Objective To identify an evidence-based treatment for a patient with aneurysmal subarachnoid hemorrhage (aSAH). Methods We first put forward clinical problems about how to prevent complications and how to treat ruptured aneurysm of aSAH, then searched The Cochrane Library (Issue 4, 2006), Ovid ACP Journal Club (1991 to 2006), Ovid MEDLINE (1966 to 2006), NGC (1998 to 2006) and CBM (1978 to 2006) to identify systematic reviews, randomized controlled trials, controlled clinical trials and treatment guidelines. Results Eleven studies and five guidelines were included. Current evidence indicated that nimodipine was effective for prophylaxis of poor outcome after vasospasm, while tirilazad was not effective in female patients with good grades. The effectiveness of other treatments to prevent complications was not clear. Evidence on the use of antifibrinolytics for the prevention of re-bleeding was inconsistent. If a ruptured aneurysm was considered suitable for both surgical clipping and endovascular coiling, coiling was associated with a better outcome. According to the available evidence and guidelines, considering the patient’s conditions and preferences, nimodipine and antifibrinolytics were administered to prevent complications and her aneurysm was treated by early endovascular embolization. She did not experience vasospasm or re-bleeding during her hospital stay. Short-term follow-up showed a good outcome. Long-term prognostic benefits after endovascular therapy need to be confirmed by prolonged follow-up. Conclusions Therapies based on the best clinical evidence and guidelines should be given to prevent complications and improve outcome for patients after an aSAH.
Objective
To analyze the clinical features of retinal detachment in macular spontaneous hemorrhage to improve the level of diagnosis and treatment of this disease.
Methods
The serial clinical data of 23 patients (23 eyes) with subretinal hemorrhage in macular region with the area over 4DDtimes;5DD who were diagnosed in our hospital from Sep, 1998 to Mar, 2003 were analyzed retrospectively. The patients included 12 males (12 eyes) and 11 females (11 eyes) with the average age of 64.1 (47-75). Fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and B-scan examination were performed on the patients to analyze the pathogenic factors, and the visual acuity and manifestation of ocular fundus were observed during the 8-24 months followed-up period.
Results
The visual acuity decreased to less than 0.2 or light perception suddenly in all affected eyes. In 23 eyes, choroidal neovascularization (CNV) of age-related macular degeneration (AMD) was found in 7, polypoidal choroidal vasculopathy (PCV) was in 5, retinal macroaneurysm was in 2, and unknow pathogenic factor in 9. Among the 23 eyes, hemorrhage was absorbed and no cicatritial formation at the fovea in 3 eyes with the visual acuity of 0.4-0.8; scar and pigment proliferation in the hemorrhage area were seen in 12 eyes with the visual acuity of finger counting (FC) to 0.2; combined vitreous hemorrhage was found in 8 eyes, including massive scar in the macular area in 3 who had undergone vitrectomy with the visual acuity of FC/66cm to 0.2 and blindness in the other 5 eyes.
Conclusion
Spontaneous hemorrhagic retinal detachment always arises in old people whose symptoms were sudden decrease or loss of the visual acuity. The configuration of the hemorrhage is local and diffuse. The prognosis of the visual acuity of most of the patients is poor due to the serious tissue injury in macula area.
(Chin J Ocul Fundus Dis, 2006, 22: 228-231)
ObjectiveTo explore the advantages and operation skills of ultra-early small bone window craniotomy surgery on cerebral hemorrhage in basal ganglia regions.
MethodsWe retrospectively analyzed the clinical data of 58 patients with cerebral hemorrhage in basal ganglia regions who underwent ultra-early small bone window craniotomy between January 2009 and December 2012.
ResultsPatients within 24 hours after surgery were re-checked by CT scan, which showed that hematoma was cleared in 53 cases, most removed in 2 cases, re-hemorrhage occurred in 2 patients whose hematoma was immediately removed by the original incision, 1 patient had large area infarction and underwent bone flap decompression. According to Glasgow outcome scale score at discharge, the outcome was good in 23, moderate disability in 18, severe disability in 12, persistent vegetative state in 2 and 3 were dead.
ConclusionUltra-early skull-window craniotomy can timely and completely remove the hematoma, provide reliable coagulation, protect important arteries with less re-hemorrhage and excellent outcome, which is one of the most effective methods for treating cerebral hemorrhage in basal ganglia regions.
ObjectivesTo systematically review the efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage.MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage from inception to March 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 23 RCTs involving 1 560 patients were included. The results of meta-analysis showed that, compared with the blank control or placebo, the addition of plasminogen activator urokinase after puncture and drainage could improve the clinical efficacy (RR=1.36, 95%CI 1.26 to 1.47, P<0.000 01), shorten removal time of hematoma (MD=?3.37, 95%CI ?3.89 to ?2.85, P<0.000 01), reduce postoperative re-bleeding rate (Peto OR=0.30, 95%CI 0.18 to 0.51, P<0.000 01), reduce the incidence of intracranial infection (Peto OR=0.47, 95%CI 0.25 to 0.87, P=0.02), and reduce mortality (Peto OR=0.45, 95%CI 0.27 to 0.76, P=0.003). The differences were statistically significant between two groups.ConclusionsCurrent evidence shows that the combination with urokinase can improve curative effect of hypertension cerebral hemorrhage patients with external ventricular drainage. In reducing hemorrhage, intracranial infection and mortality, urokinase also has great curative effect. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Cerebral small vessel disease refers to a group of pathological processes, neuroimaging features, and clinical symptoms, with various etiologies that affect the small arteries, arterioles, venules, and capillaries of the brain. The onset of cerebral small vessel disease can be insidious. It has various symptoms, some of which can attack acutely. Acute cerebral small vessel disease is characterized by lacunar stroke and brain parenchymal hemorrhage. The latter mainly includes hypertensive hemorrhage and cerebral amyloid angiopathy. This article summarizes the research advances of acute cerebral small vessel disease from the aspects of pathogenesis, clinical manifestations, neuroimaging features, and treatment methods, discussing characteristics and clinical challenges.
PURPOSE:To observe the clinical features of the macular hemorrhage in myopes.
METHOD:Twenty-four patients(30 eyes)with myopic macular hemorrhage were examined with slitlamp biomicroscopy,funduscope,A/B ultrasonography,and fundus fluorecein angiography(FFA). The patients were followed up for 3~18 months(average 12 months). RESULTS: Four of 26 eyes with
macular hemorrhage examined with FFA were found to be due to choroidal neovaseulature,and they were associated with posterior staphyloma. The other 22 eyes without neovascular change were thought to be simple type,and 19 of them were associated with lacquer cracks. The hemorrhage in simple type cases deminished usually within 1~3 months.
CONCLUSION:Myopic macular hemorrhagic eyes of neovascular type resulted usually in recurrent hemorrhage and worse prognosis in visual acuity than
those of simple type.
（Chin J Ocul Fundus Dis,1996,12: 220-222）
Objective
To explore how to integrate the various sources of information in designing an evidence-based nursing care plan for preventing gastrointestinal hemorrhage (GIH) after pancreaticoduodenectomy (PD).
Method
Papers and references about prevention of GIH after PD were searched between September and October 2015, and an evidence-based nursing care plan was drawn up and implemented from November 2015 to January 2016.
Results
A total of 79 papers were found and of which 17 were aviliable. Thirty-nine patients were cared on the basis of the effective project, of whom one was dignosed with GIH on the 3rd postoperative day and the rate of post-PD hemorrhage was 2.6%. All patients were diacharged on the 6th or 7th postoperative day.
Conclusion
Exploring evidences under the guidance of scientific method and applying them to clinical nursing can prevent post-PD hemorrhage and improve life quality of patients.
Objective
To analyze the risk factors of hypertension combined with cerebral hemorrhage.
Methods
From May 2015 to October 2016, 92 hypertension patients with cerebral hemorrhage (group A) were enrolled; simultaneously, 110 hypertension patients without cerebral hemorrhage (group B) were included. We analyzed retrospectively the clinical data of two groups and the risk factors of hypertension complicated with cerebral hemorrhage.
Results
The results of univariate analysis showed that the ratios of patients in group A with the following indexes, >65 years old, body mass index >30 kg/m2, >7-year smoking history, triglyceride level >1.7 mmol/L, cholesterol level >5.72 mmol/L, high density lipoprotein level >0.9 mmol/L, and bad medication compiance, were much more higher than those in group B (P<0.05). The rusults of multivariate analysis showed that smoking history, diabetes mellitus history, hypertension history, triglycerides level, cholesterol level, bad medication compliance were the risk factors of hypertension combined with cerebral hemorrhage (P<0.05).
Conclusions
The risk factors of hypertension combined with cerebral hemorrhage include smoking history, diabetes mellitus history, hypertension history, triglyceride level, cholesterol level, and medication compliance. We shoud pay more attention to these factors in clinical practice.
ObjectiveTo explore the risk factors and bleeding points associated with postoperative hemorrhage after thyroidectomy and provide clinical basis for prevention of postoperative bleeding.MethodsThe clinical data of 21 patients with postoperative hemorrhage and 63 patients without postoperative hemorrhage who underwent thyroidectomy from Nov. 2010 to Nov. 2017 in West China Hospital were retrospectively analyzed.ResultsUnivariate analysis showed that hypertension, maximum tumour dimension, lymph node metastasis, recurrent laryngeal nerval infiltration, T stage, N stage, serum triglyceride, and serum high density lipoprotein were significantly associated with postoperative hemorrhage (P<0.05). Multivariate analysis showed that lymph node metastasis (OR=16.219, P=0.002) and low serum high density lipoprotein (OR=0.035, P=0.006) were risk factors for postoperative hemorrhage. Among the patients with postoperative bleeding, the most common five bleeding sites were: ribbon muscle and sternocleidomastoid muscle (both was 19.2%), esophageal tracheal surface blood vessels (11.5%), thyroid bed (7.7%), and larynx recurrent paravascular small vessels (7.7%).ConclusionsLymph node metastasis and serum HDL are independent risk factors of hemorrhage after thyroidectomy. The predilection site for postoperative bleeding is mainly the neck muscle.
ObjectiveTo observe the efficacy and safety of intravitreal injection of conbercept in the treatment of proliferatived diabetic retinophathy (PDR) complicated with vitreous hemorrhage by minimally invasive vitreoretinal surgery.MethodsProspective clinical study. A total of 50 patients with PDR complicated with vitreous hemorrhage clinically diagnosed in Tianjin Medical University Eye Hospital who needed vitrectomy were recruited in this study. According to the principle of informed consent, the patients were divided into two groups: postoperative injection group and the control group. Twenty-five eyes of 25 patients in each group were examined before operation. No significant proliferative changes in the posterior pole and traction retinal detachment were observed. There was significant difference of age between two groups (t=－24.697, P=0.030), but no significant difference of sex (χ2=0.330, P=0.564), duration of diabetes (t=－1.144, P=0.258), logMAR BCVA (t=－0.148, P=0.883), lens state (χ2=0.397, P=0.529), panretinal laser photocoagulation (χ2=1.333, P=0.248). The postoperative injection group was treated with intravitreous injection of 0.05 ml conbercept (10 mg/ml) immediately after 27G minimally invasive vitrectomy. The other treatment and follow-up were the same as those in the postoperative injection group except for conbercept injection. All patients underwent routine slit-lamp examination, indirect ophthalmoscope and B-ultrasound examination before operation. The main outcome measure included the time of operation, the incidence rate of iatrogenic retinal holes and silicone oil filling. The recurrence of vitreous hemorrhage, BCVA, intraocular pressure, central retinal thickness (CRT), postoperative complications and progression were recorded 1 week, 1 month, 3 months and 6 months after operation.ResultsAt 1 week and 1, 3, 6 months after operation, there was significant difference of logMAR BCVA between the two groups (t=－4.980, －4.840, －4.892, －5.439; P<0.001). At 3 and 6 months after operation, the recurrence of vitreous hemorrhage in the postoperative injection group was lower than that in the control group, but there was no statistical difference between two groups (χ2=3.030, 4.153; P=0.192, 0.103). At 1 week and 1, 3, 6 months after operation, the CRT in the postoperative injection group was lower than that in the control group, the difference was significant (t=－2.622, －2.638, －3.613, －3.037; P=0.012, 0.010, 0.001, 0.004, 0.005). There was no complications such as choroid detachment, proliferative vitreoretinopathy, retinal detachment, iris redness and neovascular glaucoma in all the eyes after operation.ConclusionsIntravitreal injection of conbercept in the treatment of PDR after operation is safe and effective. It can reduce the recurrence of vitreous hemorrhage after vitrectomy, improve the BCVA.
