Regular-dose versus High-dose Omeprazole in Peptic Ulcer Bleeding A Prospective Randomized Double-blind Study

Background: It has been suggested that profound acid inhibition along with endoscopic therapy might prevent rebleeding and reduce mortality in patients with peptic ulcer bleeding. The aim of the study was to test the possible equivalence of a high dose and the regular dose of omeprazole in peptic ulcer bleeding. Methods: We performed a prospective randomized double-blind study involving 142 patients with acute peptic ulcer bleeding (Forrest classification I-II: spurting or oozing bleeding, non-bleeding visible vessel, clot and black base). One-hundred-and-two (71.8%) patients received endoscopic treatment (adrenaline injection and/or heater probe) in pre-entry. Patients were randomly assigned to receive the regular dose of omeprazole intravenously (20 mg once a day for 3 days, i.e. 60 mg/72 h) or a high dose of omeprazole (80 mg bolus + 8 mg/h for 3 days, i.e. 652 mg/72 h). Rebleeding, surgery and death were the outcome measures. Results: Six (8.2%) of the 73 patients receiving the regular dose of omeprazole and 8 (11.6%) of the 69 patients receiving the high dose of omeprazole rebled ( P = 0.002 for equivalence, equivalence limit 0.15). Three (4.1%) of the former patients and 5 (7.2%) of the latter group underwent surgery. Four (5.5%) patients in the regular-dose and 2 (2.9%) in the high-dose group died within 30 days. Conclusion: Under the defined tolerance limits, the regular dose of omeprazole is as successful as a high dose in preventing peptic ulcer rebleeding.     

3种危险性评分在判断NVUGIB患者预后中的价值

目的探讨3种危险性评分（Forrest分级、Rockall再出血危险积分和Baylor出血积分）在判断非静脉曲张性上消化道出血（NVUGIB）患者预后中的价值。方法以NVUGIB患者为研究对象,对所有患者随访半年,了解半年内再出血及死亡情况。首先,将再出血和死亡定义为预后不良,比较预后不良组和预后良好组各评分系统低危、中危、高危的差别;然后,比较3个评分系统低危、中危、高危患者的再出血率及病死率的差别。结果①预后良好组和预后不良组的Forrest分级低危、中危、高危患者比例比较,差异有统计学意义（P〈0．01）;②再出血发生率按照Forrest分级低危、中危和高危的顺序逐渐增加,差异有统计学意义（P〈0．01）;病死率按照Baylor出血积分低危、中危、高危顺利逐渐增加,差异有统计学意义（P〈0．05）。结论Forrest分级适合判断NVUGIB患者再出血风险;Baylor出血积分适合判断NVUGIB患者死亡风险。     

伽玛刀治疗脑动静脉畸形远期再出血分析

目的分析伽玛刀(γ-刀)治疗脑动静脉畸形(cAVM)的再出血率及相关因素。方法对1995年8月￣2002年12月间接受γ-刀治疗3年以上,并且随访资料完全的341例cAVM患者再出血情况进行统计。结果再出血10例(2.9%),其中3例直接导致死亡。结论γ-刀治疗cAVM后再出血率较低,出血较自然病程少,且有一定相关因素。     

炫速双源CT诊断SAH动脉瘤介入术后再出血的价值观察

目的观察炫速双源电子计算机断层扫描(CT)诊断蛛网膜下腔出血(SAH)动脉瘤介入术后再出血的价值。方法选取我院收治的90例SAH动脉瘤介入术后再出血病例,均于术后予以炫速双源CT检查,按照扫描时间差异,分为术后1h组、术后6h组、术后12h组及术后24h组,分析血管增强图像,并比较四组患者手术前后病灶感兴趣区(ROI)CT值、术后虚拟平扫(VNCT)CT值。结果术后蛛网膜下腔之中血液以及碘高密度混合物平均密度为(110.73±11.85)HU,与原数据图像测量结果一致;四组患者中,术后病灶ROI双源CT值明显高于术前CT平扫和术后VNCT(P<0.05),但术前CT平扫与术后VNCT比较无明显差异(P>0.05)。结论炫速双源CT能够评估蛛网膜下腔内部实际出血量,适用于检查SAH动脉瘤介入术后再出血情况。     

Efficacy and risk of ventricular drainage in cases of grade V subarachnoid hemorrhage

Abstract

We retrospectively evaluated efficacy and risk of external ventricular drainage which was performed in early management of high grade subarachnoid hemorrhage. Acute ventricular drainage was performed on 36.6% of 93 patients with grade V subarachnoid hemorrhage. The percentages of patients whose GCS improved following ventricular drainage were 14.3% from GCS 3, 61.5% from GCS 4, 42.9% from GCS 5 and 42.9% from GCS 6. The occurrence rate of rebleeding was approximately three-fold higher in patients who underwent ventricular drainage than in patients who did not. Aneurysmal surgery performed after ventricular drainage, compared with acute aneurysmal surgery, resulted in the smaller percentage of patients who became persistently vegetative and in the larger percentage of patients who became severely disabled, while it did not change the percentage of patients who resulted in favorable outcome 'and death. These results of retrospective study suggested that ventricular drainage performed on grade Vsubarachnoid hemorrhage increased the risk ofrebleeding and did not increase the percentage ofpatients who resulted in favorable outcome although it reduced the percentage of patients who resulted in persistent vegetative state. [Neural Res 1997; 19: 649-653]     

Actively bleeding intracranial aneurysm demonstrated by CT angiography

CT angiography (CTA) is increasingly being utilized in the initial diagnosis of subarachnoid hemorrhage. While active bleeding from an intracranial aneurysm has been demonstrated on conventional angiography, CT angiogram findings of active aneurysmal hemorrhage are not well described. We present a case of an actively bleeding anterior communicating artery aneurysm demonstrated by CT angiography. The initial CTA demonstrated the extravasation of contrast from the anterior communicating artery. A second CT scan less than 1h later confirmed the ongoing hemorrhage, with extension of hemorrhage into the subarachnoid cisterns and the ventricular system. Recognition of active aneurismal hemorrhage by CTA may modify plan of treatment and follow-up imaging.     

经胸吻合器联合断流加大网膜包肺治疗门奇断流术后再出血的疗效观察

目的:探讨和分析经胸吻合器联合断流加大网膜包肺治疗门脉高压断流术后再出血的手术治疗效果。方法:对2001年3月—2011年8月间采用经胸吻合器联合断流加大网膜包肺手术治疗门静脉高压症行门奇断流术后上消化道再出血的9例患者进行回顾性临床分析。结果:随访1～10年,术后门静脉(SV)血流量、最大流速、门静脉内径均有所下降,1例于术后6年再次上消化道出血导致死亡,其余病例生存质量较好。结论:经胸吻合器联合断流加大网膜包肺术适合于断流术后食管静脉曲张再出血的患者,其术后门脉系统血流动力学稳定,是较为理想的手术方式。     

消化内镜止血治疗对非静脉曲张性上消化道出血控制再出血和降低机体炎症的作用

目的 探讨消化内镜止血治疗对非静脉曲张性上消化道出血控制再出血和降低机体炎症的作用.方法 选取2019年5月至2021年5月我院收治的104例非静脉曲张性上消化道出血患者,随机分为对照组和观察组各52例.对照组采用常规止血治疗,观察组采用消化内镜止血治疗.比较两组的疗效、再出血率、炎性因子[白细胞介素-6(I.L-6)...     

Refinement in the technique of perihepatic packing: a safe and effective surgical hemostasis and multidisciplinary approach can improve the outcome in severe liver trauma

Background

Since 2005, we refined the technique of perihepatic packing including complete mobilization of the right lobe and packing around the posterior paracaval surface, lateral right side, and anterior and posteroinferior surfaces.

Methods

Two groups of patients with grade IV/V liver trauma underwent perihepatic packing before and after 2005. The study group included 12 patients treated with the new technique. The control group included 23 patients treated with the old technique.

Results

All 13 patients except one who died within 24 hours were treated with the old technique. The overall survival rate was 75% in the patients treated with the new technique (vs 30.4%, P < .02); the liver-related mortality was 8.3% versus 34.8% (P = not significant). The mean survival time in the intensive care unit was longer in the latest group (39.4 vs 22.3 days, P = not significant). The incidence of rebleeding requiring repacking was 16.7% in the patients who underwent new packing versus 45.5% in the patient who were treated with the old technique (P = not significant). The overall (81.8% vs 100%, P = not significant) and liver-related morbidity rate (18.2% vs 41.7%, P = not significant) and the incidence of abdominal sepsis (9.1% vs 41.7%, P = not significant) decreased.

Conclusions

Our refined technique of perihepatic packing seems to be safe and effective.     

Management of Variceal Hemorrhage in Children with Extrahepatic Portal Venous Obstruction-Shunt Surgery Versus Endoscopic Sclerotherapy

Extrahepatic portal venous obstruction (EHPVO) is a common cause of portal hypertention in children. Esophageal variceal hemorrhage is a major cause of morbidity and mortality in these patients. For many decades, portal systemic shunts were considered as the most effective treatment of variceal hemorrhage. Endoscopic injection sclerotherapy (EIS) was first introduced for emergency management of bleeding varices and subsequently as definitive treatment to prevent recurrent hemorrhage. The purpose of the study was to compare the safety and efficacy of shunt surgery and endoscopic sclerotherapy for patients with proven esophageal variceal bleeding due to EHPVO. The study was a prospective randomized study of 61 children with bleeding esophageal varices due to EHPVO carried out jointly by the department of General Surgery and Gastroenterology at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, between March 2001 and September 2003. Thirty patients received surgery and other 31 patients received EIS. Overall incidence of rebleeding was 22.6% in sclerotherapy group and 3.3% in shunt surgery group. Treatment failure occurred in 19.4% patients in sclerotherapy group and 6.7% in shunt surgery group. The rebleeding rate of sclerotherapy is significantly higher than that of shunt surgery. However, the therapy failure rate of sclerotherapy is not significantly different from that of shunt surgery.