Hemorrhage ; etiology ; physiopathology ; Humans ; Time Factors ; Vitamin K Deficiency ; complications

Aged ; Female ; Humans ; Lingual Thyroid ; complications ; drug therapy ; physiopathology ; Oral Hemorrhage ; diagnosis ; etiology ; physiopathology

Meckel diverticulum (MD), a congenital gastrointestinal anomaly, is often involved in pediatrics, but less in the adult population. The patient in this report was a 69-year-old female presented with massive gastrointestinal bleeding causing hemorrhagic shock due to MD containing ectopic pancreatic tissue. A review of the literature revealed that gastrointestinal bleeding from MD containing ectopic pancreatic tissue is rare in adults and difficult to be identified preoperation. MD should be considered as one of the differential diagnosis for lower gastrointestinal bleeding, although scarce in adults, especially when the patient has massive painless bleeding.
Aged ; Choristoma ; diagnosis ; physiopathology ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; etiology ; Humans ; Meckel Diverticulum ; diagnosis ; physiopathology ; Pancreas ; pathology

OBJECTIVETo explore the clinical significance, reliability and responsiveness of ITPBAT bleeding grading system for patients with immune thrombocytopenia (ITP).

METHODSOne hundred and eighty-three patients with ITP were assessed by using of ITP-BAT bleeding grading system. Test-retest reliability, responsiveness of ITP-BAT bleeding grading system and association between bleeding grades and platelet counts, age, gender, disease stage were analyzed.

RESULTSBleeding degree of ITP patients and the platelet count were negatively correlated (r=- 0.744, P<0.01) and bleeding degree increased significantly with platelet counts below 20×10⁹/L (χ²=82.40，P<0.01). Mild bleeding rate in children was 68.5%, higher than that in adult(χ²=8.839，P<0.01), and severe bleeding rate in the elderly was 14.3%, higher than that in non-elderly(χ²=7.056，P<0.01). There were no significant differences in bleeding degree in patients with different gender and disease stage (χ²=4.922, P>0.05 and χ²=3.411, P>0.05). Bleeding grades before and after treatment had more significant difference(Z=-6.61, P<0.01). Scoring consistency of two doctors was 66.1% (κ=0.561), and scoring consistency of the same doctor was 94.7% (κ=0.874).

CONCLUSIONITP-BAT bleeding grading system in China has good validity and responsiveness, closely related to clinical indicators. It is sensitive to the variation of the hemorrhage in patients. ITP-BAT could be used as a reference index of the treatment, and also be used as an observation index of curative effect.

Hemorrhage ; etiology ; physiopathology ; Humans ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic ; complications ; physiopathology ; Reproducibility of Results

Cerebral Hemorrhage ; pathology ; physiopathology ; Child ; Child, Preschool ; Female ; Heart Defects, Congenital ; pathology ; physiopathology ; Hemodynamics ; physiology ; Humans ; Infant ; Male ; Risk Factors ; Stroke ; pathology ; physiopathology ; Vascular Malformations ; pathology ; physiopathology

OBJECTIVETo evaluate the application value of percutaneous endoscopic gastrostomy (PEG) for home nutrition support in patients with stroke and post-traumatic brain.

METHODSWe retrospectively analyzed the clinical data of the 16 patients with stroke and post-traumatic brain, including cerebral infarction (n = 9), cerebral hemorrhage ( n = 5), subarachnoid hemorrhage (n = 1), and cerebral trauma (n = 1). All these patients underwent PEG in our hospital because they were not able to be orally fed.

RESULTSThe weight, triceps skinfold thickness, mid-upper arm muscle circumference, and serum albumin, hemoglobin, and lympholeukocyte cell counts 30, 60, and 120 days after hospital discharge were significantly higher than those at hospital discharge (P <0.05 or P <0.01). The NIHSS scores 30, 60, and 120 days after hospital discharge were 14.0 +/- 1.3, 14.0 +/- 1.1, and 3.0 +/- 1.2, respectively, which were significantly lower than 16.0 +/- 1.2 at hospital discharge (all P <0.05). Complications included gastric contents retention (n = 1), backstreaming (n = 1), aspirated pneumonia (n = 1), and intra-cushion syndrome (n = 1).

CONCLUSIONSPEG for home nutrition support is useful for the treatment of patients with stroke and post-traumatic brain with dysphagia and malnutrition after long-term coma. It can help to avoid the deterioration of nutritional status and improve the quality of life.

Adult ; Aged ; Aged, 80 and over ; Cerebral Hemorrhage ; physiopathology ; Cerebral Infarction ; physiopathology ; Enteral Nutrition ; methods ; Female ; Gastroscopy ; adverse effects ; methods ; Gastrostomy ; adverse effects ; methods ; Hemoglobins ; metabolism ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Serum Albumin ; metabolism ; Stroke ; physiopathology ; Subarachnoid Hemorrhage ; physiopathology

OBJECTIVETo explore the clinical value of immature platelet fraction (IPF), absolute immature platelet fraction (A- IPF) and thrombelastograph (TEG) on assessment of bleeding risk of immune thrombocytopenia (ITP).

METHODStwo hundred and seventy- one patients with ITP were assessed based on ITP-BAT bleeding grading system. IPF, A-IPF were determined in 271 patients ,TEG in 125 patients. The correlations between bleeding grades and IPF, A-IPF, variables of TEG in subgroups were analyzed by statistical method. The predictive value of IPF, A-IPF, and variables of TEG on bleeding risk of ITP patients was evaluated.

RESULTSThere were no significant differences in bleeding degree in all patients with different gender and disease stage (P>0.05). Mild bleeding rate in children was higher than that in adult (P<0.05). PLT inversely correlated with bleeding grade for the entire cohort (P<0.001). In all subjects, PLT< 30 × 10⁹/L and pediatric cohorts with PLT< 30 × 10⁹/L, PLT were negatively correlated with IPF (P<0.05), positive correlated with A-IPF (P<0.001) and the maximum amplitude (MA (P<0.05). Bleeding grades were significantly correlated with IPF, A-IPF, MA in all subjects and patients with PLT< 30 × 10⁹/L (P<0.001). IPF, A-IPF and MA did not correlate with bleeding grades in children with PLT< 30 × 10⁹/L (P>0.05). ROC curve analysis revealed IPF, A-IPF and MA had better predictive value (AUC 0.745, 0.744, 0.813, P<0.001). Multivariate analysis showed that IPF and MA were independence factors for predicting bleeding risk in ITP patients and comprehensive predictive value was higher (AUC 0.846, P<0.001) than single variable.

CONCLUSIONIPF, A-IPF and MA could accurately evaluate bleeding risk in ITP patients. It may be considered as reference index of the treatment and observation index of curative effect.

Adult ; Blood Platelets ; Child ; Hemorrhage ; etiology ; physiopathology ; Humans ; Multivariate Analysis ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic ; complications ; physiopathology ; ROC Curve

OBJECTIVETo explore the therapeutic effect of acupuncture for hypertensive cerebral hemorrhage at the early stage.

METHODSFifty-four cases of small-amount cerebral hemorrhage were randomized into an acupuncture group and a conventional treatment group, 27 cases in each one. In the conventional treatment group, special care, oxygen therapy, nerve nutrition and symptomatic support were applied. In necessary, dehydrant and hypotensive drugs were prescribed for antihypertension, or surgery was given. In the acupuncture group, on the basis of the treatment as the control group, acupuncture was applied at Quchi (LI 11), Neiguan (PC 6), Zusanli (ST 36), Sanyinjiao (SP 6) and Taichong (LR 3). Acupuncture was given at the admission, 4 h, 6 h and 12 h after disease onset respectively. Blood pressure was monitored in the whole procedure. 6 h and 24 h after disease onset, the cranial CT was re-examined. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), hematoma volume and neurological deficit score were compared at different time points between the two groups.

RESULTS(1) Blood pressure: from the admission to 12 h after disease onset, SBP, DBP and MAP were increased apparently in the conventional treatment group and increased slightly in the acupuncture group. The differences in SBP [(164.3 +/- 21.6) mmHg vs (158.6 +/- 21.5) mmHg] and MAP [(113.4 +/- 4.9) mmHg vs (106.7 +/- 6.1) mmHg] were significant between the two groups (both P < 0.05). From 12 h to 24 h after disease onset, compared with the conventional treatment group, SBP and MAP were decreased apparently in the acupuncture group [(147.3 +/- 21.6) mmHg vs (158.4 +/- 23.5) mmHg, (97.2 +/- 5.3) mmHg vs (106.6 +/- 5.1) mmHg, both P < 0.05)]. (2) Hematoma volume: from the admission to 6 h after disease onset, the volume was increased by (4.15 +/- 0.73) mL in the convertional treatment group and (2.67 +/- 0.33) mL in the acupuncture group, indicating the significant difference in comparison (P < 0.05). From the admission to 24 h after disease onset, it was increased by (5.57 +/- 1.26) mL in the convertional treatment group and (3.14 +/- 1.18) mL in the acupuncture group, indicating the significant difference in comparison (P < 0.05). (3) Neurological deficit score: the score was increasing gradually in first 3 days after disease onset in the two groups. The score (38.39 +/- 6.84) in the acupuncture group on the first day was different significantly as compared with that (42.37 +/- 7.46) in the conventional treatment group (P < 0.05). On the 10th days, the score (24.68 +/- 5.42) in the acupuncture group was different significantly from that (29.74 +/- 7.36) in the convertional treatment group (P < 0.05).

CONCLUSIONThere is no peak of blood pressure rising, and the continuous hemorrhagic volume is less in 24 h and neurological deficit score is improved in the acupuncture group. Acupuncture brings the positive significance in the treatment of cerebral hemorrhage at the early stage.

Acupuncture Therapy ; Adult ; Aged ; Blood Pressure ; Cerebral Hemorrhage ; physiopathology ; therapy ; Female ; Hematoma ; physiopathology ; therapy ; Humans ; Male ; Middle Aged

Adrenal Gland Neoplasms ; complications ; physiopathology ; Hemorrhage ; etiology ; Humans ; Male ; Middle Aged ; Peritoneal Diseases ; etiology ; Pheochromocytoma ; complications ; physiopathology

OBJECTIVETo observe the effects of cross electro-nape-acupuncture on reflex remodeling of airway protective reflex cough in patients with tracheotomy after cerebral hemorrhage.

METHODSWith the method of completely random design, according to treatment order, 60 patients who received tracheotomy after cerebral hemorrhage accompanied with cough reflex difficulty were randomly divided into a cross electro-nape-acupuncture group and an acupuncture group, 30 cases in each group. Both groups were treated with basic treatment, including anti-inflammation, eliminating phlegm, improving cerebral metabolism and so on. The acupuncture group was treated with acupuncture at Yifeng (TE 17), Fengchi (GB 20), Lianquan (CV 23), Baihui (GV 20), Touwei (ST 8), Dicang (ST 4) through Jiache (ST 6), Hegu (LI 4), Quchi (LI 11), and motor area on the affected side, and the needles were retained for 30 min. Based on the treatment of acupuncture group, the cross electro-nape-acupuncture group was additionally treated with cross electro-nape-acupuncture (continuous wave) for 30 min per treatment. The treatment was both given twice a day from Monday to Friday and once a day on Saturday and Sun day for 4 weeks. Tracheostomy cough reflex grading score (TCRGS) and clinical pulmonary infection score (CPIS) were observed before and after treatment in the two groups, and the clinical efficacy of two groups was evaluated.

RESULTSCompared before the treatment, TCRGS and CPIS were both reduced in two groups (both P < 0.01); after treatment, there were significant differences of TCRGS and CPIS between two groups (both P < 0.01), indicating cross electro-nape-acupuncture group was superior to acupuncture group. Regarding the effects of cough reflex remodeling, the cured and markedly effective rate was 96.7% (29/30) in the cross electro-nape-acupuncture group, which was significantly different from 55.2% (16/29) in the acupuncture group (P < 0.01).

CONCLUSIONCross electro-nape-acupuncture could effectively improve the remodeling of cough reflex and promote the recovery of lung infection in patients with tracheotomy after cerebral hemorrhage, leading to an increased quality of life.

Acupuncture Points ; Aged ; Cerebral Hemorrhage ; physiopathology ; surgery ; therapy ; Cough ; physiopathology ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Reflex ; Tracheotomy