Nursing Care of Labor Induction in 2 Cases of Upper GI Bleeding in Pregnancy Complicated with Decompensated Cirrhosis

Objective: To summarize the nursing experience of induced labor of upper gastrointestinal bleeding in pregnancy complicated with decompensated cirrhosis. Methods: To treat two pregnant women with upper gastrointestinal bleeding complicated with decompensated cirrhosis with early labor induction, strengthen the nursing of upper gastrointestinal bleeding before operation, monitor changes of the patient’s condition closely after operation, and strengthen the prevention and treatment of postpartum complications and health guidance. Results: No serious complications occurred in the 2 patients after operation. They were hospitalized for 11 and 17 days after operation and were discharged stably. Conclusion: The pregnant women with upper gastrointestinal bleeding complicated with decompensated cirrhosis should terminate pregnancy in time and strengthen perinatal nursing, which can improve the liver function and blood coagulation and improve the prognosis of the patients.

Guitarist Pick for Melena: A Unique Case of an Upper GI Bleed

Gastrointestinal bleeds are a commonly observed complication after left ventricular assist device placement and usually caused by formation of arteriovenous malformations or acquired von Willebrand disease in the setting of anticoagulation use. We present a unique case of an upper GI bleed in which the cause was likely due to the impaction of a guitar pick into the duodenal bulb in the setting of continuous flow-LVAD on anticoagulation with elevated INR and discuss the pathophysiology of GI bleeds post-LVAD placement and relevant concerns about finding foreign bodies in the GI tract and their complications.

Outcome of non-variceal acute upper gastrointestinal bleeding in relation to the time of endoscopy and the experience of the endoscopist: A two-year survey

AIM: To prospectively assess the impact of time of endoscopy and endoscopist's experience on the outcome of non-variceal acute upper gastrointestinal (GI) bleeding patients in a large teaching hospital.METHODS: All patients admitted for non-variceal acute upper GI bleeding for over a 2-year period were potentially eligible for this study. They were managed by a team of seven endoscopists on 24-h call whose experience was categorized into two levels (high and low) according to the number of endoscopic hemostatic procedures undertaken before the study. Endoscopic treatment was standardized according to Forrest classification of lesions as well as the subsequent medical therapy. Time of endoscopy was subdivided into two time periods: routine (8 a.m.-5 p.m.) and on-call (5 p.m.-8 a.m.). For each category of experience and time periods rebleeding rate, transfusion requirement, need for surgery, length of hospital stay and mortality we compared. Multivariate analysis was used to discriminate the impact of different variables on the outcomes that were considered.RESULTS: Study population consisted of 272 patients (mean age 67.3 years) with endoscopic stigmata of hemorrhage. The patients were equally distributed among the endoscopists, whereas only 19% of procedures were done out of working hours. Rockall score and Forrest classification at admission did not differ between time periods and degree of experience.Univariate analysis showed that higher endoscopist's experience was associated with significant reduction in rebleeding rate (14% vs 37%), transfusion requirements (1.8±0.6 vs 3.0±1.7 units) as well as surgery (4% vs 10%), but not associated with the length of hospital stay nor mortality. By contrast, outcomes did not significantly differ between the two time periods of endoscopy.On multivariate analysis, endoscopist's experience was independently associated with rebleeding rate and transfusion requirements. Odds ratios for low experienced endoscopist were 4.47 for rebleeding and 6.90 for need of transfusion after the endoscopy.CONCLUSION: Endoscopist's experience is an important independent prognostic factor for non-variceal acute upper GI bleeding. Urgent endoscopy should be undertaken preferentially by a skilled endoscopist as less expert staff tends to underestimate some risk lesions with a negative influence on hemostasis.

Hepatic Artery Aneurysm: An Unusual Cause of Upper Gastrointestinal Bleed in 49 Years Old Patient

Hepatic artery aneurysm (HAA) is a rare disease. HAA is generally asymptomatic disease when symptomatic, they usually present with abdominal pain, upper gastrointestinal (GI) bleeding and/or jaundice, hypovolaemia secondary to rupture or GI bleeding with normal GI endoscopy. Surgical repair and endovascular treatment are the two therapeutic options available at present. Case report: A 49-year-old male presented at the emergency department with high gastrointestinal bleeding, abdominal pain and jaundice. Gastroscopy showed an ulcer with flat pigmented haematin on ulcer base (Forrest IIc) that was controlled by medical treatment. CT angiography was done and showed aneurysm of the proper hepatic artery almost totally thrombosed measuring 100 × 59 mm associated with signs of contained rupture. Emergency surgery was indicated. The laparotomy objectified a rupture of the aneurysm in the biliary tree in per operative excision of aneurysm and ligation of the hepatic pedicle was carried out. After surgery, the evolution was favorable with a follow-up of 8 months. Conclusion: HAA rupture is a rare cause of upper GI bleeding. The mortality rate after rupture is relatively high. CT angiography or MRI can diagnose a ruptured of HAA. Urgent surgery should be the first choice in patients with a ruptured HAA with active hemorrhage causing hemorrhagic shock.

Detection of Angioectasias and Haemorrhages Incorporated into a Multi-Class Classification Tool for the GI Tract Anomalies by Using Binary CNNs

The proposed deep learning algorithm will be integrated as a binary classifier under the umbrella of a multi-class classification tool to facilitate the automated detection of non-healthy deformities, anatomical landmarks, pathological findings, other anomalies and normal cases, by examining medical endoscopic images of GI tract. Each binary classifier is trained to detect one specific non-healthy condition. The algorithm analyzed in the present work expands the ability of detection of this tool by classifying GI tract image snapshots into two classes, depicting haemorrhage and non-haemorrhage state. The proposed algorithm is the result of the collaboration between interdisciplinary specialists on AI and Data Analysis, Computer Vision, Gastroenterologists of four University Gastroenterology Departments of Greek Medical Schools. The data used are 195 videos (177 from non-healthy cases and 18 from healthy cases) videos captured from the PillCam(R) Medronics device, originated from 195 patients, all diagnosed with different forms of angioectasia, haemorrhages and other diseases from different sites of the gastrointestinal (GI), mainly including difficult cases of diagnosis. Our AI algorithm is based on convolutional neural network (CNN) trained on annotated images at image level, using a semantic tag indicating whether the image contains angioectasia and haemorrhage traces or not. At least 22 CNN architectures were created and evaluated some of which pre-trained applying transfer learning on ImageNet data. All the CNN variations were introduced, trained to a prevalence dataset of 50%, and evaluated of unseen data. On test data, the best results were obtained from our CNN architectures which do not utilize backbone of transfer learning. Across a balanced dataset from no-healthy images and healthy images from 39 videos from different patients, identified correct diagnosis with sensitivity 90%, specificity 92%, precision 91.8%, FPR 8%, FNR 10%. Besides, we compared the performance of our best CNN algorithm versus our same goal algorithm based on HSV colorimetric lesions features extracted of pixel-level annotations, both algorithms trained and tested on the same data. It is evaluated that the CNN trained on image level annotated images, is 9% less sensitive, achieves 2.6% less precision, 1.2% less FPR, and 7% less FNR, than that based on HSV filters, extracted from on pixel-level annotated training data.

注射用泮托拉唑钠治疗上消化道出血的临床观察

目的 :对比观察国产新药注射用泮托拉唑钠和奥美拉唑粉针剂治疗上消化道出血的临床疗效及副作用。方法 :采用临床多中心随机单盲对照法。结果 :两组在临床症状和实验室检查方面 ,无显著性差异 (P >0 .0 5 )。副作用发生率分别为 2 1.9%和 2 9.2 % (P >0 .0 5 ) ,均无因药物不良反应中断治疗的患者。结论 :泮托拉唑钠和奥美拉唑疗效相当 ,不良反应轻微。

床边急诊胃镜诊治致死性非静脉曲张性上消化道大出血

目的探讨床边急诊胃镜在急性重症非静脉曲张性上消化道大出血诊治中的作用。方法154例致死性非静脉曲张性上消化道大出血病人,入院后即刻行床边急诊胃镜明确病因、部位及出血情况后胃镜下注射肾上腺素-利多卡因-高渗盐水止血。结果急诊诊断率94.2%,总有效率92.9%,再出血率9.0%,无不良反应。结论床边急诊胃镜能有效诊断急性致死性非静脉曲张性上消化道大出血,内镜下注射肾上腺素-利多卡因-高渗盐水能有效止血,安全、简便。

切除脾血管保留脾脏的胰体尾切除术后胃脾区血流情况的改变

目的观察切除脾血管保留脾脏的胰体尾切除术后胃脾区血流情况的改变。方法上海交通大学医学院附属新华医院于2005年7月—2010年3月间对11例患者行切除脾血管保留脾脏的胰体尾切除术,于术后第3、12个月进行上腹部CT血管造影(CTA)成像和纤维胃镜检查,观察脾脏大小、胃食管及周围静脉情况。结果术后平均随访(37.4±17.7)个月。术后3个月时CTA检查示,脾脏肿大4例(4/11),胃周静脉曲张3例(3/11),胃黏膜下静脉曲张1例(1/11)。术后12个月时复查CTA示,4例脾脏肿大患者中,1例缓解,3例基本保持稳定,无新发脾脏肿大;3例胃周静脉曲张患者的情况稳定无进展,无新发胃周静脉曲张;1例胃黏膜下静脉曲张患者的情况稳定无明显进展。术后3个月胃镜检查示胃壁静脉曲张1例,术后12个月复查胃镜示胃壁静脉曲张无进展。结论切除脾血管保留脾脏的胰体尾切除术后脾胃区血流发生改变,但无证据证实上消化道出血是其远期并发症。

胶囊内镜检查后上消化道大出血1例报道

46岁男性患者接受胶囊内镜检查后发生上消化道大出血,胃镜检查提示贲门黏膜撕裂,给予抗休克和三腔双囊管压迫等治疗措施后出血停止。胶囊内镜在胃内滞留诱发患者呕吐,剧烈的呕吐导致贲门黏膜撕裂引发上消化道大出血。因此对于胶囊内镜滞留胃内的患者要警惕出血的可能。

Ileoscopy in 39 hematochezia patients with normal colonoscopy

AIM： To assess the role of retrograde terminal ileoscopy in hematochezia patients with normal colonoscopy. METHODS： Between January 1997 and March 2005, 39 hematochezia patients （males 36, females 3, mean age 44.7 years） with a reported normal colonoscopy underwent a repeat colonoscopy. After reaching the cecum, attempt was made to localize the ileocecal valve and intubate the terminal ileum. Any abnormality in the mucosa of the terminal ileum was carefully recorded and biopsies were obtained from suspiciouslooking lesions. RESULTS： During the study period there were 39 patients admitted for hematochezia in whom colonoscopy till cecum did not reveal any abnormality. Fulllength colonoscopy till the cecum could be performed in all the patients. The terminal ileum could be intubated in 36 patients. No abnormality was noted in 31 patients. Ileal ulcers were noted in two patients. Noclularity along with ulceration of the ileal mucosa, a Dieulafoy＇s lesion, and an angiomatous malformation were noted in one patient each. Histological examination of the biopsies obtained from the ulcers revealed typical tuberculous lesion in the patient with nodularity and ulceration. One of the patients had typhoid ulcers and another had non-specific ulcers. CONCLUSION： Retrograde terminal ileoscopy gives limited but valuable information, in patients with hematochezia and should be attempted in all such patients.

Clinical presentation and endoscopic management of Dieulafoy's lesions in an urban community hospital

AIM:To identify rates of occurrence,common clinical and endoscopic features,and to review the outcome of endoscopic management of Dieulafoy's lesions in the upper gastrointestinal (GI) tract in an urban community hospital setting. METHODS:Endoscopic data from esophagogastroduo denoscopies (EGDs),done at Wyckoff Heights Medical Center,Brooklyn,NY between 2000 and 2006 were reviewed to identify patients with Dieulafoy's lesions. Demographic data,medical history,examination findings,lab data,endoscopic findings and details of therapy for patients treated for Dieulafoy's lesions were reviewed retrospectively. RESULTS:Dieulafoy's lesions were documented to be the cause of bleeding in approximately 1% of patients presenting with upper gastrointestinal bleeding,while they were detected in only 2 patients when the indications for EGDs were different from active GI bleeding. When we analyzed EGDs performed in patients above age 65 years presenting with gastrointestinal bleeding,prevalence of Dieulafoy's lesions approached 10 percent. The most common location of the lesion was the body of stomach (7),followed by the cardia (4) and the esophagus (2). One patient had this lesion in the fundus and one patient in the duodenal apex. All patients were initially treated endoscopically with epinephrine injection,in eight cases heater probe was applied following epinephrine and endoscopic clips were applied in two cases. All but one of the patients did well in near and intermediate term follow-up (average follow-up period of 18 mo). One patient died of multi-organ failure during the same hospital stay. Average length hospital stay was 7 d.CONCLUSION:Community hospital gastroenterologists and endoscopists should be aware that Dieulafoy's lesions are an uncommon cause of upper GI bleeding among elderly patients. Early accurate diagnosis through emergent endoscopy and endoscopic therapy,especially in patients with multiple co-morbid conditions,can be very effective and life saving.

急性上消化道出血合并体温变化的临床分析

目的观察急性上消化道出血时体温变化现象,探讨出血与体温变化的关系及治疗。方法对急性上消化道出血合并体温变化患者的临床资料进行回顾性分析。结果体温变化发生率73．2％,主要为发热,均为不规则热,出血后第3-5d体温最高,一般不超过38．5℃,发生率、热程、平均体温与出血程度呈正相关,发热与出血原因无明显关系,对于此类发热若体温不超过38．5℃可严密观察不作特殊处理,体温超过38．5℃可予物理降温;少部分体温可不升高,反而降至正常值以下,预后不佳,应积极采取复温措施。结论排除原发病、感染等所致发热后,体温变化对于判断急性上消化道出血程度、出血继续或停止以及转归与预后都有一定的帮助。

Blue rubber bleb nevus syndrome complicated with disseminated intravascular coagulation and intestinal obstruction: A case report

BACKGROUND Blue rubber bleb nevus syndrome is a rare vascular malformation syndrome with unclear etiopathogenesis and noncurative treatments.It is characterized by multiple vascular malformations of the skin,gastrointestinal tract,and other visceral organs.The most common symptoms are intermittent gastrointestinal bleeding and secondary iron deficiency anemia,thus requiring repeated blood transfusions and hospitalizations.It is easily missed and misdiagnosed,and there is no specific treatment.CASE SUMMARY We report a case of blue rubber bleb nevus syndrome combined with disseminated intravascular coagulation and efficacy of treatment with argon plasma coagulation under enteroscopy and sirolimus.A 56-year-old female patient was admitted to the hospital with 3-year history of fatigue and dizziness that had aggravated over the past 10 d with melena.The patient had a history of repeated melena and multiple venous hemangiomas from childhood.After treatment with argon plasma coagulation combined with sirolimus for nearly 8 wk,the patient’s serum hemoglobin increased to 100 g/L.At the 12-mo follow-up,the patient was well with stable hemoglobin(102 g/L)and no recurrent intestinal bleeding.CONCLUSION Argon plasma coagulation and sirolimus may be an efficacious and safe treatment for blue rubber bleb nevus syndrome,which currently has no recommended treatments.

便携式冲牙器对牙龈炎症患者口腔卫生维护效果的研究

目的·通过比较传统的菌斑控制方法(巴斯刷牙法)与其联合便携式冲牙器对牙龈炎和轻度慢性牙周炎成人患者光滑面菌斑控制和牙龈炎症控制效果的差别,明确冲牙器在口腔卫生维护中的作用。方法·共纳入78例牙龈炎和轻度慢性牙周炎成人患者,随机分为2组,即使用牙刷(对照组)和牙刷联合便携式冲牙器(实验组)。在基线、2周和6周后测量患者的菌斑指数(plaque index,PLI)、牙龈指数(gingiva index,GI)、出血指数(bleeding index,BI)和菌斑百分率。结果·对照组和实验组在连续口腔卫生维护2周后,PLI、BI、GI和菌斑百分率均较基线时降低(均P<0.05)。对照组和实验组在6周后,PLI、BI、GI和菌斑百分率均较基线时降低(均P<0.05)。连续口腔卫生维护2周及6周后,对照组和实验组的光滑面和邻面的BI较基线时均有所改善,且实验组光滑面和邻面的BI改善程度均显著优于对照组(均P<0.05)。结论·便携式冲牙器可以在牙周治疗和维护期间辅助患者实现更好的口腔卫生,帮助患者达到并维持牙周健康。

口腔卫生维护对固定矫治患者牙周健康状况的评价性分析

目的调查固定矫治患者治疗前后口腔卫生行为的改变,及矫治中菌斑指数(PLI)、牙龈指数(GI)和龈沟出血指数(SBI)的分布及变化。方法选取在中国人民解放军总医院口腔正畸科接受治疗的患者323例(男146例,女177例)。所有入组患者填写"固定矫治患者口腔卫生行为问卷调查表",并在粘接固定矫治器前及复诊中,记录PLI、GI、SBI指数。结果经过口腔卫生宣教,患者口腔卫生习惯、饮食习惯以及口腔自检状况均有显著改善。自锁矫治器患者的菌斑指数低于非自锁矫治器患者,差异有统计学意义(P<0.05),女性患者的菌斑指数与牙龈指数均低于男性患者,差异有统计学意义(P<0.05),治疗中每两个月进行口腔牙周状况的检查,PLI、GI、SBI指数平不高于固定矫治器粘接前。拔牙或非拔牙、陶瓷或金属矫治器的选择对于PLI、GI、SBI值的影响没有统计学差异,差异无统计学意义(P>0.05)。结论正畸医师要严格控制菌斑形成,做好口腔卫生宣教与口腔健康监控,有效维持矫治中口腔内环境的健康与稳定。

上消化道出血凝血机制的研究

对75例分别接受H_2受体拮抗剂、止血剂和葡萄糖盐水治疗的上消化道出血患者,于治疗前后进行凝血指标及血液流变学检测。所有患者治疗前除VWF:Ag轻度升高,红细胞比积轻度降低外,其他指标均在正常范围。3组患者治疗前后检测结果,3组之间对比差异无统计学意义(P>0.05)。提示上消化道出血患者凝血功能没有明显的障碍,止血剂的使用是没有意义的。

脑出血患者上消化道出血早期防治探讨

目的探讨高血压脑出血患者早期使用西咪替丁、洛赛克鼻饲饮食防治上呼吸道出血的效果。方法对45例高血压脑出血患者早期应用西咪替丁、洛赛克，昏迷患者3天后或进食呛咳者给予鼻饲引流，观察上呼吸道出血情况。结果45例患者中，8例合并上呼吸道出血，经治疗4例3天内出血停止，2例死亡。讨论高血压脑出血早期使用西咪替丁、洛赛克，鼻饲给药可以预防和治疗上消化道出血并发症。

贲门周围血管离断术后上消化道再出血的原因分析和诊治

目的 :分析贲门周围血管离断术后上消化道再出血的原因 ,以提高诊断水平及治疗效果。方法 :总结 36例贲门周围血管离断术后上消化道再出血病人 ,对其出血原因、诊疗经过及其治疗效果进行回顾性分析。结果 :贲门周围血管离断术后上消化道再出血的原因依次为食管胃底曲张静脉破裂出血、胃粘膜病变出血和溃疡病出血。3 6例病人中 2 9例手术治疗 ,2 8例痊愈 ,1例死亡 ,7例保守治疗获痊愈。结论 :再手术治疗和保守治疗都能取得较好的效果 ,关键在于正确选择适应证。提倡断流的彻底性和适当保护肝功能、改善肝脏的微循环可望减少这些并发症。

肝动脉插管化疗与栓塞治疗肝癌后消化道出血及防治

肝动脉插管灌注化疗与栓塞治疗中晚期肝癌３１０例（５６０次）中，并发消化道出血１３例，发生率占全组病例的４．１９％。出血原因有：ＩＣ６例；肝功能损害，凝血机制差３例；化疗药对胃粘膜毒性作用和部分栓子误入胃供血动脉２例；食管静脉曲张破裂１例；肝肿瘤破裂１例。本文对消化道出血原因与防治方法进行了探讨，并建议在行肝动脉灌注化疗和栓塞治疗前采取肝功能估计和预防出血的方法，以减少因出血、肝衰及感染造成的死亡。

急诊胃镜下止血导致吸入性肺炎的相关危险因素分析

目的 虽然所有的内窥镜手术都有吸入性肺炎的风险,但医生对内镜操作后发生吸入性肺炎的因素知之甚少。本研究旨在确定急诊内窥镜止血后吸入性肺炎的危险因素。方法 对2018年1月至2020年1月本院急诊上消化道出血经内窥镜治疗的患者214人进行回顾性分析,病人的资料及临床特点,包括上消化道出血的原因,内镜止血时间,生命体征以及术后是否发生吸入性肺炎等。采用单因素和多因素logistic回归分析对患者合并吸入性肺炎的相关危险因素进行筛查,并进一步分析患者预后情况。结果 在214例急诊经内镜止血的患者中30例(14%)发生了吸入性肺炎。多因素分析显示年龄大于75岁(优势比(OR)5.99;95%置信区间(CI)1.7-13.8;P=0.017),内镜操作持续时间大于30分钟(OR为3.73;95%CI 1.4-18.1;P=0.027),既往有脑血管病史(OR为4.8;95%CI 1.6-14.7;P=0.02)是独立的危险因素导致吸入性肺炎。结论 急诊经内镜下止血后患吸入性肺炎的发生与患者高龄,既往有脑中风、帕金森等脑血管病史,内镜操作时间长密切相关,在治疗这些患者时,应制定相应的预防措施以降低吸入性肺炎发生率和改善预后。