Although most cases of acute nonvariceal gastrointestinal hemorrhage either spontaneously resolve or respond to medical management or endoscopic treatment,there are still a significant number of patients who require e...Although most cases of acute nonvariceal gastrointestinal hemorrhage either spontaneously resolve or respond to medical management or endoscopic treatment,there are still a significant number of patients who require emergency angiography and transcatheter treatment.Evaluation with noninvasive imaging such as nuclear scintigraphy or computed tomography may localize the bleeding source and/or confirm active hemorrhage prior to angiography.Any angiographic evaluation should begin with selective catheterization of the artery supplying the most likely site of bleeding,as determined by the available clinical,endoscopic and imaging data.If a hemorrhage source is identified,superselective catheterization followed by transcatheter microcoil embolization is usually the most effective means of successfully controlling hemorrhage while minimizing potential complications.This is now wellrecognized as a viable and safe alternative to emergency surgery.In selected situations transcatheter intra-arterial infusion of vasopressin may also be useful in controlling acute gastrointestinal bleeding.One must be aware of the various side effects and potential complications associated with this treatment,however,and recognize the high re-bleeding rate.In this article we review the current role of angiography,transcatheter arterial embolization and infusion therapy in the evaluation and management of nonvariceal gastrointestinal hemorrhage.展开更多
Objective： The aim of the study was to compare the hematologic toxicity of gemcitabine between fixed-dose rate （FDR） infusion and 30-minute standard infusion in the treatment of malignancy. Methods： The 25 maligna...Objective： The aim of the study was to compare the hematologic toxicity of gemcitabine between fixed-dose rate （FDR） infusion and 30-minute standard infusion in the treatment of malignancy. Methods： The 25 malignancy patients confirmed by histopathology or cytology received single-agent gemcitabine or gemcitabine in combination with other chemo- therapeutic agents. These patients were randomly divided into gemcitabine 1000 mg/m2 on dl, d8 at a rate of 10 mg/m2/min arm （FDR arm） or 30 rain arm （standard arm）, every 21 days one cycle. Hematologic toxicity was evaluated at the end of each cycle. Results： The 13 of 25 patients received gemcitabine FDR therapy, a total of 28 cycles was completed, and 32 cycles in the others （12 of 25 patients） with the standard arm. All patients were evaluable for hematologic toxicity. The result showed that the grades 3-4 leucopenia was significantly different between the two arms （14.3% vs 0, P 〈 0.05）, and no significant differences of neutropenia, thrombocytopenia and hemoglobin suppression of grades 3-4 （14.3% vs 3.1%, 10.7% vs 3.1%, 3.6% vs 9.4%, P 〉 0.05, respectively） were observed between the two arms, no grade 4 of hemoglobin suppression was observed. Conclusion： Hematologic toxicity of gemcitabine therapy at a fixed-dose rate for malignancy is tolerable.展开更多
文摘Although most cases of acute nonvariceal gastrointestinal hemorrhage either spontaneously resolve or respond to medical management or endoscopic treatment,there are still a significant number of patients who require emergency angiography and transcatheter treatment.Evaluation with noninvasive imaging such as nuclear scintigraphy or computed tomography may localize the bleeding source and/or confirm active hemorrhage prior to angiography.Any angiographic evaluation should begin with selective catheterization of the artery supplying the most likely site of bleeding,as determined by the available clinical,endoscopic and imaging data.If a hemorrhage source is identified,superselective catheterization followed by transcatheter microcoil embolization is usually the most effective means of successfully controlling hemorrhage while minimizing potential complications.This is now wellrecognized as a viable and safe alternative to emergency surgery.In selected situations transcatheter intra-arterial infusion of vasopressin may also be useful in controlling acute gastrointestinal bleeding.One must be aware of the various side effects and potential complications associated with this treatment,however,and recognize the high re-bleeding rate.In this article we review the current role of angiography,transcatheter arterial embolization and infusion therapy in the evaluation and management of nonvariceal gastrointestinal hemorrhage.
基金Supported by the grants of the National Natural Science Foundation of China(No.30872591)Shanghai Science and Technology Commission(No.02.04.11.006)
文摘Objective： The aim of the study was to compare the hematologic toxicity of gemcitabine between fixed-dose rate （FDR） infusion and 30-minute standard infusion in the treatment of malignancy. Methods： The 25 malignancy patients confirmed by histopathology or cytology received single-agent gemcitabine or gemcitabine in combination with other chemo- therapeutic agents. These patients were randomly divided into gemcitabine 1000 mg/m2 on dl, d8 at a rate of 10 mg/m2/min arm （FDR arm） or 30 rain arm （standard arm）, every 21 days one cycle. Hematologic toxicity was evaluated at the end of each cycle. Results： The 13 of 25 patients received gemcitabine FDR therapy, a total of 28 cycles was completed, and 32 cycles in the others （12 of 25 patients） with the standard arm. All patients were evaluable for hematologic toxicity. The result showed that the grades 3-4 leucopenia was significantly different between the two arms （14.3% vs 0, P 〈 0.05）, and no significant differences of neutropenia, thrombocytopenia and hemoglobin suppression of grades 3-4 （14.3% vs 3.1%, 10.7% vs 3.1%, 3.6% vs 9.4%, P 〉 0.05, respectively） were observed between the two arms, no grade 4 of hemoglobin suppression was observed. Conclusion： Hematologic toxicity of gemcitabine therapy at a fixed-dose rate for malignancy is tolerable.
