SUMMARY Gastric juice from patients with peptic ulcer disease and from patients with no upper gastrointestinal abnormality was studied in order to assess its effect on a formed fibrin clot. In both groups of patients gastric juice caused a marked increase in fibrinolysis as evidenced by a shortening of the euglobulin clot lysis time. This plasmin mediated fibrinolytic activity was found to be heat labile and only present in an acid environment. Addition of tranexamic acid or sucralfate to gastric juice almost completely reversed this effect, whereas pepstatin was only partially effective. It is probable that acid dependant proteases other than pepsin are responsible for the marked fibrinolysis. The ulcer healing agent sucralfate might be useful in those patients at risk of bleeding or rebleeding from active peptic ulcer disease.Haemorrhage from active peptic ulcer disease remains a common and difficult therapeutic problem. Despite many new approaches in management, the mortality has changed little over the past 50 years. Approximately 10% of patients with acute upper gastrointestinal bleeding will die' and the mortality rate may rise to over 30% in that subgroup requiring emergency surgery."Th4 poor haemostatic response seen in the bleeding upper gastrointestinal tract has been variously ascribed to increased gastrointestinal motility during haemorrhage,' the marked vascularity and absence of autoregulation of local blood flow,' and the adverse effects of both acid and pepsin on the coagulation cascade.7 Moreover, dissolution of a formed fibrin clot is thought to be responsible for the very high incidence of rebleeding observed. Several investigators have identified fibrinolytic activity in gastric venous blood of patients with gastric haemorrhage`" and in gastric juice of patients with erosive gastroduodenitis."`R ecent work has suggested a beneficial effect of specific antifibrinolytic agents in preventing rebleeding in acute upper gastrointestinal haemorrhage."'" In the present study we have assessed the degree of fibriAddress for correspondencec: D P O'Donoghue,

Purpose: To evaluate the effectiveness of radiofrequency (RF) ablation as measured by change in worst pain score from baseline to 3 mo after RF ablation for the palliative treatment of painful bone metastases.Materials and Methods: One hundred patients (mean age, 64.6 y) underwent RF ablation for metastatic bone disease and were followed up to 6 mo. Subjects' pain and quality of life were measured before RF ablation and postoperatively by using the Brief Pain Index and European Quality of Life questionnaires. Opioid agent use and device-, procedure-, and/or therapy-related adverse events (AEs) were collected.Results: Eighty-seven patients were treated for tumors involving the thoracolumbar spine and 13 for tumors located in the pelvis and/or sacrum. All ablations were technically successful, and 97% were followed by cementoplasty. Mean worst pain score decreased from 8.2 ± 1.7 at baseline to 3.5 ± 3.2 at 6 mo (n ¼ 22; P < 0.0001 for all visits). Subjects experienced significant improvement for all visits in average pain (P <.0001), pain interference (P < .0001), and quality of life (P < .003). Four AEs were reported, of which 2 resulted in hospitalization for pneumonia and respiratory failure. All 30 deaths reported during the study were attributed to the underlying malignancy and not related to the study procedure.Conclusions: Results from this study show rapid (within 3 d) and statistically significant pain improvement with sustained long-term relief through 6 mo in patients treated with RF ablation for metastatic bone disease.

No abstract

No abstract

A bleeding patient is a common consult for interventional radiologists. Prompt triage, preprocedural evaluation specific to the site of hemorrhage, and knowledge of resuscitative strategies allow for a potentially life-saving procedure to be appropriately and safely performed. Having a firm understanding of the clinical work-up and management of a bleeding patient has never been more important. In this article, a discussion of the clinical approach and work-up of a bleeding patient for whom interventional radiology is consulted is followed by a discussion of etiology-specific preprocedural work-up.