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Results for “HEMORRHAGE, GASTROINTESTINAL”

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At least 541 records · Page 30Linked to original sources
PubMed2005

The yield of bleeding scans in acute lower gastrointestinal hemorrhage.

GOALS/BACKGROUND: Previous studies have demonstrated low yield and conflicting results as to the ability of technetium-99m labeled red blood cell (TRBC) scintigraphy to accurately localize the site of bleeding in acute lower gastrointestinal hemorrhage. Our objective was to evaluate the accuracy of TRBC scintigraphy in clinical day-to-day practice at our institution and to determine predictors of a positive test. METHODS: A retrospective medical records review of all patients who underwent TRBC scintigraphy over a 5-year period was conducted at a single academic medical center. The site of bleeding found on TRBC scintigraphy was correlated with the endoscopic, angiographic, surgical, and pathologic findings in each patient. RESULTS: A total of 127 scans were performed in 115 patients. Forty-nine scans were positive (39%) and 78 were negative (61%). Forty-two patients had further evaluation after a positive scan, and the bleeding site was confirmed to be accurate in 20 of 42 patients (48%). A contradictory bleeding site was found in 5 of 49 positive scans (10%). Patients transfused greater than 2 units of packed red blood cells within 24 hours preceding the TRBC scan were twice as likely to have a positive scan (64%) than those transfused 2 units or less (32%) (P = 0.002). Multivariate analysis demonstrated that the number of units of blood transfused within 24 hours prior to the TRBC scan and the lowest recorded hematocrit were significantly different between patients with positive and negative scans. There was no difference in the rate of endoscopy between patients with a positive or negative scan result. CONCLUSIONS: TRBC scintigraphy has a relatively low yield in the evaluation of acute lower gastrointestinal bleeding. Objective selection criteria such as number of units of packed red blood cells transfused prior to obtaining the scan may increase the overall yield.

Acute Disease↗
PubMed1985

[Causes of gastrointestinal hemorrhages in chronic liver diseases].

356 patients with chronic liver diseases hospitalized in our clinic during the period from January 1, 1981, to December 12, 1983, were enrolled in a retrospective study. Of them 55 had been admitted for acute gastrointestinal hemorrhage. It appears that gastroscopy is the only method allowing to localize the origin of the bleeding with high certainty. Bleedings from varices (45%) and ulcers or erosions (22%) were seen most frequently. With regard to case history, clinic, paraclinic and prognosis, no significant differences were found between these various origins of the hemorrhages. Also it is remarkable that all bleedings occur with higher frequency in portal hypertension.

Adult↗
PubMed1999

Massive gastrointestinal hemorrhage in systemic lupus erythematosus: successful treatment with corticosteroid pulse therapy.

Although mesenteric vasculitis due to systemic lupus erythematosus (SLE) is relatively uncommon, it is the most dangerous manifestation associated with high mortality. We describe the case of a SLE patient with life-threatening gastrointestinal hemorrhage due to mesenteric vasculitis in whom methylprednisolone pulse therapy was quite effective in controlling the hemorrhage and resulted in a satisfactory long term outcome. A 47-yr-old woman presenting with high fever, rash, and melena was diagnosed with SLE from positive antinuclear antibodies, anti-dsDNA, and low complement titers. Although fever and rash subsided with administration of prednisolone, massive hematemesis appeared with melena. Endoscopy demonstrated bleeding ulceration of the antrum, which was intractable despite intensive antiulcer therapy and transfusion. Surgical exploration revealed ileal penetration, and multiple bleeding ulcerations were observed over the resected ileum as well as the antral ulceration. However, bleeding persisted after surgery and surgical findings prompted us to select methylprednisolone pulse. Hemorrhage responded promptly to the therapy, and the patient has remained well since then for >10 yr. Our report indicates that corticosteroid pulse may serve as one of the therapeutic options for SLE with massive hemorrhage due to widespread mesenteric vasculitis.

Anti-Inflammatory Agents↗
PubMed2006

Anesthetic management of Klippel-Trénaunay syndrome and attendant gastrointestinal hemorrhage. A case report.

Klippel-Trénaunay syndrome is a congenital malformation characterized by the triad of flat red hemangiomas, soft tissue and bony hypertrophy and varicose veins. In addition, venous malformations or hemangiomas may also be found in the lung, gastrointestinal tract, liver, kidney and bladder, which may result in recurrent hemor-rhage and compromise the affected organs. Involvement of the cerebrum, cerebellum or spinal cord may lead to intracerebral bleeding and compression of neurological structures. Venous thrombosis and pulmonary thromboembolism are both common and may cause pulmonary hypertension and right ventricle failure. In some patients, in addition to flat hemangiomas, cavernous hemangiomas can be seen with a rapid growth rate in the first year of the patient's lifespan, producing high-output congestive heart failure and consumptive coagulopathy (Kasabach-Merritt syndrome). We report the case of a 35-year-old male patient diagnosed with Klippel-Trénaunay syndrome who was scheduled for right hemicolectomy for relapsing gastrointestinal hemorrhage unmanageable with conservative treatment. We also discuss the pathophysiologic and clinical aspects of the Klippel-Trénaunay syndrome. Nowadays, the anesthetic management of these patients remains a matter of controversy.

Adult↗
PubMed1979

Control of upper gastrointestinal hemorrhage by endoscopic spraying of clotting factors.

A new technique for the endoscopic control of upper gastrointestinal hemorrhage has been developed. It consists of a spraying device which delivers atomized clotting factors (thrombin and fibrinogen) directly to a focal bleeding site. In vivo studies in a standardized dog model of acute gastric ulcer bleeding, demonstrated a significant reduction in bleeding time by spraying thrombin and cryoprecipitate (mean +/- SE bleeding time = 223 +/- 14 sec) as compared to a saline spray (mean 705 +/- 60 sec) or to the untreated controls (mean 498 +/- 43 sec), P less than 0.001. Similar results were obtained in the heparinized dog model. The mean bleeding time was 226 +/- 11 sec in the sprayed animals, while the control ulcers bled continuously. The four lumen spray tube fits the biopsy lumen of commercial gastroscopes. The feasibility of the technique for treatment of oozing venous bleeding sites in the upper gastrointestinal tract has been successfully tried in a clinical setting. The authors feel that the technique in its present form is ready for clinical testing in a controlled manner.

Animals↗