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Total 249 results found since Jan 2013.

Health systems organization for emergency care
Abstract: The increasing number of acute and severe digestive diseases presenting to hospital emergency departments, mainly related with an ageing population, demands an appropriate answer from health systems organization, taking into account the escalating pressure on cost reduction. However, patients expect and deserve a response that is appropriate, effective, efficient and safe. The huge variety of variables which can influence the evolution of such cases warranting intensive monitoring, and the coordination and optimization of a range of human and technical resources involved in the care of these high-risk patients, r...
Source: Best Practice and Research. Clinical Gastroenterology - October 1, 2013 Category: Gastroenterology Authors: Isabel Pedroto, Pedro Amaro, José Manuel Romãozinho Tags: Chapters Source Type: research

Novel oral anticoagulants in gastroenterology practice
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is associated with a 5-fold increase in the risk of ischemic stroke, and AF-related strokes have worse outcomes than those not associated with AF. Warfarin reduces the risk of stroke in patients with AF by approximately two-thirds and is more effective than aspirin or dual antiplatelet therapy with aspirin and clopidogrel. Although effective, warfarin has limitations that complicate its use. These include unpredictable pharmacokinetics and pharmacodynamics related to genetic polymorphisms and to variations in dietary vitamin K intake and numerous ...
Source: Gastrointestinal Endoscopy - May 31, 2013 Category: Gastroenterology Authors: Jay Desai, Christopher B. Granger, Jeffrey I. Weitz, James Aisenberg Tags: Review Articles Source Type: research

Summary of evidence-based guideline: Periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease: Report of the Guideline Development Subcommittee of the American Academy of Neurology
Objective: To assess evidence regarding periprocedural management of antithrombotic drugs in patients with ischemic cerebrovascular disease. The complete guideline on which this summary is based is available as an online data supplement to this article. Methods: Systematic literature review with practice recommendations. Results and recommendations: Clinicians managing antithrombotic medications periprocedurally must weigh bleeding risks from drug continuation against thromboembolic risks from discontinuation. Stroke patients undergoing dental procedures should routinely continue aspirin (Level A). Stroke patients underg...
Source: Neurology - May 27, 2013 Category: Neurology Authors: Armstrong, M. J., Gronseth, G., Anderson, D. C., Biller, J., Cucchiara, B., Dafer, R., Goldstein, L. B., Schneck, M., Messe, S. R. Tags: Ultrasound, All Medical/Systemic disease, All Neuro-ophthalmology, All Cerebrovascular disease/Stroke, All Trauma SPECIAL ARTICLE Source Type: research

FEES in the stroke unit : Recommendations for implementation in the clinical routine.
Abstract Dysphagia occurs in about 50 % of patients with acute stroke, is strongly related to early complications, such as aspiration pneumonia and is a major cause of increased morbidity and mortality in acute stroke. Flexible endoscopic evaluation of swallowing (FEES) has proven to be an easy to use, non-invasive tool for assessment of dysphagia in acute stroke, significantly adding accuracy to the clinical evaluation of dysphagia. With respect to the growing use of FEES in German stroke units this article summarizes recommendations for implementation and execution.A 3-step process is recommended to acquire the...
Source: Der Nervenarzt - May 23, 2013 Category: Neurology Authors: Dziewas R, Busse O, Glahn J, Grond M, Hamann GF, Ickenstein GW, Nabavi DG, Prosiegel M, Schäbitz WR, Schellinger PD, Stanschus S Tags: Nervenarzt Source Type: research

Post‐stroke dysphagia: progress at last
Abstract Oropharyngeal Dysphagia (OD) is both underestimated and underdiagnosed as a cause of malnutrition and respiratory complications following stroke. OD occurs in more than 50% of stroke patients. Aspiration pneumonia (AP) occurs in up to 20% of acute stroke patients and is a major cause of mortality after discharge. Systematic screening for OD should be performed on every patient with stroke before starting oral feeding, followed, if appropriate by clinical and instrumental (videofluroscopy and/or fiberoptic endoscopy) assessment. Bolus modification with adaptation of texture and viscosity of solids and fluids and po...
Source: Neurogastroenterology and Motility - March 11, 2013 Category: Gastroenterology Authors: L. Rofes, N. Vilardell, P. Clavé Tags: Viewpoint Source Type: research

Adverse events requiring hospitalization within 30 days after outpatient screening and nonscreening colonoscopies
Conclusions: This study provides further evidence of the safety of colonoscopy in routine practice with regard to delayed and non-GI AEs. Hospitalizations because of the investigated AEs were uncommon or rare for both screening and nonscreening colonoscopies.
Source: Gastrointestinal Endoscopy - February 15, 2013 Category: Gastroenterology Authors: Christian Stock, Peter Ihle, Andreas Sieg, Ingrid Schubert, Michael Hoffmeister, Hermann Brenner Tags: Clinical Endoscopy Source Type: research

Osler-Weber-Rendu syndrome simulating pulmonary metastasis
Osler–Weber–Rendu syndrome, also known as hereditary haemorrhagic telangiectasia (HHT), is an autosomal dominant disorder of abnormal blood vessel formation manifesting as telangiectasias and arteriovenous malformations (AVMs). The criteria for the diagnosis of HHT are epistaxis, multiple telangiectasias at mucocutaneous surfaces, AVMs in larger organ systems, and a family history of HHT.1–3 Recurrent epistaxis is the most common presenting complaint. Cerebral AVMs occur in about 10–20% of patients with HHT, and are associated with high mortality and morbidity due to stroke or brain abscess. MRI is ...
Source: Postgraduate Medical Journal - February 15, 2013 Category: Journals (General) Authors: Pereira e Silva, J. L., Zanetti, G., Marchiori, E. Tags: GI bleeding, Genetics, Echocardiography, Stroke, Radiology, Surgical diagnostic tests, General surgery, Radiology (diagnostics), Ear, nose and throat/otolaryngology, Epidemiology Images in medicine Source Type: research

Fatal dabigatran toxicity secondary to acute renal failure
We describe the case of a 74-year-old man taking dabigatran 150 mg twice daily for atrial fibrillation who presented to the emergency department after 20 mL of hematemesis at home. Laboratory evaluation revealed a partial thromboplastin time of 99 seconds, international normalized ratio of 11.7, and creatine of 3.1 mg/dL (baseline creatine, 0.9 mg/dL). Upper endoscopy revealed diffuse gastritis and bleeding. Despite treatment with packed red blood cells and fresh frozen plasma, the patient's hematemesis persisted resulting in significant aspiration requiring endotracheal intubation. Per poison control center recommendation...
Source: The American Journal of Emergency Medicine - November 19, 2012 Category: Emergency Medicine Authors: Joseph K. Maddry, Mana Kouros Amir, Daniel Sessions, Kennon Heard Tags: Case Reports Source Type: research

Swallowing Analysis for Semisolid Food Texture in Poststroke Dysphagic Patients
Conclusions: We identified the textures of different semisolid foods as being either appropriate or inappropriate for poststroke dysphagic patients.
Source: Journal of Stroke and Cerebrovascular Diseases - October 4, 2011 Category: Neurology Authors: Ryo Momosaki, Masahiro Abo, Kazushige Kobayashi Tags: Original Articles Source Type: research