MedWorm: Bleeding

Impact of early reoperation after resection for colorectal cancer on long‐term oncological outcomes

Colorectal Disease — Wed, 08 Feb 2012 21:05:54 +0100

Conclusions Compared with non‐reoperated patients matched for patient, tumour and operative characteristics, patients reoperated in the early postoperative period have worse long‐term oncological outcomes. Adoption of strategies to reduce the risk of reoperation may be associated with the additional advantage of improved oncological outcomes in addition to the short‐term advantages. (Source: Colorectal Disease)

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Analysis of Delayed Bleeding after Endoscopic Submucosal Dissection for Gastric Epithelial Neoplasms

Experimental Diabetes Research — Wed, 08 Feb 2012 19:49:39 +0100

Conclusion. Ulcer presence/absence was considered the most significant predictor of post-ESD bleeding. (Source: Experimental Diabetes Research)

The Great Prostate Debate: Does Screening Save Lives? (preview)

Scientific American Topic - Medical Technology — Wed, 08 Feb 2012 13:00:00 +0100

Last fall the U.S. Preventive Services Task Force dropped a bombshell, arguing that healthy men should stop undergoing a routine blood test as a screen for prostate cancer. An analysis of the best available evidence, it argued, had shown little or no long-term benefit from the measure--called the prostate-specific antigen (PSA) test--for most men with no symptoms of the disease. Use of the screening was not saving lives. In fact, it was needlessly exposing hundreds of thousands of men who were tested and found to have prostate cancer to such common complications as impotence and urinary incontinence (from surgical removal of the prostate) and rectal bleeding (from radiation treatment). Indeed, the task force estimated that more than one million men have been treated because of PSA testing ...

Early VTE Therapy OK After Brain Bleed (CME/CE)

MedPage Today Cardiovascular — Wed, 08 Feb 2012 12:43:01 +0100

HOUSTON --The risk of re-bleeding after intracranial hemorrhage did not increase when patients received early prophylaxis for venous thromboembolism (VTE), a retrospective review showed. (Source: MedPage Today Cardiovascular)

Von Willebrand disease: Clinical and laboratory lessons learned from the large von Willebrand disease studies

American Journal of Hematology — Wed, 08 Feb 2012 05:00:00 +0100

AbstractDuring the past 25 years, our knowledge concerning the pathogenesis, diagnostic strategies and treatment of von Willebrand disease (VWD) has increased significantly. Following the immunological differentiation of factor VIII (FVIII) and von Willebrand factor (VWF) in the 1970s and the cloning of the FVIII and VWF genes in the mid‐1980s, substantial progress has been made in our understanding of this, the most common inherited bleeding disorder. We now recognize that VWD represents a range of genetic diseases all with the clinical endpoint of increased mucocutaneous bleeding. The molecular pathology of Type 2 and Type 3 VWD is now comprehensively documented and involves rare sequence variants at the VWF locus. In contrast, the genetic causation of Type 1 disease remains incomplete...

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Vorapaxar Meets End Point But Ups Bleeding Vorapaxar Meets End Point But Ups Bleeding

Medscape Today Headlines — Tue, 07 Feb 2012 23:18:14 +0100

In its second phase 3 trial, Merck's novel antiplatelet agent reduced ischemic events but increased bleeding, including ICH. Results looked more promising in patients without a history of stroke. Heartwire (Source: Medscape Today Headlines)

TRA 2°P: Vorapaxar meets end point but ups bleeding

theHeart.org — Tue, 07 Feb 2012 17:20:03 +0100

Aspirin, Plavix Not Good Stroke Prevention Combo (CME/CE)

MedPage Today Cardiovascular — Tue, 07 Feb 2012 15:45:17 +0100

NEW ORLEANS (MedPage Today) -- Combining clopidogrel (Plavix) with aspirin did not prevent more small strokes, and even increased the risk of bleeding and death, researchers found. (Source: MedPage Today Cardiovascular)

Acquired hemophilia associated with bullous pemphigoid: a case report.

International Journal of Clinical and Experimental Pathology — Tue, 07 Feb 2012 13:36:02 +0100

We described the case of a 60-year-old female patient who developed bullous pemphigoid for 3 month and presented with bleeding tendency and hematoma in the tongue. Therapy with methylprednisolone, cyclophosphamide, intravenous immunoglobulin and factor VIII reposition was instituted, resulting in a remission of the bleeding and negativity for antibodies against factor VIII titers. We concluded that, despite its rarity, the presence of acquired factor VIII inhibitors should be investigated when patients with autoimmune diseases develop bleeding manifestations. PMID: 22295154 [PubMed - in process] (Source: International Journal of Clinical and Experimental Pathology)

Re‐prescribing of causative drugs in persons discharged after serious drug‐induced upper gastrointestinal bleeding

Alimentary Pharmacology and Therapeutics — Tue, 07 Feb 2012 05:00:00 +0100

ConclusionsDrugs with antihaemostatic action are re‐prescribed to a large extent after an episode of upper gastrointestinal bleeding, but usually covered by PPIs. This use of PPI is specific for users of drugs with antihaemostatic action. (Source: Alimentary Pharmacology and Therapeutics)

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Venous malformations of the temporal bone are a common feature in CHARGE syndrome

The Laryngoscope — Tue, 07 Feb 2012 05:00:00 +0100

Conclusions:Temporal bone venous abnormalities are a common feature in CHARGE syndrome. The pattern of venous abnormality suggests that there is a failure of the sigmoid sinus/jugular bulb to fully develop, resulting in persistence of emissary veins. Recognition of these abnormal venous structures during otologic surgery is critical to avoiding potentially catastrophic bleeding. (Source: The Laryngoscope)

Determination of Dabigatran in Human Plasma Samples

Seminars in Thrombosis and Hemostasis — Tue, 07 Feb 2012 05:00:00 +0100

This article reports the effects of dabigatran on clinical routine assays and the potential usefulness for determination in special risk groups of patients when overdose or lack of compliance are suspected.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents | Abstract | Full text (Source: Seminars in Thrombosis and Hemostasis)

Current and Emerging Therapeutics for Heparin-Induced Thrombocytopenia

Seminars in Thrombosis and Hemostasis — Tue, 07 Feb 2012 05:00:00 +0100

The objectives of this review are to discuss currently available drugs for the treatment of HIT, highlight the limitations of these agents, and examine future therapies.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents | Abstract | Full text (Source: Seminars in Thrombosis and Hemostasis)

Prophylaxis in Children with Hemophilia: Evidence-Based Achievements, Old and New Challenges

Seminars in Thrombosis and Hemostasis — Tue, 07 Feb 2012 05:00:00 +0100

Semin Thromb Hemost 2012; 38: 79-94DOI: 10.1055/s-0031-1300954Recurrent joint bleeding leading to progressive musculoskeletal damage (hemophilic arthropathy), in spite of on-demand replacement with deficient factor concentrates, is the clinical hallmark of severe hemophilia A and B (i.e., the congenital deficiencies of coagulation factors VIII and IX with circulating levels <1 IU/dL). Fifty years of clinical experience, which began in Northern Europe and then initiated in other European countries and in North America, up to the recent randomized clinical trials, have provided definitive evidence that preventing bleeding from an early age through long-term regular prophylactic concentrate infusions limits the adverse clinical consequences of arthropathy and its complications in the quali...

New Insights into von Willebrand Disease and Platelet Function

Seminars in Thrombosis and Hemostasis — Tue, 07 Feb 2012 05:00:00 +0100

Semin Thromb Hemost 2012; 38: 55-63DOI: 10.1055/s-0031-1300952Regulation of binding between von Willebrand factor (VWF) and the platelet receptor glycoprotein (GP) Ibα is one of the key steps in controlling hemostasis and thrombosis. On vascular injury at sites of high shear rates, the GPIbα interaction with subendothelial-bound VWF will initiate the tethering of circulating platelets to the vessel wall. Tethered platelets subsequently roll on the damaged vessel wall, a process that is amplified by the activation of the platelet integrin αΙΙbβ3 (GPIIb/IIIa). The initial tethering to VWF is rapidly followed by platelet binding to collagen through specific receptors (GPVI and α2β1), leading to firm adhesion, activation, and additional stable bonds mediated by αΙΙbβ3. The above de...

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Active Online Assessment of Patients Using New Oral Anticoagulants: Bleeding Risk, Compliance, and Coagulation Analysis

Seminars in Thrombosis and Hemostasis — Tue, 07 Feb 2012 05:00:00 +0100

Semin Thromb Hemost 2012; 38: 23-30DOI: 10.1055/s-0031-1300948Clinicians prescribing new oral anticoagulants (OACs; dabigatran, rivaroxaban, and apixaban) should be aware of the exclusion criteria related to bleeding risks defined in published clinical studies. At least a quarter of patients currently using warfarin have an exclusion criterion that may prevent easy transition to the new OACs. In the summary of product characteristics for dabigatran, as an example, the target populations appear generalized. Due to fixed dosing and predictable pharmacology, routine laboratory monitoring of new OACs is deemed unnecessary. Under special circumstances, however, understanding the extent of thrombin or factor (F) Xa inhibition may aid in evaluating compliance and handling emergency interventions,...

Aspirin 'not to blame' for stomach bleeding - that's due to a bug, say scientists

the Mail online | Health — Tue, 07 Feb 2012 04:03:43 +0100

It opens up the possibility that otherwise healthy people might be able to take the drug safely for its cancer-preventing benefits. (Source: the Mail online | Health)

Clopidogrel With Aspirin Doesn't Prevent More Small Strokes, May Increase Risk Of Bleeding, Death

Health News from Medical News Today — Mon, 06 Feb 2012 09:00:00 +0100

The anti-blood clot regimen that adds the drug clopidogrel (Plavix) to aspirin treatment is unlikely to prevent recurrent strokes and may increase the risk of bleeding and death in patients with subcortical stroke according to late-breaking research presented at the American Stroke Association's International Stroke Conference 2012. Because of these preliminary results, researchers ended the anti-clotting part of the Secondary Prevention of Small Subcortical Strokes Trial (SPS3) in August 2011. The part of the study that examines the effect of high blood pressure treatments will continue... (Source: Health News from Medical News Today)

For Atrial Fibrillation Patients, Rivaroxaban Has Less Risk Of Brain Bleeding In Patients At High Risk For Stroke

Health News from Medical News Today — Mon, 06 Feb 2012 08:00:00 +0100

For patients with a type of irregular heart beat called atrial fibrillation (AF), a new anti-clotting drug might be better at preventing clot-related strokes while minimizing the risk of causing a bleeding stroke. The research was presented at the American Stroke Association's International Stroke Conference 2012. The finding stems from a sub-analysis of data in a large, randomized clinical trial called ROCKET AF, conducted in 45 countries at 1,178 sites... (Source: Health News from Medical News Today)

Menstruation: Heavy Bleeding (Menorrhagia)

About.com Eating Disorders — Mon, 06 Feb 2012 05:00:00 +0100

Article Page Navigation Introduction Menstrual Disorders Causes (Source: About.com Eating Disorders)

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Cardiovascular Outcomes Using Intra-Aortic Balloon Pump in High-Risk Acute Myocardial Infarction With or Without Cardiogenic Shock: A Meta-Analysis

Journal of Cardiovascular Pharmacology and Therapeutics — Mon, 06 Feb 2012 05:00:00 +0100

Conclusion: The present meta-analysis suggests that patients with high-risk AMI without cardiogenic shock do not seem to benefit from the use of IABP as measured by in-hospital mortality, rate of reinfarction, and recurrent angina. However, in patients with AMI with cardiogenic shock (systolic blood pressure [SBP] < 90), there was significant reduction in mortality using IABP. The use of IABP is associated with increase in the rate of both moderate and severe bleeding. (Source: Journal of Cardiovascular Pharmacology and Therapeutics)

What Are the Major Diseases Involving Copper Metabolism?

PediatricEducation.org — Mon, 06 Feb 2012 00:08:49 +0100

Discussion Nutritional problems can occur in all parts of the world and in all socioeconomic strata. Caloric and/or protein inadequacy unfortunately plagues too many people because of inadequate supplies or availability. Supplemental food programs around the world attempt to provide appropriate nutrition, but can be stymied because of war, political instability, economic instability and many other social factors. The most common specific nutrient deficiencies are iron and Vitamin D deficiencies. Minerals important for essential nutrition include copper, iodine, selenium and zinc. A typical mixed diet usually provides enough minerals. In the United States, mineral deficiencies are usually uncommon unless there is an underlying disease process or abnormal food restrictions or diet. Vegan an...

Anastrozole: Arthralgia and genital bleeding, treated with Kampo medicines: case report

Reactions — Sun, 05 Feb 2012 18:29:54 +0100

(Source: Reactions)

Cedars-Sinai Neurology Researchers Present Findings At International Stroke Conference

Health News from Medical News Today — Sun, 05 Feb 2012 08:00:00 +0100

Stroke experts from Cedars-Sinai Medical Center presented research updates at the International Stroke Conference of the American Heart Association/American Stroke Association Feb. 1 through Feb. 3 in New Orleans. Highlights included: Thrombin Activity Associated with Neuronal Damage during Acute Stage of Ischemic Stroke After ischemic stroke - the type caused by a clogged artery but with no bleeding into the brain - a normal protein that plays a positive role in blood clotting escapes intact arteries and seriously damages healthy brain cells... (Source: Health News from Medical News Today)

Clopidogrel with Aspirin Doesn't Prevent More Small Strokes, May Increase Risk of Bleeding, Death

MedlinePlus Health News — Fri, 03 Feb 2012 23:46:52 +0100

Source: American Heart Association Related MedlinePlus Page: Stroke (Source: MedlinePlus Health News)

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Chronic Kidney Disease and End-Stage Renal Disease Predict Higher Risk of Mortality in Patients with Primary Upper Gastrointestinal Bleeding

Karger Publishers — Fri, 03 Feb 2012 23:00:00 +0100

Am J Nephrol 2012;35:216–224 (DOI:10.1159/000336107) (Source: Karger Publishers)

Rectocele—does the size matter?

International Journal of Colorectal Disease — Fri, 03 Feb 2012 17:12:43 +0100

Conclusion In conclusion, only the evacuation of rectoceles was correlated to the size of the rectoceles, but had no clinical significance. Other clinical, anatomical factors were also not associated to the size of the rectoceles. Rectoceles’ size alone may not be an indication for surgery. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00384-012-1425-7Authors Dan Carter, Neurogastroenterology Unit, Department of Gastroenterology, Sheba Medical Center, Ramat Gan, IsraelMarc Beer Gabel, Neurogastroenterology Unit, Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel Journal International Journal of Colorectal DiseaseOnline ISSN 1432-1262Print ISSN 0179-1958 (Source: International Journal of Colorectal Disease)

Clopidogrel with aspirin doesn't prevent more small strokes, may increase risk of bleeding and death, researchers report

ScienceDaily Headlines — Fri, 03 Feb 2012 16:33:33 +0100

Clopidogrel With Aspirin Doesn't Prevent More Small Strokes, May Increase Risk of Bleeding, Death

Medical News (via PRIMEZONE) — Fri, 03 Feb 2012 14:00:00 +0100

NEW ORLEANS, Feb. 3, 2012 (GLOBE NEWSWIRE) -- The anti-blood clot regimen that adds the drug clopidogrel (Plavix) to aspirin treatment is unlikely to prevent recurrent strokes and may increase the risk of bleeding and death in patients with subcortical stroke according to late-breaking research presented at the American Stroke Association's International Stroke Conference 2012. (Source: Medical News (via PRIMEZONE))

New device removes stroke-causing blood clots better than standard treatment

UCLA Newsroom: Health Sciences — Fri, 03 Feb 2012 14:00:00 +0100

An experimental device for removing blood clots in stroke patients dramatically outperformed the standard mechanical treatment, according to research presented by UCLA Stroke Center director Dr. Jeffrey L. Saver at the American Stroke Association's 2012 international conference in New Orleans on Feb. 3. The SOLITAIRE Flow Restoration Device is among an entirely new generation of devices designed to remove blood clots from blocked brain arteries in patients experiencing stroke. It has a self-expanding, stent-like design and, once inserted into a clot using a thin catheter tube, it compresses and traps the clot. The clot is then removed by withdrawing the device, thus reopening the blocked blood vessel. In the first U.S. clinical trial of SOLITAIRE, the device opened blocked ve...

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Reduction in alveolar bone density of patients with juvenile idiopathic arthritis

Revista Brasileira de Reumatologia — Fri, 03 Feb 2012 10:19:07 +0100

CONCLUSION: ABD was lower in patients with JIA and seemed to be influenced by neither medication nor rheumatic disease activity. In addition, no correlation was observed between ABD and periodontal and rheumatologic clinical parameters (Source: Revista Brasileira de Reumatologia)

Transcatheter Arterial Embolization for Upper Gastrointestinal Nonvariceal Hemorrhage: Is Empiric Embolization Warranted?

CardioVascular and Interventional Radiology — Fri, 03 Feb 2012 07:19:24 +0100

Conclusion Empiric arterial embolization may be advantageous in patients with a duodenal source of hemorrhage but not in patients with gastric hemorrhage. Content Type Journal ArticleCategory Clinical InvestigationPages 1-9DOI 10.1007/s00270-012-0351-yAuthors Elnasif Arrayeh, Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, Room M-361, San Francisco, CA 94134, USANicholas Fidelman, Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, Room M-361, San Francisco, CA 94134, USARoy L. Gordon, Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, Room M-361, San Francisco, CA 94134, USAJeanne M. LaBerge, Department of Radiology, University of California San Francisco, 5...

New Anti-Clotting Drug May Cut Brain Bleeding Risk: Study

MedicineNet Cholesterol General — Fri, 03 Feb 2012 07:00:00 +0100

Title: New Anti-Clotting Drug May Cut Brain Bleeding Risk: StudyCategory: Health NewsCreated: 2/2/2012 2:06:00 PMLast Editorial Review: 2/3/2012 (Source: MedicineNet Cholesterol General)

A prospective randomized open-label crossover trial of regional citrate anticoagulation vs. anticoagulation free liver dialysis by the Molecular Adsorbents Recirculating System

Critical Care — Fri, 03 Feb 2012 05:00:00 +0100

IntroductionThe Molecular Adsorbent Recycling System (MARS) is used to treat patients with liver failure. Observational data suggest that citrate anticoagulation during MARS is feasible. Comparative studies on the optimal anticoagulation regimen during MARS are lacking. The aim of the current study was to evaluate two heparin-free anticoagulation regimens. Methods: We performed a prospective randomized open-label crossover study of regional citrate anticoagulation against no anticoagulation. Ten patients (age 55 +/- 11 years) with liver failure undergoing MARS treatment were included. The primary endpoint was completion of MARS sessions. Secondary endpoints included treatment efficacy and safety. Longevity of MARS treatment was plotted as a Kaplan-Meier estimate. Fisher's exact test was us...

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Clopidogrel with aspirin doesn't prevent more small strokes, may increase risk of bleeding, death

EurekAlert! - Medicine and Health — Fri, 03 Feb 2012 05:00:00 +0100

(American Heart Association) The anti-blood clot regimen that adds the drug clopidogrel (Plavix) to aspirin treatment is unlikely to prevent recurrent strokes and may increase the risk of bleeding and death in patients with subcortical stroke according to late-breaking research presented at the American Stroke Association's International Stroke Conference 2012. (Source: EurekAlert! - Medicine and Health)

skin_wounds_signs_your_wound

About.com Eating Disorders — Fri, 03 Feb 2012 05:00:00 +0100

If your cut or scrape is jagged, gaping, on your face, contains embedded dirt or won't stop bleeding, you need to see a doctor. (Source: About.com Eating Disorders)

A rare gastrointestinal presentation of a common malignancy

Gut — Fri, 03 Feb 2012 05:00:00 +0100

Clinical presentation A 61-year-old man presented with a 4-week history of rectal bleeding, constipation, bloating, abdominal distension and low back pain. His bowels had not opened for 4 days prior to admission. Physical examination revealed a distended, tympanic abdomen. Routine laboratory tests confirmed renal failure (urea 13 mmol/l, creatinine 200 μmol/l), hypercalcaemia (3.7 mmol/l), albumin 32 g/l and C-reactive protein (CRP) 25 mg/l. Parathormone was suppressed (7 pg/l (15–65)). Abdominal x-ray suggested an ileus. CT abdomen revealed mural thickening of the left hemi-colon along with collapse of the third lumbar vertebra. An isotope bone scan was unremarkable, while MRI of the spine confirmed the presence of multiple lytic lesions. Immuno...

Effect of letrozole on the uterine Doppler flow indices during early pregnancy: a randomised trial

Ultrasound in Obstetrics and Gynecology — Fri, 03 Feb 2012 05:00:00 +0100

Conclusion: We demonstrated that the use of letrozole in first trimester pregnancy suppressed serum estradiol level, but resulted in an increase in blood flow to the uterus. Further studies should be carried out to elucidate the mechanism of letrozole pretreatment in medical abortion. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd. (Source: Ultrasound in Obstetrics and Gynecology)

Adams–Oliver syndrome and portal hypertension: Fortuitous association or common mechanism?

American Journal of Medical Genetics Part A — Fri, 03 Feb 2012 05:00:00 +0100

We present a boy with AOS who developed a progressive splenomegaly and hypersplenism at the age of 2 months, and was admitted for acute gastrointestinal bleeding (GI) at the age of 9 months. Subsequently, we documented an extrahepatic portal vein obstruction and esophageal varices. After several episodes of cataclysmic upper GI bleeding a mesentero‐portal shunt (MPS) was performed at 10 months. The shunt thrombosed, and after three failed attempts of thrombectomy, it was removed. One month later a splenorenal shunt was performed, and this closed spontaneously by 3 years. The patient suffered from ischemic stroke after placing the first shunt, and has spastic diplegia, left frontal lobe epilepsy, hyperactivity and attention deficit disorder, and severe psychomotor delay. At 11 years and h...

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Effect of letrozole on the uterine Doppler flow indices during early pregnancy: a randomised trial.

The Ultrasound Review of Obstetrics and Gynecology — Fri, 03 Feb 2012 05:00:00 +0100

Rivaroxaban Has Less Risk of Brain Bleeding in Patients at High Risk of Stroke

MedlinePlus Health News — Fri, 03 Feb 2012 01:15:10 +0100

Source: American Heart Association Related MedlinePlus Page: Atrial Fibrillation (Source: MedlinePlus Health News)

Early complications after stoma formation: a prospective cohort study in 100 patients with 1-year follow-up

International Journal of Colorectal Disease — Thu, 02 Feb 2012 18:12:55 +0100

Conclusions In this heterogenic patient population with formation of different stoma types, a high complication rate was detected. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00384-012-1413-yAuthors H. A. Formijne Jonkers, Department of Colorectal Surgery, Meander Medical Centre Amersfoort, Utrechtseweg 160, 3818 ES Amersfoort, the NetherlandsW. A. Draaisma, Department of Colorectal Surgery, Meander Medical Centre Amersfoort, Utrechtseweg 160, 3818 ES Amersfoort, the NetherlandsA. M. Roskott, Department of Colorectal Surgery, Meander Medical Centre Amersfoort, Utrechtseweg 160, 3818 ES Amersfoort, the NetherlandsA. J. van Overbeeke, Department of Colorectal Surgery, Meander Medical Centre Amersfoort, Utrechtseweg 160, 3818 ES Amersfoort, t...

Obscure and occult gastrointestinal bleeding: role of radionuclide imaging

Abdominal Imaging — Thu, 02 Feb 2012 18:12:44 +0100

Content Type Journal ArticlePages 1-2DOI 10.1007/s00261-012-9841-2Authors Tamer Aksoy, Nuclear Medicine Division, Haydarpasa Numune Training & Research Hospital, Istanbul, Turkey Journal Abdominal ImagingOnline ISSN 1432-0509Print ISSN 0942-8925 (Source: Abdominal Imaging)

Effect of nonsurgical periodontal therapy and strict plaque control on preterm/low birth weight: a randomized controlled clinical trial

Clinical Oral Investigations — Thu, 02 Feb 2012 18:12:31 +0100

Conclusions Comprehensive periodontal treatment and strict plaque control significantly improved periodontal health; however, no reduction of PTLBW rates was observed. Thus, remaining periodontal inflammation posttreatment cannot explain the lack of effect of periodontal treatment on PTLBW. Clinical relevance This study demonstrated that periodontal diseases may be successfully treated during pregnancy. Our results do not support a potential beneficial effect of periodontal treatment on PTLBW. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s00784-012-0679-3Authors Patricia Weidlich, Section of Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, Bra...

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The use of novel hemostatic sealant (Tisseel®) in laparoscopic myomectomy: a case–control study

Surgical Endoscopy — Thu, 02 Feb 2012 18:07:53 +0100

Conclusions The use of Tisseel® during LM may represent a valid alternative solution for obtaining hemostasis, reducing intra- and postoperative bleeding. Furthermore, it may help the surgeon to obtain a rapid healing of the injured surfaces, probably reducing the use of electrocoagulation and traumatisms. Content Type Journal ArticlePages 1-8DOI 10.1007/s00464-012-2154-2Authors Roberto Angioli, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyFrancesco Plotti, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyRoberto Ricciardi, Department of Obstetrics and Gynecology, “Campus Bio Medico” University...

Oral Ulipristal Proves Highly Effective for Uterine FibroidsOral Ulipristal Proves Highly Effective for Uterine Fibroids

Medscape Today Headlines — Thu, 02 Feb 2012 18:02:11 +0100

The selective progesterone receptor modulator ulipristal acetate reduced bleeding and fibroid size in 2 trials, offering gynecologists a new tool for treating uterine fibroids prior to surgery. Medscape Medical News (Source: Medscape Today Headlines)

Are CT Scans For Dizziness In ER Cost-Effective?

Health News from Medical News Today — Thu, 02 Feb 2012 18:00:00 +0100

Henry Ford Hospital researchers have found that conducting CT scans in the emergency department (ED) for individuals experiencing dizziness may not be cost effective. The researchers discovered that less than 1% of CT scans carried out in the ED showed a more serious underlying cause for dizziness (stroke or intracranial bleeding), which required intervention. The finding comes at a time when hospitals across the nation seek ways to reduce costs without sacrificing patient care... (Source: Health News from Medical News Today)

Rivaroxaban Has Less Risk of Brain Bleeding in Patients at High Risk for Stroke

Medical News (via PRIMEZONE) — Thu, 02 Feb 2012 14:00:00 +0100

NEW ORLEANS, Feb. 2, 2012 (GLOBE NEWSWIRE) -- Study Highlights: (Source: Medical News (via PRIMEZONE))

New European pill works against uterine fibroids

CTV Health — Thu, 02 Feb 2012 13:14:35 +0100

New research offers hope for the first pill to treat a common problem in young women: fibroids in the uterus. The growths can cause pain, heavy bleeding and fertility problems, and they are the leading cause of hysterectomies. (Source: CTV Health)

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Reduced 'Second Stroke' After Aneurysm Rupture Shown In Trial Of Experimental Drug

Health News from Medical News Today — Thu, 02 Feb 2012 09:00:00 +0100

An experimental drug, clazosentan, reduced the risk of blood vessel spasm in patients with a brain aneurysm, according to research presented at the American Stroke Association's International Stroke Conference 2012. In patients with a subarachnoid hemorrhage, even after the burst weak spot in the vessel is closed, irritation from the initial bleeding can cause blood vessels to constrict, cutting off normal blood supply and resulting in even more brain damage. This is often called a "second stroke... (Source: Health News from Medical News Today)

Rivaroxaban has less risk of brain bleeding in patients at high risk for stroke

EurekAlert! - Medicine and Health — Thu, 02 Feb 2012 05:00:00 +0100

(American Heart Association) For patients with a type of irregular heart beat called atrial fibrillation, a new anti-clotting drug might be better at preventing clot-related strokes while minimizing the risk of causing a bleeding stroke. The research was presented at the American Stroke Association's International Stroke Conference 2012. (Source: EurekAlert! - Medicine and Health)

New Anti-Clotting Drug May Cut Brain Bleeding Risk: Study

Pharmacy News - Doctors Lounge — Thu, 02 Feb 2012 05:00:00 +0100

People with abnormal heartbeat taking Xarelto were less likely to bleed out than warfarin patients (Source: Pharmacy News - Doctors Lounge)

RCTs: Ulipristal acetate for preoperative treatment of symptomatic uterine fibroids

NeLM - News — Thu, 02 Feb 2012 05:00:00 +0100

Source: N Engl J Med Area: News The results of two RCTs examining the efficacy of the progesterone-receptor modulator ulipristal acetate for preoperative treatment of symptomatic uterine fibroids have been published in the New England Journal of Medicine. The first study compared the efficacy and safety of oral ulipristal acetate for the treatment of symptomatic uterine fibroids before surgery with placebo in women who experienced excessive uterine bleeding (>100 on pictorial blood-loss assessment chart [PBAC, monthly scores range from 0 to >500, with higher numbers indicating more bleeding]) and anaemia (haemoglobin level of ?10.2 g/dl). They were randomised to treatment for up to 13 weeks with oral ulipristal acetate 5mg/d (n= 96) or 10 mg per day (n= 98) or placebo (...

Apixaban vs. aspirin in patients with atrial fibrillation and previous stroke or TIA: subgroup analysis from AVERROES trial

NeLM - News — Thu, 02 Feb 2012 05:00:00 +0100

Source: Lancet Neurology Area: News Apixaban, reduced the risk of stroke or systemic embolism in patients with atrial fibrillation who were at high risk of stroke but unsuitable for vitamin K antagonist therapy in the AVERROES study (n= 5599). In a report in the Lancet Neurolgy, researchers evaluated whether the subgroup of patients with previous stroke or transient ischaemic attack (TIA) would show a greater benefit from apixaban compared with aspirin than patients without previous cerebrovascular events. Patients were randomised to apixaban 5mg BD or aspirin (81 to 324mg daily). The mean follow-up was 1.1 years. The primary efficacy outcome was stroke or systemic embolism; the primary safety outcome was major bleeding. This pre-specified subgroup analysis estimated compared 1...

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Lung Transplantation in Patients with Prior Cardiothoracic Surgical Procedures

American Journal of Transplantation — Thu, 02 Feb 2012 05:00:00 +0100

The full spectrum of prior cardiothoracic procedures in lung transplant candidates and the impact of prior procedures on outcomes after lung transplantation (LTx) remain unknown, though the impact is considered to be large. Patients transplanted at our institution from 2004 to 2009 were identified (n = 554) and divided into two groups: patients who had undergone cardiothoracic surgical (CTS) procedures prior to LTx (n = 238) and patients who had not (non‐CTS: n = 316). Our primary endpoint was survival. Secondary endpoints included allograft function and the incidence of major complications including reexploration due to bleeding, prolonged ventilation, renal insufficiency and primary graft dysfunction. Long‐term survival was not significantly different between the groups whereas posto...

Anticoagulation monitoring during extracorporeal circulation with the HEPCON/HMS device.

Perfusion — Thu, 02 Feb 2012 05:00:00 +0100

CONCLUSION: During cardiac surgery under CPB, heparin and protamine titration with the Hepcon/HMS device could predict a lower protamine dose and lower postoperative bleeding without higher thromboembolic events, and lower perioperative red blood cell transfusion with a shorter chest closure time. PMID: 22301392 [PubMed - as supplied by publisher] (Source: Perfusion)

Association between oral health and gastric precancerous lesions

Carcinogenesis — Thu, 02 Feb 2012 05:00:00 +0100

Although recent studies have suggested that tooth loss is positively related to the risk of gastric non-cardia cancer, the underlying oral health conditions potentially responsible for the association remain unknown. We investigated whether clinical and behavioral measures of oral health are associated with the risk of gastric precancerous lesions. We conducted a cross-sectional study of 131 patients undergoing upper gastrointestinal endoscopy. Cases were defined as those with gastric precancerous lesions including intestinal metaplasia or chronic atrophic gastritis on the basis of standard biopsy review. A validated structured questionnaire was administered to obtain information on oral health behaviors. A comprehensive clinical oral health examination was performed on a subset of 91 pati...

‘Morning-After’ Pill May Be New Option to Treat Painful Fibroids

Gynecology News - Doctors Lounge — Thu, 02 Feb 2012 01:00:00 +0100

Study found it shrank fibroids, reduced excessive bleeding (Source: Gynecology News - Doctors Lounge)

'Morning-After' Pill May Be New Option to Treat Painful Fibroids

MedlinePlus Health News — Thu, 02 Feb 2012 00:00:00 +0100

Study found it shrank fibroids, reduced excessive bleeding Source: HealthDay Related MedlinePlus Pages: Birth Control, Uterine Fibroids (Source: MedlinePlus Health News)

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New Drug Treats Fibroids With Fewer Side Effects

WebMD Health — Wed, 01 Feb 2012 22:25:52 +0100

The drug ulipristal acetate effectively controlled bleeding and shrunk uterine fibroids in two new studies. (Source: WebMD Health)

Morning-After Pill Does Double Duty (CME/CE)

MedPage Today OB/GYN — Wed, 01 Feb 2012 21:00:00 +0100

(MedPage Today) -- An emergency contraceptive pill is also effective at controlling excessive bleeding associated with fibroids, two studies found. (Source: MedPage Today OB/GYN)

Uganda: The Ongoing Perils of Child Birth

AllAfrica News: Pregnancy and Childbirth — Wed, 01 Feb 2012 12:48:54 +0100

[Independent] Fertility rates in Rwanda have been falling steadily over the past several years, but this year close to 400,000 Rwandan women will become pregnant and give birth. Next door in Uganda, four times as many women will become pregnant, approximately 1.5 million. If recent trends hold, nearly 10,000 of these women will lose their lives during or shortly after their pregnancy. Many of them will suffer from bleeding and infections that can be treated or prevented. (Source: AllAfrica News: Pregnancy and Childbirth)

Dabigatran for patients with a mechanical valve

Heart, Lung and Circulation — Wed, 01 Feb 2012 05:00:00 +0100

We read with great interest the case report by Stewart et al. , describing a 62 year-old Caucasian patient who suffered thrombosis of a mechanical aortic valve and an embolic stroke whilst being treated for more than eight months with dabigatran (150mg b.i.d.) and 100mg aspirin. Dabigatran etexilate is a new oral direct thrombin inhibitor currently approved for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation. In the RELY study , a dose of 150mg b.i.d. was shown to be associated with a significantly lower risk of stroke and systemic embolism with a similar risk of major bleeding when compared with warfarin. (Source: Heart, Lung and Circulation)

Predictors and time trends in clopidogrel and proton pump inhibitor coprescription with low‐dose acetylsalicylic acid

Pharmacoepidemiology and Drug Safety — Wed, 01 Feb 2012 05:00:00 +0100

ConclusionClopidogrel and PPI coprescription with low‐dose ASA increased markedly between 2000–2001 and 2006–2007; however, many patients on low‐dose ASA did not receive the recommended coprescriptions at the end of the study period. Copyright © 2012 John Wiley & Sons, Ltd. (Source: Pharmacoepidemiology and Drug Safety)

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Direct cauterization of the nasal septal artery for epistaxis

The Laryngoscope — Wed, 01 Feb 2012 05:00:00 +0100

AbstractEmergency management of epistaxis may include the use of local pressure and vasoconstrictors, chemical or electric cautery, hemostatic agents, nasal packing, embolization and surgical arterial ligation. There is no definitive protocol for the management of epistaxis although various protocols have been proposed in the literature. As approaches to surgical ligation of the arterial supply of the nasal cavity have undergone evolution from external carotid ligation to minimally invasive approaches, surgical management of epistaxis has become more cost‐effective than embolization and may be less risky. In the surgical management of epistaxis, arterial ligation immediately proximal to the bleeding site is preferred. We propose a simple variation of the endoscopic sphenopalatine artery ...

A simple reminder system improves venous thromboembolism prophylaxis rates and reduces thrombotic events for hospitalized patients1

Journal of Thrombosis and Haemostasis — Wed, 01 Feb 2012 05:00:00 +0100

Conclusion: Adding an electronic reminder to the admission note improved prophylaxis rates and reduced VTE rates across services. The system is easily reproducible and applicable to other facilities. The improvement obtained was modest, so additional measures will probably be needed to optimize prophylaxis rates. (Source: Journal of Thrombosis and Haemostasis)

Anticoagulant activity of select dietary supplements

Nutrition Reviews — Wed, 01 Feb 2012 05:00:00 +0100

This review considers the potential of certain dietary supplements, including garlic, Ginkgo biloba, ginger, ginseng, fish oil, and vitamin E, to interfere with hemostasis. Dietary supplements are common components of the diet in the United States, with about half the US adult population taking some type of dietary supplement regularly. It has been suggested that some supplements could adversely affect coagulation when taken alone or in combination with antiplatelet medications. Supplements could alter hemostasis by a variety of mechanisms, such as reducing platelet aggregation or inhibiting arachidonic acid, a cellular signaling messenger and inflammatory intermediate. To conduct this review, multiple databases were searched using a variety of search terms to ensure relevant papers were l...

Med Sci Monit 2012; 18(2):CS8-11 "Massive bleeeding from upper gastrointestinal tract as a symptom of rupture of splenic artery aneurysm to stomach"

Medical Science Monitor — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: The case described confirms that splenic artery aneurysm can be a cause of bleeding to both upper and lower parts of the gastrointestinal tract, and the aneurysm rupture is usually of a dramatic and life-threatening course. (Source: Medical Science Monitor)

Osteoporosis/Osteopenia and hemophilic arthropathy in severe hemophilic patients.

Archives of Iranian Medicine — Wed, 01 Feb 2012 05:00:00 +0100

CONCLUSION: Our results suggest that men with severe hemophilia have reduced BMD. Patients at risk are those with signs of hemophilic arthropathy. Because osteoporosis may complicate the future treatment of patients with hemophilia, screening of patients with hemophilic arthropathy for reduction of BMD and preventive therapies is highly recommended. PMID: 22292576 [PubMed - in process] (Source: Archives of Iranian Medicine)

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Saw-scaled viper bites in sri lanka: is it a different subspecies? Clinical evidence from an authenticated case series.

The American Journal of Tropical Medicine and Hygiene — Wed, 01 Feb 2012 05:00:00 +0100

We report a series of 48 (n-48) SSV bites from the Northern Province of Sri Lanka. The majority (65%) of victims had evidence of local envenoming at the site of the bite; however, 29% showed spontaneous bleeding and 71% had coagulopathy. There were no deaths in the series. The envenoming was mild in contrast to the mortality and significant morbidity associated with SSV bites in West Africa and some parts of India. These observations need to be further explored with laboratory studies to identify the venom components, study of morphological characteristics, and genetic profiling of the Sri Lankan SSV to see if it is different from the subspecies found elsewhere. PMID: 22302858 [PubMed - in process] (Source: The American Journal of Tropical Medicine and Hygiene)

Newest-generation drug-eluting and bare-metal stents combined with prasugrel-based antiplatelet therapy in large coronary arteries: The BAsel Stent Kosten Effektivitäts Trial PROspective Validation Examination part II (BASKET-PROVE II) trial design

American Heart Journal — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: This study will test the comparative long-term safety and efficacy of newest-generation stents on the background of contemporary antiplatelet therapy in a large all-comer population undergoing large native coronary artery stenting. (Source: American Heart Journal)

Rationale and design of the TAXUS Libertē Post-Approval Study: Examination of patients receiving the TAXUS Liberté stent with concomitant prasugrel therapy in routine interventional cardiology practice

American Heart Journal — Wed, 01 Feb 2012 05:00:00 +0100

Background: Observational studies of new coronary stents are necessary to assess performance in a variety of complex patient and lesion types. Furthermore, the optimal dose and duration of thienopyridine treatment is unclear, particularly in patients with complex clinical conditions. The TAXUS Libertē Post-Approval Study is designed to provide 5-year data on the TAXUS Liberté paclitaxel-eluting stent with concomitant prasugrel therapy in routine clinical practice and to contribute data to the DAPT study.Study Design: The TAXUS Libertē Post-Approval Study is a prospective, multicenter, observational study. Enrollment of approximately 4,200 patients receiving ≥1 TAXUS Liberté stents is planned. All patients without a contraindication will be prescribed prasugrel plus aspirin for 1 year...

Reduced immediate ischemic events with cangrelor in PCI: A pooled analysis of the CHAMPION trials using the universal definition of myocardial infarction

American Heart Journal — Wed, 01 Feb 2012 05:00:00 +0100

Conclusion: With the use of the universal definition of myocardial infarction, cangrelor was associated with a significant reduction in early ischemic events when compared with clopidogrel in patients with non–ST-elevation ACS undergoing PCI. (Source: American Heart Journal)

Percutaneous coronary intervention outcomes in US hospitals with varying structural characteristics: Analysis of the NCDR®

American Heart Journal — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: Specialty hospitals appear to have lower rates of most adverse outcomes for PCI. Specialty hospitals may have developed expertise in narrow procedural areas that could be adapted to the larger population of general hospitals. (Source: American Heart Journal)

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Pain and bleeding are the main determinants of unscheduled contacts after outpatient tonsillectomy.

Pain Physician — Wed, 01 Feb 2012 05:00:00 +0100

CONCLUSION: Outpatient tonsillectomy seems safe in Denmark. A minimum postoperative observation period of four hours will reduce the need for postoperative contacts. Because of the potentially life-threatening risk related to tonsillectomy, careful patient selection is mandatory and continuous monitoring of the quality of the procedure is essential. FUNDING: not relevant. TRIAL REGISTRATION: not relevant. PMID: 22293052 [PubMed - in process] (Source: Pain Physician)

Acquired Hemophilia A in a Patient with Essential Thrombocythemia.

Acta Haematologica — Wed, 01 Feb 2012 05:00:00 +0100

Authors: Mori N, Totsuka K, Ishimori N, Yoshinaga K, Teramura M, Noguchi S, Oda H, Motoji T Abstract A 69-year-old woman with essential thrombocythemia (ET) developed giant ecchymosis, and she was admitted to hospital. Marked anemia (Hb 8.1 g/dl) accompanied by a prolonged activated partial thromboplastin time (89.6 s) was observed, and she received red blood cells (RBC) and fresh frozen plasma (FFP). On day 2 after admission, consciousness disturbance suddenly occurred, whereas computed tomography of the brain showed no evidence of bleeding. As the ecchymosis progressed, she developed shock. Although RBC and FFP transfusions were administered, she developed multi-organ failure and died 48 h after admission. Low factor VIII activity (<1%) accompanied by factor VIII inhibitor (17...

Is management of acute traumatic brain injury effective? A literature review of published Cochrane Systematic Reviews.

Chinese Journal of Traumatology — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: For clinical physicians, to translate these conclusions into practice with caution is essential. Basic medication and nursing care deserve additional attention as well and can be beneficial. For researchers, high quality trials with perfect design and comprehensive consideration of various factors are urgently required. PMID: 22300914 [PubMed - in process] (Source: Chinese Journal of Traumatology)

Gastric disorders: modifications of gastric content, antacids and drugs influencing gastric secretions and motility

Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

Abstract: Gastric disorders have clinical implications in both anaesthesia and critical care medicine. Aspiration of acidic gastric contents in the perioperative setting is linked to pneumonitis and later development of pneumonia. Pharmacological strategies to minimize this risk include histamine-2 receptor antagonists, sucralfate, proton pump inhibitors and sodium citrate. Use of gastric acid-suppressing therapy is widespread in critical care. The aim is to reduce the incidence of stress-related mucosal bleeding. Intestinal failure is common in critical illness. Medications that decrease gastric motility and contribute to ileus, include opioid analgesics, catecholamines and α2-adrenoceptor antagonists. Current pharmacological strategies for increasing gastric motility include the use of ...

Outcome and Complications of EUS Guided Pancreatic Pseudocyst Drainage Utilizing Combined Endoprosthesis and Naso‐cystic Drain.

Journal of Gastroenterology and Hepatology — Wed, 01 Feb 2012 05:00:00 +0100

Conclusion: EUS‐PPD with modified combined technique is safe and is associated with high success rate.© 2012 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd (Source: Journal of Gastroenterology and Hepatology)

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Successful Conservative Treatment of a Cesarean Scar Pregnancy with Systemically Administered Methotrexate and Subsequent Dilatation and Curettage: A Case Report

International Journal of Photoenergy — Tue, 31 Jan 2012 11:10:23 +0100

Cesarean scar pregnancy is a rare type of ectopic pregnancy associated with severe complications such as uterine rupture, uncontrollable bleeding which may lead to hysterectomy, and definitive infertility. Many therapeutic options are available such as Dilatation & Curetage, excision of trophoblastic tissues using either laparotomy or laparoscopy, systemically administered Methotrexate, and more recently uterine artery embolization. The use of Methotrexate sometimes required laparotomy later because of severe hemorrhage. Through this paper, we demonstrated that viable cesarean scar pregnancy can be managed safely by systemically delivered Methotrexate at the cost of a prolonged followup. (Source: International Journal of Photoenergy)

Perioperative Management of a Patient with Recently Placed Drug-Eluting Stents Requiring Urgent Spinal Surgery

Journal of General Internal Medicine — Tue, 31 Jan 2012 07:11:13 +0100

We report the case of a woman who required spinal surgery 3 months after she underwent placement of two drug-eluting stents. The patient’s clopidogrel was stopped 5 days prior to surgery and an infusion of eptifibatide was used to “bridge” antiplatelet therapy during the perioperative period. Postoperatively, anticoagulation therapy was reinstituted using aspirin with clopidogrel. This case serves as a successful example of bridging therapy using a short acting and gycoprotein (GP) IIb/IIIa inhibitor as a means of maintaining antiplatelet therapy during the perioperative period to minimize the risk of stent thrombosis and the risk of intraoperative bleeding. Content Type Journal ArticleCategory Clinical Practice: Clinical VignettesPages 1-4DOI 10.1007/s11606-012-1...

A successful rescue with extra-anatomical bypass for massive bleeding of the brachiocephalic artery following salvage pharyngo-esophagectomy

Esophagus — Tue, 31 Jan 2012 07:07:17 +0100

Abstract Massive bleeding from large vessels is a serious and life-threatening complication after radical esophagectomy. Here, we present the rare case of patient survival following two episodes of massive bleeding from a tracheo-brachiocephalic artery fistula after salvage surgery for cervical esophageal cancer following definitive chemoradiation. During the first episode of bleeding, the damaged part of the brachiocephalic artery was transected with an extra-anatomical arterial bypass (right femoro-axillo artery bypass graft) to maintain the arterial blood flow to the brain and the free jejunal graft. During the second bleeding, the distal stump of the brachiocephalic artery was reclosed. During both episodes of bleeding, the musculocutaneous flap was effectively employe...

Antidepressants and the risk of abnormal bleeding during spinal surgery: a case–control study

European Spine Journal — Tue, 31 Jan 2012 07:05:28 +0100

Conclusion Clinicians treating patients who are planning to undergo elective spinal surgery and are on an antidepressant medication should be aware of this potential effect and should consider tapering off the serotonergic antidepressant prior to surgery. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s00586-011-2132-8Authors Amirali Sayadipour, Division of Spinal Surgery, Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th floor, Philadelphia, PA 19107, USARajnish Mago, Department of Psychiatry, Thomas Jefferson University, Philadelphia, USAChristopher K. Kepler, Division of Spinal Surgery, Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, 925 Ches...

Complications after end-to-end vs. side-to-side anastomosis in ileocecal Crohn’s disease—early postoperative results from a randomized controlled multi-center trial (ISRCTN-45665492)

Langenbeck's Archives of Surgery — Tue, 31 Jan 2012 07:04:16 +0100

Conclusions Because of the early discontinuation of the study, it is not possible to provide a statement about the perianastomotic recurrence rates regarding the primary endpoint. With regard to the early postoperative outcome, we observed no difference between the two types of anastomosis. Content Type Journal ArticleCategory Controlled Clinical TrialPages 1-8DOI 10.1007/s00423-012-0904-1Authors Urte Zurbuchen, Department of General, Vascular and Thoracic Surgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, GermanyAnton J. Kroesen, Department of General, Visceral and Trauma Surgery, Hospital Porz am Rhein, Cologne, GermanyPhilipp Knebel, Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Ge...

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Unusual case of right atrial reinfarction.

Atherosclerosis — Tue, 31 Jan 2012 05:19:26 +0100

Authors: Radojevic N, Savic S, Aleksic V, Cukic D Abstract It is well known that atrial infarctions are rare comparing to the ventricular. They cannot easily be verified on ECG and the standard autopsy technique does not include a detailed review of the atrial wall, so the atrial infarction often remains undiagnosed. A 63-year-old male was treated and died in an intensive care unit due to decompensated liver insufficiency and cardiac disease following long-lasting alcohol abuse. At autopsy, the extreme cardiomegaly was found, severe atherosclerosis of the anterior descending branch of left coronary artery. The posterior wall of the right atrium was thickened (cca 9 mm) in diameter of cca 3 × 3 cm, and this area was yellowish in the luminal part, while the central part was fille...

Pericardiocentesis: A clinical anatomy review

Clinical Anatomy — Tue, 31 Jan 2012 05:00:00 +0100

AbstractThe safe and successful performance of pericardiocentesis demands a working and specific knowledge of anatomy. Misunderstanding of anatomy may result in failure or serious complications. This review attempts to aid understanding of the anatomical framework, pitfalls, and complications of pericardiocentesis. Pericardiocentesis is carried out for aspiration of blood from the pericardial cavity in cases of cardiac tamponade and symptomatic pericardial effusion. In addition, this technique may be used for the diagnosis of neoplastic effusions, purulent pericarditis, and introduction of cytotoxic agents into the pericardial space. Most complications of the procedure are due to the needle penetrating the heart and surrounding structures such a coronary arteries, lungs, stomach, colon, an...

Narrow safety range of intraoperative rectal irradiation exposure volume for avoiding bleeding after seed implant brachytherapy

Radiation Oncology — Tue, 31 Jan 2012 05:00:00 +0100

Conclusion: By retrospective analysis exploring rV100 as intraoperative rectal dose-volume thresholds in 125I seed implant brachytherapy for prostate cancer, it is proved that rV100 should be less than 0.1 cc for preventing rectal bleeding. (Source: Radiation Oncology)

mTHPC mediated interstitial photodynamic therapy of recurrent nonmetastatic base of tongue cancers: Development of a new method

Head and Neck — Tue, 31 Jan 2012 05:00:00 +0100

ConclusionThe initial results are encouraging. There is room for improvement to control the destructive potential of iPDT through planning and monitoring tools. © 2012 Wiley Periodicals, Inc. Head Neck, 2012 (Source: Head and Neck)

Cardiac dysfunction in cirrhosis – does adrenal function play a role? A hypothesis

Liver International — Tue, 31 Jan 2012 05:00:00 +0100

AbstractCirrhotic cardiomyopathy (CCM), a condition of unknown pathogenesis, is characterized by suboptimal ventricular contractile response to stress, diastolic dysfunction and QT interval prolongation. It is most often found in patients with advanced cirrhosis. It is clinically relevant during stressful conditions, such as sepsis, bleeding and surgery. CCM reverses after liver transplantation and potentially has a role in the pathogenesis of hepatorenal syndrome. In adrenal insufficiency (AI), cardiac dysfunction is a feature with low ejection fraction, decreased left ventricular chamber size and electrocardiographic abnormalities, including QT interval prolongation. With optimal diagnostic tests, AI is present in approximately 10% of patients with cirrhosis, particularly in those with a...

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Silent Pulmonary Embolism in Patients with Proximal Deep Vein Thrombosis in the Lower Limbs

Journal of Thrombosis and Haemostasis — Tue, 31 Jan 2012 05:00:00 +0100

Conclusions: DVT patients with silent PE at baseline had an increased incidence of symptomatic PE events during the first 15 days of anticoagulant therapy. This effect disappeared after 3 months of anticoagulation. (Source: Journal of Thrombosis and Haemostasis)

Sonography in Postmenopausal Bleeding

Journal of Ultrasound in Medicine — Tue, 31 Jan 2012 05:00:00 +0100

(Source: Journal of Ultrasound in Medicine)

Undiagnosed, Untreated Acute Promyelocytic Leukemia Presenting as a Suspicious Sudden Death*

Journal of Forensic Sciences — Tue, 31 Jan 2012 05:00:00 +0100

We report the sudden death of a 40-year-old male without significant medical history in which foul play had been initially suspected. A thorough postmortem investigation performed on the decedent lead to the diagnosis of APL. Cause of death was a cerebellar hematoma. Underlying APL should be considered in the differential diagnosis when unexplained bleeding is encountered in a decedent. This case emphasizes the value of routinely collecting bone marrow during an autopsy to enable accurate testing and diagnosis. PMID: 22292852 [PubMed - as supplied by publisher] (Source: Journal of Forensic Sciences)

A Congenital Arteriovenous Malformation Originating from the Aorta Locating in the Posterior Mediastinum.

Annals of Thoracic and Cardiovascular Surgery — Tue, 31 Jan 2012 05:00:00 +0100

Authors: Oto O, Metin SK, Guzeloglu M, Gulcu A, Karabay N, Gurel D, Maltepe F Abstract Vascular malformations located in the posterior mediastinum are extremely rare. Most of them are found coincidentally during routine examinations. Only a small percentage of these posterior mediastinal arteriovenous malformation cases may cause symptoms such as dyspnea due to compression of surrounding tissues. Radiologic imaging can be insufficient in some cases for differential diagnosis. Because of their vascular nature, diagnostic needle biopsy may have a high risk of bleeding. Open surgical resection is a safe treatment choice under many circumstances, and it helps the diagnosis as well. In this paper, a case of a 31-year-old male is presented with an incidentally diagnosed arteriovenous mal...

Dabigatran in Clinical Practice for Atrial Fibrillation With Special Reference to Activated Partial Thromboplastin Time.

Circulation Journal — Tue, 31 Jan 2012 05:00:00 +0100

Conclusions: We found a wide distribution of APTT in NVAF patients under dabigatran treatment. High APTT might help screen for bleeding risks among patients under dabigatran, but requires future investigation. PMID: 22293451 [PubMed - as supplied by publisher] (Source: Circulation Journal)

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The Pharmacology and Therapeutic Use of Dabigatran Etexilate.

The Journal of Clinical Pharmacology — Tue, 31 Jan 2012 05:00:00 +0100

Authors: Spinler S Abstract Dabigatran etexilate is an oral prodrug of dabigatran, a direct thrombin inhibitor, that provides the first available oral anticoagulant alternative to warfarin for reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (AF). Although warfarin is effective, many patients with AF remain undertreated, primarily because of the management challenges associated with warfarin therapy. Dabigatran etexilate offers several potential advantages over warfarin, including fixed dosing, no requirement for blood coagulation monitoring, and reduced propensity for drug-drug interactions. In a large phase 3 trial in patients with nonvalvular AF, the US Food and Drug Administration (FDA)-approved dose of dabigatran etexilate (150...

Modified bentall procedure using two short grafts for coronary reimplantation: long-term results.

The Annals of Thoracic Surgery — Tue, 31 Jan 2012 04:22:20 +0100

CONCLUSIONS: The modified Bentall procedure using 2 separated grafts for the coronary reimplantation is a feasible, safe, easy, and reproducible operative technique for aortic root surgery. PMID: 22269710 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

A rare case of bilateral massive hemothorax from spontaneous rupture of a primary mediastinal mixed germ cell tumor.

The Annals of Thoracic Surgery — Tue, 31 Jan 2012 04:17:26 +0100

In this report, we describe a case of a primary mediastinal mixed germ cell tumor that presented with bilateral massive hemothorax and hemorrhagic shock. An urgent thoracotomy, which was performed to control bleeding, confirmed bilateral hemothorax secondary to a ruptured mediastinal tumor. Pathologic diagnosis revealed the mediastinal tumor to be mixed choriocarcinoma and immature teratoma, with lung metastatic choriocarcinoma. The patient recovered well from the operation and received salvage chemotherapy. Two years after diagnosis, the patient remains in remission with no evidence of disease. PMID: 22269740 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

Maxillary rehabilitation of periodontally compromised patients with extensive one-piece fixed prostheses supported by natural teeth: a retrospective longitudinal study

Clinical Oral Investigations — Mon, 30 Jan 2012 16:05:27 +0100

Conclusions Restorative treatment with extensive one-piece FDPs resulted in long-term stability of the periodontal outcomes. Gingival conditions were shown to deteriorate mildly despite periodic recalls for SPT. An association between deterioration and compliance was observed, suggesting that periodic examinations are essential for maintaining oral hygiene and hence to the success of treatment. Clinical relevance Given a favorable distribution of potential abutment teeth, treatment with tooth-supported extensive FDPs is desirable even in patients with a history of periodontitis. Removable dentures would involve a number of shortcomings, including functional problems and severe degradation of oral ecology. Tooth-supported FDPs are capable of restoring fun...

Risk factors for postoperative bleeding after thyroid surgery (Br J Surg 2012; 99: 373–379)

British Journal of Surgery — Mon, 30 Jan 2012 14:18:30 +0100

(Source: British Journal of Surgery)

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Baxter Announces FDA Approval Of Expanded Indication For TISSEEL [Fibrin Sealant] For General Hemostasis In Surgery

Medical Design Online News — Mon, 30 Jan 2012 14:00:00 +0100

Baxter International Inc. announced today that the U.S. Food and Drug Administration (FDA) has approved TISSEEL [Fibrin Sealant] to include general hemostasis in surgery when control of bleeding by standard surgical techniques is ineffective or impractical (Source: Medical Design Online News)

Temporary clamping of external carotid artery in convexity, parasagittal and temporal base meningioma.

Turkish Neurosurgery — Mon, 30 Jan 2012 05:00:02 +0100

CONCLUSION: Temporary clamping of external carotid artery is a safe, simple and cost-effective alternative to embolization for the surgery of large meningiomas. This can be practiced at all the centers. PMID: 22274970 [PubMed - in process] (Source: Turkish Neurosurgery)

Modifying the Details of Aspiration Operation may Contribute to the Improvement of Prognosis of Patients with ICH.

Turkish Neurosurgery — Mon, 30 Jan 2012 05:00:02 +0100

CONCLUSION: Our data suggested that modifying details of aspiration operation may contribute to the improved prognosis of ICH patients. PMID: 22274965 [PubMed - in process] (Source: Turkish Neurosurgery)

Intracranial Hemorrhage: Diagnosis and Management

Neurologic Clinics — Mon, 30 Jan 2012 02:28:35 +0100

This article addresses the diagnosis and general management of ICH and discusses specialized management for select ICH subtypes. (Source: Neurologic Clinics)

A new look at antiplatelet agent‐related peptic ulcer: An update of prevention and treatment

Journal of Gastroenterology and Hepatology — Sun, 29 Jan 2012 20:50:05 +0100

AbstractPatients taking antiplatelet agent for the prevention of cardiovascular diseases who develop gastrointestinal bleeding represent a serious challenge in clinical practice. The initial step in reducing gastrointestinal risk of antiplatelet therapy is to assess whether the patient has a continued need for antiplatelet therapy. The next step is to eliminate the risk factors that may place the patient at increased gastrointestinal risk. In the management of bleeding ulcer patients with high‐risk stigmata of recent hemorrhage, resuming antiplatelet agents at 3‐5 days after the last dosing is a reasonable strategy. However, patients with low‐risk stigmata can keep taking antiplatelet agents immediately following endoscopy. In the management of aspirin‐related uncomplicated peptic ...

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The Levonorgestrel-Releasing Intrauterine System in Heavy Menstrual Bleeding: A Benefit-Risk Review

Drugs — Sun, 29 Jan 2012 18:40:57 +0100

(Source: Drugs)

Depending on a Woman's Age, Hysterectomy May Be the Best Option for Resolving Chronic Pelvic Pain and Heavy Bleeding

MedlinePlus Health News — Sun, 29 Jan 2012 13:20:51 +0100

Source: Agency for Healthcare Research and Quality Related MedlinePlus Page: Hysterectomy (Source: MedlinePlus Health News)

Evaluation of circulating concentrations of glucose homeostasis biomarkers, progesterone, and growth hormone in healthy Elkhounds during anestrus and diestrus.

American Journal of Veterinary Research — Sun, 29 Jan 2012 12:44:40 +0100

Conclusions and Clinical Relevance-Results provided evidence that circulating insulin concentrations during diestrus are higher than those during anestrus in Elkhounds, which could contribute to development of diestrus-associated diabetes mellitus. PMID: 22280385 [PubMed - in process] (Source: American Journal of Veterinary Research)

Too Many CT Scans Performed In The ER For Dizziness

Health News from Medical News Today — Sun, 29 Jan 2012 08:00:00 +0100

Performing CT scans in the emergency department for patients experiencing dizziness may not be worth the expense - an important finding from Henry Ford Hospital researchers as hospitals across the country look for ways to cut costs without sacrificing patient care. According to the Henry Ford study, less than 1 percent of the CT scans performed in the emergency department revealed a more serious underlying cause for dizziness - intracranial bleeding or stroke - that required intervention... (Source: Health News from Medical News Today)

Unusual case of right atrial reinfarction

Journal of Forensic and Legal Medicine — Sat, 28 Jan 2012 08:18:45 +0100

Abstract: It is well known that atrial infarctions are rare comparing to the ventricular. They cannot easily be verified on ECG and the standard autopsy technique does not include a detailed review of the atrial wall, so the atrial infarction often remains undiagnosed. A 63-year-old male was treated and died in an intensive care unit due to decompensated liver insufficiency and cardiac disease following long-lasting alcohol abuse. At autopsy, the extreme cardiomegaly was found, severe atherosclerosis of the anterior descending branch of left coronary artery. The posterior wall of the right atrium was thickened (cca 9 mm) in diameter of cca 3 × 3 cm, and this area was yellowish in the luminal part, while the central part was filled with dark red blood. A detailed dissection of the coron...

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Fatal idiopathic pulmonary haemosiderosis in association with pregnancy – Medico-legal evaluation

Journal of Forensic and Legal Medicine — Sat, 28 Jan 2012 08:18:44 +0100

Abstract: Idiopathic pulmonary haemosiderosis is a rare disorder characterised by repeated episodes of intra-alveolar bleeding in association with consecutive anaemia, pulmonary fibrosis, pulmonary hypertension and respiratory failure. Pregnancy may exacerbate the symptoms of idiopathic pulmonary haemosiderosis typically worsening in the third trimester. A 32-year-old female after delivery was admitted to hospital with progressive dyspnoea of about 1-month duration. Sudden circulatory collapse caused fatal complication. During the post-mortem investigation, lung haemorrhage and histologically abundant iron deposition in macrophages and interstitial fibrosis were found. Medico-legal post-mortem evaluation of fatal cases may support the clinico-pathological context of the diagnosis of this e...

Autopsy following death by homicide in 644 cases

Journal of Forensic and Legal Medicine — Sat, 28 Jan 2012 08:18:42 +0100

The objectives of this study are to determine the cause of death and based on the wounds, to analyze the different epidemiological variables on homicide in Dakar.Included were all homicides cases where an autopsy was performed and these results recorded in the autopsy register. The data collected in our work included, identity, sex, age, place of crime (location), the cause of death (the causative agent and the anatomical region injured) and the mechanism of death (the pathophysiological phenomenon causing death).On average 56 cases of homicide a year are reported, ranging from 44 cases in 2005 to 80 cases in 1999. Extrapolated to the population of Dakar this corresponds to 1.9 homicides per 100,000 inhabitants. Victims aged over 55 years represented only 4.03% of all victims. 6.52% of cas...

[Comment] Vitamin K antagonists: self-determination by self-monitoring?

LANCET — Sat, 28 Jan 2012 05:00:00 +0100

Vitamin K antagonists have been successfully used for more than 50 years as oral anticoagulant drugs in patients at risk of venous or arterial thromboembolism. Because of a narrow therapeutic window and an unpredictable dose response, regular laboratory monitoring is mandatory. A strong association exists between the intensity of anticoagulation and adverse clinical events, with an increased thrombotic risk at an international normalised ratio (INR) of less than 2·0 and an enhanced risk of bleeding when the INR exceeds 4·0. (Source: LANCET)

Hypofractionated radiotherapy as local hemostatic agent in advanced cancer

Indian Journal of Palliative Care — Sat, 28 Jan 2012 05:00:00 +0100

Conclusion : Of 25 patients, 22 (88%) responded, and there was complete cessation of bleeding. Both 15 Gray and 20 Gray dose schedule had equal efficacy. Treatment was well tolerated without any intermission. Radiotherapy is a safe and effective option in controlling tumor bleeding. (Source: Indian Journal of Palliative Care)

Treatment of intrabony defects with beta-tricalciumphosphate alone and in combination with platelet-rich plasma.

Biomed Res — Sat, 28 Jan 2012 05:00:00 +0100

CONCLUSION: After a 6-month healing period, both β-TCP and PRP/β-TCP were found effective in the treatment of three-walled intrabony defects and no additional statistically significant benefits were found with PRP. © 2012 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2012. PMID: 22287494 [PubMed - as supplied by publisher] (Source: Biomed Res)

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Subarachnoid Hemorrhage Risk Factors In Pregnant Women

Health News from Medical News Today — Fri, 27 Jan 2012 18:00:00 +0100

Approximately 1 in every 15,000 pregnant women will develop subarachnoid hemorrhage (SAH) - bleeding in the area between the brain and the thin membranes that cover the brain, according to a study published in the February issue of Anesthesiology. The researchers found that: the most common risk factor for pregnancy-related SAH is high-blood pressure disorders its incidence is elevated in pregnant women ruptured aneurysms play a less important role in pregnant patients than non-pregnant patients with SHA Lead researcher Brian T. Bateman, M.D... (Source: Health News from Medical News Today)

Clinical features and prognostic factors of Asian patients with paroxysmal nocturnal hemoglobinuria: results from a single center in China

Annals of Hematology — Fri, 27 Jan 2012 06:53:43 +0100

Abstract Although all patients with paroxysmal nocturnal hemoglobinuria (PNH) have acquired mutations in the phosphatidylinositol glycan class-A(PIG-A)gene, their clinical courses are highly variable. We reviewed 280 PNH cases referred to our hospital from January 1990 through June 2010 to assess clinical presentations, prognostic factors influencing survival, difference among subcategories, and clinical significance of PNH clone size. The overall survival at 10 years after diagnosis estimated by Kaplan–Meier was 77.6%. Both univariate and multivariate analyses identified risk factors affecting survival, including age >40 years, absolute neutrophil count<0.5 × 109 cells/L, development of thrombotic events, evolution to myelodysplastic syndrome or acut...

Coumarins and survival in incident dialysis patients

Nephrology Dialysis Transplantation — Fri, 27 Jan 2012 05:00:00 +0100

Conclusions. Our data suggest that coumarins might be less harmful than previously anticipated when clearly indicated and closely monitored. (Source: Nephrology Dialysis Transplantation)

Value of percutaneous embolotherapy for the management of traumatic vascular limb injury.

Acta Radiologica — Fri, 27 Jan 2012 05:00:00 +0100

ConclusionEmbolotherapy for the management of hemorrhagic, traumatic vascular injuries in upper and lower limbs is relatively safe, very effective without recurrence or other embolization-related symptoms. PMID: 22287145 [PubMed - as supplied by publisher] (Source: Acta Radiologica)

Gingival bleeding and jaw bone necrosis in patients with metastatic renal cell carcinoma receiving sunitinib: Report of 2 cases with clinical implications

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics — Thu, 26 Jan 2012 20:43:21 +0100

We report on 2 patients with mRCC treated with sunitinib. The first patient, a 19-year-old woman, treated with cisplatin and sunitinib, presented with oral pain, malodor, spontaneous and continuous gingival bleeding, and painful necrotic ulcerations clinically resembling necrotizing ulcerative gingivitis (NUG). Suntinib-related stomatitis and bleeding were considered cumulative to NUG symptoms. The second patient, a 64-year-old woman, treated with sunitinib only, complained of mandibular pain. Sunitinib-related jaw osteonecrosis was diagnosed. Gingival bleeding and soft tissue necrosis, as well as jaw osteonecrosis may develop as adverse events of sunitinib use. Antiangiogenic therapies are increasingly used in the treatment of cancers. The presented cases are aimed to alert health care pr...

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Cesarean scar molar pregnancy.

Obstetrics and Gynecology — Thu, 26 Jan 2012 20:33:06 +0100

CONCLUSION: : A high index of suspicion is needed for early diagnosis and management of cesarean scar molar pregnancy. PMID: 22270435 [PubMed - in process] (Source: Obstetrics and Gynecology)

Complex ovarian pregnancy.

Obstetrics and Gynecology — Thu, 26 Jan 2012 20:31:02 +0100

CONCLUSION: : In rare cases, an aborted ovarian pregnancy can persist for years, producing no symptoms except abdominal swelling. PMID: 22270445 [PubMed - in process] (Source: Obstetrics and Gynecology)

Continuous passive motion for preventing venous thromboembolism after total knee arthroplasty.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: There is not enough evidence from the available RCTs to conclude that CPM reduces VTE after TKA. We cannot assess the effect of CPM on death because no such events occurred amongst the participants of these trials. PMID: 22258981 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Tranexamic acid for upper gastrointestinal bleeding.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: Considering the internal and external validity of the evidence, tranexamic acid cannot be recommended for routine use. Additional trials in which tranexamic acid is used in combination with the currently recommended interventions are required. PMID: 22258969 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Laparoscopic splenectomy and azygoportal disconnection with intraoperative splenic blood salvage

Surgical Endoscopy — Thu, 26 Jan 2012 06:55:34 +0100

Conclusion Laparoscopic splenectomy with azygoportal disconnection is a feasible, effective, and safe surgical method for the treatment of bleeding portal hypertension. Intraoperative splenic blood salvage can avoid the risk associated with allogeneic transfusion during the procedure, with an advantage of significantly increased postoperative hemoglobin levels. Content Type Journal ArticlePages 1-7DOI 10.1007/s00464-012-2159-xAuthors Yuedong Wang, Department of General Surgery, Zhejiang Provincial People’s Hospital, 158 Shangtang Rd, Hangzhou, 310014 ChinaYun Ji, Department of General Surgery, Zhejiang Provincial People’s Hospital, 158 Shangtang Rd, Hangzhou, 310014 ChinaYangwen Zhu, Department of General Surgery, Zhejiang Provincial People’s Hospital, 158 Sha...

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Use of fibrin sealant (Tisseel/Tissucol) in hernia repair: a systematic review

Surgical Endoscopy — Thu, 26 Jan 2012 06:55:34 +0100

Conclusions Clinical evidence published to date supports the use of Tisseel/Tissucol as an option for mesh fixation in open and laparoscopic/endoscopic repair of inguinal and incisional hernias. Guidelines of the International Endohernia Society recommend fibrin sealant mesh fixation, especially in inguinal hernia repair. Nonfixation is reserved for selected cases. Content Type Journal ArticleCategory ReviewPages 1-10DOI 10.1007/s00464-012-2156-0Authors René H. Fortelny, Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, AustriaAlexander H. Petter-Puchner, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, AustriaKarl S. Glaser, Department of General, Visceral and Oncological Surgery, Wilhelminenspital, V...

The association of lymphoid protein tyrosine phosphatase non-receptor 22 (PTPN22) gene polymorphism with Egyptian immune thrombocytopenic purpura

Comparative Clinical Pathology — Thu, 26 Jan 2012 06:44:01 +0100

Abstract Immune thrombocytopenic purpura (ITP) is an autoimmune syndrome involving platelets destruction and suppression of platelet production that may predispose to bleeding. Protein tyrosine phosphatase non-receptor 22 gene (PTPN22) is an important negative regulator of signal transduction through the T-cell receptors (TCR). A single nucleotide polymorphism (SNP) 1858C > T within this gene was reported to be associated with increased risk of autoimmune diseases. The aim of the work was to study the frequency of the 1858C > T single nucleotide polymorphism in the PTPN22 gene in Egyptian ITP patients. After full clinical and laboratory examination of our subjects, the expression of the PTPN22 (1858C > T) gene polymorphism was analyzed in 60 ITP patient...

Megakaryocyte-specific RhoA deficiency causes macrothrombocytopenia and defective platelet activation in hemostasis and thrombosis

Blood — Thu, 26 Jan 2012 05:00:00 +0100

In this study, we analyzed the in vitro and in vivo consequences of megakaryocyte- and platelet-specific RhoA gene deletion in mice. We found a pronounced macrothrombocytopenia in RhoA-deficient mice, with platelet counts of approximately half that of wild-type controls. The mutant cells displayed an altered shape but only a moderately reduced life span. Shape change of RhoA-deficient platelets in response to G13-coupled agonists was abolished, and it was impaired in response to Gq stimulation. Similarly, RhoA was required for efficient secretion of α and dense granules downstream of G13 and Gq. Furthermore, RhoA was essential for integrin-mediated clot retraction but not for actomyosin rearrangements and spreading of activated platelets on fibrinogen. In vivo, RhoA deficiency result...

Liver angiosarcoma, a rare liver malignancy, presented with intraabdominal bleeding due to rupture- a case report

World Journal of Surgical Oncology — Thu, 26 Jan 2012 05:00:00 +0100

Liver angiosarcoma is a rare disease, however it still ranks as the third of most common primary liver maligancies. The prognosis of liver angiosarcoma is very poor with almost all patients with this kind of disease die within 2 years after diagnosis. No specific symptoms and signs are closely associated with this disease. Here, we report a case presenting shock status at first due to rupture of liver angiosarcoma- induced internal bleeding. After emergent transarterial embolization (TAE), she received partial hepatectomy two weeks later. 4 months after operation, she is still with a good performance status without obvious recurrence or metastasis identified. (Source: World Journal of Surgical Oncology)

Efficacy of Bypassing Agents in Patients With Hemophilia and Inhibitors: A Systematic Review and Meta-Analysis.

Clinical Therapeutics — Thu, 26 Jan 2012 05:00:00 +0100

CONCLUSIONS: Given the paucity of high-quality studies, the findings from the present review and meta-analysis suggest no conclusive evidence that aPCC or rFVIIa is significantly more efficacious than the other in the treatment of joint bleeding episodes in hemophiliac patients with inhibitors. PMID: 22285208 [PubMed - as supplied by publisher] (Source: Clinical Therapeutics)

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Dual or Mono Antiplatelet Therapy for Patients With Acute Ischemic Stroke or Transient Ischemic Attack: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Stroke — Thu, 26 Jan 2012 05:00:00 +0100

CONCLUSIONS: Dual antiplatelet therapy appears to be safe and effective in reducing stroke recurrence and combined vascular events in patients with acute ischemic stroke or transient ischemic attack as compared with mono therapy. These results need to be tested in prospective studies. PMID: 22282894 [PubMed - as supplied by publisher] (Source: Stroke)

Er:YAG laser treatment in supportive periodontal therapy.

Journal of Clinical Periodontology — Thu, 26 Jan 2012 05:00:00 +0100

CONCLUSION: Employing both sonic and laser treatment procedures during supportive periodontal care, similar clinical and microbiological outcomes can be expected. © 2012 John Wiley & Sons A/S. PMID: 22276957 [PubMed - as supplied by publisher] (Source: Journal of Clinical Periodontology)

Well Blog: Patient Voices: Hemophilia

NYT Health — Wed, 25 Jan 2012 20:23:32 +0100

Five people talk about life with bleeding disorders. (Source: NYT Health)

Statins, inflammation and deep vein thrombosis: a systematic review

Journal of Thrombosis and Thrombolysis — Wed, 25 Jan 2012 18:13:38 +0100

Abstract Venous thromboembolism (VTE) includes both deep vein thrombosis (DVT) and pulmonary embolism. The 2009 JUPITER trial showed a significant decrease in DVT in non-hyperlipidemic patients, with elevated C-reactive protein (CRP) levels, treated with rosuvastatin. The effects of statins on thrombosis are unclear, prompting this literature review. A literature search was performed (1950 to February 2011) with MEDLINE, EMBASE, and PUBMED databases including the following keywords: “statins”, “hydroxymethylglutaryl-CoA reductase inhibitors”, “VTE”, “PE”, “DVT”, and either “anti-coagulation” or “inflammation”. Editorials, reviews, case reports, meta-analysis and duplicates were excluded. Inflammatory biomarkers of DVT, include interleukin (IL)-6,...

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FDA's MedWatch Safety Alerts: December 2011

FDA Consumer Updates — Wed, 25 Jan 2012 17:16:00 +0100

FDA gives updated safety information on ADHD drugs and heart disease in adults, dietary supplements that could be contaminated with Salmonella, and a blood thinner that may lead to bleeding problems. Learn about these and other safety alerts at http://www.fda.gov/ForConsumers/ConsumerUpdates/ucmXXXXXX.htm (Source: FDA Consumer Updates)

Assessment of Crohn’s Disease Lesions in Wireless Capsule Endoscopy Images

IEEE Transactions on Biomedical Engineering — Wed, 25 Jan 2012 14:46:08 +0100

Capsule endoscopy (CE) provides noninvasive access to a large part of the small bowel that is otherwise inaccessible without invasive and traumatic treatment. However, it also produces large amounts of data (approximately 50 000 images) that must be then manually reviewed by a clinician. Such large datasets provide an opportunity for application of image analysis and supervised learning methods. Automated analysis of CE images has only focused on detection, and often only for bleeding. Compared to these detection approaches, we explored assessment of discrete disease for lesions created by mucosal inflammation in Crohn’s disease (CD). Our work is the first study to systematically explore supervised classification for CD lesions, a classifier cascade to classify discrete lesio...

Intima-media thickness and other markers of atherosclerosis in patients with type 2 diabetes and periodontal disease.

Kardiologia Polska — Wed, 25 Jan 2012 06:54:02 +0100

Conclusions: Periodontal inflammation in patients with DM2 seems to be associated with increased IMT and BP, but not with greater arterial stiffness. These results support the hypothesis that periodontal disease may be associated with a vascular pathology. Kardiol Pol 2012; 70, 1: 7-13. PMID: 22267416 [PubMed - in process] (Source: Kardiologia Polska)

Anatomical liver segmentectomy 2 for combined hepatocellular carcinoma and cholangiocarcinoma with tumor thrombus in segment 2 portal branch

World Journal of Surgical Oncology — Wed, 25 Jan 2012 05:00:00 +0100

Conclusion: The separation method of the hepatic arteries, portal veins, and bile duct is safe and feasible for a liver cancer patient with portal vein tumor thrombus. Modified selective hepatic vascular exclusion was useful to control bleeding during liver transection. Anatomical liver segmentectomy 2 using these procedures should be considered for a patient with a liver tumor located at segment 2 arising from a damaged liver. (Source: World Journal of Surgical Oncology)

Safety of Dental Extractions in Coronary Drug‐Eluting Stenting Patients Without Stopping Multiple Antiplatelet Agents

Clinical Cardiology — Wed, 25 Jan 2012 05:00:00 +0100

Conclusions:We found that most dental extractions in coronary stenting patients can be carried out safely without stopping multiple antiplatelet agents.The authors have no conflicts of interest to disclose.This study was supported in part by a grant from Yuhan Corporation, Ltd., Seoul, The Republic of Korea. (Source: Clinical Cardiology)

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Sequence of treatments for adults with primary immune thrombocytopenia (ITP)

American Journal of Hematology — Wed, 25 Jan 2012 05:00:00 +0100

AbstractManagement of adults with primary immune thrombocytopenia (ITP) has changed dramatically in the past 10 years. New regimens of corticosteroids for 1st‐line treatment have been introduced and are currently being evaluated in a randomized clinical trial. Many patients may not have durable remissions with initial corticosteroid regimens and may require additional, 2nd‐line, treatment. For these patients, rituximab has been increasingly used, as it has for other autoimmune disorders, and new thrombopoietin (TPO)‐receptor agonists have been developed. Although splenectomy was the first effective and remains the most effective treatment for ITP, inducing durable complete remissions in 66% of patients, rituximab and TPO‐receptor agonists are now additional options for 2nd‐line t...

Stereotactic Brainstem Biopsy in a Patient with Coagulopathy of Unclear Etiology: Case Report

min - Minimally Invasive Neurosurgery — Wed, 25 Jan 2012 05:00:00 +0100

We report the case of a patient with coagulopathy of unclear etiology undergoing a stereotactic brainstem biopsy.A medication scheme with tranexamic acid and desmopressin effectively decreased the patient’s bleeding time in vivo and the procedure was carried out without complications.[...]© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents | Abstract | Full text (Source: min - Minimally Invasive Neurosurgery)

Massive Swelling of Surgicel® Fibrillar™ Hemostat after Spinal Surgery. Case Report and a Review of the Literature

min - Minimally Invasive Neurosurgery — Wed, 25 Jan 2012 05:00:00 +0100

We report on a 65-year-old woman who was operated for a high-grade spinal stenosis at the L2-L3 level. Small portions of Surgicel® Fibrillar™ were used to control bleeding from the epidural venous plexus. The immediate postoperative course was uneventful. However, one day after surgery, the patient complained about progressive worsening pain at the operated level. A non-contrast lumbar CT scan showed no evidence of a postoperative hematoma or other complication. MR imaging showed a horseshoe-shaped mass compressing the dural sac at the operated level from posterior and both sides. Because we suspected a postoperative hematoma, the patient was re-operated. No hemorrhage was seen but instead we found large, swollen firm pieces of Surgicel® Fibrillar™ compressing the dural sac. These pi...

Risk is not our business: safety of thoracic surgery in patients using antiplatelet therapy

Interactive CardioVascular and Thoracic Surgery — Wed, 25 Jan 2012 05:00:00 +0100

American Heart Association recommendations have changed preoperative management of patients with antiplatelet therapy (APT). We assessed safety and outcomes of surgery in patients who were receiving APT. A prospective study of patients operated on while receiving APT was matched with those with no APT (ratio 1:4), using the propensity score method. Logistic regression analysis was used to identify covariates among imbalanced baseline patient variables. Both 2 test and Fisher's test were used to calculate the probability value for the comparison of dichotomous variables. Between January 2008 and December 2010, 38 patients who received APT at the time of surgery were matched with 141 patients who had not received APT. APT indications were a history of myocardial infarction, coronary artery b...

Peripartum Subarachnoid Hemorrhage: Nationwide Data and Institutional Experience

Anesthesiology — Tue, 24 Jan 2012 22:05:24 +0100

Conclusion: SAH during pregnancy results from a range of etiologies, and is less likely to be because of a cerebral aneurysm than SAH occurring in the nonpregnant patient. Peripartum SAH frequently occurs in the setting of hypertensive disorders. (Source: Anesthesiology)

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Long-term Results with the Modified Sugiura Procedure for the Management of Variceal Bleeding: Standing the Test of Time in the Treatment of Bleeding Esophageal Varices

World Journal of Surgery — Tue, 24 Jan 2012 07:55:30 +0100

Conclusions The modified Sugiura procedure remains an effective rescue therapy for patients with bleeding esophageal varices when alternative treatments fail or are not indicated. Moreover, it can be a life-saving procedure in patients with anatomy unsuitable for shunt surgery or for patients treated in nonspecialized centers where surgical expertise for a shunt operation is not available. Content Type Journal ArticlePages 1-8DOI 10.1007/s00268-011-1418-7Authors D. Voros, 2nd Department of Surgery, Aretaieio Hospital, Medical School, University of Athens, 76 Vassilissis. Sophias Avenue, 11528 Athens, GreeceA. Polydorou, 2nd Department of Surgery, Aretaieio Hospital, Medical School, University of Athens, 76 Vassilissis. Sophias Avenue, 11528 Athens, GreeceG. Polymene...

Clinical features and surgical management of four peculiar cases of intracranial metastases from renal cell carcinoma

Neurological Sciences — Tue, 24 Jan 2012 07:34:35 +0100

In this study, four patients (age range 56–72 years) were treated for intracranial metastases from renal cell carcinoma. The metastasis was solitary in all four patients and was located in the temporoparietal region in two patients, cerebellum in one patient, and bilateral lateral ventricles in one patient. Preoperative magnetic resonance imaging showed hemorrhage and necrosis in the tumor in all four patients, and one patient had edema in the region of the tumor. All patients were treated with craniotomy for tumor resection, and histopathologic examination showed clear cell carcinoma. Marked bleeding occurred in all patients during the operation, but preoperative direct injection of ethanol into epidural metastases (2 patients) was effective in decreasing intraoperative blood...

Henoch–Schönlein purpura with hypocomplementemia

Pediatric Nephrology — Tue, 24 Jan 2012 07:27:25 +0100

Conclusion Hypocomplementemia associated with HSP is a transient phenomenon. The incidence of significant sequelae such as HSPN between patients with and without hypocomplementemia does not differ. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00467-011-2070-zAuthors Qiang Lin, Department of Nephrology, Children’s Hospital Affiliated to Soochow University, Suzhou, 215003 Jiangsu Province, The People’s Republic of ChinaYue Min, Department of Nephrology, Children’s Hospital Affiliated to Soochow University, Suzhou, 215003 Jiangsu Province, The People’s Republic of ChinaYanhong Li, Department of Nephrology, Children’s Hospital Affiliated to Soochow University, Suzhou, 215003 Jiangsu Province, The People’s Republic of ChinaYun Zhu...

Demonstration of liver metastases on postmortem whole body CT angiography following inadvertent systemic venous infusion of the contrast medium

International Journal of Legal Medicine — Tue, 24 Jan 2012 07:15:46 +0100

Abstract An 86-year-old woman was hospitalized for breathlessness and a large right-sided pleural effusion. Approximately 1 h after thoracentesis, she developed a hemothorax resulting in hypotension and death. Routine postmortem CT scanning showed a large volume right hemothorax and a markedly enlarged liver. In an attempt to determine the origin of bleeding prior to autopsy, a postmortem CT angiogram was performed. Following inadvertent cannulation of the left long saphenous vein and infusion of ∼1,700 mL of a polyethylene glycol 200 and iodine-based radiographic contrast solution into systemic veins using a mechanical pump, CT scanning revealed a dense hepatic "parenchogram" containing multiple large, filling defects indicative of metastases. These were confi...