The essential problem of acute gastrointestinal bleeding is hemorrhagic shock. Using a high-power Nd-Yag laser, transmitted endoscopically by Dr. Nath's triconic quartz fiber, it was possible to occlude massive arterial bleeding ulcers immediately after endoscopic localization. Of 202 bleeding ulcers in the upper gastrointestinal tract, 193 = 96% could be stopped. The mortality rate was reduced in bleeding acute ulcers from 58% to 36% and in bleeding chronic ulcers from 21% to 5.1%.
Objective: Adverse drug events (ADEs) in the outpatient pediatric pharmacotherapy can be serious and lead to inpatient admissions. Recent research only focused on ADE identification during hospitalization. The aim of the present study was to develop an algorithm to identify drugrelated hospital admissions in pediatrics.Methods: A systematic literature research was performed, and a pediatric trigger tool for identifying drug-related inpatient admissions was built. The initial version was tested in a sample of 292 patients admitted to a German university children's hospital. Subsequently, the tool was further improved by combining different modules as a novel approach.
Results:The obtained algorithm with 39 triggers in 5 modules identified drug-related inpatient admissions at a sensitivity of 95.5% (95% confidence interval [CI], 89.3%-100%) and a specificity of 16.5% (95% CI, 11.9%-21.2%), respectively. After modifications including trigger activation requiring a combination of different modules, specificity increased to 56.9% (95% CI, 50.7%-63.0%). Identifying 36 of 44 ADEs leading to admission, sensitivity remained high (81.8% [95% CI, 70.4%-93.2%]). The overall positive predictive value was 25.2% (95% CI, 18.1%-32.3%).
Conclusions:The algorithm is the first trigger tool to identify ambulant acquired ADEs leading to hospital admission in pediatrics. However, the underlying patient sample is small.Using a larger population for refinement will allow further specifications and reduction in the total amount of triggers and thus signals.
The high mortality rate of up to 64% as a result of emergency for gastrointestinal hemorrhage indicates the need for a reliable method for endoscopic bleeding control. By developing a special flexible endoscopic laser transmission system it was possible to transmit high-power Nd-Yag laser radiation, which is especially effective in massive hemorrhages. In 11/2 years 186 (94%) of 198 bleeding incidents in 150 unselected patients could be controlled by endoscopic laser irradiation (varices: 60; Mallory-Weiss tears: 14; ulcers: 101; multiple erosions: 11).
We report the case of a 24-year-old patient who underwent a duodenal biopsy due to the suspicion of graft-versus-host disease following allogeneic stem cell transplantation 3 months previously. The patient developed severe upper abdominal pain after the biopsy. A computed tomography scan revealed diffuse hemorrhaging in the duodenal wall and mesenteric root. Following supraselective angioembolization to stop the bleeding a control computed tomography scan was carried out the following day and revealed increasing destruction of the duodenal wall due to a dissecting aneurysm. A pancreas-preserving duodectomy was carried out.
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