A woman with five previous normal vaginal deliveries and a history of right salpingectomy for ectopic preg-nancyhas sudden pain in term labour, with epidural analgesia. A concurrent worsening of fetal heart rate patte...A woman with five previous normal vaginal deliveries and a history of right salpingectomy for ectopic preg-nancyhas sudden pain in term labour, with epidural analgesia. A concurrent worsening of fetal heart rate pattern with bradycardia urges quick vacuum delivery. Maternal post-partum pain and hemoglobin (Hb) drop suggest intra-abdominal haemorrhage. The combination of sudden, strong intra-partum pain and fetal distress should raise the suspicion of intra-abdominal haemorrhage. After vaginal delivery an accurate follow-up is mandatory.展开更多
<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Postpartum haemorrhage ...<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Postpartum haemorrhage is one of the leading causes of maternal morbidity and mortality worldwide. It occurs predominantly in developing countries due to poorly developed infrastructures and lack of skilled birth attendants.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Objective:</span></b></span></span><span><span><b><span style="font-family:""> </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">To identify the prevalence, causes and risk factors of primary postpartum haemorrhage following vaginal deliveries in a referral hospital (Douala General Hospital-Cameroon).</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Methods:</span></b></span></span><span><span><b><span style="font-family:""> </span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">This was a descriptive and analytical study carried in the Douala General Hospital (DGH) for which socio-demographic, clinical, obstetric and post-partum data were collected using a pre-tested questionnaire. Descriptive statistics, multivariate analysis and logistic regression allowed us to present and discuss our results, with a 95% confidence interval (CI) and </span><i><span style="font-family:Verdana;">p </span></i><span style="font-family:Verdana;">value <</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">0.05.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Results:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> The prevalence of Primary Postpartum Haemorrhage was 1.33%. Quantification of bleeding was reported in only 13.15% of cases. The main causes were: uterine atony (36.18%), placental retention (25.65%), cervical tears (12.50%), perineal tears (10.52%) and cervico-vaginal tears (08.52%). The risk factors were: age between 19</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">35 years aOR = 4.52;95% CI = 2.65</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">7.98;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.021);unemployment (aOR = 4.74;95% CI = 2.91</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">6.02;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.001);being multigravida (aOR = 9.21;95% CI = 6.43</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">12.48;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.035);history of abortion (aOR = 5.11;95% CI = 2.05</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">7.29;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.004);preterm delivery (aOR = 6.88;95% CI = 2.72</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">9.06;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.002);duration of labour</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">> 12 hours (aOR = 4.05;95% CI = 2.46</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">7.98;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.003) and macrosomia (aOR = 3.27;95% CI = 1.03</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">5</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">68;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.041).</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusion:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Primary postpartum haemorrhage remains a poorly assessed obstetric complication in the maternity ward of the Douala General Hospital (DGH);Training staff on quantifying postpartum blood loss and monitoring the second and third stages of labour can help to better manage and reduce its occurrence.</span></span></span>展开更多
BACKGROUND Minimally invasive surgery(MIS)and craniotomy(CI)are the current treatments for spontaneous supratentorial cerebral haemorrhage(SSTICH).AIM To compare the efficacy and safety of MIS and CI for the treatment...BACKGROUND Minimally invasive surgery(MIS)and craniotomy(CI)are the current treatments for spontaneous supratentorial cerebral haemorrhage(SSTICH).AIM To compare the efficacy and safety of MIS and CI for the treatment of SSTICH.METHODS Clinical and imaging data of 557 consecutive patients with SSTICH who underwent MIS or CI between January 2017 and December 2022 were retrospectively analysed.The patients were divided into two subgroups:The MIS group and CI group.Propensity score matching was performed to minimise case selection bias.The primary outcome was a dichotomous prognostic(favourable or unfavourable)outcome based on the modified Rankin Scale(mRS)score at 3 months;an mRS score of 0–2 was considered favourable.RESULTS In both conventional statistical and binary logistic regression analyses,the MIS group had a better outcome.The outcome of propensity score matching was unexpected(odds ratio:0.582;95%CI:0.281–1.204;P=0.144),which indicated that,after excluding the interference of each confounder,different surgical modalities were more effective,and there was no significant difference in their prognosis.CONCLUSION Deciding between MIS and CI should be made based on the individual patient,considering the hematoma size,degree of midline shift,cerebral swelling,and preoperative Glasgow Coma Scale score.展开更多
Spontaneous intracerebral haemorrhage (sICH) is characterised by bleeding within the brain parenchyma, without any accompanying vascular malformation, parenchymal abnormality or coagulation disorder. The study aimed t...Spontaneous intracerebral haemorrhage (sICH) is characterised by bleeding within the brain parenchyma, without any accompanying vascular malformation, parenchymal abnormality or coagulation disorder. The study aimed to depict the management of sICH at the University Hospital of Brazzaville (UHB). It was an observational, descriptive, and cross-sectional analysis. Data collection was conducted retrospectively, covering the period from January 1, 2020 to August 31, 2022, spanning two years and eight months. The study examined socio-demographic, diagnostic, therapeutic, and evolutionary variables. We included 274 cases. We observed 160 men (58.4%) and 114 women (41.6%), resulting in a sex ratio of 1.4. The mean age was 55.3 ± 11.4 years, with ages ranging from 31 to 93 years. The detection of sICH was typically a result of experiencing motor deficits (59.5%) or disorders of consciousness (37.2%). The weightiness of one half of the body was the most common reason for seeking medical advice. Hematoma was capsulo-lenticular in 159 cases (58%) and capsulo-thalamic in 63 cases (23%). Hematomas were <30 ml in 162 cases (59.1%) and >30 ml in 112 cases (40.9%), and associated with hydrocephalus in 11.7% of cases. Conservative medical treatment was administered in 257 cases (94.2%) while surgical treatment was performed in 16 cases (5.8%). The surgical techniques used were external ventricular drainage (EVD) in 2 cases, ventriculo-peritoneal shunt in 5 cases, and hematoma evacuation in 10 cases. Death occurred before the 7th day of hospitalisation in 73 cases (57.8%) and after in 46 cases (42.2%). The median time to death was four days (Q1 = 2 days;Q3 = 7 days), with extremes of 0 and 216 days. .展开更多
Objective:To analyze the risk factors for death during hospitalization in patients with acute myocardial infarction(AMI)complicated by gastrointestinal bleeding(GIB).Methods:260 patients with AMI complicated by GIB wh...Objective:To analyze the risk factors for death during hospitalization in patients with acute myocardial infarction(AMI)complicated by gastrointestinal bleeding(GIB).Methods:260 patients with AMI complicated by GIB who were admitted to the cardiology department of a hospital from January 2022 to December 2023 were retrospectively analyzed.27 patients who died during hospitalization were designated as the control group and the 233 patients who survived as the observation group.Baseline data and clinical indexes of patients in the two groups were compared,and multifactorial logistic regression was applied to analyze the risk factors for death during hospitalization in patients with AMI complicated by GIB.Results:Univariate analysis showed that the control group had higher proportions of patients with Killip classification III to IV on admission,new arrhythmias,and mechanical complications,as well as higher heart rates,white blood cell counts,urea nitrogen,and creatinine levels.The proportion of patients who received transfusion therapy during hospitalization was also higher in the control group.Conversely,the control group had lower systolic and left ventricular ejection fraction rates compared to the observation group,with statistically significant differences(P<0.05).Multifactorial logistic regression analysis revealed that new-onset arrhythmia(OR=2.724,95%CI 1.289-5.759),heart rate>100 beats/min(OR=3.824,95%CI 1.472-9.927),left ventricular ejection fraction<50%(OR=1.884,95%CI 0.893-3.968),BUN level(OR=1.029,95%CI 1.007-1.052),and blood transfusion(OR=3.774,95%CI 1.124-6.345)were independently associated with an increased risk of death during hospitalization in patients with AMI complicated by GIB.Conclusions:New arrhythmia,heart rate>100 beats/min,left ventricular ejection fraction<50%,elevated BUN levels,and blood transfusion are risk factors for death during hospitalization in patients with AMI complicated by GIB.展开更多
BACKGROUND Cervical haemorrhage due to spontaneous rupture of a parathyroid adenoma is a rare complication that may cause life-threatening acute airway compromise.CASE SUMMARY A 64-year-old woman was admitted to the h...BACKGROUND Cervical haemorrhage due to spontaneous rupture of a parathyroid adenoma is a rare complication that may cause life-threatening acute airway compromise.CASE SUMMARY A 64-year-old woman was admitted to the hospital 1 day after the onset of right neck enlargement, local tenderness, head-turning difficulty, pharyngeal pain, and mild dyspnoea. Repeat routine blood testing showed a rapid decrease in the haemoglobin concentration, indicating active bleeding. Enhanced computed tomography images showed neck haemorrhage and a ruptured right parathyroid adenoma. The plan was to perform emergency neck exploration, haemorrhage removal, and right inferior parathyroidectomy under general anaesthesia. The patient was administered 50 mg of intravenous propofol, and the glottis was successfully visualised on video laryngoscopy. However, after the administration of a muscle relaxant, the glottis was no longer visible and the patient had a difficult airway that prevented mask ventilation and endotracheal intubation. Fortunately, an experienced anaesthesiologist successfully intubated the patient under video laryngoscopy after an emergency laryngeal mask placement. Postoperative pathology showed a parathyroid adenoma with marked bleeding and cystic changes. The patient recovered well without complications.CONCLUSION Airway management is very important in patients with cervical haemorrhage. After the administration of muscle relaxants, the loss of oropharyngeal support can cause acute airway obstruction.Therefore, muscle relaxants should be administered with caution. Anaesthesiologists should pay careful attention to airway management and have alternative airway devices and tracheotomy equipment available.展开更多
All paediatric tonsillectomies were examined from 2012–2019 at a single tertiaryreferral institution,and all were performed by one of two paediatric otolaryngologists.One exclusively used the diathermy,the other excl...All paediatric tonsillectomies were examined from 2012–2019 at a single tertiaryreferral institution,and all were performed by one of two paediatric otolaryngologists.One exclusively used the diathermy,the other exclusively used the Coblator II.Two Coblator units were purchased simultaneously in 2012 and not replaced.There was no significant difference in number of tonsillectomies performed(1298 via diathermy,1221 via Coblator),nor in postoperative day of bleed,patient age,indication for procedure,and no patient had an underlying coagulopathy.The most common indication for tonsillectomy in both groups was sleep-disordered breathing.There was no significant difference in postoperative haemorrhage rates between groups for the first six years of the study(0%-1.4%/year).Years 7 and 8 saw the Coblator group haemorrhage rate significantly increase(0%-0.6%diathermy group vs 2%-3%Coblator group),though still fell within accepted rate of postoperative haemorrhage.The devices were then replaced,and the differences in haemorrhage disappeared.There appears to be a significant increase in paediatric post-tonsillectomy haemorrhage when using a Coblator device greater than six years old.This may suggest a useful lifespan for the Coblator II device.展开更多
Invasive fungal infections have grown significantly over the last two decades, owing to an increase in immunocompromised hosts and geriatric patients. When the host’s defenses are compromised, such infections are ass...Invasive fungal infections have grown significantly over the last two decades, owing to an increase in immunocompromised hosts and geriatric patients. When the host’s defenses are compromised, such infections are associated with severe morbidity and mortality. Here, a rare case of fungal infection in a 61-year-old immunocompetent male patient from Saudi Arabia was reported, who suffered from pulmonary hemorrhage and Systemic Lupus Erythematous. Bronchoalveolar Lavage was used as a diagnostic tool to identify the fungus reported in the case. The pathogenic fungal specie identified as Magnusiomyces capitatus, in macroscopic and microscopic morphological characteristics of the colonies. Based on clinical evidence, liposomal amphotericin formulation was recommended for initial therapy against fungal infection. Also, liposomal amphotericin B induced mycological eradication up to 70 percent in patients with proven Magnusiomyces capitatus infection. In addition to addressing suspected Systemic lupus erythematosus, the patient’s health has improved with no evidence of pulmonary bleeding and hemoptysis.展开更多
Portal hypertension occurs as a complication of liver cirrhosis and complications such as variceal bleeding lead to significant demands on resources. Endoscopy is the gold standard method for screening cirrhotic patie...Portal hypertension occurs as a complication of liver cirrhosis and complications such as variceal bleeding lead to significant demands on resources. Endoscopy is the gold standard method for screening cirrhotic patients however universal endoscopic screening may mean a lot of unnecessary procedures as the presence of oesophageal varices is variable hence a large time and cost burden on endoscopy units to carry out both screening and subsequent follow up of variceal bleeds. A less invasive method to identify those at high risk of bleeding would allow earlier prophylactic measures to be applied. Hepatic venous pressure gradient (HVPG) is an acceptable indirect measurement of portal hypertension and predictor of the complications of portal hypertension in adult cirrhotics. Varices develop at a HVPG of 10-12 mmHg with the appearance of other complications with HPVG > 12 mmHg. Variceal bleeding does not occur in pressures under 12 mmHg. HPVG > 20 mmHg measured early after admission is a significant prognostic indicator of failure to control bleeding varices, indeed early transjugular intrahepatic portosystemic shunt (TIPS) in such circumstances reduces mortality significantly. HVPG can be used to identify responders to medical therapy. Patients who do not achieve the suggested reduction targets in HVPG have a high risk of rebleeding despite endoscopic ligation and may not derive significant overall mortality benefit from endoscopic intervention alone, ultimately requiring TIPS or liver transplantation. Early HVPG measurements following a variceal bleed can help to identify those at risk of treatment failure who may benefit from early intervention with TIPS. Therefore, we suggest using HVPG measurement as the investigation of choice in those with confirmed cirrhosis in place of endoscopy for intitial variceal screening and, where indicated, a trial of B-blockade, either intravenously during the initial pressure study with assessment of response or oral therapy with repeat HVPG six weeks later. In those with elevated pressures, primary medical prophylaxis could be commenced with subsequent close monitoring of HVPG thus negating the need for endoscopy at this point. All patients presenting with variceal haemorrhage should undergo HVPG measurement and those with a gradient greater than 20 mmHg should be considered for early TIPS. By introducing portal pressure studies into a management algorithm for variceal bleeding, the number of endoscopies required for further intervention and follow up can be reduced leading to significant savings in terms of cost and demand on resources.展开更多
Variceal haemorrhage is one of the most devastating consequences of portal hypertension, with a 1-year mortality of 40%. With the passage of time, acute management strategies have developed with improved survival. The...Variceal haemorrhage is one of the most devastating consequences of portal hypertension, with a 1-year mortality of 40%. With the passage of time, acute management strategies have developed with improved survival. The major historical treatment landmarks in the management of variceal haemorrhage can be divided into surgical, medical, endoscopic and radiological breakthroughs. We sought to provide a historical overview of the management of variceal haemorrhage and how treatment modalities over time have impacted on clinical outcomes. A PubMed search of the following terms: portal hypertension, variceal haemorrhage, gastric varices, oesophageal varices, transjugular intrahepatic portosystemic shunt was performed. To complement this, Google™ was searched with the aforementioned terms. Other relevant references were identified after review of the reference lists of articles. The review of therapeutic advances was conducted divided into pre-1970s, 1970/80s, 1990s, 2000-2010 and post-2010. Also, a summary and review on the pathophysiology of portal hypertension and clinical outcomes in variceal haemorrhage was performed. Aided by the development of endoscopic therapies, medication and improved radiological interventions; the management of variceal haemorrhage has changed over recent decades with improved survival from an often-terminating event in recent past.展开更多
Despite the advances of medical,endoscopic and radiological therapy over recent years the mortality rates of acute variceal haemorrhage are still 16%-20% and the medium term outcome has not improved in the last 25 yea...Despite the advances of medical,endoscopic and radiological therapy over recent years the mortality rates of acute variceal haemorrhage are still 16%-20% and the medium term outcome has not improved in the last 25 years. Early transjugular intrahepatic portosystemic shunt has proved to be an effective therapy for selected groups of patients with a high risk of re-bleeding and moderate liver disease. However,there is an unmet need for a therapy that can be applied in patients with a high risk of re-bleeding and advanced liver disease either as definitive therapy or as a bridge to permanent therapy. Selfexpanding metal stents can be placed without the need for endoscopic or fluoroscopic control and,once in place,will provide effective haemostasis and allow a route for oral fluids and nutrition. They can remain in place whilst liver function recovers and secondary prophylaxis is initiated. We review the results of 6 case series including a total of 83 patients and the first randomised controlled trial of self-expanding metal stents vs balloon tamponade(BT) in the management of refractory variceal haemorrhage. We report that self-expanding metal stents provide effective haemostasis and perform better than BT in refractory bleeding,where they are associated with fewer complications. Whilst the most effective place for self-expanding metal stents in the management algorithm needs to be determined by further randomised controlled trials,currently they provide an effective alternative to BT in selected patients.展开更多
5α-reductase inhibitors （5α-RIs）, including finasteride and dutasteride, are commonly used medical therapies for benign prostatic hyperplasia （BPH）. Many studies reported that preoperative 5α-RI had impact on i...5α-reductase inhibitors （5α-RIs）, including finasteride and dutasteride, are commonly used medical therapies for benign prostatic hyperplasia （BPH）. Many studies reported that preoperative 5α-RI had impact on intraoperative haemorrhage during surgery for BPH, but it was still in controversial. So, we conducted a systematic review of the effects and mechanisms of 5α-RIs on intraoperative bleeding for BPH. MEDLINE, EMBASE, the Cochrane Controlled Trail Register of Controlled Trials and the reference lists of retrieved studies were searched in the analysis. Sixteen publications involving 15 different randomized controlled trials （RCTs） and a total of 1156 patients were used in the analysis, including 10 RCTs for finasteride and five RCTs for dutasteride. We found that preoperative finasteride treatment decreases microvessel density （MVD） in resected prostate specimens. Total blood loss, blood loss per gram of resected prostate tissue and decreases in haemoglobin were all greatly reduced in the finasteride group as compared to controls. Dutasteride appeared to have no effect on bleeding. This meta-analysis shows that preoperative finasteride treatment could decrease intraoperative haemorrhage during surgery for BPH. Preoperative dutasteride had no effect on intraoperative haemorrhage, but further high-qualitv prospective studies are still needed to confirm this observation.展开更多
Pancreatitis represents nearly 3% of acute admissions to general surgery in United Kingdom hospitals and has a mortality of around 1%-7% which increases to around 10%-18% in patients with severe pancreatitis. Patients...Pancreatitis represents nearly 3% of acute admissions to general surgery in United Kingdom hospitals and has a mortality of around 1%-7% which increases to around 10%-18% in patients with severe pancreatitis. Patients at greatest risk were those identified to have infected pancreatic necrosis and/or organ failure. This review seeks to highlight the potential vascular complications associated with pancreatitis that despite being relatively uncommon are associated with mortality in the region of 34%-52%. We examine the current evidence base to determine the most appropriate method by which to image and treat pseudo-aneurysms that arise as the result of acute and chronic inflammation of pancreas. We identify how early recognition of the presence of a pseudo-aneurysm can facilitate expedited care in an expert centre of a complex pathology that may require angiographic, percutaneous, endoscopic or surgical intervention to prevent catastrophic haemorrhage.展开更多
There are few studies regarding imaging markers for predicting postoperative rebleeding after stereotactic minimally invasive surgery(MIS)for hypertensive intracerebral haemorrhage(ICH),and little is known about the r...There are few studies regarding imaging markers for predicting postoperative rebleeding after stereotactic minimally invasive surgery(MIS)for hypertensive intracerebral haemorrhage(ICH),and little is known about the relationship between satellite sign on computed tomography(CT)scans and postoperative rebleeding after MIS.This study aimed to determine the value of the CT satellite sign in predicting postoperative rebleeding in patients with hypertensive ICH who undergo stereotactic MIS.We retrospectively examined and analysed 105 patients with hypertensive ICH who underwent standard stereotactic MIS for hematoma evacuation within 72 h following admission.Postoperative rebleeding occurred in 14 of 65(21.5%)patients with the satellite sign on baseline CT,and in 5 of the 40(12.5%)patients without the satellite sign.This diiTerence was statistically significant.Positive and negative values of the satellite sign for predicting postoperative rebleeding were 21.5%and 87.5%,respectively.Multivariate logistic regression analysis verified that baseline ICH volume and intraventricular rupture were independent predictors of postoperative rebleeding.In conclusion,the satellite sign on baseline CT scans may not predict postoperative rebleeding following stereotactic MIS for hypertensive ICH.展开更多
Upper gastrointestinal haemorrhage (UGIH) remains a common medical emergency worldwide. It is increasingly recognised that early risk assessment is an important part of management, which helps direct appropriate patie...Upper gastrointestinal haemorrhage (UGIH) remains a common medical emergency worldwide. It is increasingly recognised that early risk assessment is an important part of management, which helps direct appropriate patient care and the timing of endoscopy. Several risk scores have been developed, most of which include endoscopic findings, although a minority do not. These scores were developed to identify various end-points including mortality, rebleeding or clinical intervention in the form of transfusion, endoscopic therapy or surgery. Recent studies have reported accurate identification of a very low risk group on presentation, using scores which require simple clinical or laboratory parameters only. This group may not require admission, but could be managed with early out-patient endoscopy. This article aims to describe the existing pre- and post-endoscopy risk scores for UGIH and assess the published data comparing them in the prediction of outcome. Recent data assessing their use in clinical practice, in particular the early identification of low-risk patients, are also discussed.展开更多
Aim: The following work studied how tribal affiliation, educational level and occupation of some women that had PPH in Maiduguri metropolis between September 2007 and March 2009 relate with PPH occurrence. The study w...Aim: The following work studied how tribal affiliation, educational level and occupation of some women that had PPH in Maiduguri metropolis between September 2007 and March 2009 relate with PPH occurrence. The study was aimed at identifying possible risk factors and also to compare the relative prevention efficacies of oxytocin or misoprostol within the matrix of these factors. Method: A total of 1800 pregnant women who have received either oxytocin injection or oral misoprostol in third stage of labour as a prophylaxis of postpartum haemorrhage, were enrolled within three health care facilities in Maiduguri, Nigeria. Each patient was observed at parturition and for 24 h after, during which blood lost was estimated to the nearest millilitres. Demographic characteristics were recorded in a structured proforma. The relationship of the occurrence of PPH (occurrence of blood loss > 500 ml) and mean blood loss (MBL) was studied with respect to the prophylactic medication used and some demographic factors. Results: The incidence of PPH was higher in Igbo, and some “minority” tribes of Borno state (Babur, Bura, Mafa). The tribes that constituted the majority of the study population (Kanuri, and Hausa) exhibited low incidences of PPH. Significant relationships were demonstrated between PPH and educational levels and occupations of participants. Conclussions: It was concluded that PPH occurrence is related to tribal affiliation, educational level and occupation, and the relative efficacies of oxytocin and misoprostol varies between the tribal groups.展开更多
AIMTo investigate mortality and rebleeding rate and identify associated risk factors at 6 wk and 5 d following acute variceal haemorrhage in patients with liver cirrhosis and schistosomal periportal fibrosis. METHODST...AIMTo investigate mortality and rebleeding rate and identify associated risk factors at 6 wk and 5 d following acute variceal haemorrhage in patients with liver cirrhosis and schistosomal periportal fibrosis. METHODSThis is a prospective study conducted during the period from March to December 2014. Patients with portal hypertension presenting with acute variceal haemorrhage secondary to either liver cirrhosis (group A) or schistosomal periportal fibroses (group B) presenting within 24 h of the onset of the bleeding were enrolled in the study and followed for a period of 6 wk. Analysis of data was done by Microsoft Excel and comparison between groups was done by Statistical Package of Social Sciences version 20 to calculate means and find the levels of statistical differences and define the mortality rates, the P value of RESULTSA total of 94 patients were enrolled in the study. Thirty-two patients (34%) had liver cirrhosis (group A) and 62 (66%) patients had periportal fibrosis (group B). Mortality: The 6-wk and 5-d mortality were 53% and 16% respectively in group A compared to 10% and 0% in group B (P value P value P value P value P value P value P value CONCLUSIONThe 6-wk and 5-d mortality and rebleeding rate were significantly higher in patients with liver cirrhosis compared to patients with schistosomal periportal fibrosis.展开更多
BACKGROUND Massive pulmonary haemorrhage can spoil the entire lung and block the airway in a short period of time due to severe bleeding,which quickly leads to death.Alveolar lavage is an effective method for haemosta...BACKGROUND Massive pulmonary haemorrhage can spoil the entire lung and block the airway in a short period of time due to severe bleeding,which quickly leads to death.Alveolar lavage is an effective method for haemostasis and airway maintenance.However,patients often cannot tolerate alveolar lavage due to severe hypoxia.We used extracorporeal membrane oxygenation(ECMO)to overcome this limitation in a patient with massive pulmonary haemorrhage due to severe trauma and succeeded in saving the life by repeated alveolar lavage.CASE SUMMARY A 22-year-old man sustained multiple injuries in a motor vehicle accident and was transferred to our emergency department.On admission,he had a slight cough and a small amount of bloody sputum;computed tomography revealed multiple fractures and mild pulmonary contusion.At 37 h after admission,he developed severe chest tightness,chest pain,dizziness and haemoptysis.His oxygen saturation was 68%.Emergency endotracheal intubation was performed,and a large amount of bloody sputum was suctioned.After transfer to the intensive care unit,he developed refractory hypoxemia and heparin-free venovenous ECMO was initiated.Fibreoptic bronchoscopy revealed diffuse and profuse blood in all bronchopulmonary segment.Bleeding was observed in the trachea and right bronchus,and repeated alveolar lavage was performed.On day 3,the patient’s haemoptysis ceased,and ECMO support was terminated 10 d later.Tracheostomy was performed on day 15,and the patient was weaned from the ventilator on day 21.CONCLUSION Alveolar lavage combined with ECMO can control bleeding in trauma-induced massive pulmonary haemorrhage,is safe and can be performed bedside.展开更多
Objective To evaluate the role of multidetector computed tomography-angiography(MDCTA) for management of life-threatening spontaneous retroperitoneal haemorrhage(SRH).Methods A retrospective analysis of the medical re...Objective To evaluate the role of multidetector computed tomography-angiography(MDCTA) for management of life-threatening spontaneous retroperitoneal haemorrhage(SRH).Methods A retrospective analysis of the medical records of all SRH patients admitted to our hospital from January 1,2005 to November 31,2014 was performed.SRH was defined as unrelated to invasive procedures,surgery,trauma,abdominal tumor or aortic aneurysm.Life-threatening SRH was defined as hemodynamic instability with hypotension.Sixteen cases met the inclusive criteria.Patients' characteristics,clinical presentation,imaging of MDCTA,treatment modalities,morbidity,and follow-up data were analyzed.Results The group of 16 patients included 11 men and 5 women,with a mean age of 51.5 ± 16.4years.All patients underwent MDCTA scan examinations,and active contrast media(CM) extravasation were found in 9 patients.Angiography was performed for 8 patients in the CM extravasation group.Bleeding vessels were found in 7 patients who underwent successful embolization.One patient in the CM extravasation group did not undergo angiography and died of bleeding.Seven patients without active CM extravasation underwent conservative management.Bleeding was controlled for all these 7 patients,and 1 patient died of multiple organ failure.Fourteen patients survived from SRH were successfully discharged.One patient died of heart failure during follow-up.Conclusion MDCTA was useful in the diagnosis of SRH and proved to be predictive for the outcome of conservative treatment and early intervention.展开更多
Purpose: Feto-maternal haemorrhage (FMH) is a complication of pregnancy and large FMH may lead to life-threatening anaemia in the fetus or newborn. In addition, exposure of Rhesus (Rh) D negative women to small amount...Purpose: Feto-maternal haemorrhage (FMH) is a complication of pregnancy and large FMH may lead to life-threatening anaemia in the fetus or newborn. In addition, exposure of Rhesus (Rh) D negative women to small amounts of fetal Rh D positive red cells during pregnancy or delivery may result in sensitization with its attendant problems of isoimmunisation. In most cases, the cause of FMH IS unknown. Through this study, we sought to determine if placental weight & diameter have any direct relationship with incidence and severity of FMH.Methods: This was a prospective study of parturients for presence of fetal red cells in the maternal blood circulation. The prepared slide was processed as in the acid elution test described by Kleihauer-Betke. The FMH was calculated using Mollison formula. Baseline data included maternal biodata, blood group, Rh D factor, placenta weight and diameter. Data generated were analysed with Frequency tables, cross-tabulations and Odd ratio and confidence intervals as appropriate.Results: Three hundred parturients were studied. However, only two hundred and ninety-five parturients were analysed, with five excluded due to lysed blood samples. A total of 52 parturients (17.63%) had demonstrable FMH, of which 8 (2.71%) were large FMH (>15 ml foetal cells). Both the placenta weight (P g, in contrast to 4.17% (4/96) in the group with weight of placenta below or equal to 500 g. All the 8 parturients with large FMH had placenta weights greater than 500 g. Placenta diameters were greater than 22 cm in 41/197 (20.81%) who had demonstrable FMH, compared with 11/98 (11.23%) whose diameter was less than 22 cm. Conclusion:Both the placenta weight and diameter are significant predictors of FMH in parturients. However, placenta diameter appears to be a minor predictor. These are factors that can be assessed antenatally by ultrasonography and in conjunction with other known obstetric factors, may possibly be considered in risk-based scoring system for predicting feto-maternal haemorrhage.展开更多
文摘A woman with five previous normal vaginal deliveries and a history of right salpingectomy for ectopic preg-nancyhas sudden pain in term labour, with epidural analgesia. A concurrent worsening of fetal heart rate pattern with bradycardia urges quick vacuum delivery. Maternal post-partum pain and hemoglobin (Hb) drop suggest intra-abdominal haemorrhage. The combination of sudden, strong intra-partum pain and fetal distress should raise the suspicion of intra-abdominal haemorrhage. After vaginal delivery an accurate follow-up is mandatory.
文摘<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Postpartum haemorrhage is one of the leading causes of maternal morbidity and mortality worldwide. It occurs predominantly in developing countries due to poorly developed infrastructures and lack of skilled birth attendants.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Objective:</span></b></span></span><span><span><b><span style="font-family:""> </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">To identify the prevalence, causes and risk factors of primary postpartum haemorrhage following vaginal deliveries in a referral hospital (Douala General Hospital-Cameroon).</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Methods:</span></b></span></span><span><span><b><span style="font-family:""> </span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">This was a descriptive and analytical study carried in the Douala General Hospital (DGH) for which socio-demographic, clinical, obstetric and post-partum data were collected using a pre-tested questionnaire. Descriptive statistics, multivariate analysis and logistic regression allowed us to present and discuss our results, with a 95% confidence interval (CI) and </span><i><span style="font-family:Verdana;">p </span></i><span style="font-family:Verdana;">value <</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">0.05.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Results:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> The prevalence of Primary Postpartum Haemorrhage was 1.33%. Quantification of bleeding was reported in only 13.15% of cases. The main causes were: uterine atony (36.18%), placental retention (25.65%), cervical tears (12.50%), perineal tears (10.52%) and cervico-vaginal tears (08.52%). The risk factors were: age between 19</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">35 years aOR = 4.52;95% CI = 2.65</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">7.98;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.021);unemployment (aOR = 4.74;95% CI = 2.91</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">6.02;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.001);being multigravida (aOR = 9.21;95% CI = 6.43</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">12.48;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.035);history of abortion (aOR = 5.11;95% CI = 2.05</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">7.29;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.004);preterm delivery (aOR = 6.88;95% CI = 2.72</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">9.06;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.002);duration of labour</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">> 12 hours (aOR = 4.05;95% CI = 2.46</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">7.98;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.003) and macrosomia (aOR = 3.27;95% CI = 1.03</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">5</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">68;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.041).</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusion:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Primary postpartum haemorrhage remains a poorly assessed obstetric complication in the maternity ward of the Douala General Hospital (DGH);Training staff on quantifying postpartum blood loss and monitoring the second and third stages of labour can help to better manage and reduce its occurrence.</span></span></span>
基金Supported by The Technology Innovation Guidance Programme of Science and Technology,Department of Hunan Province,No.2020SK51708The Scientific Research Programme of Hunan Provincial Health Commission,No.B2019110 and No.20201959The Hunan Nature Science Foundation,No.S2023JJMSXM1898.
文摘BACKGROUND Minimally invasive surgery(MIS)and craniotomy(CI)are the current treatments for spontaneous supratentorial cerebral haemorrhage(SSTICH).AIM To compare the efficacy and safety of MIS and CI for the treatment of SSTICH.METHODS Clinical and imaging data of 557 consecutive patients with SSTICH who underwent MIS or CI between January 2017 and December 2022 were retrospectively analysed.The patients were divided into two subgroups:The MIS group and CI group.Propensity score matching was performed to minimise case selection bias.The primary outcome was a dichotomous prognostic(favourable or unfavourable)outcome based on the modified Rankin Scale(mRS)score at 3 months;an mRS score of 0–2 was considered favourable.RESULTS In both conventional statistical and binary logistic regression analyses,the MIS group had a better outcome.The outcome of propensity score matching was unexpected(odds ratio:0.582;95%CI:0.281–1.204;P=0.144),which indicated that,after excluding the interference of each confounder,different surgical modalities were more effective,and there was no significant difference in their prognosis.CONCLUSION Deciding between MIS and CI should be made based on the individual patient,considering the hematoma size,degree of midline shift,cerebral swelling,and preoperative Glasgow Coma Scale score.
文摘Spontaneous intracerebral haemorrhage (sICH) is characterised by bleeding within the brain parenchyma, without any accompanying vascular malformation, parenchymal abnormality or coagulation disorder. The study aimed to depict the management of sICH at the University Hospital of Brazzaville (UHB). It was an observational, descriptive, and cross-sectional analysis. Data collection was conducted retrospectively, covering the period from January 1, 2020 to August 31, 2022, spanning two years and eight months. The study examined socio-demographic, diagnostic, therapeutic, and evolutionary variables. We included 274 cases. We observed 160 men (58.4%) and 114 women (41.6%), resulting in a sex ratio of 1.4. The mean age was 55.3 ± 11.4 years, with ages ranging from 31 to 93 years. The detection of sICH was typically a result of experiencing motor deficits (59.5%) or disorders of consciousness (37.2%). The weightiness of one half of the body was the most common reason for seeking medical advice. Hematoma was capsulo-lenticular in 159 cases (58%) and capsulo-thalamic in 63 cases (23%). Hematomas were <30 ml in 162 cases (59.1%) and >30 ml in 112 cases (40.9%), and associated with hydrocephalus in 11.7% of cases. Conservative medical treatment was administered in 257 cases (94.2%) while surgical treatment was performed in 16 cases (5.8%). The surgical techniques used were external ventricular drainage (EVD) in 2 cases, ventriculo-peritoneal shunt in 5 cases, and hematoma evacuation in 10 cases. Death occurred before the 7th day of hospitalisation in 73 cases (57.8%) and after in 46 cases (42.2%). The median time to death was four days (Q1 = 2 days;Q3 = 7 days), with extremes of 0 and 216 days. .
文摘Objective:To analyze the risk factors for death during hospitalization in patients with acute myocardial infarction(AMI)complicated by gastrointestinal bleeding(GIB).Methods:260 patients with AMI complicated by GIB who were admitted to the cardiology department of a hospital from January 2022 to December 2023 were retrospectively analyzed.27 patients who died during hospitalization were designated as the control group and the 233 patients who survived as the observation group.Baseline data and clinical indexes of patients in the two groups were compared,and multifactorial logistic regression was applied to analyze the risk factors for death during hospitalization in patients with AMI complicated by GIB.Results:Univariate analysis showed that the control group had higher proportions of patients with Killip classification III to IV on admission,new arrhythmias,and mechanical complications,as well as higher heart rates,white blood cell counts,urea nitrogen,and creatinine levels.The proportion of patients who received transfusion therapy during hospitalization was also higher in the control group.Conversely,the control group had lower systolic and left ventricular ejection fraction rates compared to the observation group,with statistically significant differences(P<0.05).Multifactorial logistic regression analysis revealed that new-onset arrhythmia(OR=2.724,95%CI 1.289-5.759),heart rate>100 beats/min(OR=3.824,95%CI 1.472-9.927),left ventricular ejection fraction<50%(OR=1.884,95%CI 0.893-3.968),BUN level(OR=1.029,95%CI 1.007-1.052),and blood transfusion(OR=3.774,95%CI 1.124-6.345)were independently associated with an increased risk of death during hospitalization in patients with AMI complicated by GIB.Conclusions:New arrhythmia,heart rate>100 beats/min,left ventricular ejection fraction<50%,elevated BUN levels,and blood transfusion are risk factors for death during hospitalization in patients with AMI complicated by GIB.
基金Supported by Key Clinical Projects of Peking University Third Hospital,No. BYSYZD2021013Beijing Haidian District Innovation and transformation project,No. HDCXZHZB2021202。
文摘BACKGROUND Cervical haemorrhage due to spontaneous rupture of a parathyroid adenoma is a rare complication that may cause life-threatening acute airway compromise.CASE SUMMARY A 64-year-old woman was admitted to the hospital 1 day after the onset of right neck enlargement, local tenderness, head-turning difficulty, pharyngeal pain, and mild dyspnoea. Repeat routine blood testing showed a rapid decrease in the haemoglobin concentration, indicating active bleeding. Enhanced computed tomography images showed neck haemorrhage and a ruptured right parathyroid adenoma. The plan was to perform emergency neck exploration, haemorrhage removal, and right inferior parathyroidectomy under general anaesthesia. The patient was administered 50 mg of intravenous propofol, and the glottis was successfully visualised on video laryngoscopy. However, after the administration of a muscle relaxant, the glottis was no longer visible and the patient had a difficult airway that prevented mask ventilation and endotracheal intubation. Fortunately, an experienced anaesthesiologist successfully intubated the patient under video laryngoscopy after an emergency laryngeal mask placement. Postoperative pathology showed a parathyroid adenoma with marked bleeding and cystic changes. The patient recovered well without complications.CONCLUSION Airway management is very important in patients with cervical haemorrhage. After the administration of muscle relaxants, the loss of oropharyngeal support can cause acute airway obstruction.Therefore, muscle relaxants should be administered with caution. Anaesthesiologists should pay careful attention to airway management and have alternative airway devices and tracheotomy equipment available.
文摘All paediatric tonsillectomies were examined from 2012–2019 at a single tertiaryreferral institution,and all were performed by one of two paediatric otolaryngologists.One exclusively used the diathermy,the other exclusively used the Coblator II.Two Coblator units were purchased simultaneously in 2012 and not replaced.There was no significant difference in number of tonsillectomies performed(1298 via diathermy,1221 via Coblator),nor in postoperative day of bleed,patient age,indication for procedure,and no patient had an underlying coagulopathy.The most common indication for tonsillectomy in both groups was sleep-disordered breathing.There was no significant difference in postoperative haemorrhage rates between groups for the first six years of the study(0%-1.4%/year).Years 7 and 8 saw the Coblator group haemorrhage rate significantly increase(0%-0.6%diathermy group vs 2%-3%Coblator group),though still fell within accepted rate of postoperative haemorrhage.The devices were then replaced,and the differences in haemorrhage disappeared.There appears to be a significant increase in paediatric post-tonsillectomy haemorrhage when using a Coblator device greater than six years old.This may suggest a useful lifespan for the Coblator II device.
文摘Invasive fungal infections have grown significantly over the last two decades, owing to an increase in immunocompromised hosts and geriatric patients. When the host’s defenses are compromised, such infections are associated with severe morbidity and mortality. Here, a rare case of fungal infection in a 61-year-old immunocompetent male patient from Saudi Arabia was reported, who suffered from pulmonary hemorrhage and Systemic Lupus Erythematous. Bronchoalveolar Lavage was used as a diagnostic tool to identify the fungus reported in the case. The pathogenic fungal specie identified as Magnusiomyces capitatus, in macroscopic and microscopic morphological characteristics of the colonies. Based on clinical evidence, liposomal amphotericin formulation was recommended for initial therapy against fungal infection. Also, liposomal amphotericin B induced mycological eradication up to 70 percent in patients with proven Magnusiomyces capitatus infection. In addition to addressing suspected Systemic lupus erythematosus, the patient’s health has improved with no evidence of pulmonary bleeding and hemoptysis.
文摘Portal hypertension occurs as a complication of liver cirrhosis and complications such as variceal bleeding lead to significant demands on resources. Endoscopy is the gold standard method for screening cirrhotic patients however universal endoscopic screening may mean a lot of unnecessary procedures as the presence of oesophageal varices is variable hence a large time and cost burden on endoscopy units to carry out both screening and subsequent follow up of variceal bleeds. A less invasive method to identify those at high risk of bleeding would allow earlier prophylactic measures to be applied. Hepatic venous pressure gradient (HVPG) is an acceptable indirect measurement of portal hypertension and predictor of the complications of portal hypertension in adult cirrhotics. Varices develop at a HVPG of 10-12 mmHg with the appearance of other complications with HPVG > 12 mmHg. Variceal bleeding does not occur in pressures under 12 mmHg. HPVG > 20 mmHg measured early after admission is a significant prognostic indicator of failure to control bleeding varices, indeed early transjugular intrahepatic portosystemic shunt (TIPS) in such circumstances reduces mortality significantly. HVPG can be used to identify responders to medical therapy. Patients who do not achieve the suggested reduction targets in HVPG have a high risk of rebleeding despite endoscopic ligation and may not derive significant overall mortality benefit from endoscopic intervention alone, ultimately requiring TIPS or liver transplantation. Early HVPG measurements following a variceal bleed can help to identify those at risk of treatment failure who may benefit from early intervention with TIPS. Therefore, we suggest using HVPG measurement as the investigation of choice in those with confirmed cirrhosis in place of endoscopy for intitial variceal screening and, where indicated, a trial of B-blockade, either intravenously during the initial pressure study with assessment of response or oral therapy with repeat HVPG six weeks later. In those with elevated pressures, primary medical prophylaxis could be commenced with subsequent close monitoring of HVPG thus negating the need for endoscopy at this point. All patients presenting with variceal haemorrhage should undergo HVPG measurement and those with a gradient greater than 20 mmHg should be considered for early TIPS. By introducing portal pressure studies into a management algorithm for variceal bleeding, the number of endoscopies required for further intervention and follow up can be reduced leading to significant savings in terms of cost and demand on resources.
文摘Variceal haemorrhage is one of the most devastating consequences of portal hypertension, with a 1-year mortality of 40%. With the passage of time, acute management strategies have developed with improved survival. The major historical treatment landmarks in the management of variceal haemorrhage can be divided into surgical, medical, endoscopic and radiological breakthroughs. We sought to provide a historical overview of the management of variceal haemorrhage and how treatment modalities over time have impacted on clinical outcomes. A PubMed search of the following terms: portal hypertension, variceal haemorrhage, gastric varices, oesophageal varices, transjugular intrahepatic portosystemic shunt was performed. To complement this, Google™ was searched with the aforementioned terms. Other relevant references were identified after review of the reference lists of articles. The review of therapeutic advances was conducted divided into pre-1970s, 1970/80s, 1990s, 2000-2010 and post-2010. Also, a summary and review on the pathophysiology of portal hypertension and clinical outcomes in variceal haemorrhage was performed. Aided by the development of endoscopic therapies, medication and improved radiological interventions; the management of variceal haemorrhage has changed over recent decades with improved survival from an often-terminating event in recent past.
文摘Despite the advances of medical,endoscopic and radiological therapy over recent years the mortality rates of acute variceal haemorrhage are still 16%-20% and the medium term outcome has not improved in the last 25 years. Early transjugular intrahepatic portosystemic shunt has proved to be an effective therapy for selected groups of patients with a high risk of re-bleeding and moderate liver disease. However,there is an unmet need for a therapy that can be applied in patients with a high risk of re-bleeding and advanced liver disease either as definitive therapy or as a bridge to permanent therapy. Selfexpanding metal stents can be placed without the need for endoscopic or fluoroscopic control and,once in place,will provide effective haemostasis and allow a route for oral fluids and nutrition. They can remain in place whilst liver function recovers and secondary prophylaxis is initiated. We review the results of 6 case series including a total of 83 patients and the first randomised controlled trial of self-expanding metal stents vs balloon tamponade(BT) in the management of refractory variceal haemorrhage. We report that self-expanding metal stents provide effective haemostasis and perform better than BT in refractory bleeding,where they are associated with fewer complications. Whilst the most effective place for self-expanding metal stents in the management algorithm needs to be determined by further randomised controlled trials,currently they provide an effective alternative to BT in selected patients.
文摘5α-reductase inhibitors （5α-RIs）, including finasteride and dutasteride, are commonly used medical therapies for benign prostatic hyperplasia （BPH）. Many studies reported that preoperative 5α-RI had impact on intraoperative haemorrhage during surgery for BPH, but it was still in controversial. So, we conducted a systematic review of the effects and mechanisms of 5α-RIs on intraoperative bleeding for BPH. MEDLINE, EMBASE, the Cochrane Controlled Trail Register of Controlled Trials and the reference lists of retrieved studies were searched in the analysis. Sixteen publications involving 15 different randomized controlled trials （RCTs） and a total of 1156 patients were used in the analysis, including 10 RCTs for finasteride and five RCTs for dutasteride. We found that preoperative finasteride treatment decreases microvessel density （MVD） in resected prostate specimens. Total blood loss, blood loss per gram of resected prostate tissue and decreases in haemoglobin were all greatly reduced in the finasteride group as compared to controls. Dutasteride appeared to have no effect on bleeding. This meta-analysis shows that preoperative finasteride treatment could decrease intraoperative haemorrhage during surgery for BPH. Preoperative dutasteride had no effect on intraoperative haemorrhage, but further high-qualitv prospective studies are still needed to confirm this observation.
文摘Pancreatitis represents nearly 3% of acute admissions to general surgery in United Kingdom hospitals and has a mortality of around 1%-7% which increases to around 10%-18% in patients with severe pancreatitis. Patients at greatest risk were those identified to have infected pancreatic necrosis and/or organ failure. This review seeks to highlight the potential vascular complications associated with pancreatitis that despite being relatively uncommon are associated with mortality in the region of 34%-52%. We examine the current evidence base to determine the most appropriate method by which to image and treat pseudo-aneurysms that arise as the result of acute and chronic inflammation of pancreas. We identify how early recognition of the presence of a pseudo-aneurysm can facilitate expedited care in an expert centre of a complex pathology that may require angiographic, percutaneous, endoscopic or surgical intervention to prevent catastrophic haemorrhage.
文摘There are few studies regarding imaging markers for predicting postoperative rebleeding after stereotactic minimally invasive surgery(MIS)for hypertensive intracerebral haemorrhage(ICH),and little is known about the relationship between satellite sign on computed tomography(CT)scans and postoperative rebleeding after MIS.This study aimed to determine the value of the CT satellite sign in predicting postoperative rebleeding in patients with hypertensive ICH who undergo stereotactic MIS.We retrospectively examined and analysed 105 patients with hypertensive ICH who underwent standard stereotactic MIS for hematoma evacuation within 72 h following admission.Postoperative rebleeding occurred in 14 of 65(21.5%)patients with the satellite sign on baseline CT,and in 5 of the 40(12.5%)patients without the satellite sign.This diiTerence was statistically significant.Positive and negative values of the satellite sign for predicting postoperative rebleeding were 21.5%and 87.5%,respectively.Multivariate logistic regression analysis verified that baseline ICH volume and intraventricular rupture were independent predictors of postoperative rebleeding.In conclusion,the satellite sign on baseline CT scans may not predict postoperative rebleeding following stereotactic MIS for hypertensive ICH.
文摘Upper gastrointestinal haemorrhage (UGIH) remains a common medical emergency worldwide. It is increasingly recognised that early risk assessment is an important part of management, which helps direct appropriate patient care and the timing of endoscopy. Several risk scores have been developed, most of which include endoscopic findings, although a minority do not. These scores were developed to identify various end-points including mortality, rebleeding or clinical intervention in the form of transfusion, endoscopic therapy or surgery. Recent studies have reported accurate identification of a very low risk group on presentation, using scores which require simple clinical or laboratory parameters only. This group may not require admission, but could be managed with early out-patient endoscopy. This article aims to describe the existing pre- and post-endoscopy risk scores for UGIH and assess the published data comparing them in the prediction of outcome. Recent data assessing their use in clinical practice, in particular the early identification of low-risk patients, are also discussed.
文摘Aim: The following work studied how tribal affiliation, educational level and occupation of some women that had PPH in Maiduguri metropolis between September 2007 and March 2009 relate with PPH occurrence. The study was aimed at identifying possible risk factors and also to compare the relative prevention efficacies of oxytocin or misoprostol within the matrix of these factors. Method: A total of 1800 pregnant women who have received either oxytocin injection or oral misoprostol in third stage of labour as a prophylaxis of postpartum haemorrhage, were enrolled within three health care facilities in Maiduguri, Nigeria. Each patient was observed at parturition and for 24 h after, during which blood lost was estimated to the nearest millilitres. Demographic characteristics were recorded in a structured proforma. The relationship of the occurrence of PPH (occurrence of blood loss > 500 ml) and mean blood loss (MBL) was studied with respect to the prophylactic medication used and some demographic factors. Results: The incidence of PPH was higher in Igbo, and some “minority” tribes of Borno state (Babur, Bura, Mafa). The tribes that constituted the majority of the study population (Kanuri, and Hausa) exhibited low incidences of PPH. Significant relationships were demonstrated between PPH and educational levels and occupations of participants. Conclussions: It was concluded that PPH occurrence is related to tribal affiliation, educational level and occupation, and the relative efficacies of oxytocin and misoprostol varies between the tribal groups.
文摘AIMTo investigate mortality and rebleeding rate and identify associated risk factors at 6 wk and 5 d following acute variceal haemorrhage in patients with liver cirrhosis and schistosomal periportal fibrosis. METHODSThis is a prospective study conducted during the period from March to December 2014. Patients with portal hypertension presenting with acute variceal haemorrhage secondary to either liver cirrhosis (group A) or schistosomal periportal fibroses (group B) presenting within 24 h of the onset of the bleeding were enrolled in the study and followed for a period of 6 wk. Analysis of data was done by Microsoft Excel and comparison between groups was done by Statistical Package of Social Sciences version 20 to calculate means and find the levels of statistical differences and define the mortality rates, the P value of RESULTSA total of 94 patients were enrolled in the study. Thirty-two patients (34%) had liver cirrhosis (group A) and 62 (66%) patients had periportal fibrosis (group B). Mortality: The 6-wk and 5-d mortality were 53% and 16% respectively in group A compared to 10% and 0% in group B (P value P value P value P value P value P value P value CONCLUSIONThe 6-wk and 5-d mortality and rebleeding rate were significantly higher in patients with liver cirrhosis compared to patients with schistosomal periportal fibrosis.
文摘BACKGROUND Massive pulmonary haemorrhage can spoil the entire lung and block the airway in a short period of time due to severe bleeding,which quickly leads to death.Alveolar lavage is an effective method for haemostasis and airway maintenance.However,patients often cannot tolerate alveolar lavage due to severe hypoxia.We used extracorporeal membrane oxygenation(ECMO)to overcome this limitation in a patient with massive pulmonary haemorrhage due to severe trauma and succeeded in saving the life by repeated alveolar lavage.CASE SUMMARY A 22-year-old man sustained multiple injuries in a motor vehicle accident and was transferred to our emergency department.On admission,he had a slight cough and a small amount of bloody sputum;computed tomography revealed multiple fractures and mild pulmonary contusion.At 37 h after admission,he developed severe chest tightness,chest pain,dizziness and haemoptysis.His oxygen saturation was 68%.Emergency endotracheal intubation was performed,and a large amount of bloody sputum was suctioned.After transfer to the intensive care unit,he developed refractory hypoxemia and heparin-free venovenous ECMO was initiated.Fibreoptic bronchoscopy revealed diffuse and profuse blood in all bronchopulmonary segment.Bleeding was observed in the trachea and right bronchus,and repeated alveolar lavage was performed.On day 3,the patient’s haemoptysis ceased,and ECMO support was terminated 10 d later.Tracheostomy was performed on day 15,and the patient was weaned from the ventilator on day 21.CONCLUSION Alveolar lavage combined with ECMO can control bleeding in trauma-induced massive pulmonary haemorrhage,is safe and can be performed bedside.
文摘Objective To evaluate the role of multidetector computed tomography-angiography(MDCTA) for management of life-threatening spontaneous retroperitoneal haemorrhage(SRH).Methods A retrospective analysis of the medical records of all SRH patients admitted to our hospital from January 1,2005 to November 31,2014 was performed.SRH was defined as unrelated to invasive procedures,surgery,trauma,abdominal tumor or aortic aneurysm.Life-threatening SRH was defined as hemodynamic instability with hypotension.Sixteen cases met the inclusive criteria.Patients' characteristics,clinical presentation,imaging of MDCTA,treatment modalities,morbidity,and follow-up data were analyzed.Results The group of 16 patients included 11 men and 5 women,with a mean age of 51.5 ± 16.4years.All patients underwent MDCTA scan examinations,and active contrast media(CM) extravasation were found in 9 patients.Angiography was performed for 8 patients in the CM extravasation group.Bleeding vessels were found in 7 patients who underwent successful embolization.One patient in the CM extravasation group did not undergo angiography and died of bleeding.Seven patients without active CM extravasation underwent conservative management.Bleeding was controlled for all these 7 patients,and 1 patient died of multiple organ failure.Fourteen patients survived from SRH were successfully discharged.One patient died of heart failure during follow-up.Conclusion MDCTA was useful in the diagnosis of SRH and proved to be predictive for the outcome of conservative treatment and early intervention.
文摘Purpose: Feto-maternal haemorrhage (FMH) is a complication of pregnancy and large FMH may lead to life-threatening anaemia in the fetus or newborn. In addition, exposure of Rhesus (Rh) D negative women to small amounts of fetal Rh D positive red cells during pregnancy or delivery may result in sensitization with its attendant problems of isoimmunisation. In most cases, the cause of FMH IS unknown. Through this study, we sought to determine if placental weight & diameter have any direct relationship with incidence and severity of FMH.Methods: This was a prospective study of parturients for presence of fetal red cells in the maternal blood circulation. The prepared slide was processed as in the acid elution test described by Kleihauer-Betke. The FMH was calculated using Mollison formula. Baseline data included maternal biodata, blood group, Rh D factor, placenta weight and diameter. Data generated were analysed with Frequency tables, cross-tabulations and Odd ratio and confidence intervals as appropriate.Results: Three hundred parturients were studied. However, only two hundred and ninety-five parturients were analysed, with five excluded due to lysed blood samples. A total of 52 parturients (17.63%) had demonstrable FMH, of which 8 (2.71%) were large FMH (>15 ml foetal cells). Both the placenta weight (P g, in contrast to 4.17% (4/96) in the group with weight of placenta below or equal to 500 g. All the 8 parturients with large FMH had placenta weights greater than 500 g. Placenta diameters were greater than 22 cm in 41/197 (20.81%) who had demonstrable FMH, compared with 11/98 (11.23%) whose diameter was less than 22 cm. Conclusion:Both the placenta weight and diameter are significant predictors of FMH in parturients. However, placenta diameter appears to be a minor predictor. These are factors that can be assessed antenatally by ultrasonography and in conjunction with other known obstetric factors, may possibly be considered in risk-based scoring system for predicting feto-maternal haemorrhage.
