Predicting the outcome of transhepatic embolisation to control life-threatening haemorrhage from oesophageal varices

Acute haemorrhage from ruptured oesophageal varices is a serious consequence of portal hypertension in cirrhotic patients. It represents a medical emergency with a high morbidity and mortality rate. Studies over the years have shown a direct link with chronic alcoholism in the development of such complications. Although the gastrointestinal system accounts for a few numbers of sudden deaths, bleeding through ruptured varices represent a life-threatening condition. The role of forensic pathologist is vital in dealing with sudden deaths. Here, we report a case of a 46-year-old man who died suddenly following the rupture of oesophageal varices.

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The potential lethality of caput medusae

Medicine Science and the Law ◽

10.1177/0025802420986704 ◽

2021 ◽

pp. 002580242098670

Author(s):

Marianna Russo ◽

Matteo Bolcato ◽

Anna Aprile

Keyword(s):

Portal Hypertension ◽

Medical Malpractice ◽

Scientific Literature ◽

Vascular Lesion ◽

The Body ◽

Oesophageal Varices ◽

Negative Consequences ◽

External Examination ◽

Threatening Condition ◽

Life Threatening

While gastro-oesophageal varices commonly complicate portal hypertension and may be a life-threatening condition, fatal haemorrhaging from cirrhosis-related caput medusae has seldom been described in the scientific literature. This article documents a rare death due to the rupture of a varix in the umbilical area. This case raises a number of points for medico-legal discussion, such as the negative consequences of an erroneous cause of death in evaluating medical malpractice cases and the importance of a thorough external examination of the body in order to ensure this type of vascular lesion is not overlooked.

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Management of oesophageal variceal haemorrhage

Current Surgical Guidelines ◽

10.1093/med/9780198794769.003.0028 ◽

2018 ◽

pp. 259-266

Author(s):

Abdullah Jibawi ◽

Mohamed Baguneid ◽

Arnab Bhowmick

Keyword(s):

Risk Reduction ◽

Low Risk ◽

Oesophageal Varices ◽

Variceal Haemorrhage ◽

Surveillance Strategy ◽

Pharmacological Prophylaxis ◽

International Guidelines ◽

Life Threatening ◽

Cirrhotic Patients ◽

Acute Haemorrhage

Haemorrhage from oesophageal varices is potentially life-threatening and occurs unpredictably. Risk reduction can be achieved by identifying varices in cirrhotic patients and employing a surveillance strategy for low-risk cases, or pharmacological prophylaxis in higher-risk cases. This chapter sets out a summary of current national/international guidelines and includes detailed recommendations for management of acute haemorrhage including terlipressin, endoscopic EVL/sclerotherapy and Sengastaken tube therapy and TIPS.

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Prescribing Warfarin to a Patient with Oesophageal Varices—A Case Report and Review of the Literature

Reports ◽

10.3390/reports1030018 ◽

2018 ◽

Vol 1 (3) ◽

pp. 18

Author(s):

Jayan George ◽

Hasan Haboubi

Keyword(s):

Therapeutic Option ◽

Factor V Leiden ◽

Oesophageal Varices ◽

Factor V ◽

Vein Thrombosis ◽

Subsequent Investigation ◽

Upper Gastrointestinal Bleed ◽

Life Threatening ◽

Endoscopic Investigation ◽

State Factor

We describe the case of a 42-year old man who presented with melaena. He was found to have bleeding varices during endoscopic investigation. Subsequent investigation revealed the aetiology to be a portal vein thrombosis (PVT) due to an underlying pro-coagulable state (Factor V Leiden). He was managed with cautious anticoagulation but suffered a life-threatening upper gastrointestinal bleed that was not amenable to endoscopic treatment or transjugular intrahepatic portosystemic shunting (TIPS). As such, the only therapeutic option involved the pursuit of surgical shunt operations. We review the literature regarding this atypical cause of GI-bleeding and discuss medical and surgical considerations for the management of such patients.

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Assembly of VP26 in herpes simplex virus-1 capsid implicated by 3-D structure of recombinant capsid

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100140579 ◽

1995 ◽

Vol 53 ◽

pp. 840-841

Author(s):

Z. Hong Zhou ◽

Jing He ◽

Joanita Jakana ◽

J. D. Tatman ◽

Frazer J. Rixon ◽

...

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

3D Structure ◽

Structure Study ◽

Herpes Simplex Virus 1 ◽

Shell Proteins ◽

Life Threatening ◽

Infected Cells ◽

Simplex Virus ◽

Hsv 1

Herpes simplex virus-1 (HSV-1) is a ubiquitous virus which is implicated in diseases ranging from self-curing cold sores to life-threatening infections. The 2500 Å diameter herpes virion is composed of a glycoprotein spike containing, lipid envelope, enclosing a protein layer (the tegument) in which is embedded the capsid (which contains the dsDNA genome). The B-, and A- and C-capsids, representing different morphogenetic stages in HSV-1 infected cells, are composed of 7, and 5 structural proteins respectively. The three capsid types are organized in similar T=16 icosahedral shells with 12 pentons, 150 hexons, and 320 connecting triplexes. Our previous 3D structure study at 26 Å revealed domain features of all these structural components and suggested probable locations for the outer shell proteins, VP5, VP26, VP19c and VP23. VP5 makes up most of both pentons and hexons. VP26 appeared to bind to the VP5 subunit in hexon but not to that in penton.

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An Overview of Dementias

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd21.3.75 ◽

2012 ◽

Vol 21 (3) ◽

pp. 75-84

Author(s):

Venkata Vijaya K. Dalai ◽

Jason E. Childress ◽

Paul E Schulz

Keyword(s):

Clinical Presentation ◽

Treatment Options ◽

Current Treatment ◽

Great Variability ◽

Health Concern ◽

Public Health Concern ◽

Life Threatening ◽

The Common ◽

Neurodegenerative Dementias ◽

Made In

Dementia is a major public health concern that afflicts an estimated 24.3 million people worldwide. Great strides are being made in order to better diagnose, prevent, and treat these disorders. Dementia is associated with multiple complications, some of which can be life-threatening, such as dysphagia. There is great variability between dementias in terms of when dysphagia and other swallowing disorders occur. In order to prepare the reader for the other articles in this publication discussing swallowing issues in depth, the authors of this article will provide a brief overview of the prevalence, risk factors, pathogenesis, clinical presentation, diagnosis, current treatment options, and implications for eating for the common forms of neurodegenerative dementias.

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