Severe bleeding from misdiagnosed urethral prolapse in two young girls

Five new cases of circular urethral prolapse in young girls occurred. All had vaginal bleeding. The proposed etiologies, differential diagnoses, management, and treatment are presented. Prolapse of the urethra should be considered in the differential diagnosis of girls with minimal bleeding per vaginam.

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Urethral prolapse in young girls

Journal of Pediatric Surgery ◽

10.1016/0022-3468(75)90341-3 ◽

1975 ◽

Vol 10 (2) ◽

pp. 295-296

Author(s):

Clifford Rubin

Keyword(s):

Urethral Prolapse ◽

Young Girls

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Anticoagulation in addition to dual antiplatelet therapy has no impact on long-term follow-up after endovascular treatment of (sub)acute lower limb ischemia

VASA ◽

10.1024/0301-1526/a000786 ◽

2019 ◽

Vol 48 (4) ◽

pp. 321-329

Author(s):

Mariya Kronlage ◽

Erwin Blessing ◽

Oliver J. Müller ◽

Britta Heilmeier ◽

Hugo A. Katus ◽

...

Keyword(s):

Endovascular Treatment ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Limb Ischemia ◽

Bleeding Complications ◽

Severe Bleeding ◽

Short Term ◽

Long Term Follow Up

Summary. Background: To assess the impact of short- vs. long-term anticoagulation in addition to standard dual antiplatelet therapy (DAPT) upon endovascular treatment of (sub)acute thrombembolic occlusions of the lower extremity. Patient and methods: Retrospective analysis was conducted on 202 patients with a thrombembolic occlusion of lower extremities, followed by crirical limb ischemia that received endovascular treatment including thrombolysis, mechanical thrombectomy, or a combination of both between 2006 and 2015 at a single center. Following antithrombotic regimes were compared: 1) dual antiplatelet therapy, DAPT for 4 weeks (aspirin 100 mg/d and clopidogrel 75 mg/d) upon intervention, followed by a lifelong single antiplatelet therapy; 2) DAPT plus short term anticoagulation for 4 weeks, followed by a lifelong single antiplatelet therapy; 3) DAPT plus long term anticoagulation for > 4 weeks, followed by a lifelong anticoagulation. Results: Endovascular treatment was associated with high immediate revascularization (> 98 %), as well as overall and amputation-free survival rates (> 85 %), independent from the chosen anticoagulation regime in a two-year follow up, p > 0.05. Anticoagulation in addition to standard antiplatelet therapy had no significant effect on patency or freedom from target lesion revascularization (TLR) 24 months upon index procedure for both thrombotic and embolic occlusions. Severe bleeding complications occurred more often in the long-term anticoagulation group (9.3 % vs. 5.6 % (short-term group) and 6.5 % (DAPT group), p > 0.05). Conclusions: Our observational study demonstrates that the choice of an antithrombotic regime had no impact on the long-term follow-up after endovascular treatment of acute thrombembolic limb ischemia whereas prolonged anticoagulation was associated with a nominal increase in severe bleeding complications.

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No Country For Young Girls?

PsycEXTRA Dataset ◽

10.1037/e609922010-001 ◽

2008 ◽

Author(s):

Nupur Basu ◽

Keyword(s):

Young Girls

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When Girls Have Been Sexually Abused: A Guide for Young Girls

PsycEXTRA Dataset ◽

10.1037/e612642012-001 ◽

2008 ◽

Keyword(s):

Sexually Abused ◽

Young Girls

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Thrombolysis in Arterial Occlusion

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615565 ◽

1999 ◽

Vol 82 (S 01) ◽

pp. 109-111 ◽

Cited By ~ 3

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%.

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Inhibitor treatment by rituximabin congenital haemophilia A

Hämostaseologie ◽

10.1055/s-0037-1617028 ◽

2009 ◽

Vol 29 (02) ◽

pp. 151-154 ◽

Cited By ~ 13

Author(s):

Escuriola Ettingshausen ◽

R. Linde ◽

G. Kropshofer ◽

L.-B. Zimmerhackl ◽

W. Kreuz ◽

...

Keyword(s):

B Cell ◽

Immune Tolerance ◽

High Titre ◽

Clotting Factor ◽

Severe Bleeding ◽

High Morbidity ◽

Haemophilia A ◽

Concomitant Treatment ◽

Bleeding Tendency ◽

Severe Haemophilia

SummaryThe development of neutralizing alloanti-bodies (inhibitors) to factor VIII (FVIII) is one of the most serious complications in the treatment of haemophiliacs. Inhibitors occur in approximately 20 to 30% of previously untreated patients (PUPs), predominantly children, with severe haemophilia A within the first 50 exposure days (ED). Immune tolerance induction (ITI) leads to complete elimination of the inhibitor in up to 80% of the patients and offers the possibility to restore regular FVIII prophylaxis. However, patients with high titre inhibitors, in whom standard ITI fails, usually impose with high morbidity and mortality and therefore prompting physicians to alternate therapy regimens. Rituximab, an anti-CD 20 monoclonal antibody has been successfully used in children and adults for the management of B-cell mediated disorders. We report on the use of a new protocol including rituximab in two adolescents with severe haemophilia A and high titre inhibitors, severe bleeding tendency and high clotting factor consumption after failing standard ITI. Both patients received a concomitant treatment with FVIII according to the Bonn protocol, cyclosporine A and immunoglobulin. Treatment with rituximab resulted in a temporary B-cell depletion leading to the disappearance of the inhibitor. FVIII recovery and half-life turned towards normal ranges. In patient 1 the inhibitor reappeared 14 months after the last rituximab administration. In patient 2 complete immune tolerance could be achieved for 60 months. Bleeding frequency diminished significantly and clinical joint status improved in both patients. In patient 1 the treatment course was complicated by aspergillosis and hepatitis B infection. Conclusion: Rituximab may be favourable for patients with congenital haemophilia, high-titre inhibitors and a severe clinical course in whom standard ITI has failed. Prospective studies are required to determine safety, efficacy and predictors of success.

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The Spectrum of von Willebrand’s Disease

Thrombosis and Haemostasis ◽

10.1055/s-0038-1655015 ◽

1967 ◽

Vol 18 (01/02) ◽

pp. 040-056 ◽

Cited By ~ 13

Author(s):

E. J Walter Bowie ◽

P Didisheim ◽

J. H Thompson ◽

C. A Owen

Keyword(s):

Factor Viii ◽

Bleeding Time ◽

Severe Bleeding ◽

Platelet Adhesiveness ◽

Platelet Activity ◽

Von Willebrand's Disease ◽

Von Willebrand’S Disease ◽

The Third ◽

Generation Test

SummaryPatients (from 5 kindreds) with variants of von Willebrand’s disease are described. In one kindred the depression of factor VIII was moderate (20 to 40% of normal) and transfusion of 500 ml of normal plasma led to an increase higher than anticipated and to an almost normal level of factor VIII 17 to 24 hrs later. This represents the usual type of von Willebrand’s disease.In the second kindred the concentration of factor VIII was less than 2 % of normal in the son and daughter, who had severe bleeding and hemarthroses.The third kindred was characterized by reduction of factor VIII and a long bleeding time as well as by a serum defect in the thromboplastin-generation test comparable to that seen in patients with hemophilia B, yet with normal levels of factors IX, X, and VII. The severity of the serum defect, the positive result with the Rumpel-Leede test, and the reduced platelet activity in the thromboplastin-generation test are all compatible with the diagnosis of thrombopathy or ‘‘thrombopathic hemophilia.” In two other kindreds, one patient had a long bleeding time and normal levels of factor VIII and another had a normal bleeding time and decrease of factor VIII. The last patient had the type of response to transfusion usually seen in von Willebrand’s disease.In four kindreds, platelet adhesiveness in vivo was found to be strikingly abnormal (virtually absent).It would appear, therefore, that von Willebrand’s disease forms a spectrum, and whether the kindreds reported simply reflect variations of a single genetic disease state or represent separate entities will be answered only by clarification of the underlying etiology of that disease.

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