hemorrhage

摘要： Third trimester bleeding is a common concern in obstetrics. The main objective of this work was to study the management of hemorrhages in the third trimester of pregnancy in the maternity ward of the Sominé Dolo hospital in Mopti. Our prospective descriptive cross-sectional survey type study conducted at the maternity ward of Sominé Dolo hospital in Mopti over a period from January 1, 2017 to December 31, 2017 included 94 cases collected. During this period we had performed 1485 deliveries including 94 cases of pregnancies complicated by 3rd trimester hemorrhage, a frequency of 6.33%. The main cause of hemorrhage in the third trimester was represented by placenta preavia 42.6% followed by retroplacental hematoma 28.7%, uterine rupture 26.6% and association Placenta preavia and retroplacental hematoma 2.1%. The type of intervention depended on the cause of the hemorrhage and the maternal and fetal condition. More than half of the cases of uterine rupture 52% had benefited from a hysterorrhaphy during a laparotomy (n = 13/25) against 48% from hysterectomy (n = 12/25). Caesarean section was performed in 87.5% (n = 35/40) against 12.5% vaginal delivery (n = 5/40) in case of placenta preavia. In the end, in 74% of cases (n = 20/27) of retroplacental hematoma, first-line cesarean section was performed. The maternal prognosis was represented by a mortality rate of 12% (n = 11/94) and morbidity dominated by hypovolemic shock 48.9% (n = 22/94), infections 28.8% (n = 13/94) and coagulopathy 11.1% (n = 5/94). The fetal prognosis was very poor. More than half (55%) of the newborns had succumbed against 45% of the newly born. In 55.3% of cases neonatal mortality occurred antenatally. Neonatal morbidity was represented by prematurity, i.e. 20.2% (n = 19/94) and low birth weight, i.e. 22.3% (n = 21/94).

摘要： BACKGROUND:The Clinical Randomisation of an Anti-fibrinolytic in Significant Hemorrhage-2(CRASH-2)is the largest randomized control trial(RCT)examining circulatory resuscitation for trauma patients to date and concluded a statistically significant reduction in all-cause mortality in patients administered tranexamic acid(TXA)within 3 hours of injury.Since the publication of CRASH-2,significant geographical variance in the use of TXA for trauma patients exists.This study aims to assess TXA use for major trauma patients with hemorrhagic shock in Ireland after the publication of CRASH-2.METHODS:A retrospective cohort study was conducted using data derived from the Trauma Audit and Research Network(TARN).All injured patients in Ireland between January 2013 and December 2018 who had evidence of hemorrhagic shock on presentation(as defined by systolic blood pressure[SBP]1(70.68%vs.57.43%)and higher Injury Severity Score(ISS>25;49.62%vs.23.76%).Administration of TXA was not associated with mortality at hospital discharge(odds ratio[OR]0.86,95%CI 0.31–2.38).CONCLUSIONS:Among injured Irish patients presenting with hemorrhagic shock,TXA was administered to 56.8%of patients.Patients administered with TXA were on average more severely injured.However,a mortality benefit could not be demonstrated.

摘要： BACKGROUND Multiple myeloma patients usually present with CRAB symptoms(hypercalcemia,renal disease,anemia and bone diseases)as initial manifestations.Bleeding symptoms are less common,most of which result from thrombocytopenia or infiltration of plasmacytoma.Relatively,coagulopathy is not so common,especially isolated coagulopathy without CRAB manifestations,which is very rare.Herein,we report a 54-year old female who was hospitalized for intermittent and recurrent mild oral mucosal hemorrhage without other bleeding symptoms for almost one month or typical myeloma features.CASE SUMMARY Two months before admission,the patient underwent implantation of a permanent pacemaker due to sick sinus syndrome.Prothrombin time and activated partial thromboplastin time were significantly prolonged.Factor X deficiency was demonstrated to account for the coagulation dysfunction.An M protein peak was shown by serum protein electrophoresis.26.11%of abnormal plasma cells were detected in bone marrow by flow cytometry,expressing CD38,CD138,CD56 and intracellular immunoglobulin Kappa light chain.Bone marrow biopsy also proved the presence of abnormal plasma cells,but Congo red stain was negative.The patient was finally diagnosed with multiple myeloma IgA-κtype.A literature review indicated that factor X deficiency was highly related to amyloidosis.Before bleeding signs,the patient had cardiac arrhythmia,enlargement of the heart,and progressive heart failure;thus,cardiac amyloidosis was suspected.CONCLUSION Bleeding related to coagulation dysfunction is uncommon in multiple myeloma,especially as the initial manifestation.Amyloidosis is a well-recognized cause of isolated acquired factor X deficiency.

摘要： 1背景动脉瘤性蛛网膜下腔出血(aneurysmal sub⁃arachnoid hemorrhage,aSAH)是一种严重危害人类健康的脑血管疾病,占所有自发性蛛网膜下腔出血(sub⁃arachnoid hemorrhage,SAH)的85%左右。在世界卫生组织的一项研究中显示,aSAH在世界范围内的总体年发病率约为9.1/10万,芬兰和日本两国aSAH年发病率可高达(22.5~27.0)/10万;我国北京地区aSAH的年发病率为2.0/10万。

摘要： 自发性脑出血(intracerebral hemorrhage,ICH)会引起局部和全身炎症反应,形成白细胞-血小板聚集,黏附于脑内皮细胞,导致血-脑脊液屏障(blood-cerebrspinal fluid barrier,BCFB)破坏、脑水肿和脑实质损伤,进而加重脑出血后脑损伤[1]。

摘要： Subaracoid hemorrhage caused by intracranial aneurysms is characterized by high morbidity and mortality.There is no definite conclusion regarding the mechanism of formation,development,and rupture of intracranial aneurysms.It is generally believed to be related to congenital hereditary connective tissue diseases and acquired hemodynamic factors,vascular inflammation,and oral pathogens.In addition,gender,age,hypertension,and psychological status are also important factors.Relevant studies show a significantly lower quality of life in patients with intracranial aneurysms,and psychological factors should be studied in more depth.Neurological complications are considered an important factor in the decrease in quality of life.In conclusion,the formation,development,and rupture of intracranial aneurysms should result from a combination of congenital and acquired factors.

摘要： BACKGROUND Brain arteriovenous malformation(AVM),an aberrant vascular development during the intrauterine period,is traditionally considered a congenital disease.Sporadic reports of cases of de novo AVM formation in children and adults have challenged the traditional view of its congenital origin.CASE SUMMARY In this report,we have presented the case of a child with a de novo brain AVM.Magnetic resonance imaging and magnetic resonance angiography of the brain showed no AVM at the age of 5 years and 2 mo.Brain AVM was first detected in this child at the age of 7 years and 4 mo.The brain AVM was significantly advanced,and hemorrhage was seen for the first time at the age of 12 years and 8 mo.There was further progression in the AVM,and hemorrhage occurred again at the age of 13 years and 5 mo.Genetic analysis of this patient revealed a mutation in the NOTCH2(p.Asp473 Val)gene.CONCLUSION In short,our case has once again confirmed the view that brain AVM is an acquired disease and is the result of the interaction of genes,environment,and molecules.

摘要： BACKGROUND Hydrodissection is a widely used technique during radiofrequency ablation(RFA)for benign thyroid nodules.Although it could effectively avoid thermal injury to the surrounding critical structures and achieve complete treatment,routine operation of the remaining needle could cause perithyroidal hemorrhage.In this report,we present 2 cases of perithyroidal hemorrhage during RFA caused by a hydrodissection needle,which have not been reported before.CASE SUMMARY A 21-year-old female and a 45-year-old male were admitted for RFA for benign thyroid nodules.Considering that their nodules were adjacent to the recurrent laryngeal nerve,the needle used for hydrodissection was placed and remained between the dorsal capsule of the lateral lobe and the recurrent laryngeal nerve.During the procedure,active bleeding near the needle appeared on ultrasonography(US).Although moderate pressure was quickly applied to the neck for several minutes,contrast-enhanced US(CEUS)still showed an active hemorrhage.A radiofrequency electrode was placed at the bleeding point under the guidance of CEUS to stop the bleeding,and the procedure was finally confirmed to be successful by CEUS,without other complications.CONCLUSION Hydrodissection during RFA of benign thyroid nodules was associated with a risk of perithyroidal hemorrhage.The timely recognition of this acute hemorrhage could help in the timely control of the bleeding,and CEUS-guided ablation of the bleeding point could be useful.

摘要： BACKGROUND Gallbladder hemorrhage is a life-threatening disorder.Trauma(accidental or iatrogenic such as a percutaneous biopsy or cholecystectomy surgery),cholelithiasis,biliary tract parasitosis,vasculitis,vascular malformations,autoimmune and neoplastic diseases and coagulopathies have been described as causes of hemorrhage within the lumen of the gallbladder.The use of nonsteroidal anti-inflammatory drugs and anticoagulants may represent a risk factor.CASE SUMMARY We report the case of a 76-year-old male patient.An urgent contrast computed tomography scan demonstrated relevant distension of the gallbladder filled with hyperdense non-homogeneous content.The gallbladder walls were of regular thickness.Near the anterior wall a focus of suspected active bleeding was observed.Due to the progressive decrease in hemoglobin despite three blood transfusions,this was an indication for urgent surgery.CONCLUSION Early diagnosis of this potentially fatal pathology is essential in order to plan a strategy and eventually proceed with urgent surgical treatment.

摘要： Introduction: Hemorrhage is one of the most common causes of maternal morbidity and mortality. This study was conducted to investigate how much abnormal placentation can affect blood bank capacity and to measure the burden on the blood bank caused by excessive use of blood and blood products. Methodology: This is a retrospective study conducted at King Saud Medical City Maternity Hospital in Riyadh, Kingdom of Saudi Arabia, from January 2019-September 2020. It includes 170 cases diagnosed with abnormal placentation (low-lying placenta or placenta previa, accreta, increta, or percreta). The primary purpose was to measure consumption of blood and blood products in cases of placental abnormalities and to investigate how much this affects blood bank capacity. A secondary aim was to report rates of admission to the ICU and maternal mortality. Results: This study included 170 women with placental abnormalities. Placental previa had occurred in 96 cases, followed by placenta accreta in 46 cases, placenta increta in 13 cases, placenta percreta in 8 cases, and low-lying placenta in 7 cases. Most patients (93) were treated with a Bakri balloon to prevent hemorrhage, but 38 patients had a hysterectomy. The average estimation of blood loss was 2210 ml, with no maternal mortality. An average of 3.39 units of packed red blood cells (PRBC) with a maximum of 20 units, 2.12 units of fresh frozen plasma (FFP) with a maximum of 20 units, and 0.7 units of packed platelets (PP) with maximum of 12 units consumed per patient. Eighty-seven patients (51.2%) were admitted to the ICU and 83 others (48.8%) were admitted to the high dependency unit. Conclusion: Blood and blood product volumes had a linear relationship with the severity of placental abnormalities and estimated blood loss. Therefore, blood bank services should be available to save mothers’ life.