Treatment of bleeding stomach ulcers

1927 ◽  
Vol 23 (4) ◽  
pp. 467-467
Keyword(s):  
Surgical Intervention ◽  
Gastric Ulcers ◽  
Recurrent Bleeding ◽  
Severe Bleeding ◽  
Stomach Ulcers

Considering indications for surgical intervention in bleeding gastric ulcers, the author divides cases of this kind into 2 groups: 1) cases where the ulcer is accompanied by a single severe bleeding, and 2) cases where there is acute recurrent bleeding.

scholarly journals Jejunostomia. Alkan (Deut. med. Woch., 1921, No. 51)

2021 ◽  
Vol 19 (1) ◽  
pp. 96-96
Keyword(s):  
Surgical Intervention ◽  
Gastric Ulcers ◽  
Severe Bleeding ◽  
Therapeutic Value ◽  
Multiple Ulcers

This operation is the best type of surgical intervention for fresh burns of the esophagus and stomach. In older calloused, perforating gastric ulcers, especially those lying closer to the cardia, as well as in case of multiple ulcers and severe bleeding it is equal to resection in its therapeutic value, especially in severely weakened patients.

Thrombolysis in Arterial Occlusion

1999 ◽  
Vol 82 (S 01) ◽  
pp. 109-111 ◽  
Author(s):  
Raymond Verhaeghe
Keyword(s):  
Clinical Practice ◽  
Thrombolytic Therapy ◽  
Hemorrhagic Stroke ◽  
Surgical Intervention ◽  
Bypass Graft ◽  
Surgical Techniques ◽  
Arterial Occlusion ◽  
Second Step ◽  
Severe Bleeding ◽  
Initial Management

SummaryIntra-arterial thrombolytic therapy has replaced systemic intravenous infusion of thrombolytic agents as a treatment modality for arterial occlusion in the limbs. Several catheter-guided techniques and various infusion methods and schemes have been developed. At present there is no scientific proof of definite superiority of any agent in terms of efficacy or safety but clinical practice favours the use of urokinase or alteplase. Studies which compared thrombolysis to surgical intervention suggest that thrombolytic therapy is an appropriate initial management in patients with acute occlusion of a native leg artery or a bypass graft. Underlying causative lesions are treated in a second step by endovascular or open surgical techniques. Severe bleeding is the most feared complication: the risk of hemorrhagic stroke is 1-2%.

scholarly journals Development of antibodies to thrombin and factor V with recurrent bleeding in a patient exposed to topical bovine thrombin

Blood ◽  
1990 ◽  
Vol 76 (10) ◽  
pp. 2011-2016 ◽  
Author(s):  
JL Zehnder ◽  
LL Leung
Keyword(s):  
Enzyme Linked Immunosorbent Assay ◽  
Recurrent Bleeding ◽  
Severe Bleeding ◽  
Factor V ◽  
Bleeding Events ◽  
Bovine Thrombin ◽  
Normal Plasma ◽  
Human Thrombin ◽  
Immunomodulatory Therapies ◽  
Bovine Factor

Abstract A 65 year old patient who was exposed to topical bovine thrombin during cardiac surgery developed markedly prolonged clotting times and a severe bleeding diathesis. Mixing studies with normal plasma failed to correct the clotting times. Platelet transfusions, immunosuppressive and immunomodulatory therapies were ineffective, but plasmapheresis was effective in decreasing clotting times and in the resolution of clinical bleeding events. The patient's purified IgG reacted with bovine thrombin by immunoblotting and enzyme-linked immunosorbent assay (ELISA). However, the IgG reacted minimally with human thrombin. In view of the severe bleeding, a coexisting inhibitor was sought. The patient's factor V activity was 1% of normal and was not corrected by mixing with normal plasma, demonstrating the presence of an inhibitor against factor V. The patient's IgG reacted with both bovine and human factor V. Immunoblotting localized the site of antibody binding to the light chain of activated bovine factor V. Detectable amounts of bovine factor V were found in commercial bovine thrombin preparations by ELISA. The data suggest that patients exposed to topical bovine thrombin may develop antibodies to thrombin and factor V. Anti-thrombin antibodies may mask coexisting factor V inhibitors responsible for clinical bleeding.

Menorrhagia in Women with Severe Bleeding Disorders

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4626-4626
Author(s):  
Susan Halimeh ◽  
Joanna Davies ◽  
Debra Pollard ◽  
Rezan Abdul-Kadir
Keyword(s):  
Tranexamic Acid ◽  
Surgical Intervention ◽  
Postoperative Bleeding ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Bleeding Disorders ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment ◽  
Factor Concentration

Abstract Abstract 4626 The management of menorrhagia presents a challenge in women with severe bleeding disorders. Conservative medical management is the first line treatment and most women with severe bleeding disorder require combination treatment. Surgical intervention may ultimately be offered to women in whom medical management has failed and whom no longer desire fertility. Women with low factor levels are at risk of perioperative bleeding complications and may require haemostatic support. A total of 50 women with severe factor deficiencies (less than 20iu/dL) were included in this study. 46 women were registered at the Haemophilia Centre at the Royal Free Hospital in London. Four cases were also included from the Rhine-Ruhr Haemophilia Centre in Duisburg, Germany. We reviewed the occurrence of menorrhagia and the management options that were offered. In those that required surgical intervention, the incidence of postoperative bleeding complications and the requirement for factor concentration was also reviewed. The bleeding disorders in these women were 34 (68%) with severe factor XI deficiency, 10 (20%) with severe type 1 and type 3 von Willebrand's disease, 4 (8%) with factor VII deficiency, 2 (4%) had factor V or X deficiencies and one (2%) had a combination of factor VI and VIII deficiency. The ISTH/SSC joint working group bleeding assessment tool was used to assess the severity and frequency of bleeding symptoms among this cohort of women. The bleeding scores ranged from −2 to 30 with a median score of 9.5. In total, 32 out of 50 (64%) women with severe factor deficiency required medical attention for menorrhagia. Medical treatment included hormonal preparations (combined oral contraceptive pill or levonorgestrel intrauterine device), which was used as a first line treatment in 15 out of 32 (46.8%) women. Haemostatic treatment included antifibrinolytic medication such as tranexamic acid, which was used in combination with hormonal therapy. One women required intranasal DDAVP, von Willebrand factor concentrate and tranexamic acid. Failure to control menstrual bleeding occurred in 14 (43.7%) women and surgical intervention was required. 7 out of 14 (50%) women required hysterectomy and the remaining 7 women underwent endometrial ablation. Prophylaxis with factor concentration to cover surgical intervention was given in 8 out of 14 women (64.2%). The remainder received tranexamic acid for 24–48 hours following surgery. Postoperative bleeding occurred in 7 women that had surgical intervention, despite two women receiving prophylaxis. This study highlights the complexity involved in the management of menorrhagia in women with severe bleeding disorders and the high risk of postoperative bleeding. Disclosures: No relevant conflicts of interest to declare.

Peptic ulcer disease

2020 ◽  
pp. 2849-2861
Author(s):  
Joseph Sung
Keyword(s):  
Peptic Ulcer ◽  
Proton Pump Inhibitor ◽  
Peptic Ulcer Disease ◽  
Proton Pump ◽  
Gastric Ulcers ◽  
High Dose ◽  
Recurrent Bleeding ◽  
Ulcer Disease ◽  
H Pylori ◽  
Line Of Therapy

Helicobacter pylori infection, use of nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin, and smoking are the most important causes of peptic ulcer disease. Peptic ulcer disease is characterized by a history of waxing and waning symptoms of localized, dull, aching pain in the upper abdomen. Bleeding is the most common complication; free perforation of the stomach or duodenum into the peritoneal cavity is uncommon but serious. The diagnosis of peptic ulcer disease is made by endoscopy, which offers an opportunity for biopsy of gastric ulcers (which may be malignant) and reveals important prognostic indicators in patients with bleeding ulcers. A single daily dose of a proton pump inhibitor gives quick relief of symptoms and effective healing of peptic ulcers in 4 to 6 weeks. The management of patients with upper gastrointestinal haemorrhage requires a multidisciplinary medical and surgical approach. Early risk stratification based on clinical and endoscopic criteria allows delivery of appropriate care, with endoscopic intervention now widely accepted as the first line of therapy. This should be followed by administration of a high dose of an intravenous proton pump inhibitor to further reduce recurrent bleeding. Treatment of H. pylori is a cure for peptic ulcer disease in most patients. This usually requires at least two antimicrobial agents, with the most popular triple therapy combining a proton pump inhibitor with any two of amoxicillin, metronidazole, and clarithromycin for 7 to 14 days. Eradication of H. pylori infection, avoidance of high-dose NSAIDs or aspirin, and the maintenance use of proton pump inhibitors in high-risk individuals are the best ways to prevent recurrence of ulcer and ulcer complications.

Transcatheter embolization in prevention of recurrent bleeding from stomach ulcers

2017 ◽  
pp. 31 ◽  
Author(s):  
N. V. Lebedev ◽  
G. E. Belozerov ◽  
A. E. Klimov ◽  
P. Yu. Sokolova ◽  
A. A. Spasskiy ◽  
...  
Keyword(s):  
Transcatheter Embolization ◽  
Recurrent Bleeding ◽  
Stomach Ulcers

Inhibitors in Hemophilia: Treatment Challenges and Novel Options

2017 ◽  
Vol 44 (06) ◽  
pp. 544-550 ◽  
Author(s):  
Assaf Barg ◽  
Tami Livnat ◽  
Gili Kenet
Keyword(s):  
Replacement Therapy ◽  
Joint Damage ◽  
Therapy Response ◽  
Factor Ix ◽  
Individual Therapy ◽  
Optimal Decision ◽  
Recurrent Bleeding ◽  
Severe Bleeding ◽  
Bleeding Tendency ◽  
Bypassing Agents

AbstractHemophilia A (HA) and hemophilia B (HB) are rare congenital severe bleeding disorders, that may be controlled by proper administration of adequate prophylaxis with factor VIII (FVIII), and factor IX (FIX) concentrates, respectively, to prevent joint damage due to recurrent bleeding. However, approximately 30% of patients develop inhibitory antibodies that render factor replacement therapy ineffective. Due to the high variability of patients' bleeding tendency, there is a need to “individually tailor treatment” for this unique group of patients. While replacement therapy with FVIII or FIX can be used for treating HA or HB patients with low responding inhibitors, hemophilia patients with high-responding inhibitors are treated with bypassing agents. Unfortunately, the Bethesda assay applied for inhibitor measurement in most laboratories does not fully predict either bleeding tendency or therapy response. Immune tolerance induction (ITI) may eradicate most inhibitors, yet treatment is challenging during bleeding episodes. The role of bypassing agents and their various treatment strategies still deserves attention. Recently, new nonreplacement therapies have emerged for patients with hemophilia including patients with inhibitors. Adequate monitoring of bypassing therapy and of the new nonreplacement therapies in inhibitor patients is extremely challenging, thus global hemostatic assays are increasingly used to assess clot formation. This review aims to summarize the current treatment and monitoring challenges for inhibitor patients; in this perspective, we will discuss our institutional approach for optimal decision-making and individual therapy tailoring.

scholarly journals Cost-Effectiveness of Intravenous Proton Pump Inhibitors in High-Risk Bleeders

2004 ◽  
Vol 18 (12) ◽  
pp. 749-750
Author(s):  
Sander Veldhuyzen van Zanten
Keyword(s):  
Cost Effectiveness ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Gastric Ulcers ◽  
Recurrent Bleeding ◽  
Gi Bleeding ◽  
H2 Blockers ◽  
Rapid Healing ◽  
Upper Gastrointestinal

There is unequivocal evidence that proton pump inhibitors (PPIs) are currently the most effective acid suppressive agents available. Intravenous (IV) formulations have been developed, although only IV pantoprazole is available in Canada. In patients presenting with serious upper gastrointestinal (GI) bleeding due to duodenal or gastric ulcers, it has always been believed that IV administration of acid-lowering agents would improve clinical outcomes. The reason behind this thinking is twofold. First, there is in vitro evidence that formed clots are more stable at or near neutral pH (1). Second, by administering the agent intravenously, suppression of acid production is achieved much more quickly, thereby promoting more rapid healing of the ulcer and reducing the risk of persistent or recurrent bleeding. Interestingly and surprisingly, however, the data for intravenous H2-blockers have been disappointing (2). This failure to demonstrate clinical benefit has never been fully explained.

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