Objective
To analyze clinicopathologic characteristics of 1 008 patients with gallbladder polyps by minimally invasive gallbladder-preserving surgery, and to explore hemostatic effect of 0–4 ℃ cold saline plus different concentrations norepinephrines in flushing gallbladder mucosa bleeding.
Methods
The clinical data of 1 008 patients with gallbladder polyps by the minimally invasive gallbladder-preserving surgery from 2009 to 2016 in the General Hospital of Xinjiang Military Command were retrospectively analyzed. The clinicopathologic types of gallbladder polyps and the relationship between the operation time and the recurrence of gallbladder polyps were analyzed, the hemostatic effects of 0–4 ℃ cold saline plus different concentrations (0, 16, 24, and 30 mg/L) norepinephrines in flushing gallbladder mucosa bleeding (The hemostatic effect was reflected by the time of flushing gallbladder mucosa bleeding) were compared.
Results
One thousand patients with non-tumorous gallbladder polyps successfully underwent the minimally invasive gallbladder-preserving surgery, another 8 cases patients with tumorous gallbladder polyps underwent the cholecystectomy immediately. There were 128 cases of single polyps and 880 cases of multiple polyps. The polyp diameters of 910 cases were 5–10 mm and 98 cases were 10–15 mm. The pathological analysis indicated that there were 912 (90.5%) cases of the cholesterol polyps, 74 (7.3%) cases of the inflammatory polyps, 14 (1.4%) cases of the adenoid hyperplasia, and 8 (0.8%) cases of the neoplastic polyps ［adenoma 6 cases, adenocarcinoma (T0N0M0) 2 cases］. The gallbladder polyps recurrences were found in 30 (3.0%) cases during 1–8 years of follow-up (average 4 years), all of them were the multiple and cholesterol polyps. The flushing gallbladder mucosa bleeding time of 0–4 ℃ cold saline plus 0, 16, 24, and 30 mg/L concentraions norepinephrine was (44±5) min, (33±6) min, (17±5) min, and (17±4) min in the 125, 230, 555, and 98 patients with gallbladder polyps, respectively. The time of flushing gallbladder mucosa bleeding between the other concentration groups had significant difference (P<0.05) except for between the 24 mg/L concentration group and the 30 mg/L concentration group (P>0.05). The operation time was (62±21) min and (60±19) min of the 30 patients with gallbladder polyps recurrence and the 970 patients without gallbladder polyps recurrence, which had no significant difference (P>0.05).
Conclusions
Cholesterol polyp is a common pathological type of gallbladder polyp, inflammatory polyp and adenomyosis polyp are uncommon, and multiple polyps are common. Hemostatic effects of 0–4 ℃ cold saline plus different concentraions norepinephrine in flushing gallbladder mucosa bleeding are desirable, expecially at a 24 mg/L concentraion norepinephrine is the most effective. No correlation is found between operation time and recurrence of gallbladder polyp.
Objective To analyze the characteristics and risk factors of hemorrhagic adverse events (AEs) associated with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Methods AEs reports with SSRIs/SNRIs as the primary suspected (PS) drugs from the first quarter of 2009 to the third quarter of 2024 in the FAERS database were extracted. Hemorrhagic AEs reports were screened using the MedDRA standard terminology (SMQ). Descriptive statistics were used to analyze patient characteristics, and signal detection was performed using the reporting odds ratio (ROR), proportional reporting ratio (PRR), and the polynomial gamma Poisson distribution reduction method (MGPS). Multiplicative and additive models were used to assess the interaction risk with antiplatelet/anticoagulant drugs. Results A total of 5 073 reports of hemorrhagic AEs associated with SSRIs (6.5%) and 2 740 reports related to SNRIs (4.1%) were included. The proportion of patients aged ≥65 years (P<0.001), the time-to-onset >90 days (P<0.001), reports from healthcare professionals (P<0.001), and serious adverse events (P<0.001) were higher. The gastrointestinal tract and central nervous system were the main bleeding sites for SSRIs, among which sertraline had the most signals for gastrointestinal adverse events, while the central nervous system had the fewest. All positive signals for SNRIs were associated with venlafaxine. Among AEs of various SSRIs/SNRIs combined with other drugs, the proportion of hemorrhagic AEs was higher in the combination with antiplatelet or anticoagulant drugs (P<0.001). Conclusion Hemorrhagic adverse events associated with SSRIs/SNRIs are mostly severe. In clinical practice, it is essential to implement proper pharmaceutical care, focusing on the bleeding risks associated with SSRIs/SNRIs use in elderly patients, those on long-term medication regimens, and patients concurrently using anticoagulants. Individualized medication regimens should be implemented based on the patient's underlying diseases and drug characteristics.
