直肠癌Miles术后患者结肠镜检查肠道准备方法的探讨

目的探讨直肠癌Miles术后患者结肠镜检查前的肠道准备方法。方法纳入拟行结肠镜检查的90例直肠癌Miles术后患者,并随机分为A、B、C 3组,每组30例,A组于结肠镜检前6 h口服复方聚乙二醇电解质散(SF-PEG)328.8 g(3 000 ml)清洁肠道;B组结肠镜检查前6 h口服328.8 g SF-PEG,检查前2 h开塞露40 ml入结肠造口;C组检查前1 d三餐后2 h口服SF-PEG 27.4 g(250 ml),检查前6 h口服164.4 g(1 500 ml)SF-PEG,检查前2 h开塞露40 ml入结肠造口。3组患者检查前1 d进流食,当日禁食至检查完毕。内镜医师行Boston肠道准备量表(BBPS)和肠腔内气泡评分,采用问卷调查的方式评价患者对肠道准备的耐受性,记录肠道准备过程中的不良反应及肠镜检查时间。结果 C组BBPS总分(7.90±0.65)分明显高于A组(6.05±0.80)分和B组(6.65±0.35)分(P 0.05),C组肠腔内气泡评分(0.35±0.15)分明显低于A组(0.75±0.35)分和B组(0.55±0.45)分(P 0.05),C组肠镜检查时间(9.25±0.80)min少于A组(12.65±0.55) min和B组(10.50±0.75)min(P 0.05),C组肠道准备接受率(96.67%)高于A组(80.00%)和B组(83.33%)(P 0.05),C组再次肠道准备接受率(90.00%)高于A组(60.00%)和B组(70.00%)(P 0.05),C组总体不良反应评分(1.25±0.10)分明显低于A组(1.85±0.45)分和B组(1.55±0.35)分(P 0.05)。结论 SF-PEG联合开塞露用于直肠癌Miles术后患者肠道准备能明显提高肠道准备质量,减少不良反应,增加其依从性和耐受性。     

Colonic lipoma presenting with recurrent rectal bleeding

A case of colonic lipoma in a patient who presented with rectal bleeding is presented. The final diagnosis was established at histology. Rarity of the symptomatic colonic lipomas is highlighted.     

Prolonged thrombocytopenia associated with isotretinoin

OBJECTIVE: To report a case of severe prolonged thrombocytopenia possibly associated with isotretinoin. CASE SUMMARY: A 27-year-old white woman developed severe thrombocytopenia and elevated transaminases after 3(1/2) months of treatment with isotretinoin. Prior to the onset of thrombocytopenia, the patient had also received a 10-day course of cephalexin. Rectal bleeding was reported by the patient, who was otherwise asymptomatic. Liver enzyme values returned to normal approximately 1 week after discontinuation of isotretinoin; however, platelet counts required approximately 2 months to normalize. Based on the Naranjo probability scale, possible causality exists between isotretinoin and thrombocytopenia. DISCUSSION: The exact mechanism by which isotretinoin caused thrombocytopenia in this patient is not clearly understood. To our knowledge, only 3 previous cases of isotretinoin-associated thrombocytopenia have been reported. The long recovery process that occurred in our patient is possibly a direct result of the long elimination half-life of both the parent compound and active metabolites of isotretinoin. CONCLUSIONS: Clinicians prescribing isotretinoin should be aware of the potential life-threatening consequence of thrombocytopenia, and a complete blood cell count with platelets should be part of the routine monthly monitoring in all patients receiving isotretinoin therapy.     

电子结肠镜检查在儿童下消化道出血中的应用价值

目的 探讨电子结肠镜检查在儿童下消化道出血(LGIB)中的临床应用价值和胃镜替代电子结肠镜检查的可行性.方法 回顾性分析2017年1月-2020年3月该院消化内科收治的267例LGIB患儿的病历资料,对病因及电子结肠镜检查结果进行归纳总结.结果 学龄前儿童占69.29％.儿童LGIB的常见病因为肠道息肉、结直肠炎、炎症...     

Bedside colonoscopy for critically ill patients with acute lower gastrointestinal bleeding

Objective: To determine the clinical impact of bedside colonoscopy for critically ill patients with acute lower gastrointestinal (GI) bleeding. Design and setting: A 3-year retrospective analysis (chart review). Medical intensive care unit (ICU) of a 1,312-bed tertiary-care center in Taiwan. Patients and participants: Fifty-five people undergoing bedside colonoscopy for lower GI bleeding that developed while in the ICU. Interventions: Bedside colonoscopy. Measurements and results: Colonoscopy was successful in diagnosing the source of bleeding in 37 patients. Among them, colitis (15 patients, including ischemic, pseudomembranous, or radiation-induced) and acute hemorrhagic rectal ulcer (nine patients) were the most frequent confirmed causes. In seven patients, fresh blood was noticed above the colonoscopically accessible area and considered to originate from the small bowel. No adverse event was associated with colonoscopy. Spontaneous cessation of bleeding was noted in 29 (29/55, 53%) patients, whereas 16 (16/55, 29%) achieved endoscopic hemostasis. Ten (10/55, 18%) patients failed primary hemostasis or localization. Overall in-hospital mortality was 53% (29/55); however, hemorrhage-related death occurred in only two patients. Conclusions: ICU patients with acute lower GI bleeding have distinctive causes. Bedside colonoscopy is effective for diagnosis in two-thirds of patients, but only a minority of them needs endoscopic hemostasis.     

Vaginal bleeding associated with pregnancy

Vaginal bleeding during pregnancy provokes physical and emotional stress to patients and physicians. Physicians must be prepared to assess the medical implications of acute blood loss to these patients and their unborn children quickly. When mother and fetus are stable, the recognition and treatment of the underlying cause is essential to decreasing additional maternal and fetal morbidity and mortality associated with the bleeding episode.     

Fiberoptic colonoscopy: diagnostic value in 250 consecutive patients.

Endoscopic findings and accomplishments in 250 consecutive patients are presented. Of these patients 72% were found to have polyps, cancer, inflammatory bowel disease or other specific positive findings. In almost half of these patients, no definitive diagnosis had been made before the procedure. In half of the patients, new information was obtained which was not known before the procedure. Indications for colonoscopy are presented to demonstrate the situations in which the procedure was valuable not only to remove polyps, but also to explain nonspecific radiologic abnormalities, unexplained rectal bleeding, or diarrhea, and to detect unknown cancers and polyps.     

Prolonged ventricular pause associated with ticagrelor use: A case report

CaseWe report a case of a 76‐year‐old female who presented with non‐ST elevation myocardial infarction and developed a 22‐second ventricular pause with ticagrelor that did not recur after shifting to clopidogrel. Based on the Naranjo algorithm, the likelihood that our patient''s prolonged ventricular pause was due to ticagrelor exposure was probable.ConclusionTicagrelor use is associated with prolonged ventricular pauses, warranting close monitoring, particularly during the first week of therapy.     

结肠镜检查时机对急性下消化道出血患者预后影响的Meta分析

目的 系统评价结肠镜检查时机对急性下消化道出血（LGIB）患者预后的影响。方法 计算机检索PubMed、Medline、Embase、The Cochrane Library、维普、中国知网和万方数据自建库到2022年9月,结肠镜检查时机对急性LGIB患者预后影响的相关临床研究。由两名研究者独立筛选文献,提取信息,并进行偏倚风险评价后,采用RevMan 5.4软件对急诊结肠镜组和常规结肠镜组的再出血率、内镜下止血成功率、出血来源定位率和总体死亡率等多方面进行Meta分析。结果 共纳入12篇回顾性研究和4篇随机对照试验（RCT）,包括400 180例患者。回顾性研究的Meta分析结果显示,急诊结肠镜在以下４个方面优于常规结肠镜：内镜下止血成功率（OR＾ = 1.64,95%CI：1.07～2.52,P = 0.020）、住院天数（MD = -1.67,95%CI：-2.92～-0.42,P = 0.009）、外科手术率（OR＾ = 0.52,95%CI：0.42～0.64,P = 0.000）和输血率（OR＾ = 0.83,95%CI：0.78～0.88,P = 0.000）;两组患者再出血率、总体死亡率、介入治疗率和出血来源定位率比较,差异均无统计学意义（P > 0.05）。RCT的Meta分析结果显示,急诊结肠镜内镜下止血成功率（OR＾ = 1.74,95%CI：1.04～2.93,P = 0.040）和出血来源定位率（OR＾ = 2.31,95%CI：1.28～4.17,P = 0.006）明显高于常规结肠镜,两组间其他结局指标比较,差异均无统计学意义（P > 0.05）。结论 与常规结肠镜相比,急诊结肠镜并不能降低再出血率和总体死亡率,但能够提高内镜下止血成功率,并在一定程度上缩短了住院天数,降低了外科手术率和输血率,在临床中需根据实际情况进行时机选择。     

Anisakiasis of the colon: report of two cases with emphasis on the diagnostic and therapeutic value of colonoscopy

Anisakiasis of the colon is a rare entity as compared with gastric anisakiasis, and its diagnosis is very difficult. We present here two cases--a 42-year-old woman and a 30-year-old woman--of anisakiasis of the colon treated by colonoscopic removal of the worm without surgery. The importance of colonoscopy for the diagnosis and treatment of this disease is briefly discussed.     

Management of bleeding associated with malignant wounds

Bleeding malignant wounds in palliative care patients can be anxiety-provoking for patients, their caregivers, and healthcare providers, and can be difficult to manage. We present the case of a 60-year-old man with a bleeding neck wound due to squamous cell carcinoma of the hypopharynx admitted to our inpatient palliative care unit. Management of bleeding included local wound care measures and psychosocial support for the patient and his wife. We review therapeutic approaches to managing bleeding malignant wounds with the aim of providing clinically useful information.     

Massive gastrointestinal bleeding after endoscopic rubber band ligation of internal hemorrhoids: A case report

BACKGROUNDRubber band ligation (RBL) using rigid anoscope is a commonly recommended therapy for grade I-III symptomatic internal hemorrhoids. Severe complications of RBL include pain, hemorrhage and sepsis. Flexible endoscopic RBL (ERBL) is now more commonly used in RBL therapy but few severe complications have been reported. Here we report on a case of massive bleeding after ERBL.CASE SUMMARYA 31-year-old female was admitted to the department of gastroenterology with a chief complaint of discontinuous hematochezia for 2 years. No previous history, accompanying diseases or drug use was reported. Physical examination and colonoscopy showed grade II internal hemorrhoids. The patient received ERBL therapy. Five days after ligation, the patient presented with mild hematochezia. On days 7 and 9 after ligation, she presented with a large amount of rectal bleeding, dizziness and weakness. Emergency colonoscopy revealed active bleeding and an ulcer in the anal wound. The patient received two sessions of hemoclipping on days 7 and 9 to treat the bleeding. No further bleeding was reported up to day 15 and she was discharged home. Although the hemorrhoid prolapse disappeared after ERBL, she was dissatisfied with the subsequent complications.CONCLUSIONERBL therapy is an effective treatment for symptomatic internal hemorrhoids with satisfactory short and long-term recovery. Pain and anal bleeding are the most frequently reported postoperative complications. Coagulation disorders complicate the increased risk of bleeding. Although rarely reported, our case reminds us that those patients without coagulation disorders are also at risk of massive life-threatening bleeding and need strict follow-up after ligation.     

Abnormal uterine bleeding associated with hormonal contraception

Millions of women in the United States use some type of hormonal contraception: combination oral contraceptive pills (OCPs), progestin-only pills, medroxyprogesterone acetate injections, or subdermal levonorgestrel implants. Abnormal uterine bleeding is a common but rarely dangerous side effect of hormonal contraception. It is, however, a major cause for the discontinuation of hormonal contraception and the resultant occurrence of unplanned pregnancy. The evaluation of abnormal uterine bleeding in women who are using hormonal contraception includes an assessment of compliance, a thorough history and complete physical examination to exclude organic causes of bleeding, and a targeted laboratory evaluation. Pregnancy and the misuse of OCPs are frequent causes of abnormal uterine bleeding. Bleeding is common during the first three months of OCP use; counseling and reassurance are adequate during this time period. If bleeding persists beyond three months, it can be treated with supplemental estrogen and/or a nonsteroidal anti-inflammatory drug (NSAID). Other options are to change to an OCP with a higher estrogen content or to a different formulation (i.e., a low-dose OCP containing a different progestin). Management strategies for women with abnormal uterine bleeding who are using progestin-only contraceptive methods include counseling and reassurance, as well as the administration of supplemental estrogen and/or an NSAID during bleeding episodes.     

Abnormal bleeding associated with reproductive tract infection

Reproductive tract infection is an often unrecognized, but relatively common, cause of abnormal reproductive tract bleeding. Postcoital bleeding, menorrhagia, metrorrhagia, and oral contraceptive break-through bleeding are potentially infection-related complaints. The microorganisms most often associated with abnormal reproductive tract bleeding include: Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus type 2, and microorganisms associated with bacterial vaginosis. The clinical conditions cervicitis, endometritis, and pelvic inflammatory disease and the related microorganisms are discussed, as are strategies for clinical management and counseling.