fibrin and Gastrointestinal-Hemorrhage

A 58-year-old man with hepatitis B cirrhosis noticed black stools and underwent an endoscopy at a community hospital. The presence of esophageal varices (EVs) was confirmed, but the bleeding point was not found. He was referred to our institution and underwent a second endoscopy. Extensive white patches of esophageal candidiasis were visible on endoscopy by white-light imaging (WLI), but it was difficult to find the fibrin cap of the EVs. This was easier under narrow-band imaging (NBI), however, as the color turned red from absorption by hemoglobin adhered to it. We retrospectively measured the color differences (CD) between the fibrin cap and the surrounding mucosa 10 times using the CIE (L*a*b*) color space method. The median value of CD increased after NBI (13.9 → 43.0, p < 0.001), with increased visibility. However, the median CD between the white patch and surrounding mucosa decreased after NBI (44.8 → 30.3, p < 0.001). The fibrin cap was paler than the white patch of candidiasis, but the increased visibility of the fibrin cap by NBI enabled it to be found more easily. This is the first report of a case in which NBI was helpful in locating a fibrin cap of EVs.

Topics: Candidiasis; Color; Esophageal and Gastric Varices; Esophagoscopy; Fibrin; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Narrow Band Imaging

Obscure gastrointestinal (GI) bleeding is identified as persistent or repeated bleeding from the gastrointestinal tract which could not be defined by conventional gastrointestinal endoscopy and radiological examinations. These GI bleedings are assessed through invasive diagnostic and treatment methods including enteroscopy, angiography and endoscopy. In addition, video capsule endoscopy (VCE) is a non-invasive method used to determine the location of the bleeding, however, this does not provide any treatment. Despite of these successful but invasive methods, an effective non-invasive treatment is desperately needed. Herein, we prepare non-invasive theranostic capsules to cure obscure GI bleeding. An effective theranostic capsule containing endothelin as the targeting agent, thrombin-fibrinogen or fibrin as the treating agent, and fluorescein dye as the diagnostic tool is suggested. These theranostic capsules can be administered orally in a simple and non-invasive manner without a risk of complication. By using these novel capsules, one can diagnose obscure GI bleeding with having a possibility of curing.

Topics: Administration, Oral; Angiography; Capsule Endoscopy; Capsules; Endoscopy, Gastrointestinal; Erythrocytes; Fibrin; Fibrinogen; Gastrointestinal Hemorrhage; Humans; Polymers; Technetium; Theranostic Nanomedicine; Thrombin; Tomography, X-Ray Computed; Treatment Outcome

An 80-years-old man was admitted to our clinic because of upper gastrointestinal bleeding with tarry stool for 3 days after taking non steroidal antiinflammatory drugs (NSAID) for back pain. The history was otherwise unremarkable.. Laboratory results showed anaemia. Initial endoscopy revealed acute bleeding from an elevated ulcer in the pars inferior of the duodenum. The bleeding was successfully treated by epinephrine and fibrin injection. Biopsies showed inflammatory changes without presence of malignant cells. In the CT scan of the abdomen there was a mass near the ligament of Treitz of 6.3 cm in diameter adjacent to the duodenum.. The abdominal tumor was not suitable for ultrasound-guided biopsy. Therefore, laparotomy and surgical resection of the tumor were performed. Histology showed a gastrointestinal stromal tumor (GIST) with infiltration of the muscle layer of the duodenal wall with one small local metastasis. No lymph node metastases were present. The tumor was surgically completely removed and the regular follow-up examinations have fo far shown no evidence for tumor recurrence or metastases.. In upper gastrointestinal bleeding from unusual sites, GIST has to be considered as an underlying disease even if endoscopic biopsies are negative for neoplastic changes.

Topics: Aged; Aged, 80 and over; Anemia; Biopsy; Duodenal Neoplasms; Endoscopy, Digestive System; Epinephrine; Fibrin; Gastrointestinal Hemorrhage; Humans; Immunohistochemistry; Male; Stromal Cells; Tomography, X-Ray Computed; Treatment Outcome

A 16-yr-old adult male northern fur seal (Callorhinus ursinus) was found dead in its outdoor pool in November 1995. The animal was maintained at Mystic Aquarium (Mystic, Connecticut, USA) from March 1980 to November 1995. Gross necropsy findings included hemoperitoneum and locally extensive gastric intramural hemorrhage that involved the posterior fundic, antral, and pyloric regions and extended into the duodenum. The gastric mural thickening grossly resembled hemangioma, and the gastric serosa was ruptured at the site of maximal mural expansion. In histologic sections of the stomach, a cribiform network of fibrin, which encompassed numerous variably-sized aggregates of closely packed erythrocytes, markedly expanded the submucosa. No vascular endothelium was identified in serial histologic sections of the expanded gastric submucosa stained with hematoxylin and eosin or immunohistochemically with antibodies to vimentin and Factor VIII-related antigen, establishing an absence of hemangioma. Carstairs' and Weigert's histochemical stains confirmed that the framework expanding the submucosa was fibrin. Although the appearance of the gastric wall resembled hemangioma, a population of neoplastic endothelial cells was not identified within the submucosal expansion of hemorrhage and fibrin, and microscopic evidence was most consistent with the diagnosis of gastric intramural hematoma. This lesion is a rare pathologic event that has not been reported in marine mammals, but one that should be included in diagnostic considerations of hemoperitoneum and gastric mural expansion.

Topics: Animals; Fatal Outcome; Fibrin; Fur Seals; Gastric Mucosa; Gastrointestinal Hemorrhage; Hematoma; Hemoperitoneum; Immunohistochemistry; Male; Stomach; Stomach Diseases

E. coli O157:H7 may cause hemorrhagic colitis resembling ischemic colitis. Diagnosis is usually made by finding sorbitol-negative colonies on MacConkey agar that react with O157 and H7 antisera. Most ischemic colitis is idiopathic, but some may be caused by E. coli O157:H7, inasmuch as this organism can produce fibrin thrombi in colon vasculature. The objectives of this study were to determine whether E. coli O157:H7 infection can be diagnosed retrospectively from paraffin blocks of colon sections and whether an association exists between E. coli O157:H7 infection and colonic ischemia.. Paraffin-embedded sections of normal colon (n = 2) and various colitides [ischemic (n = 11), E. coli O157:H7 (n = 2), IBD (n = 8) and pseudomembranous (n = 3)] were used. Sections were deparaffinized, rehydrated, incubated with 3% peroxide in methanol, rinsed, and incubated with peroxidase-labeled antibody isolated from goats immunized with whole E. coli O157:H7. Sections were stained with peroxidase chromagen reagent and counterstained with hematoxylin. Coarse, granular, orange-brown staining was considered positive. To determine the localization of the chromagen deposits, three cases that stained positive, including one of the culture-proved E. coli O157:H7 colitis and two of colonic ischemia, were processed for electron microscopy.. Both cases (100%) of E. coli O157:H7 colitis and three of 11 (27.3%) cases of ischemic colitis stained positive by light microscopy. In one culture-proved case, electron microscopy demonstrated staining of bacillary structures; in two cases of colonic ischemia, extensive deposits of chromagen material were present that were associated neither with inflammatory cells nor with bacterial forms.. Immunoperoxidase staining of archival sections may be used to diagnose E. coli O157:H7 infection. An etiological role for this organism is possible in some cases of colonic ischemia.

Topics: Aged; Antibodies, Bacterial; Chromogenic Compounds; Colitis; Colitis, Ischemic; Colon; Coloring Agents; Enterocolitis, Pseudomembranous; Escherichia coli Infections; Escherichia coli O157; Female; Fibrin; Gastrointestinal Hemorrhage; Hematoxylin; Humans; Immunoenzyme Techniques; Inflammatory Bowel Diseases; Male; Microscopy, Electron; Middle Aged; Paraffin Embedding; Retrospective Studies; Thrombosis

Endoscopic injection therapy is a well established method of controlling peptic ulcer haemorrhage but the optimum injection solution and the mechanism involved in inducing haemostasis are unknown.. The efficacy and effects on tissue of various therapeutic agents used in the control of gastric mucosal haemorrhage were studied in ten rabbits. Thirty-eight bleeding mucosal ulcers (blood loss above 1.5 ml/min) created at gastrotomy were studied. Adrenaline (1:100,000), thrombin, fibrin (thrombin plus fibrinogen), 5 per cent ethanolamine and 50 per cent dextrose were injected; a fibrin suspension was also sprayed around bleeding ulcers.. Sclerosants were found to be least effective in the control of bleeding and were associated with significant tissue necrosis. Although all the other solutions significantly decreased blood loss within 30 min of injection (median blood loss 0.25 ml/min), only an injected mixture of adrenaline plus thrombin and sprayed fibrin achieved complete haemostasis within 2 min of treatment and with no recurrence of bleeding. Neither agent caused significant tissue damage. Histological examination showed that no solution caused arterial thrombosis when injected next to a major ear artery.. Sclerosants caused extensive tissue necrosis and were least effective in the control of ulcer haemorrhage. A combination of dilute adrenaline and human thrombin may represent optimal haemostatic therapy for peptic ulcer haemorrhage.

Topics: Animals; Epinephrine; Ethanol; Fibrin; Gastrointestinal Hemorrhage; Glucose; Hemostasis; Injections; Rabbits; Stomach Ulcer; Thrombin

Topics: Blood Platelets; Esophageal and Gastric Varices; Esophagoscopy; Fibrin; Gastrointestinal Hemorrhage; Humans

The distinction between venomous, potentially dangerous snakes and snakes considered to be harmless to humans is not always clear. A man was bitten by an assumed harmless pet snake, Rhabdophis subminatus (the red neck keelback), that had been obtained from a pet store. The patient experienced a severe coagulopathy with life-threatening hemorrhage unresponsive to transfusion. Since this snake frequently is sold legally in the United States, we wish to alert the medical community to its potential danger and to discuss the pathophysiological mechanism by which the coagulopathy was produced.

Topics: Adult; Animals; Animals, Domestic; Blood Coagulation Disorders; Blood Coagulation Tests; Fibrin; Gastrointestinal Hemorrhage; Hematuria; Humans; Male; Snake Bites

Topics: Catheterization; Coronary Vessels; Embolization, Therapeutic; Esophageal and Gastric Varices; Fibrin; Gastrointestinal Hemorrhage; Gelatin Sponge, Absorbable; Glucose; Humans; Injections, Intravenous; Male; Middle Aged; Sclerosing Solutions; Stomach; Stomach Diseases; Veins

A 48-year-old man with accelerated hypertension developed right-sided ischemic colitis. There was no evidence of another cause of vascular inadequacy. Microscopically, the bowel showed ischemic alterations of different stages. The arterial alterations of different stages. The arterial vessels showed minimal changes. In older lesions, fibrosis was prominent and the mucosa was atrophic. In more recent lesions, some vessels of the submucosa were plugged with fibrin and the overlying mucosa was infiltrated by nonorganized hemorrhage and cellular elements.

Topics: Arteries; Atrophy; Colitis; Colon; Fibrin; Gastrointestinal Hemorrhage; Humans; Hypertension; Intestinal Mucosa; Ischemia; Male; Middle Aged

Fibrin clots may form in the biliary tract from hemobilia or in inflammatory disease. There is a wide variation in the clinical course of such clots which is exemplified by 9 patients. They may either dissolve through fibrinolysis, get ejected into the intestine, remain and obstruct the biliary tract, or may even transform into gallstones. In order to elucidate the mechanisms involved, the behavior of blood clots in bile was studied in vitro. A model was constructed of the biliary tract and, drained by a T-tube, where human bile circulated with a flow rate resembling that in vivo. When a small amount of human blood was injected, it flowed immiscibly to the lowest level, displaced the bile, and formed a clot of pure blood. Even a minor bleeding may thus form a coagulum. This is different from the mixed clot of blood and bile that forms in experiments simulating major hemorrhage. These findings are related to clinical experience and especially to the disappearance of "retained stones" with or without the use of dissolving agents.

Topics: Biliary Tract; Biliary Tract Diseases; Blood Coagulation; Cholangiography; Cholecystectomy; Cholelithiasis; Cholestasis; Diagnostic Errors; Female; Fibrin; Fibrinolysis; Gallstones; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Male; Models, Biological; Postoperative Complications

Topics: Aged; Aminocaproates; Duodenal Diseases; Fibrin; Gastrointestinal Hemorrhage; Hemostatics; Humans; Middle Aged; Stomach Diseases

Topics: Acute Disease; Adult; Disseminated Intravascular Coagulation; Fatty Liver; Female; Fibrin; Gastrointestinal Hemorrhage; Humans; Jaundice; Liver; Maternal Mortality; Pregnancy; Pregnancy Complications; Time Factors

Topics: Adult; Alpha-Globulins; Aminocaproates; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Esophageal and Gastric Varices; Factor V; Factor VII; Factor X; Female; Fibrin; Fibrinolysin; Fibrinolysis; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Macroglobulins; Male; Middle Aged; Plasminogen; Protamines

Topics: Aged; Blood Coagulation Tests; Blood Platelet Disorders; Chronic Disease; Disseminated Intravascular Coagulation; Fibrin; Gastrointestinal Hemorrhage; Heparin; Humans; Male; Middle Aged; Neoplasm Metastasis; Prostatic Neoplasms; Prothrombin Time; Thromboplastin

Topics: Biopsy; Colitis, Ulcerative; Crohn Disease; Fibrin; Fibrinolysis; Gastrointestinal Hemorrhage; Histocytochemistry; Humans; Intestinal Mucosa; Peptide Hydrolases; Proctitis; Radiotherapy; Rectum; Sigmoidoscopy

Topics: Aged; Esophageal and Gastric Varices; Fibrin; Gastritis; Gastrointestinal Hemorrhage; Gastrointestinal Neoplasms; Hemostasis; Humans; Peptic Ulcer; Thrombin

Topics: Aminocaproates; Aminocaproic Acid; Amniotic Fluid; Blood Coagulation Disorders; Blood Coagulation Tests; Blood Transfusion; Embolism; Embolism, Amniotic Fluid; Female; Fibrin; Fibrinolysin; Fibrinolysis; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Male; Physiology; Plasminogen; Pregnancy; Prostatic Neoplasms