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Hemorrhoid Coagulation

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61. Hypofractionated Radiation Therapy for Localized Prostate Cancer

(criterion removed July 1, 2009). Of note, 11% of participants had diabetes, 40% hypertension, 4% inflammatory bowel disease, 8% previous pelvic surgery, 7% symptomatic hemorrhoids, and 8% prior TURP. In prespecified subgroup analyses, older men (age >69 years) had a reduced biochemical or clinical failure rate with 6000 cGy in 300 cGy fractions compared to 7400 cGy in 200 cGy fractions (Hazard ratio [HR] 0.59; 90% CI: 0.43-0.81), but younger men (age ≤69 years) showed no difference between treatment

2018 American Urological Association

64. Bruising

acid. Quinine. Propranolol. Thiazide diuretics. Drugs which cause coagulation inhibition Warfarin. Heparins. Apixaban, dabigatran, and rivaroxaban. [ ; ; ; ; ] Diagnosis of bruising causes How should I assess a person with bruising? Ask about symptoms which suggest an underlying platelet or coagulation disorder: Nosebleeds or gingival bleeding (mucocutaneous bleeding). Excessive or prolonged bleeding from haemorrhoids, other rectal bleeding, haematuria, or menorrhagia. Previous excessive bruising (...) , or exacerbated by, an underlying bleeding disorder or medical condition, including: Vascular disorders (for example senile or simple purpura). Platelet disorders (for example idiopathic thrombocytopenic purpura, leukaemia, or liver disease). Coagulation disorders (for example haemophilia, vitamin K deficiency, or von Willebrand disease). Drugs (such as corticosteroids, warfarin, and alcohol). The presence of a bleeding disorder or underlying medical condition does not rule out non-accidental injury

2017 Prodigy

65. NOACs/DOACs: Management of Bleeding

for dabigatran is now available in Canada, while specific antidotes for the other drugs are expected to be available soon. Studies of successful reversal strategies using non-specific products in patients with bleeding have not been reported. Appropriate management in all cases of bleeding requires a systematic approach to assessing the competing risks and consequences of bleeding and thrombosis. MANAGEMENT OF BLEEDING EPISODES Minor Bleeding e.g. extremity bruising, hemorrhoid bleeding, subconjunctival (...) antiplatelet therapy. Consider higher platelet count threshold of 100 x 10 9 /L in patients with bleeding into a critical site (e.g. intracranial hemorrhage). ? Plasma and/or cryoprecipitate transfusion only if concomitant coagulopathy (e.g. massive transfusion, disseminated intravascular coagulation, liver disease). Reversal for severe/life-threatening bleeding (see Table 2) Recommended coagulation test assays and thresholds for clinically relevant plasma DOAC concentrations are estimates based

2017 Thrombosis Interest Group of Canada

66. CRACKCast E177 – Acute Complications of Pregnancy

% of women will have no pain or vaginal bleeding. Assessment is generally based on clinical features, coagulation parameters, and signs of fetal distress. Hypertension in Pregnancy Gestational hypertension occurs during pregnancy (>20wks), resolves during the postpartum period and equals a new blood pressure reading of 140/90 mm Hg or higher. Preeclampsia is gestational hypertension with proteinuria (>300 mg/24 hr); eclampsia is the occurrence of seizures in the patient with signs of preeclampsia (...) labour Occult marginal placental separations Cervical or vaginal lesions Lower genital tract lesions Hemorrhoids Bleeding during the second trimester before the fetus is potentially viable (14–24 weeks) is not benign. One-third of fetuses are ultimately lost when maternal bleeding occurs. 10) List 6 RFs for placental abruption. Differentiate clinically between a placental abruption and a placenta previa. Risk factors for placental abruption: Trauma Don’t forget to screen for domestic abuse Non

2018 CandiEM

67. Management of bleeding in the late preterm period

Possible etiologies of late preterm third-trimester bleeding Obstetric Nonobstetric Placenta previa Internal or external hemorrhoids Placental accreta, increta, or percreta Urinary tract infection Placental abruption Bladder or kidney stones Vasa previa Lower gastrointestinal bleeding Early labor Lower genital tract lesions SMFM. Management of bleeding in the late preterm period. Am J Obstet Gynecol 2018 . Etiologies of late preterm bleeding Placenta previa Placenta previa can cause late preterm third (...) coagulation factors, and fibrinogen. Blood urea nitrogen, creatinine, and electrolytes may also be assessed if the likelihood for transfusion is high. A wall clot is a useful test to assess coagulopathy with acute bleeding. To perform this test, blood is placed into a plain (red-top) tube and put aside. The blood should clot within 6 minutes, and delayed clotting beyond this time is suggestive of coagulopathy. x 50 Hull AD. in: R.K.R.R. Creasy, J.D. Iams, C.J. Lockwood, T.R. Moore, M.F. Greene (Eds

2017 Society for Maternal-Fetal Medicine

68. Commissioning guide for rectal bleeding

test to check whether there is blood hidden in faeces flexible sigmoidoscopy telescope examination of the lower bowel full blood count (FBC) a blood test for anaemia Glyceryl trinitrate (GTN) medication to relax the anal sphincter and improve blood supply to allow fissure healing haemorrhoidal artery ligation operation doppler guided haemorrhoidal operation designed to identify and tie off blood vessels haemorrhoids piles high value care pathway clear and consistent commissioning guideline (...) proctitis Inflammatory condition of rectum occurring after radiotherapy second degree haemorrhoids piles that prolapse on bearing down but go back on their own solitary rectal ulcer condition caused by straining at stool,rectal intussusception or anal digitation, with trauma to the lining of the back passage and subsequent ulceration third degree haemorrhoids piles that prolapse on bearing down but need to be pushed back to go back inside transanal haemorrhoidal dearterialization doppler guided

2018 Association of Coloproctology of Great Britain and Ireland

70. Management of Uterine Fibroids

below by category of intervention, providing data about adverse events when available and statistically informative. We categorized interventions using the publication authors’ description. Interventions include expectant management or placebo; medications to improve or resolve symptoms or reduce size of fibroids (including those delivered via IUDs); procedures (uterine artery occlusion via embolization, ligation, or coagulation; and fibroid ablation (e.g., high intensity focused ultrasound (...) within a category of intervention, for instance comparing myomectomy conducted by laparoscopy to myomectomy through a laparotomy incision. These are reviewed within categories of interventions above and when clinically and statistically significant advantages have been demonstrated they are noted. Comparisons across types of surgical interventions were meager, and the three related studies are noted below. Comparison of Laparoscopic Bipolar Coagulation With and Without Uterine Nerve Ablation

2017 Effective Health Care Program (AHRQ)

71. Diagnosis, Assessment and Management of Constipation in Advanced Cancer: ESMO Clinical Practice Guidelines

Perineal inspection Digitalrectal examination Distension Abdominal masses Liver enlargement Tenderness Increased/decreased bowel sounds Skin tags Fissures Prolapse Anal warts Perianal ulceration Inner haemorrhoids Sphincter tone Tenderness Obstruction/stenosis Impacted faeces Complete absence of stool Tumour masses Blood Clinical Practice Guidelines Annals of Oncology iv116 | Larkin et al. Volume 29 | Supplement 4 | October 2018 Downloaded from https://academic.oup.com/annonc/article-abstract/29 (...) - administered enemas should be administered by an experienced health professional [IV, C] [25]. The use of enemas involves risks of perforation of the intestinal wall (which should be anticipated and suspected if abdominal pain occurs), rectal mucosal damage and bacteraemia. Patients on therapeutic or prophylactic antico- agulation or who are affected by coagulation and platelet disor- ders are at risk of bleeding complications or intramural haematomas [73, 74]. Contraindications to enemas in the treatment

2018 European Society for Medical Oncology

72. Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy

perform colonoscopy, at least 20 of these procedures should be performed under direct supervision and should demonstrate a consistent insertion depth to more than 50 cm. 29 Achievement of competency in colonoscopy implies competency to perform ?exible sigmoidoscopy. More advanced skills such as hemorrhoidal banding or stent placement require further training and separate credentialing and monitoring to maintain privileges. Providers performing ?exible sigmoidoscopy should complete a formal training (...) for therapeutic purposes, and thus competency in standard endoscopic therapeutic maneuvers, including argon plasma coagulation, injection sclerotherapy and tattooing, polypectomy, and hydrostatic dilation of strictures, is expected. 45 An analysis of learning curves among expert endoscop- ists suggests that measurable improvement after 10 upper DE cases and 20 retrograde double-balloon enteroscopy cases are required to ensure stable overtube intubation of the ileum. 46 Performance of these minimum numbers has

2017 American Society for Gastrointestinal Endoscopy

75. New/Novel Oral Anticoagulants (NOACs): Management of Bleeding

anticoagulants, bleeding is the major complication of therapy. Specific antidotes for these drugs are expected to be available soon. Studies of successful reversal strategies using non-specific products in patients with bleeding have not been reported. Appropriate management in all cases of bleeding requires a systematic approach to assessing the competing risks and consequences of bleeding and thrombosis. MANAGEMENT OF BLEEDING EPISODES Minor Bleeding e.g. anterior epistaxis, hemorrhoid bleeding (...) . intracranial hemorrhage). ? Plasma and/or cryoprecipitate transfusion only if concomitant coagulopathy (e.g. massive transfusion, disseminated intravascular coagulation, liver disease). Reversal for severe/life-threatening bleeding (see Table 2) Recommended coagulation test assays and thresholds for clinically relevant plasma NOAC concentrations are estimates based on available evidence that require further study/validation. Dabigatran ? If dabigatran level 30 ng/mL = likely significant anticoagulant

2016 Thrombosis Interest Group of Canada

76. BindRen (colestilan)

(3 months only), rat (up to 12 months + 3 months recovery) and the dog (up to 12 months + 3 months recovery). The main effects observed following repeat dosing can be ascribed to the pharmacology, i.e. bile acid sequestration potential of MCI-196 resulting in lipid lowering. Cholesterol, fatty acids and triglycerides levels were decreased in both rats and dogs. These effects were seen from 4 weeks of dosing through to 12 months but were minimal at all time-points. Increased coagulation parameters (...) /day which is only 2-fold to the clinical dose. There was no evidence of vitamin K deficiency in dogs and there was no consistent increase in PT and APTT in any of the dog studies. Coagulation parameters and vitamin K levels are easily monitored in the clinic and deficiencies are easily manageable by supplementation. Very slightly decreased vitamin K, and increased PT and APTT was observed in the clinical studies of up to one year, however this did not translate into an obviously increased bleeding

2015 European Medicines Agency - EPARs

77. Zontivity - vorapaxar

receptor on human platelets, which mediates the downstream effects of this critical coagulation factor in hemostasis and thrombosis. Thrombin-induced platelet activation has been implicated in a variety of cardiovascular disorders including thrombosis, atherosclerosis, and restenosis following percutaneous coronary intervention (PCI). As an antagonist of PAR-1, vorapaxar blocks thrombin-mediated platelet aggregation and thereby has the potential to reduce the risk of atherothrombotic complications (...) patients. This request was discussed at the CHMP and not accepted by the Committee. 2.2 About the product Vorapaxar is a first - in - class selective antagonist of the protease-activated receptor 1 (PAR-1), the primary thrombin receptor on human platelets, which mediates the downstream effects of this critical coagulation factor in haemostasis and thrombosis. Thrombin-induced platelet activation has been implicated in a variety of cardiovascular disorders including thrombosis, atherosclerosis

2015 European Medicines Agency - EPARs

78. Blood and stool biomarker for colorectal cancer screening

generation FOBT - an automated immunochemical faecal occult blood test (iFOBT). 4 Faecal occult blood testing looks for minute traces of haemoglobin in stool samples, which may be a result of upper or lower gastrointestinal bleeding potentially caused by not only benign or malignant growths or polyps of the colon, but many conditions including: inflammatory bowel disease, haemorrhoids, ulcerative colitis or Crohn’s disease. The gFOBT uses hydrogen peroxide, which in the presence of blood results (...) plasma coagulation. b RNA = ribonucleic acid Blood and stool biomarker testing for CRC screening: Update August 2016 3 Figure 1 Rates of marker release into the bloodstream via vascular invasion and into the stool via exfoliation 7 DNA stool-based assays Whereas the established FOBT is used to detect minute traces of haemoglobin in stool samples, new tests on the market may be used to detect DNA fragments in stool samples. These tests rely on the fact that the colorectal epithelium sloughs cells

2016 COAG Health Council - Horizon Scanning Technology Briefs

79. The Prevention and Treatment of the More Common Complications Related to Prostate Biopsy Update

clot retention with need for urethral catheterization and hospital admission can occur in up to 0.4 percent of patients post-biopsy. 76 Nonetheless, hematuria is rarely problematic for patients. 88 Larger prostate volume as well as increased transition zone size, 89 but not the number of biopsy cores, 90,91 are reproducibly associated with hematuria. Rectal bleeding The rectal mucosa receives a rich vascular supply from the inferior and middle rectal arteries, and patients with hemorrhoids (...) of hemostatic agents, or direct vessel ligation. 98,99 If excessive rectal bleeding is encountered, consultation with general surgery, interventional radiology, and/or gastroenterology may be necessary. Large-volume hematuria requiring intervention is similarly uncommon, and these rare occurrences can be initially managed with urethral catheter insertion, clot irrigation, and external traction for a compressive effect. Refractory cases may require cystoscopy and coagulation. III. Urinary Obstruction

2016 American Urological Association

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