4 research outputs found
Prevention of Recurrent Esophageal Variceal Bleeding in Patients with Cirrhosis
No full textAbstract
Purpose: The purpose of this clinical review article is to demonstrate the benefits of prophylactic treatment with beta-blockers for the prevention of recurrent esophageal variceal bleeding in patients with cirrhosis.
Method: A PubMed literature search of English-language articles was conducted with search key terms “esophageal varices/variceal,” “varix hemorrhage,” “variceal bleeding”, “prophylaxis with beta blockers,” “complications of cirrhosis,” “treatment of varices,” “endoscopic variceal ligation (EVL), “hepatic cirrhosis,” “portal hypertension,” “NSBB,” “burden of variceal bleeding.” The author identified twenty-three pertinent articles/publications for inclusion in this clinical review with use of retrieved article reference lists. Selections were based on relevance to the focused topic and served as the basis for this clinical review; many were excluded either due to irrelevance or a date of publish over 10 years ago.
Results: Multiple evidence based research studies include, peer review articles, systematic reviews, observational studies, and meta-analysis studies. Overall, concurring results demonstrate superior therapeutic management in the prevention of recurrent esophageal variceal bleeding with beta blockers.
Conclusion: Nonselective Beta Blockers (NSBB) have been the cornerstone of treatment for esophageal variceal bleeding for several decades. The goal of treatment is not only to control acute hemorrhaging with primary prophylaxis, but more importantly to prevent re-bleeding necessitating secondary prophylaxis to prevent patient decompensation and death. Therefore, prevention of variceal hemorrhaging begins with proper screening of all patients with cirrhosis. Over one-third of patients will have esophageal varices and up to 50% are likely to experience variceal hemorrhage with up to 75% likely to have future variceal bleeding episodes without proper management. The effects of daily NSBB with propranolol dosed between 40mg and 80mg has proven to increase survival rates with a 45% reduction in mortality
Use of Non-Selective Beta-Blocker for Refractory Stomal Variceal Hemorrhage
No full textBleeding stomal varices are often difficult to manage given the comorbidities that are associated with their presentation. Here, we report a case of a 62-year-old female with stomal variceal hemorrhage in the setting of chronic portal vein thrombosis who was ineligible for transhepatic intrajugular portosystemic shunt or surgery as a result of her challenging anatomy and peri-operative risks. Despite coil embolization, this patient experienced refractory bleeds which ceased following the initiation of a non-selective beta-blocker (NSBB). This case provides further evidence for the expanding role of NSBBs as an important therapeutic agent for complicated ectopic varices.Memorial University Open Access Author's Fun
Voices of Residents – An Analytical Method; Henri Raymond 1966
No full textAs a current observation this contribution intends to situate origins of the notion of the primacy of residential quality in urban creation in a historical context before May ‘68 and to show the relevance and actuality of this concept in emerging contemporary projective urban architectural practices. This is done through a retrospective re-reading of a major research contribution of architectural residential sociology elaborated by Henri Raymond and his team of ISU directed by Henri Lefebvre. A summary of results were published in 1966 as l’Habitat pavillonnaire and re-published in 2001 with the three different components together with the never published applied methodological instruction for inquiries of non-directed deep interviews with residents in modest single family housing suburban zones. This ground breaking qualitative interpretive approach in social sciences with repercussions in residential architectural design orientations is regarded by the author as a still valid example of how social sciences can provide a more profound understanding of residents’ perceptions of their spatio-social residential situation, than what the standard survey can offer for design guidance
