1/17. Postbulbar duodenal ulcer.Postbulbar duodenal ulceration is not common, but when present is difficult to diagnose and treat. Between January 1965 and September 1971, 1,080 patients with duodenal ulcers were treated surgically at St James Hospital. Forty-one ulcers were found at operation to lie distal to the duodenal bulb. pain was the most common indication for surgery. In six-patients it was clinically indistinguishable from biliary pain, giving rise to diagnostic difficulty. Twelve patients (29%) presented with haemorrhage, a percentage similar to the 25% of bulbar ulcers presenting with this complication over the period of this study. This is contrary to the finding in most other series, that postbulbar ulceration is more frequently complicated by haemorrhage than is bulbar ulceration. Perforation and stenosis are uncommon complications. Postbulbar ulceration is easily overlooked in conventional barium studies. Only one-third of the patients subjected to barium meal x-ray examination had their ulcers identified in the first study. In a further third the presence of an ulcer was suspected, and the remainder required multiple investigations for undiagnosed symptoms before the condition was demonstrated. duodenoscopy was not performed in a sufficient number of patients for its value to be assessed, but other reports indicate that it should be a valuable manoeuvre. The technical difficulties and potential hazards of Polya gastrectomy are discussed and special reference is made to the surgical management of bleeding postbulbar ulcers.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/17. blindness following gastrointestinal haemorrhage.Loss of vision is a rare but well known complication of distant and recurrent haemorrhage. It shares a poor prognosis, with only 10-14% of cases likely to make a complete recovery. Visual symptoms, due to ischaemic anterior optic neuropathy, vary from blurred vision to complete loss of vision in one or both eyes. The pathogenesis of such ischaemia remains unclear. Gastrointestinal bleeding seems to be the leading cause of loss of vision secondary to haemorrhage. However, complete and permanent blindness following gastrointestinal bleeding has rarely been reported. We report the case of a 51 -year-old woman who complained of complete blindness following blood loss, secondary to peptic ulcer, and discuss the pathogenesis of such a complication.- - - - - - - - - - ranking = 3keywords = haemorrhage (Clic here for more details about this article) |
3/17. Post-tonsillectomy bleed: a delayed diagnosis of duodenal ulceration.Post-operative haemorrhage is one of the commonest complications of tonsillectomy. We report a case of a 36-year-old lady who presented with three haemorrhagic episodes following tonsillectomy. Although initially treated as secondary tonsillar haemorrhage, the actual cause of the bleeding was later identified to be a duodenal ulcer. The case is presented with a review of the literature.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
4/17. Protein A sepharose immunoadsorption: immunological and haemostatic effects in two cases of acquired haemophilia.Acquired haemophilia is a life-threatening disorder caused by circulating auto-antibodies that inhibit factor viii coagulant activity (FBIII:C). Immunoadsorption on protein A sepharose (IA-PA) was performed in two bleeding patients with acquired haemophilia: we observed a dramatic and quick decrease in the anti-FVIII:C inhibitor titre leading to a normal, albeit transient, haemostatic status. In one case, IA-PA was the only procedure which succeeded in stopping massive haemorrhage. In the second case, IA-PA reinforced the haemostatic effect of recombinant activated factor VII by increasing the endogenous plasma factor viii level. The efficacy of IA-PA was sustained with immunosuppressive treatment introduced, respectively, 10 and 15 d before the IA-PA procedures. Our experience with IA-PA suggests that this extracorporeal anti-FVIII:C removal procedure is a valuable therapeutic tool for acquired haemophilia and can alleviate life-threatening haemorrhages.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
5/17. Management of massive upper gastrointestinal haemorrhage from multiple sites of peptic ulceration with somatostatin and octreotide--a report of five cases.Surgical management of massive upper gastrointestinal bleeding after failed medical treatment may be hazardous because of diffuse bleeding from several sites, further complicated in some patients by intercurrent disease, age, or previous surgery. Experience with combined somatostatin and octreotide therapy in five such patients is described. All were treated initially with either intravenous somatostatin (250 micrograms/hour) or octreotide (Sandostatin) (50 micrograms/hour) for periods ranging from three to five days, after which they were given subcutaneous octreotide (50 or 100 micrograms three times daily). Bleeding was controlled by this regimen in all cases. The patients were all discharged from hospital on either ranitidine (n = 4) or omeprazole (n = 1). Repeat endoscopy at the end of the treatment period with somatostatin and octreotide (n = 1) or four weeks after discharge (n = 3) showed complete healing of the bleeding sites. somatostatin and octreotide may be of value in controlling severe upper gastrointestinal bleeding in patients in whom surgery is hazardous because of bleeding from several peptic lesions further complicated in some by intercurrent disease or age.- - - - - - - - - - ranking = 2keywords = haemorrhage (Clic here for more details about this article) |
6/17. Severe acute haemorrhagic gastritis controlled by hydrogen peroxide.A 92-year-old woman presented with severe acute haemorrhagic gastritis due to abuse of non-steroidal anti-inflammatory drugs (NSAIDs). She was treated with instillation of 150 ml 3% hydrogen peroxide (H2O2) every 2 h via a nasogastric tube. The copious amount of bright red blood through the nasogastric tube started to decline substantially after the first administration of H2O2 and continued to reveal clear material during the second and third instillation of H2O2. The total amount of H2O2 administered was 600 ml. No rebleeding and only a few flame-shaped intramucosal haemorrhages were observed on the following four consecutive daily endoscopic evaluations. These are promising observations which will have to be confirmed with respect to the safety and efficacy of H2O2 treatment by further controlled studies.- - - - - - - - - - ranking = 0.5keywords = haemorrhage (Clic here for more details about this article) |
7/17. plasma exchange as a treatment for endogenous glycosaminoglycan anticoagulant induced haemorrhage in a patient with myeloma kidney.A 57-year-old man with end-stage renal failure secondary to myeloma kidney developed haemorrhagic complications due to endogenous glycosaminoglycan anticoagulant production. Glycosaminoglycan levels and anticoagulant effect were reduced by plasma exchange and this contributed to control of the haemorrhagic manifestations.- - - - - - - - - - ranking = 2keywords = haemorrhage (Clic here for more details about this article) |
8/17. Complicated peptic ulceration in a child.The dual complications of haemorrhage and perforation from a peptic ulcer only rarely co-exist synchronously in adults and even more rarely in children. We report a case in an adolescent.- - - - - - - - - - ranking = 0.5keywords = haemorrhage (Clic here for more details about this article) |
9/17. pancreatic pseudocyst haemorrhage presenting as a bleeding duodenal ulcer.We present a case of upper gastrointestinal haemorrhage where the preoperative endoscopic findings suggested a duodenal ulcer as the cause. Although at operation this proved to be the site of bleeding, the source was found to be the splenic artery in the base of a pancreatic pseudocyst.- - - - - - - - - - ranking = 2.5keywords = haemorrhage (Clic here for more details about this article) |
10/17. A caliber-persistent artery of the gastric wall resulting in fatal haemorrhage.A 12-year-old girl was admitted to hospital with haematemesis. Her family suffered from histidinaemia. Due to her numerous injuries the police suspected a crime. After a short period of clinical treatment she died. autopsy showed the left ureter to be narrowed and a consecutive abscedens pyelonephritis. Pyloric ulcer caused erosion of a caliber-persistent artery which led to death with haemorrhage. The death had nothing to do with violence. Adequate surgical treatment could have saved the patient's life.- - - - - - - - - - ranking = 2.5keywords = haemorrhage (Clic here for more details about this article) |
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