Haemostatic actions of the folkloric medicinal plant extract Ankaferd Blood Stopper

Ankaferd Blood Stopper (ABS), a standardized mixture of five plants, has been used historically as a haemostatic agent but its mechanism of action remains unknown. This study investigated the in vitro effects of ABS on haemostatic parameters. When added to plasma or serum, ABS induced the very rapid formation of a protein network and erythrocyte aggregation. The levels of coagulation factors II, V, VII, VIII, IX, X, XI, and XIII were not affected by ABS. Plasma fibrinogen activity and antigen levels were decreased following the addition of ABS, in parallel with the prolonged thrombin time. Total protein, albumin, and globulin levels decreased after the addition of ABS. Our findings suggest that ABS stimulates the formation of an encapsulated protein network that provides focal points for erythrocyte aggregation. ABS has the therapeutic potential to be used for the management of haemorrhage and this agent should be investigated further in clinical trials.     

In Vitro Antifungal Activity of Ankaferd Blood Stopper Against Candida albicans

Background

Candida albicans is a memeber of the oral flora that can lead to various complications in immunosupresive patients after oral surgery processes. Ankaferd Blood Stopper® (ABS) is a medical plant extract that is safe to use in patients with dental surgery bleedings in Turkey.

Objective

The study evaluated the antifungal activity of ABS medicinal plant extract against C albicans using the agar diffusion and broth microdilution methods.

Methods

The plant extract antifungal activity was assessed in vitro either by applying the ABS extract directly and by applying different concentrations of ABS onto Candida culture. For these experiments, an agar diffusion method was used. To determine the minimum inhibitory concentration (MIC), a broth microdilution method was used.

Results

Different volumes of the active substance (10, 20, 30, and 40 μL) were applied onto Candida (0.5 McFarland solution) cultivated plate; Candida growth was inhibited in accordance with the volumes of ABS. However, when various dilutions of ABS (1:2, 1:20, 1:40, and 1:80) were added as drops containing 20 μL, no antifungal effects were found. No MIC values were identified using broth microdilution. When different dilutions of ABS containing 100 μL of 0.5 McFarland solution of C albicans were cultured depending on the time (10, 20, 30, and 40 minutes), the effect of the duration was not significant.

Conclusion

The various tests were carried out to investigate antifungal effects of ABS on Candida, but none were found.     

慢性放射性直肠炎经直肠超声表现

目的 观察慢性放射性直肠炎的经直肠超声表现。方法 对52例晚期宫颈癌放疗后发生慢性放射性直肠炎患者行经直肠超声检查,其中7例已行横结肠造瘘（造瘘组）,45例未行横结肠造瘘术（非造瘘组）,采用二维灰阶超声观察并记录可探及范围内直肠肠壁厚度和层次、溃疡及直肠阴道瘘等情况;能量多普勒观察肠壁血流,并根据Limberg标准进行分级。分析肠壁厚度与血供分级的相关性;比较造瘘组与非造瘘组患者病变肠壁厚度、血流情况。结果 52例患者病变肠壁平均厚度（7.88±2.05）mm,肠壁血供Ⅲ~Ⅳ级35例（35/52,67.31%）;肠壁厚度与血供分级存在相关性（r_s=0.48,P<0.01）;造瘘组与非造瘘组患者肠壁厚度、血供分级的差异均有统计学意义（P均<0.05）。结论 慢性放射性直肠炎的经直肠超声特征性表现为病变肠管壁弥漫性增厚、血流信号增多。     

Argon plasma coagulation in chronic radiation proctitis

Chronic radiation proctitis is a relatively common late complication of pelvic irradiation. The main symptoms are diarrhea, urgency, tenesmus, and rectal bleeding. While mild cases may settle spontaneously over some months, severe hemorrhagic radiation proctitis may require repeated blood transfusions and is difficult to treat with medical therapy. Argon plasma coagulation (APC) is a noncontact thermal coagulation technique which can be applied endoscopically. A probe passed through the scope delivers a field of argon gas to the mucosal surface where it is ionized by a high voltage filament, resulting in superficial mucosal heating and coagulation of friable blood vessels. The technique reduces rectal bleeding in 80%-90% of cases, and may improve the other troublesome symptoms of diarrhea and urgency. APC is probably less effective in very severe cases of hemorrhagic radiation proctitis; in these cases topical formalin or a combination of APC and topical formalin can be useful. Overall, APC has proved to be a safe and well tolerated technique.     

Ankaferd Blood Stopper Is More Effective Than Adrenaline Plus Lidocaine and Gelatin Foam in the Treatment of Epistaxis in Rabbits

Background

Epistaxis is an important emergency that can sometimes be life threatening without effective intervention. Persistent and recurrent bleeding can lead to aspiration, hypotension, hypoxia, or even severe and mortal cardiovascular complications. Providing prompt hemostasis is important, and the hemostatic method used must be easily and locally applicable, efficient, and inexpensive.

Objective

The aim of this study was to assess the hemostatic efficacy of Ankaferd Blood Stopper (ABS) in an experimental epistaxis model and to determine the histopathologic alterations with topical ABS application.

Methods

Twenty-eight New Zealand rabbits were evaluated in 4 study groups. Topical ABS, gelatin foam (GF), adrenalin + lidocaine (AL), and serum physiologic as negative control (C) were applied to the animals for controlling epistaxis. The bleeding was generated with a standard mucosal incision in all groups. Cotton pieces soaked with ABS, AL, C, and GF were applied to the nasal bleeding area. Time of hemostasis was recorded. Tissue samples were obtained after hemostasis for histopathologic examination. The samples were stained with hematoxylin and eosin (HE) and phosphotungstic acid hematoxylin (PTAH) and were examined under a light microscope. In this experimental study, the observers were blind to ABS, AL, and C but not to GF, because of its solid nature.

Results

Median durations required for hemostasis in ABS, AL, GF, and C groups were recorded as 30, 90, 90, and 210 seconds, respectively. The time until termination of bleeding in the ABS group was significantly shorter than that in the AL, GF, and C groups (P = 0.002, P = 0.002, and P = 0.001, respectively). On histopathologic evaluation, after staining with HE, minimal fibrin at the incision edges and a few extravasated erythrocytes were observed in the C, AL, and GF groups. In the ABS group, a dark amorphous material surrounded by fibrin, filling the space between the edges of incisions, was noticed. Fibrin was determined in the C, GF, and AL groups with PTAH stain and in the positive control group. In the ABS group, it was observed that the amorphous substance surrounded by fibrin seen in the HE sections was not stained with PTAH.

Conclusions

Topical nasal ABS application controlled epistaxis faster than C, GF, and AL in this animal bleeding model. The bleeding model used here might fail to replicate the type of injury that would be likely to result in life-threatening bleeding in humans, which should be considered a limitation of the present study. The histopathologic findings in the nasal incision area suggest that ABS might affect global hemostasis by inducing a unique protein network formation, potentially representing a different mechanism of action among conventional antihemorrhagic applications.     

Treatment of radiation proctitis with argon plasma coagulation

BACKGROUND AND STUDY AIMS: Radiation proctitis is a troublesome complication of pelvic irradiation for malignancy. One common and occasionally serious complication is rectal bleeding. Therapeutic options for this condition are limited. This study was undertaken to evaluate the usefulness of argon plasma coagulation (APC) in the treatment of rectal bleeding due to radiation proctitis. PATIENTS AND METHODS: Fifteen patients referred for treatment of rectal bleeding due to radiation proctitis were offered APC during flexible sigmoidoscopy. Data were collected retrospectively to assess patients' response to treatment. Patients were asked to score overall well-being, bleeding, fecal urgency, incontinence, and stool frequency. Transfusion requirements and nadir hemoglobin before and after treatment were also recorded. Matched data were assessed using the Wilcoxon signed-rank test. RESULTS: Rectal bleeding improved significantly after treatment with APC (median pre-treatment score = 3, median post-treatment score = 1; P<0.001). Transfusion requirements ceased in three patients who had previously been anemic. Hemoglobin levels increased from a mean of 108 g/l to 133 g/l in 13 patients. In addition, other parameters of bowel function, including urgency, incontinence, and stool frequency, improved significantly after treatment. Two patients developed rectal strictures after therapy, but these were asymptomatic and treated with rectal dilation. No other complications were observed. CONCLUSION: APC improved patient well-being and significantly reduced rectal bleeding in patients with radiation proctitis. Transfusion requirements were also reduced. APC is useful and safe in patients in whom radiation proctitis is refractory to other treatments.     

云南白药混合液灌肠治疗放射性直肠炎病人的疗效观察与护理

放射性直肠炎是腹腔、盆腔肿瘤放射治疗过程中常见的并发症[1],不仅会给病人带来生活不便和痛苦,而且可造成放疗疗程延长或中断,影响疗效,若不积极预防和早期治疗则会形成肠出血、梗阻、穿孔、坏死等晚期放射性直肠损伤甚至危及病人生命。国内外学者对放射性肠损伤的防治研究一直比较关注,但到目前为止仍未获得突破性进展[2]。为此,我科在前期进行了放射性直肠损伤动物实验研究[3],在此基础上筛选出复方云南白药混合液、白头翁加减味煎剂等药物保留灌肠对治疗急性放     

急性放射性直肠炎的防护现状

阐述了急性放射性直肠炎发病机制和分级,从盆腔放疗方案的改良与设计、预防用药、社会支持、饮食指导方面综述了急性放射性直肠炎的防护.     

表皮生长因子治疗放射性直肠炎的临床研究

目的评价表皮生长因子治疗放射性直肠炎的效果。方法将60例放射性直肠炎患者随机分为两组,中药保留灌肠组（对照组）和表皮生长因子保留灌肠组（治疗组）。治疗两周后,比较两组患者腹痛、腹泻、里急后重、血便等临床症状减轻情况,比较中药及表皮生长因子对放射性直肠炎的疗效。结果治疗组治愈23例、显效3例、有效3例、无效1例。对照组治愈17例、显效2例、有效6例、无效5例。P〈0．05,差异有显著意义。结论表皮生长因子治疗放射性直肠炎疗效优于中药灌肠。     

Application of 4% formaldehyde under electronic colonoscope as a minimally invasive treatment of chronic hemorrhagic radiation proctitis

BACKGROUND:To investigate the effectiveness of topical application of 4% formaldehyde as a minimally invasive treatment of rectal bleeding due to chronic radiation proctitis (CRP) under direct vision of electronic colonoscope.METHODS: The clinical data of 13 CRP patients complicated with ≥ grade II bleeding admitted to our hospital between January 2003 and December 2018 were retrospectively analyzed. Under the guidance of electronic colonoscope, 4% formaldehyde combined with 5-aminosalicylic acid (5-ASA) suppositories was topically applied. Patients were followed up for two months after treatment, and the therapeutic effectiveness was observed and analyzed.RESULTS: The rectal bleeding due to CRP was markedly reduced after topical application of 4% formaldehyde under colonoscope in all 13 patients. The bleeding stopped after one treatment session in 11 patients and after the second session in 2 patients. 5-ASA was also applied along with the use of 4% formaldehyde. The therapeutic effectiveness was satisfactory during the 1- and 2-month follow-up period.CONCLUSION: Topical application of 4% formaldehyde under the direct vision of colonoscope as a minimally invasive treatment for CRB-induced bleeding is a simple, effective, affordable, and repeatable technique without obvious complications, which deserves further exploration and promotion.     

Argon plasma coagulation for the treatment of hemorrhagic radiation proctitis

BACKGROUND AND STUDY AIMS: Chronic radiation proctitis is a complication of radiotherapy for malignant pelvic diseases. Rectal bleeding caused by radiation proctitis is difficult to manage. Argon plasma coagulation (APC) is an electrocoagulation technique that appears to be an effective and low-cost alternative to the use of lasers in gastrointestinal endoscopy. The aim of this study was to evaluate the efficacy of APC, as well as patients' tolerance of the procedure, in the treatment of bleeding radiation-induced proctitis. PATIENTS AND METHODS: The charts of 16 patients with chronic radiation proctitis were analyzed retrospectively. Their average age was 73.5 (range 62-80). Fifteen patients had prostate cancer, and one had uterine cancer. The average time to onset of symptoms after radiotherapy was 15 months (range 6-36 months). All patients had intermittent or daily rectal bleeding, and three patients needed blood transfusions. The severity of bleeding was graded from 0 to 4. APC treatment was administered every month; the argon gas flow was set at 0.6 l/min with an electrical power setting of 40 W. RESULTS: All patients were improved with APC treatment. A mean of 3.7 sessions was necessary to relieve symptoms. APC therapy resulted in a reduction in the mean severity score from 2.4 to 0.6. Seven patients had no recurrent rectal bleeding, and the bleeding was significantly reduced to occasional and negligible spotting (less than one bleeding episode per week) in nine patients. None of the patients required transfusions after treatment. During the follow-up period (average 10.7 months, range 8-28 months), one patient had a recurrence of rectal bleeding that required two repeat sessions. The tolerance was good, with no long-term treatment-related complications. CONCLUSIONS: APC is an effective, safe and well-tolerated treatment for rectal bleeding caused by chronic radiation proctitis. It should be considered as a first-line therapy for radiation proctitis.     

保留灌肠法防治放射性直肠炎的护理

目的观察康复新液保留灌肠对防治放射性直肠炎的作用。方法将80例患者随机分为观察组（康复新护理组）与对照组（常规护理组）各40例,均采用康复新液灌肠,观察组为自放疗开始后灌肠,每日1次,至常规放射治疗结束为止,出现放射性直肠炎患者灌肠处理直至症状消失。常规护理组为出现Ⅱ级肠道反应后开始灌肠,每天1次,直至症状消失。晚期出现放射性直肠炎时以同样治疗方法进行治疗,直至症状消失。结果康复新液灌肠治疗急性放射性直肠炎总治愈率82.6%,总有效率100%,治疗慢性放射性直肠炎总治愈率69.5%,总有效率91.3%。观察组急性放射性直肠炎发生率为32.5%,对照组为65%（P〈0.05）;慢性放射性直肠炎发生率观察组为17.5%,对照组为30.0%,（P〈0.05）。结论康复新液灌肠治疗放射性直肠炎效果好,且无明显不良反应,放疗期间持续保留灌肠可明显降低放射性直肠炎发生率。     

宫颈癌放射治疗并发放射性直肠炎的预防

子宫颈癌是女性最常见肿瘤之一,是女仅次于乳腺癌的第2个常见恶性肿瘤.放射治疗适应证广泛,各期宫颈浸润癌均可采用放射治疗[1].放射治疗所致肠道并发症有:放射性直肠炎、乙状结肠炎、直肠肠道瘘、肠粘连、肠梗阻、肠穿孔等,以直肠炎最为常见,轻者因严重近期反应而中断治疗,影响放疗效果;重者因严重远期反应,导致肠道功能受损,影响病人的生存质量.现总结2001年5月-2005年5月共74例宫颈癌病人进行放射治疗并发放射性直肠炎的预防经验如下.     

药物保留灌肠治疗放射性直肠炎的效果观察及护理

目的探讨药物保留灌肠在治疗放射性直肠炎的效果及总结护理要点。方法对36例放射性直肠炎患者进行药物保留灌肠及护理。结果36例患者治疗总有效率第5 d达到94.4%,第10 d达到100.0%。结论药物保留灌肠治疗放射性直肠炎并辅以综合护理,可有效治疗放射性直肠炎。     

中医药治疗放射性直肠炎新进展

放射性直肠炎（Radiation Proctitis, RP）是一种特殊的直肠炎症,为直肠或者骨盆内脏器在放疗时或放疗后发生的直肠炎症。在中医学中,又名“肠澼”、“泄泻”、“痢疾”,也归属于“肠风”、“脏毒”、“便血”、“内痈”等范畴[1]。按照病程的长短,该病有急慢性之分,一般情况下,3个月为急慢性直肠炎的分界点[2]。该病病位在肠腑,与脾胃相关,病久易损及肝肾。病机为本虚标实,风、寒、湿、热、火、瘀、毒等均可为该病的病理因素。中医对于放射性直肠炎的辨证分型大致可分为湿热蕴结、寒热错杂、脾虚湿困、脾肾阳虚、阴虚津亏、气血两虚等。治疗上,西医尚没有标准的治疗方案,临床上主要采用抗炎、抗感染、止泻、止血等方法对症治疗。中医以补虚泻实为主,辨证使用中药内服或灌肠,口服联合灌肠亦常见。此外,针灸、穴位埋针、穴位注射等中医疗法也在临床中有所应用。该病中医疗效显著,安全性好,但目前尚缺乏多中心、大样本的临床研究。本文对祖国医学治疗放射性直肠炎的现有研究进行了综述。现报道如下：