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Bae SJ, Namgung M, Jung KY, Lee DH, Choi YH, Choi Y, Chung HS. Lactate to albumin ratio as a prognosis predictor in gastrointestinal bleeding in the emergency department. Intern Emerg Med 2024:10.1007/s11739-024-03723-3. [PMID: 39060871 DOI: 10.1007/s11739-024-03723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/22/2024] [Indexed: 07/28/2024]
Abstract
Gastrointestinal bleeding (GIB) is a common cause of emergency department (ED) visits, and has various prognoses. This study aimed to verify the prognostic ability of the lactate/albumin (L/A) ratio in patients with GIB compared with the AIMS65 score and blood urea nitrogen/albumin (B/A) ratio. This retrospective study included patients with GIB symptoms who visited the ED in 2019. Baseline characteristics and laboratory data were obtained to calculate the L/A and B/A ratios and AIMS65 score. Each score was evaluated as a predictor of intensive care unit (ICU) admission and in-hospital mortality by using the area under the receiver operating characteristic (AUROC) curve. The multivariate logistic regression analysis revealed that the L/A ratio significantly predicted ICU admission and in-hospital mortality. The AUROC curve for predicting ICU admission were 0.788, 0.695, and 0.586 for the L/A, B/A, and AIMS65 scores, respectively, while the AUROC curve for predicting in-hospital mortality were 0.807, 0.799, and 0.683 for the L/A, B/A, and AIMS65 scores, respectively. The L/A ratio, which consists of the serum lactate and albumin levels, showed superior performance relative to the B/A ratio and AIMS65 score in predicting the prognosis of patients with GIB.
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Affiliation(s)
- Sung Jin Bae
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, Seoul, 110, Deokan-Ro, Gwangmyeong-Si, Gyeonggi-Do, Republic of Korea
| | - Myeong Namgung
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, Seoul, 110, Deokan-Ro, Gwangmyeong-Si, Gyeonggi-Do, Republic of Korea
| | - Kwang Yul Jung
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, Seoul, 110, Deokan-Ro, Gwangmyeong-Si, Gyeonggi-Do, Republic of Korea
| | - Dong Hoon Lee
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, Seoul, 110, Deokan-Ro, Gwangmyeong-Si, Gyeonggi-Do, Republic of Korea
| | - Yoon Hee Choi
- Department of Emergency Medicine, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, 1071, Anyangcheon-Ro, Yangcheon-Gu, Seoul, Republic of Korea
| | - Yunhyung Choi
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, Seoul, 110, Deokan-Ro, Gwangmyeong-Si, Gyeonggi-Do, Republic of Korea
| | - Ho Sub Chung
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, Seoul, 110, Deokan-Ro, Gwangmyeong-Si, Gyeonggi-Do, Republic of Korea.
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Ini' C, Distefano G, Sanfilippo F, Castiglione DG, Falsaperla D, Giurazza F, Mosconi C, Tiralongo F, Foti PV, Palmucci S, Venturini M, Basile A. Embolization for acute nonvariceal bleeding of upper and lower gastrointestinal tract: a systematic review. CVIR Endovasc 2023; 6:18. [PMID: 36988839 DOI: 10.1186/s42155-023-00360-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Acute non-variceal gastrointestinal bleedings (GIBs) are pathological conditions associated with significant morbidity and mortality. Embolization without angiographic evidence of contrast media extravasation is proposed as an effective procedure in patients with clinical and/or laboratory signs of bleeding. The purpose of this systematic review is to define common clinical practice and clinical and technical outcomes of blind and preventive embolization for upper and lower gastrointestinal bleeding. MAIN BODY Through the PubMed, Embase and Google Scholar database, an extensive search was performed in the fields of empiric and preventive embolization for the treatment of upper and lower gastrointestinal bleedings (UGIB and LGIB). Inclusion criteria were: articles in English for which it has been possible to access the entire content; adults patients treated with empiric or blind transcatheter arterial embolization (TAE) for UGIB and/or LGIB. Only studies that analysed clinical and technical success rate of blind and empiric TAE for UGIB and/or LGIB were considered for our research. Exclusion criteria were: recurrent articles from the same authors, articles written in other languages, those in which the entire content could not be accessed and that articles were not consistent to the purposes of our research. We collected pooled data on 1019 patients from 32 separate articles selected according to the inclusion and exclusion criteria. 22 studies focused on UGIB (total 773 patients), one articles focused on LGIB (total 6 patients) and 9 studies enrolled patients with both UGIB and LGIB (total 240 patients). Technical success rate varied from 62% to 100%, with a mean value of 97.7%; clinical success rate varied from 51% to 100% with a mean value of 80%. The total number of complications was 57 events out of 1019 procedures analysed. CONCLUSION TAE is an effective procedure in the treatment of UGIB patients in which angiography does not demonstrate direct sign of ongoing bleeding. The attitude in the treatment of LGIBs must be more prudent in relation to poor vascular anastomoses and the high risk of intestinal ischemia. Blind and preventive procedures cumulatively present a relatively low risk of complications, compared to a relatively high technical and clinical success.
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Affiliation(s)
- Corrado Ini'
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Giulio Distefano
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. 'Policlinico-Vittorio Emanuele', Catania, Italy
| | - Davide Giuseppe Castiglione
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Daniele Falsaperla
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Francesco Tiralongo
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, Insubria University, Viale Luigi Borri 57, 21100, Varese, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
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Importance of communication of CT indication for imaging yield in patients with gastrointestinal bleed. Am J Emerg Med 2023; 64:101-105. [PMID: 36508753 DOI: 10.1016/j.ajem.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/26/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The indications for requesting a diagnostic test are important for the selection and timing of imaging protocols. We sought to evaluate the diagnostic yield and impact on patient disposition when evaluating computed tomography (CT) of the abdomen and pelvis in adult patients presenting with gastrointestinal bleeding (GIB) to the Emergency Department (ED). METHODS This study was an observational cohort study of consecutive adult ED patients with ICD10 codes related to GIB between 5/5/2018 and 6/1/2020. CT reports were reviewed for indications, exam type and findings. Reports were classified as positive (active bleeding, recent bleeding or suspected etiology for GIB), negative or other significant findings. Methodological guidelines for reporting observational studies were followed (STROBE). RESULTS Among 943 patients with GIB during the study period, 33% (n = 312) had an abdominopelvic CT ordered. Most CTs included contrast, 64.1% (n = 200) used a single portal venous phase and 28.9% (n = 90) were multi-phase. CT identified active bleeding in 4.2% (n = 13/312) and intraluminal blood in 2.9% (n = 9/312) patients. Patients that had GIB indications on the CT order (n = 142) were more likely to receive a multiphase study compared to those without GIB indication (n = 94) (43.0% vs. 8.5%, difference 34.5%, 95% CI 23.7% to 43.7%, p < 0.0001). Patients that received multiphase studies were more likely to have a source of GIB identified compared to single-phase (18.9% vs 1.5%, OR 15.3, 95% CI 4.4 to 53.7, p < 0.0001). In 40.3% (n = 117/290) of patients without bleeding, an intra-abdominal cause for their symptoms was identified. Those with GIB or with an identified cause were more likely to be admitted. CONCLUSIONS One-third of patients evaluated in the ED with GIB had a CT ordered. Active GIB was detected more often when multiphase exams were performed. Multiphase exams are done more often if GIB is listed in the CT indication. When a CT is positive, patients are more likely to be admitted or observed. Accurate indications are critical to optimize exam performance.
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Yang Q, Tang S, Lu D, Li Y, Wan F, Li J, Chen Q, Cong Z, Zhang X, Wu S. Pollen Typhae-Based Magnetic-Powered Microrobots toward Acute Gastric Bleeding Treatment. ACS APPLIED BIO MATERIALS 2022; 5:4425-4434. [PMID: 35969274 DOI: 10.1021/acsabm.2c00565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Traditional Chinese herbal medicine (TCHM) is the naturally available pharmaceutical with millennia of evolution from ancient China, capable of a superior therapeutic index and minimized unwanted effects on the human body. This work presents a therapeutic microrobotic platform based on pollen typhae (PT), a typical type of TCHM, fabricated by coating porous PT microspheres with Fe3O4 nanoparticles (PT robots) via electrostatic adsorption. The PT robots exhibit effective and controllable motion in various biological media upon external magnetic control and, meanwhile, preserve the inherent hemostasis property of PT. The blood clotting capacity of PT robots is attributed to their stimulation of the endogenous blood coagulation pathway and platelets with increased counts, which could be further improved by their effective magnetic propulsion. The remote magnetic control also allows the manipulation of PT robots in mice stomach, inducing enhanced binding and prolonged retention of PT robots in stomach mucosa. Moreover, PT robots upon magnetic control show an enhanced hemostatic effect in treating the mice bearing acute gastric bleeding compared with other passive groups. This work offers a facile and feasible route to integrate TCHM with manmade micromachines possessing the innate curative features of TCHM. Such a design expanded the versatility of microrobots and can be generalized to vast types of TCHM for broader biomedical applications.
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Affiliation(s)
- Qingxin Yang
- Institute of Urology, The Third Affiliated Hospital of Shenzhen University, Luohu Hospital Group, Shenzhen 518000, P. R. China
| | - Songsong Tang
- Institute of Urology, The Third Affiliated Hospital of Shenzhen University, Luohu Hospital Group, Shenzhen 518000, P. R. China
| | - Dongdong Lu
- Institute of Urology, The Third Affiliated Hospital of Shenzhen University, Luohu Hospital Group, Shenzhen 518000, P. R. China
| | - Yangyang Li
- Institute of Urology, The Third Affiliated Hospital of Shenzhen University, Luohu Hospital Group, Shenzhen 518000, P. R. China
| | - Fangchen Wan
- Institute of Urology, The Third Affiliated Hospital of Shenzhen University, Luohu Hospital Group, Shenzhen 518000, P. R. China
| | - Jiahong Li
- Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, California 91125, United States
| | - Qiwei Chen
- Institute of Urology, The Third Affiliated Hospital of Shenzhen University, Luohu Hospital Group, Shenzhen 518000, P. R. China
| | - Zhaoqing Cong
- Institute of Urology, The Third Affiliated Hospital of Shenzhen University, Luohu Hospital Group, Shenzhen 518000, P. R. China
| | - Xueji Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, P. R. China
| | - Song Wu
- Institute of Urology, The Third Affiliated Hospital of Shenzhen University, Luohu Hospital Group, Shenzhen 518000, P. R. China
- South China Hospital, Shenzhen University, Shenzhen 518116, P. R. China
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Tariq W, Jamil H, Tahir MJ, Yousaf Z, Asghar MS. ENDOSCOPY SERVICES FOR ACUTE GASTROINTESTINAL BLEEDING IN LOW- AND MIDDLE-INCOME COUNTRIES: CHALLENGES AND SOLUTIONS. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:315-316. [PMID: 35830047 DOI: 10.1590/s0004-2803.202202000-55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 02/21/2022] [Indexed: 06/15/2023]
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Lai HY, Wu KT, Liu Y, Zeng ZF, Zhang B. Angiography and transcatheter arterial embolization for non-variceal gastrointestinal bleeding. Scand J Gastroenterol 2020; 55:931-940. [PMID: 32650690 DOI: 10.1080/00365521.2020.1790650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND GOALS Acute non-variceal gastrointestinal bleeding (NVGIB) is one of the most common medical emergencies, leading to significant morbidity and mortality without proper management. This study was to analyze the causes of NVGIB and to evaluate the safety, efficacy, and feasibility of transcatheter arterial embolization (TAE) for the treatment of NVGIB. STUDY From November 2012 to October 2018, 158 patients with NVGIB underwent digital subtraction angiography, and TAE was performed for confirmed gastrointestinal bleeding. Patient characteristics, cause of bleeding, angiographic findings, technical and clinical success rates, complication rates, and outcomes were retrospectively analyzed. RESULTS Bleeding was confirmed in 71.5% (113/158) of performed angiographies, and 68 patients had visible contrast extravasation on angiography, with the other 45 patients having indirect signs of bleeding. Among the 113 patients with confirmed gastrointestinal bleeding, TAE was technically successful in 111 patients (98.2%). The mean procedure time required for TAE was 116 ± 44 min (ranging from 50 to 225 min). The primary total clinical success rate of TAE was 84.7% (94/111). The primary clinical success rates of TAE for vascular abnormality, neoplastic disease, and iatrogenic condition were 84.5% (49/58), 84.1% (37/44), and 88.9% (8/9), respectively. Intestinal necrosis and perforation were found in two patients after TAE. CONCLUSIONS The causes of NVGIB are complex and the onset, location, risk, and clinical presentations are variable. NVGIB can be generally divided into three types: vascular abnormality, neoplastic disease, and iatrogenic condition. TAE is a safe, effective, and fast procedure in the management of gastrointestinal bleeding.
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Affiliation(s)
- Hai-Yang Lai
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ke-Tong Wu
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yang Liu
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhao-Fei Zeng
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bo Zhang
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Serpico M, Riscinti M. Proton Pump Inhibitors for Acute Upper Gastrointestinal Bleeding. Acad Emerg Med 2020; 27:336-338. [PMID: 31808973 DOI: 10.1111/acem.13899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/29/2019] [Accepted: 11/30/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Mark Serpico
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO
| | - Matthew Riscinti
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO
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Järnbert-Pettersson H, Andersson ML, Bilén K, Broström O, Lindh JD, Mannheimer B. Is tramadol associated to bleeding peptic ulcer? A nationwide case-control study in hospitalized Swedish patients. PLoS One 2019; 14:e0215356. [PMID: 30995259 PMCID: PMC6469788 DOI: 10.1371/journal.pone.0215356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 04/01/2019] [Indexed: 01/08/2023] Open
Abstract
AIMS Tramadol, a widely used analgesic drug, inhibits the reuptake of noradrenaline and serotonin impairing the aggregation function of thrombocytes. However, the risk for severe bleeding has previously not been studied. The aim of the present study is to investigate the association between tramadol and bleeding peptic ulcer in the Swedish population. METHODS In this register based case-control study based on the Swedish national patient registry and prescription drug registry, we included 18 306 patients hospitalized with a first-time diagnosis of bleeding peptic ulcer. For every case, 4 matched controls were included. To investigate the temporal aspects of tramadol induced bleeding ulcer, exposure was divided into patients with newly initiated and ongoing treatment. To explore a possible confounding by indication, the effect of codeine, a drug also prescribed for the treatment of moderate pain, but not known to affect thrombocyte function, was investigated. Univariable and multivariable logistic regression was used to analyse the association between tramadol use and bleeding ulcer. RESULTS Tramadol was associated with an increased risk of bleeding ulcer (adjusted odds ratio (aOR) 2.1, 95% confidence interval: (2.0-2.3). The association was stronger for newly initiated treatment with tramadol 2.8 (2.5-3.2) and weaker for ongoing treatment 1.7 (1.6-1.9). Codeine was also associated with an increased risk of bleeding ulcer 1.9 (1.7-2.1) and this association was also stronger for newly initiated treatment with codeine 2.3 (2.0-2.6) and weaker for ongoing treatment 1.7 (1.5-1.9). CONCLUSION Treatment with tramadol was associated with an increased risk of bleeding peptic ulcer. Most of this association may be mediated by factors related to the pain condition rather than the pharmacologic effect per se.
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Affiliation(s)
- Hans Järnbert-Pettersson
- Karolinska Institutet, Department of Clinical Science and Education at Södersjukhuset, Stockholm, Sweden
- * E-mail:
| | - Marine L. Andersson
- Karolinska Institutet, Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Katarina Bilén
- Karolinska Institutet, Department of Clinical Science and Education at Södersjukhuset, Stockholm, Sweden
| | - Olle Broström
- Karolinska Institutet, Department of Clinical Science and Education at Södersjukhuset, Stockholm, Sweden
| | - Jonatan D. Lindh
- Karolinska Institutet, Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Buster Mannheimer
- Karolinska Institutet, Department of Clinical Science and Education at Södersjukhuset, Stockholm, Sweden
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Tringali A, Balassone V, De Angelis P, Landi R. Complications in pediatric endoscopy. Best Pract Res Clin Gastroenterol 2016; 30:825-839. [PMID: 27931639 DOI: 10.1016/j.bpg.2016.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/17/2016] [Accepted: 09/06/2016] [Indexed: 02/07/2023]
Abstract
The experience of the "endoscopic community" in pediatric patients is limited, but during recent years increased skills of the endoscopists and technological improvements lead to a standardization of pediatric endoscopy and the development of specialized pediatric endoscopy unit. Adverse events related to diagnostic and therapeutic endoscopy in children are usually rare. Diagnosis, prevention and treatment of complications in pediatric endoscopy is crucial when dealing with benign diseases in children. The complication rate of diagnostic EGD and colonoscopy in children are extremely low. Therapeutic procedures have obviously an increased rate of adverse events. Esophageal dilations are the most common indication for endoscopic therapy in children and can lead to perforations which requires prompt diagnosis and management. Complications of ERCP in pediatric age are similar to those reported in adults. The experience in pediatric emergency endoscopy (mainly foreign body removal) is consolidated and related adverse events extremely rare. Sedation of children during endoscopy maybe needs further evaluation and standardization, to reduce the rate of specific complications.
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Affiliation(s)
| | - Valerio Balassone
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy.
| | - Paola De Angelis
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy.
| | - Rosario Landi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy.
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Pinheiro MDA, Magalhães RM, Torres DM, Cavalcante RC, Mota FSX, Oliveira Coelho EMA, Moreira HP, Lima GC, Araújo PCDC, Cardoso JHL, de Souza ANC, Diniz LRL. Gastroprotective effect of alpha-pinene and its correlation with antiulcerogenic activity of essential oils obtained from Hyptis species. Pharmacogn Mag 2015; 11:123-30. [PMID: 25709221 PMCID: PMC4329611 DOI: 10.4103/0973-1296.149725] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/12/2014] [Accepted: 01/21/2015] [Indexed: 01/17/2023] Open
Abstract
Background: Alpha-pinene (α-pinene) is a monoterpene commonly found in essential oils with gastroprotective activity obtained from diverse medicinal plants, including Hyptis species. The genus Hyptis (lamiaceae) consists of almost 400 species widespread in tropical and temperate regions of America. In the north and northeastern Brazil, some Hyptis species are used in traditional medicine to treat gastrointestinal disturbances. Objective: The present study has investigated the gastoprotective effect of purified α-pinene in experimental gastric ulcer induced by ethanol and indomethacin in mice. Materials and Methods: Gastric ulcers were induced in male Swiss mice (20-30 g) by oral administration of absolute ethanol or indomethacin 45 min after oral pretreatment with vehicle, standard control drugs or α-pinene (10, 30, and 100 mg/kg). One hour after the ulcerative challenges, the stomach were removed, and gastric lesions areas measured. The effects of α-pinene on the gastric juice acidity were determined by pylorus ligation model. The gastrointestinal motility and mucus depletion were determined by measuring the gastric levels of phenol red and alcian blue, respectively. Hematoxylin and eosin stained sections of gastric mucosa of the experimental groups were used for histology analysis. Results: α-pinene pretreatment inhibited ethanol-induced gastric lesions, reduced volume and acidity of the gastric juice and increased gastric wall mucus (P < 0.05). Furthermore, we showed an interesting correlation between concentration of α-pinene and gastroprotective effect of Hyptis species (P Pearson = 0.98). Conclusion: Our data showed that the α-pinene exhibited significant antiulcerogenic activity and a great correlation between concentration of α-pinene and gastroprotective effect of Hyptis species was also observed.
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Affiliation(s)
- Marcelo de Almeida Pinheiro
- Department of Medical Sciences, Faculty of Medicine, Centro Universitário Unichristus, Fortaleza, CE, Brazil
| | - Rafael Matos Magalhães
- Department of Medical Sciences, Faculty of Medicine, Centro Universitário Unichristus, Fortaleza, CE, Brazil
| | - Danielle Mesquita Torres
- Department of Medical Sciences, Faculty of Medicine, Centro Universitário Unichristus, Fortaleza, CE, Brazil
| | - Rodrigo Cardoso Cavalcante
- Department of Medical Sciences, Faculty of Medicine, Centro Universitário Unichristus, Fortaleza, CE, Brazil
| | | | | | - Henrique Pires Moreira
- Department of Medical Sciences, Faculty of Medicine, Centro Universitário Unichristus, Fortaleza, CE, Brazil
| | - Glauber Cruz Lima
- Department of Physiology, Superior Institute of Biomedical Sciences, University of Ceará, Fortaleza, CE, Brazil
| | | | - José Henrique Leal Cardoso
- Department of Medical Sciences, Faculty of Medicine, Centro Universitário Unichristus, Fortaleza, CE, Brazil
| | | | - Lúcio Ricardo Leite Diniz
- Department of Medical Sciences, Faculty of Medicine, Centro Universitário Unichristus, Fortaleza, CE, Brazil
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Capsule Endoscopy in Patients with Implantable Electromedical Devices is Safe. Gastroenterol Res Pract 2013; 2013:959234. [PMID: 23710168 PMCID: PMC3654345 DOI: 10.1155/2013/959234] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 02/24/2013] [Indexed: 02/08/2023] Open
Abstract
Background and Study Aims. The presence of an implantable electromechanical cardiac device (IED) has long been considered a relative contraindication to the performance of video capsule endoscopy (CE). The primary aim of this study was to evaluate the safety of CE in patients with IEDs. A secondary purpose was to determine whether IEDs have any impact on images captured by CE. Patients and Methods. A retrospective chart review of all patients who had a capsule endoscopy at Mayo Clinic in Scottsdale, AZ, USA, or Rochester, MN, USA, (January 2002 to June 2010) was performed to identify CE studies done on patients with IEDs. One hundred and eighteen capsule studies performed in 108 patients with IEDs were identified and reviewed for demographic data, method of preparation, and study data. Results. The most common indications for CE were obscure gastrointestinal bleeding (77%), anemia (14%), abdominal pain (5%), celiac disease (2%), diarrhea (1%), and Crohn's disease (1%). Postprocedure assessments did not reveal any detectable alteration on the function of the IED. One patient with an ICD had a 25-minute loss of capsule imaging due to recorder defect. Two patients with LVADs had interference with capsule image acquisition. Conclusions. CE did not interfere with IED function, including PM, ICD, and/or LVAD and thus appears safe. Additionally, PM and ICD do not appear to interfere with image acquisition but LVAD may interfere with capsule images and require that capsule leads be positioned as far away as possible from the IED to assure reliable image acquisition.
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Dumkow LE, Voss JR, Peters M, Jennings DL. Reversal of dabigatran-induced bleeding with a prothrombin complex concentrate and fresh frozen plasma. Am J Health Syst Pharm 2012; 69:1646-50. [DOI: 10.2146/ajhp120055] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Svoboda P, Konecny M, Martinek A, Hrabovsky V, Prochazka V, Ehrmann J. Acute upper gastrointestinal bleeding in liver cirrhosis patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 156:266-70. [DOI: 10.5507/bp.2012.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 02/24/2012] [Indexed: 01/15/2023] Open
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