1/14. Medical and hormonal therapy in occult gastrointestinal bleeding.In this age of modern technology and aggressive but noninvasive therapies, the idea of treating an identifiable but discrete bleeding lesion with systemic medical therapy seems an anachronism. But medical therapy can be the treatment of choice for some bleeding vascular lesions of the gut. Though most vascular lesions appear similar endoscopically and are a cause of gastrointestinal bleeding, they consist of various pathologic identities. These different lesions have not only different pathologic appearances, but also different prognoses. The natural history of many of these lesions remains largely unknown. Long-term success in controlling bleeding must be measured in the context of the responsible lesion's frequency of occurrence and recurrence. Medical therapy can include hopeful watchful waiting, routine blood transfusions, or specific medications. Medical therapy has been pursued along two lines. The most common form of medical therapy has been simple supportive care. This may include iron therapy and avoidance of aspirin and other anticoagulants. Transfusions may be necessary, occasionally or on a regular basis. The second form of medical therapy has been the use of estrogens. There have been other medical attempts to control bleeding from intestinal vascular lesions. somatostatin has been used in an uncontrolled fashion, as has aminocaproic acid. Vascular lesions of the bowel are not all the same. Medical therapy of vascular lesions is contrary to general present practice. Endoscopic or surgical therapy is presently considered best because of its ease, relatively good long-term results, and the lack of a clearly effective, well-tolerated medical therapy. Medical therapy is usually reserved for diffuse vascular diseases of the bowel, for vascular lesions located in relatively inaccessible locations, for patients with continued bleeding despite endoscopic or surgical management, and for patients who are not candidates for either endoscopic or surgical therapy.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/14. The efficacy of octreotide therapy in chronic bleeding due to vascular abnormalities of the gastrointestinal tract.BACKGROUND: The treatment of angiodysplasia and watermelon stomach, vascular abnormalities implicated in gastrointestinal bleeding of obscure origin, is a major clinical problem. AIM: To determine the efficacy of octreotide in patients with long-standing gastrointestinal bleeding due to acquired angiodysplasia and watermelon stomach, resistant to previous treatments and not suitable for surgery because of old age and/or concomitant disorders. patients AND methods: We treated 17 patients (seven had isolated angiodysplasia, seven had multiple upper and lower gastrointestinal angiodysplasia, and three had watermelon stomach) with octreotide (0. 1 mg subcutaneous t.d.s. for 6 months). Six of the patients had liver cirrhosis, one had Glanzmann-type platelet derangement, two had cardiovascular diseases and one had chronic uraemia. RESULTS: octreotide treatment stopped bleeding in 10 patients. A transient improvement was observed in four, who needed subsequent cyclical retreatment to correct low haemoglobin levels. No effect was observed in three, probably due to the severity of the concomitant disorders. CONCLUSIONS: octreotide is a safe drug that may be useful to control the recurrent gastrointestinal bleeding due to acquired angiodysplasia and watermelon stomach, especially in patients who are not candidates for surgery due to old age and/or concomitant disorders.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
3/14. Hemangiomas of the cecum. Colonoscopic diagnosis and therapy.Five cases of hemangiomas of the cecum and gastrointestinal bleeding are presented. All were demonstrated by colonscopy after more conventional diagnostic methods failed. The hemangiomas were bright red, flat lesions clearly seen through the colonscope. They were successfully treated by electrocoagulation. All patients in this series had some type of associated cardiac or vascular disease. These patients may represent a syndrome of gastrointestinal blood loss of obscure cause, hemangiomas of the cecum, and cardiovascular disease.- - - - - - - - - - ranking = 2keywords = vascular disease (Clic here for more details about this article) |
4/14. aspirin for the prevention of cardiovascular disease: calculating benefit and harm in the individual patient.AIMS: To estimate the absolute reduction in the risk of cardiovascular events and absolute increase in gastrointestinal haemorrhage associated with aspirin for individuals with different baseline risks. methods: Calculation of absolute treatment effects from estimates of: (i) baseline risks for cardiovascular event and gastrointestinal haemorrhage; and (ii) relative risks of these events with treatment. Baseline cardiovascular risks were derived from existing risk scores, and baseline risk of gastrointestinal haemorrhage from an observational cohort study. Changes in relative risks were obtained from clinical trial data. The effects of aspirin treatment were calculated in examples of two individuals with very different baseline risks. RESULTS: Treatment of a healthy 74-year-old man (blood pressure 144/88 mm Hg and no history of gastrointestinal disorder) would reduce his annual risk of a cardiovascular event from 2% to 1.74% (absolute risk reduction 0.26%, number needed to treat 385), but increase the gastrointestinal haemorrhage risk from 0.3% to 0.51% (absolute risk increase 0.21%, number needed to harm 476). In a 66-year-old obese man, following a transient ischaemic attack, and with a history of hospital treatment for a peptic ulcer, the annual risk of a cardiovascular event would be reduced from 5% to 4.35% (absolute risk reduction 0.65%, number needed to treat 153), but the risk of gastrointestinal haemorrhage would increase from 1.08% to 1.83% (absolute risk increase 0.75%, number needed to harm 133). CONCLUSIONS: Estimating benefit and harm by taking into account the baseline risks in each individual allows patients and doctors to judge for themselves the magnitude of the trade-offs involved in taking aspirin.- - - - - - - - - - ranking = 4keywords = vascular disease (Clic here for more details about this article) |
5/14. Surgical eradication of esophageal carcinoma in a patient with Klippel-Trenaunay syndrome.Klippel-Trenaunay syndrome (KTS) is a rare congenital vascular disease of unknown etiology, and its occurrence with malignant tumor is extremely rare. We herein report a case of KTS presenting chronic gastrointestinal bleeding and complicating with adenosquamous cell carcinoma (ASCC) of the esophagus. The therapeutic dilemma of managing ASCC of the esophagus in a patient who combined with the rare congenital syndrome posed a difficult and interesting clinical problem. However, ASCC is also a very rare histological tumor in the esophagus, and its relationship to KTS has never been reported. In this article, we reviewed all the reported malignancies related to KTS. The possible surgical risks and complications, as well as preoperative imaging investigation, are also discussed.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
6/14. cytomegalovirus-induced small-bowel hemorrhage in a patient with nonsystemic vasculitic neuropathy.A 73-year-old man who was being treated with corticosteroids for nonsystemic vasculitic neuropathy developed small-bowel hemorrhage after ileostomy for ileus. Immunohistochemical staining for cytomegalovirus (CMV) antigen in the ulcer in the resected ileum was positive; thus, cytomegalovirus infection of the small intestine caused his gastrointestinal manifestations. cytomegalovirus infection should be considered in the differential diagnosis of gastrointestinal diseases in patients with collagen vascular diseases receiving immunosuppressive agents.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
7/14. rhabdomyolysis and cutaneous necrosis following intravenous vasopressin infusion.A continuous IV infusion of vasopressin was administrated to a patient with cirrhosis of the liver and acute gastrointestinal bleeding from esophageal varices. In the first 24 hours, the patient developed rhabdomyolysis and cutaneous necrosis. Stopping vasopressin infusion resulted in relief of these lesions. The rarity of these complications suggests an idiosyncratic reaction of susceptible individuals that may be related to previous vascular disease or a failure in baroreceptor regulation.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
8/14. hemobilia from ruptured hepatic artery aneurysm. Report of a case and review of the literature.hepatic artery aneurysm is a rare vascular disease associated with high mortality caused by massive hemorrhage or by complications following surgical treatment. Over the past twenty-five years it has been managed surgically with increasing success. Eighty reported cases of hepatic artery aneurysms ruptured into the biliary tree were reviewed and the etiology, clinical signs, diagnosis, and treatment of such an aneurysm are discussed. A personal case with an aneurysm of the right hepatic artery ruptured into the common hepatic duct is reported. The diagnosis was made before surgery by arteriography and the aneurysm was successfully managed by ligation of the right hepatic artery both proximal and distal to the aneurysm, closure of the communication between the common hepatic duct and the aneurysm, and choledochal drainage. hemobilia secondary to hepatic artery aneurysm must be considered in thedifferential diagnosis of unexplained gastrointestinal hemorrhage.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
9/14. Upper gastrointestinal bleeding in acute mesenteric thrombosis.We report an unusual case of upper gastrointestinal bleeding secondary to superior mesenteric vein thrombosis and review the literature to assess the frequency of upper GI bleeding in patients with superior mesenteric vascular disease. Clinical features and laboratory and radiological findings are nonspecific; endoscopy and abdominal angiograms are helpful to rule out the common causes of GI bleeding and to suspect the diagnoses of superior mesenteric vein thrombosis. Without early surgical intervention, mortality is close to 100%.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
10/14. Nodular regenerative hyperplasia with portal hypertension in a patient with myasthenia gravis.Nodular regenerative hyperplasia of the liver is a rare cause of portal hypertension and bleeding esophageal varices, occurring mainly in association with collagen vascular diseases. The patient described herein had both myasthenia gravis and nodular regenerative hyperplasia. To the best of our knowledge, this is the first report of this association.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
| | Next -> |