Continuous-flow left ventricular assist devices(CF-LVADs)have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or,more recently,as destination ...Continuous-flow left ventricular assist devices(CF-LVADs)have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or,more recently,as destination therapy.However,its implantations carries a risk of complications including infection,device malfunction,arrhythmias,right ventricular failure,thromboembolic disease,postoperative and nonsurgical bleeding.A significant number of left ventricular assist devices(LVAD)recipients may experience recurrent gastrointestinal hemorrhage,mainly due to combination of antiplatelet and vitamin K antagonist therapy,activation of fibrinolytic pathway,acquired von Willebrand factor deficiency,and tendency to develop small intestinal angiodysplasias due to increased rotary speed of the pump.Gastrointestinal bleeding in LVAD patients remains a source of increased morbidity including the need for blood transfusions,extended hospital stays,multiple readmissions,and overall mortality.Management of gastrointestinal bleeding in LVAD patients involves multidisciplinary approach in stabilizing the patients,addressing risk factors and performing structured endoluminal evaluation with focus on upper gastrointestinal tract including jejunum to find and eradicate culprit lesion.Medical and procedural intervention is largely successful and universal bleeding cessation occurs in transplanted patients.展开更多
We present a case of Cronkhite-Canada syndrome(CCS) in which the entire intestine was observed using a prototype of magnifying single-balloon enteroscope(SIF Y-0007, Olympus). CCS is a rare, non-familial gastrointesti...We present a case of Cronkhite-Canada syndrome(CCS) in which the entire intestine was observed using a prototype of magnifying single-balloon enteroscope(SIF Y-0007, Olympus). CCS is a rare, non-familial gastrointestinal polyposis with ectodermal abnormalities. To our knowledge, this is the first report showing magnified intestinal lesions of CCS. A 73-year-old female visited our hospital with complaints of diarrhea and dysgeusia. The blood test showed mild anemia and hypoalbuminemia. The esophagogastroduodenoscopy and colonoscopy revealed diffuse and reddened sessile to semi-pedunculated polyps, resulting in the diagnosis of CCS. In addition to the findings of conventional balloon-assisted enteroscopy or capsule endoscopy, magnifying observation revealed tiny granular structures, non-uniformity of the villus, irregular caliber of the loop-like capillaries, scattered white spots in the villous tip, and patchy redness of the villus. Histologically, the scattered white spots and patchy redness of the villus reflect lymphangiectasia and bleeding to interstitium, respectively.展开更多
文摘Continuous-flow left ventricular assist devices(CF-LVADs)have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or,more recently,as destination therapy.However,its implantations carries a risk of complications including infection,device malfunction,arrhythmias,right ventricular failure,thromboembolic disease,postoperative and nonsurgical bleeding.A significant number of left ventricular assist devices(LVAD)recipients may experience recurrent gastrointestinal hemorrhage,mainly due to combination of antiplatelet and vitamin K antagonist therapy,activation of fibrinolytic pathway,acquired von Willebrand factor deficiency,and tendency to develop small intestinal angiodysplasias due to increased rotary speed of the pump.Gastrointestinal bleeding in LVAD patients remains a source of increased morbidity including the need for blood transfusions,extended hospital stays,multiple readmissions,and overall mortality.Management of gastrointestinal bleeding in LVAD patients involves multidisciplinary approach in stabilizing the patients,addressing risk factors and performing structured endoluminal evaluation with focus on upper gastrointestinal tract including jejunum to find and eradicate culprit lesion.Medical and procedural intervention is largely successful and universal bleeding cessation occurs in transplanted patients.
文摘We present a case of Cronkhite-Canada syndrome(CCS) in which the entire intestine was observed using a prototype of magnifying single-balloon enteroscope(SIF Y-0007, Olympus). CCS is a rare, non-familial gastrointestinal polyposis with ectodermal abnormalities. To our knowledge, this is the first report showing magnified intestinal lesions of CCS. A 73-year-old female visited our hospital with complaints of diarrhea and dysgeusia. The blood test showed mild anemia and hypoalbuminemia. The esophagogastroduodenoscopy and colonoscopy revealed diffuse and reddened sessile to semi-pedunculated polyps, resulting in the diagnosis of CCS. In addition to the findings of conventional balloon-assisted enteroscopy or capsule endoscopy, magnifying observation revealed tiny granular structures, non-uniformity of the villus, irregular caliber of the loop-like capillaries, scattered white spots in the villous tip, and patchy redness of the villus. Histologically, the scattered white spots and patchy redness of the villus reflect lymphangiectasia and bleeding to interstitium, respectively.
