Le coronarien âgé : un patient à haut risque hémorragique

Bleeding complications are frequent in coronary artery disease patients and are associated with increased mortality. Among clinical factors increasing the risk of bleeding, age appears to be a major determinant, whatever the clinical presentation (stable disease, acute coronary syndrome, PCI). Evidence of the role of age comes from the weight given to age in most existing bleedingrisk scores.     

Implicaciones anestésicas en gestante con trombocitopenia extrema por síndrome de May-Hegglin: ¿anestesia regional o general?

The May-Hegglin anomaly is an inherited disorder, so uncommon that the incidence is still unknown. It is characterized by macro-thrombocytopenia with normal platelet function and cytoplasmic inclusion bodies in granulocytes.The case is reported of a 28-year-old primiparous patient who had an urgent caesarean section due to failed induction of labour. The patient had no history of abnormal bleeding. Other causes of thrombocytopenia or platelet dysfunction, such as preeclampsia, HELLP syndrome, or placental abruption, were ruled out. The platelet count prior to surgery was 20,900/mm³ with normal platelet function. General anaesthesia was performed. No excessive bleeding occurred and a platelet transfusion was not needed.     

结扎速血管闭合切割系统在巨大神经纤维瘤手术中的应用效果

目的：探讨结扎速血管闭合切割系统(LigaSure vessel sealing system, LVSS)在巨大神经纤维瘤手术中的应用效果。方法：选取2013年10月至2020年5月行巨大神经纤维瘤手术的患者22例纳入本研究。传统手术组12例采用常规缝扎电凝止血手术方式,LigaSure组10例采用LigaSure血管闭合切割的手术方式,对比两组患者切除瘤体大小、手术时间、术中出血量、术后引流量、术后拔管时间及术后并发症情况。结果：两组间患者的一般资料具有可比性。LigaSure组术中出血量、术后引流量、术后拔管时间均较传统手术组显著降低(P＜0.05)。两组间切除瘤体大小、手术时间及术前术后血红蛋白差值无统计学差异。传统手术组出现1例术后皮下积液,予再次引流后伤口愈合良好。结论：LigaSure在手术治疗巨大神经纤维瘤方面的应用安全有效,能显著地减少出血量,简化手术操作,缩短术后恢复时间,值得在临床上进一步推广。     

Bleeding gastric varices： Results of endoscopic injection with cyanoacrylate at King Chulalongkorn Memorial Hospital

AIM: To evaluate the efficacy and safety of gastric varices injection with cyanoacrylate in patients with gastric variceal bleeding. METHODS: Twenty-four patients (15 males, 9 females) with gastric variceal bleeding underwent endoscopic treatment with cyanoacrylate injection. Successful hemostasis, rebleeding rate, and complications were retrospectively reviewed. Followed up endoscopy was performed and repeat cyanoacrylate injection was given until gastric varices were obliterated. RESULTS: Seventeen patients achieved definite hemostasis. Of these, 14 patients had primary success after initial endoscopic therapy. Ten patients developed recurrent bleeding. Repeated cyanoacrylate injection stopped rebleeding in three patients. Transjugular intrahepatic portosystemic shunt (TIPS) was performed to control rebleeding in one patient which occured after repeat endoscopic therapy. Six patients died (three from uncontrolled bleeding, two from sepsis, and one from mesenteric vein thrombosis). Minor complications occurred in 11 patients (six epigastric discomfort and five post injection ulcers). Cyanoacrylate embolism developed in two patients. One of these patients died from mesenteric vein thrombosis. The other had pulmonary embolism which resolved spontaneously. Advanced cirrhosis and hepatocellular carcinoma (HCC) were major risk factors for uncontrolled bleeding. CONCLUSION: Endoscopic treatment for bleeding gastric varices with cyanoacrylate injection is effective for immediate hemostasis. Repeat cyanoacrylate injection has a lower success rate than the initial injection. Cyanoacrylate embolism is not a common serious complication.     

Prognostic Implications of Declining Hemoglobin Content in Patients Hospitalized With Acute Coronary Syndromes

BackgroundContemporary definitions of bleeding endpoints are restricted mostly to clinically overt events. Whether hemoglobin drop per se, with or without overt bleeding, adversely affects the prognosis of patients with acute coronary syndrome (ACS) remains unclear.ObjectivesThe aim of this study was to examine in the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial the incidence, predictors, and prognostic implications of in-hospital hemoglobin drop in patients with ACS managed invasively stratified by the presence of in-hospital bleeding.MethodsPatients were categorized by the presence and amount of in-hospital hemoglobin drop on the basis of baseline and nadir hemoglobin values and further stratified by the occurrence of adjudicated in-hospital bleeding. Hemoglobin drop was defined as minimal (<3 g/dl), minor (≥3 and <5 g/dl), or major (≥5 g/dl). Using multivariate Cox regression, we modeled the association between hemoglobin drop and mortality in patients with and without overt bleeding.ResultsAmong 7,781 patients alive 24 h after randomization with available hemoglobin data, 6,504 patients (83.6%) had hemoglobin drop, of whom 5,756 (88.5%) did not have overt bleeding and 748 (11.5%) had overt bleeding. Among patients without overt bleeding, minor (hazard ratio [HR]: 2.37; 95% confidence interval [CI]: 1.32 to 4.24; p = 0.004) and major (HR: 2.58; 95% CI: 0.98 to 6.78; p = 0.054) hemoglobin drop were independently associated with higher 1-year mortality. Among patients with overt bleeding, the association of minor and major hemoglobin drop with 1-year mortality was directionally similar but had wider CIs (minor: HR: 3.53 [95% CI: 1.06 to 11.79]; major: HR: 13.32 [95% CI: 3.01 to 58.98]).ConclusionsAmong patients with ACS managed invasively, in-hospital hemoglobin drop ≥3 g/dl, even in the absence of overt bleeding, is common and is independently associated with increased risk for 1-year mortality. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox; NCT01433627)     

奥曲肽联合泮托拉唑治疗胃十二指肠溃疡出血的临床疗效探讨

目的：研究分析奥曲肽联合泮托拉唑治疗胃十二指肠溃疡出血的临床疗效。方法回顾性分析该院于2012年12月-2014年2月收治的100例胃十二指肠溃疡出血患者的病历资料,随机的分为对照组和治疗组,对照组和治疗组各50例,对照组患者采取泮托拉唑治疗,治疗组患者采取奥曲肽联合泮托拉唑治疗,对比分析两组患者的止血效果、临床疗效和不良反应情况。结果治疗组患者治疗1 d后止血效果明显优于对照组,P<0.05,治疗2 d后的止血效果和对照组患者止血效果比较,P>0.05,差异无统计学意义。治疗组患者的临床总有效率明显大于对照组,P<0.05,治疗组患者不良反应发生率小于对照组,P<0.05。结论胃十二指肠溃疡出血患者实施奥曲肽联合泮托拉唑治疗,有较好的止血效果和较少的不良反应,临床疗效显著,有一定的安全性和可行性,值得临床推广应用。