China
Africa
Explore chapters and articles related to this topic
Scheme for Investigating Cases of Death due to Traumatic Injuries
Published in Paul T. Jayaprakash, Crime Scene Investigation and Reconstruction, 2023
The uncut hair tip will be finely tapered and usually unpigmented (Figure 5.54A). If the distal ends are cut, the tips normally begin to take on a rounded form within 2 to 3 weeks after cutting (Figure 5.54B), and the rounded tips continue to elongate becoming thinner as the hair grows further. If the uncut or cut hair is badly damaged, the tip will be split or frayed (Figure 5.54C and D).
Treatment of Variceal Bleeding in Cirrhotic Patients
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Prior to 2010, TIPS was only indicated for re-bleeding as a bridge to liver transplant. TIPS creates a low resistance channel between the hepatic vein and the portal vein. Complications of TIPS include portosystemic encephalopathy and technical complications such as cardiac arrhythmias, traversal of the liver capsule, and TIPS stenosis. TIPS is contraindicated in patients with heart failure, polycystic liver disease, severe pulmonary hypertension, uncontrolled systemic infection or sepsis, and severe tricuspid regurgitation.
The patient with acute gastrointestinal problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Rebecca Maindonald, Adrian Jugdoyal
Patients with a variceal bleed are more likely to need further intervention due to a high risk of recurrent bleeding, with 15–30% rebleeding in the six weeks following initial bleed (Siau et al. 2017). In addition to fluid resuscitation and close monitoring, the patient with a variceal bleed is likely to require any of the following interventions: Pharmacological control with Terlipressin (NICE 2016) to reduce portal blood pressure.Prophylactic antibiotic therapy (NICE 2016) to prevent infection, which is common after upper gastrointestinal bleeding in patients with cirrhosis.Endoscopic variceal ligation (EVL), which involves rubber bands placed so that they strangulate the bleeding varices.Transjugular intrahepatic portosystemic shunt (TIPS), which is a procedure whereby a catheter is inserted into the portal vein (under radiological guidance) and a stent is then inserted between the portal vein and the systemic circulation, thereby reducing portal blood pressure. This latter intervention is reserved for patients with recurrent bleeding not controlled by band ligation (NICE 2016).
Fabrication and characterization of dissolving microneedles for transdermal drug delivery of allopurinol
Published in Drug Development and Industrial Pharmacy, 2021
Jianmin Chen, Xinying Liu, Siwan Liu, Zemin He, Sijin Yu, Zhipeng Ruan, Nan Jin
To determine the application time, DMNs were inserted into the abdominal skin of mouse at 10, 20, 30, 45, and 60 min. As shown in Figure 6(A), it was observed that a half of the tips were dissolved in the skin after 10 min. With the time increasing, the more parts of the tips were dissolved. At 60 min, the tips were dissolved completely. Therefore, the application time should be set more than 60 min in the following experiments. Subsequently, DMNs with various doses of AP were inserted into the abdominal skin of mouse for 60 min, and the contents of drug delivered into the skin and the in vivo DDE were both calculated. As shown in Figure 6(B), the drug delivered into the skin of DMNs encapsulating 1.0, 2.5, and 3.5 mg was 384.85 ± 62.34, 1054.53 ± 135.87, and 1268.56 ± 138.74 µg, respectively, which were lower than the drug residual that has not been delivered into skin. Moreover, there was no significant difference of DDE in vivo among these groups (p>.05), the average of which was 38.9% (Figure 6(C)). This value was lower than the drug content centralized in the tips (45%), indicating that not all of the drug in the tips being delivered into skin. It was probably due to the high variability and elasticity of skin in vivo [28], which resulted in the incomplete insertion of DMNs into skin. Therefore, some of the drug residual can be retained on the surface of the skin and served as the drug reservoir, which would help to realize the sustained release of AP.
A rare case of hemodialysis-related portosystemic encephalopathy and review of the literature.
Published in Acta Clinica Belgica, 2020
Barbara Geerinckx, Rachel Hellemans, Amaryllis H. Van Craenenbroeck, Sven Francque, Liesbeth De Waele, Jeroen Kerstens, Pieter-Jan Van Gaal, Bart Bracke, Peter Michielsen, Thomas Vanwolleghem
Our case is the first report of a TIPS-associated HRPSE. The presence of a TIPS is a known risk factor for PSE. The pathogenesis is due to a combination of increased bioavailability of gut-derived toxins and hypoperfusion of the hepatic microcirculation. As mentioned before, hemodialysis can create hemodynamic changes with an increase of the ICV-PV pressure gradient. As ammonia-rich portal venous blood flows into the systemic circulation, substances such as ammonia may cause central nervous system toxicity. Figure 3 shows the close proximity of the jugular hemodialysis catheter with its tip in the superior caval vein and a TIPS. In view of this anatomic relation, we assumed that by altering the access of hemodialysis from the jugular to the femoral vein, these hemodynamic changes would be decrease. In combination with optimal laxation and antibiotics, our patient’s symptoms indeed resolved. After his living donor kidney transplant a couple of weeks later, hemodialysis could be stopped and the patient remained asymptomatic.
Clinical value of hemodynamic changes in diagnosis of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt
Published in Scandinavian Journal of Gastroenterology, 2022
Wanyan Li, Yayang Duan, Zhike Liu, Xiaofeng Lu, Jingwen She, Jing Qing, Chaoxue Zhang
Transjugular intrahepatic portosystemic shunt (TIPS) is an interventional operation method, which builds an artificial channel connecting the portal vein with higher pressure and the hepatic vein with lower pressure by placing a metal stent to reduce the pressure in the portal vein. The TIPS is an effective treatment method for portal hypertension and its complications [1,2]. Hepatic encephalopathy (HE) is one of the major complications after TIPS, and it has been reported that approximately 20–31% of patients developed HE or experienced further deterioration of pre-existing HE after TIPS [3]. Increasing blood ammonia caused by the portal blood directly enters the postcava without going through the detoxification in the liver contributes to developing HE in patients after TIPS [4].