available on cardiac rhythm and on autonomic nervous control to the heart at birth. The aims of the study weew: 1) to study the cardiac rhythm in healthy newborn babies; 2) to asses the normal values for HRV at birth. METHODS: We studied 20 full term healthy newborn babies. Newborns underwent 24-hours ECG-Holter monitoring. Analysis was performed by a 750 A Del Mar Avionics Analyzer. We determined: Heart Rate (HR), number of extrasystoles, Standard Deviation of all R-R intervals over 24 hours (SDNN) and mean hourly HRV (HRVM). Results about HRV were matched with those of 50 healthy adults. RESULTS: 1) Average HR in the newborn babies was 108 (range: 55-198); we found high prevalence of supraventricular extrasystoles. 2) We determined reference value for HRV. SDNN was 55 +/- 17 ms in newborns. SDNN of adults was 132 +/- 25 ms (44% higher than in newborns; p < 0.001). HRVM was 46 +/- 14 ms in newborns and 76 +/- 14 ms (p < 0.001). CONCLUSION: 1) Larger intervals of HR in newborn babies compared to literature data and an high prevalence of supraventricular arrhythmias in full term healthy newborn babies. 2) Reference values for HRV in newborn babies. The low values of HRV confirm the immaturity of autonomic cardiac control.

Adult↗

PubMedDate not supplied

Carcinoma of the pancreatic head area. Diagnostic imaging. Direct cholangiography: ERCP.

In case of clinical and radiologic findings suggestive for periampullary cancer, primary goals of ERCP are the observation of the duodenum and the periampullary region and the opacification of biliopancreatic ducts to confirm the diagnosis of neoplastic stricture of biliopancreatic ducts and to establish its origin and extent at the level of the ducts and of the intestinal lumen. Secondarily, during ERCP, histologic and/or cytologic typing of the neoplasm by biopsy sampling and brushing of the lesion or exfoliative cytology of the bile and pancreatic juice, is feasible. At the level of the area of the pancreatic head various types of neoplasms can arise with different prognostic features which require different therapeutic approaches. Endoscopic cholangiopancreatography for its high sensitivity and specificity plays a major role in a correct combined radiodiagnostic imaging.

Cholangiopancreatography, Endoscopic Retrograde↗