Management of bleeding in palliative care patients in the general internal medicine ward: a systematic review

Sood, Rahul; Mancinetti, Marco; Betticher, Daniel; Cantin, Boris; Ebneter, Andreas Samuel

doi:10.1016/j.amsu.2019.12.002

Cited by 21 publications

(19 citation statements)

References 86 publications

(100 reference statements)

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“…Like some other methods of hemostasis, alginate dressings, local tranexamic acid, or adrenaline-soaked gauze are validated topical treatments. 13 Oral antifibrinolytics can be considered to prevent further bleeding. 13 Embolization or radiotherapy may be considered according to overall patient attitude.…”

Section: Discussionmentioning

confidence: 99%

“…13 Oral antifibrinolytics can be considered to prevent further bleeding. 13 Embolization or radiotherapy may be considered according to overall patient attitude. 13 Later application of metronidazole powder is helpful for a more complete deodorization.…”

Section: Discussionmentioning

confidence: 99%

“…13 Embolization or radiotherapy may be considered according to overall patient attitude. 13 Later application of metronidazole powder is helpful for a more complete deodorization. 3 One of the major limitations of this study is the number of patients in each group and the fact that patient 9 received both the Mohs' and the zinc oxide treatments.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Usefulness of a Modified Mohs' Technique and Topical Application of Zinc Oxide Powder for Treating Skin Infiltration Caused by Unresectable Malignant Tumors

Arima

Saito

Maeda

et al. 2021

Palliative Medicine Reports

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Background: Infiltrative lesions of the skin caused by unresectable malignant tumors reduce the quality of life of patients significantly due to the presence of bleeding, exudate, pain, and/or malodor. Objective: We compared the efficacy of a modified Mohs' technique and topical application of a starch powder containing zinc oxide as palliative treatments for skin lesions caused by unresectable tumors in our hospital. Design: This is a retrospective study. Settings/Subjects: This study included nine patients who were treated for skin-infiltrating lesions caused by unresectable malignant tumors at our hospital in Japan from April 2008 to December 2019. Measurements: Mohs' paste or zinc oxide powder (50%) was applied to the infiltrative skin lesions. Arterial embolization was performed before the application of the Mohs' paste for patients at risk for arterial hemorrhage. Patients were evaluated for pain, tumor size, bleeding, wound exudate, and malodor. Results: Both treatments were useful for alleviating symptoms, such as tumor size, local bleeding, malodor, and exudate in patients with unresectable malignant tumors. Pain was reduced in patients treated with Mohs' paste for 1 hour as compared with those treated for 24 hours. Conclusions: Effective management of skin infiltrative lesions can be achieved by using a modified Mohs' technique, topical application of starch powder containing zinc oxide, and arterial embolization to reduce the vascularization of the tumors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical Usefulness of a Modified Mohs' Technique and Topical Application of Zinc Oxide Powder for Treating Skin Infiltration Caused by Unresectable Malignant Tumors

Arima

Saito

Maeda

et al. 2021

Palliative Medicine Reports

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“…При цьому спостерігається тенденція росту числа пацієнтів літнього віку та складає 30-35% загального числа пацієнтів, також зберігається значна гендерна диспропорція: частіше розвивається ГШКК у чоловіків (в 2,5-3 рази) відносно жінок відповідного віку, проте рівень смерт-DOI:https://doi.org/10.37699/2308-7005.5-6.2021.09 ності не має гендерних відмінностей за Sood R., Лавро З. Я., Козловим І. Б. [1,2].…”

Section: вступunclassified

Features of the Dynamic of Acute C-Reactive Protein and Indicators of the Body’s Immune System and Their Relationship With the Clinical Picture in Elderly Patients With Ulcerative Gastrointestinal Bleeding

Chukhriienko¹,

Trofimov²

2021

Khark. Surg. Sch.

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The aim. Improve the effectiveness of treatment of elderly patients with ulcerative gastrointestinal bleeding by studying the dynamics of the level of C-reactive protein (CRP) and immune system parameters, their relationship with the clinical picture. Materials and methods. 35 elderly patients in the period from 2019 to 2021 (according to the WHO classification — 61-90 years) with ulcerative gastrointestinal bleeding complicated by cardiovascular pathology. The gender distribution is as follows: men — 19 (54%), women — 16 (46%). The average age of the patients was 76.3 years. This category of patients was divided according to the methods of treatment of concomitant cardiovascular pathology: group A — patients who received therapy according to the standard scheme (n = 20), B — double (n = 15). As a control category of patients (n = 50) was selected. There are relatively healthy (donors), who were similar to the study group in terms of age, gender, and the method for determining indicators. Results. The state of local endoscopic hemostasis in group “A” was investigated: Forrest II was detected in 14 (70%) patients, Forrest III — in 6 (30%) patients; in group “B”: Forrest I — in 7 (47%) patients, Forrest II — in 8 (53%) patients. These results indicate that using of dual therapy leads to a change in the rheological properties of blood, which, in turn, leads to a decrease in the stability of local endoscopic hemostasis and an increased risk of recurrent bleeding compared with standard antihypertensive therapy (the studied groups are represented, respectively, 100% each). Conclusions. We have analyzed the C-reactive protein, interleukin-6 and interleukin-4. The main result of the study was the identification of the dynamics of markers in groups A and B. On the seventh day, normalization of these indicators was not revealed (in group B, it was especially pronounced). But the state of the latter was influenced by the therapy of concomitant pathology in patients with cardiovascular pathology. The clinical significance of immune indicators has been proven in many clinical examples and can be one of the objective criteria for assessing the patient’s condition, predicting the disease and correcting the treatment started.

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“…Constant bleeding has a significant impact on a patient's quality of life [ 7 ]. Additionally, clinically serious bleeding requires burdensome medical interventions, such as blood transfusions, which significantly impact the length of hospital stay and medical costs [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Hemostatic Radiotherapy for Advanced Malignancies Assessed by World Health Organization Bleeding Status

Katano¹,

Yamashita²

2021

Cureus

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This retrospective study aimed to evaluate the efficacy of radiotherapy for the palliation of bleeding symptoms of advanced malignancies. Patients and methodsWe included 36 consecutive patients treated for hemostatic intent by radiotherapy at our institution, from August 2013 to January 2019. Patient bleeding status was assessed according to the World Health Organization (WHO) bleeding status before and after radiotherapy. ResultsWe identified 36 consecutive patients, consisting of 14 men and 22 women. The median follow-up period after radiotherapy for all cases was 2.5 months (range: 0.4-37.7 months), and the one-year OS was 47.1% (95% confidence interval: 23.5%-67.6%). Of the 36 patients, 29 (81%) showed improvement by one point or more in the WHO bleeding status. A total of 15 patients received 30 Gy in 10 fractions with a biologically effective dose (BED10) of 39 Gy (high BED arm). The remaining 21 patients had received radiotherapy with a BED10 of less than 39 (low BED arm, range of BED10: 11.2-30 Gy). In the high BED arm, 14 of the 15 patients (91%) showed improvement on the WHO bleeding status. In the low BED arm, 15 of the 21 patients (71%) showed improvement on the WHO bleeding status. There was no statistically significant difference in the improvement rate between the high and low BED arms (p = 0.200). ConclusionThere is no universal standard to evaluate the hemostatic effect of palliative radiotherapy. In this retrospective study, we investigated the clinical outcomes of hemostatic irradiation as assessed by WHO bleeding status.

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Management of bleeding in palliative care patients in the general internal medicine ward: a systematic review

Cited by 21 publications

References 86 publications

Clinical Usefulness of a Modified Mohs' Technique and Topical Application of Zinc Oxide Powder for Treating Skin Infiltration Caused by Unresectable Malignant Tumors

Clinical Usefulness of a Modified Mohs' Technique and Topical Application of Zinc Oxide Powder for Treating Skin Infiltration Caused by Unresectable Malignant Tumors

Features of the Dynamic of Acute C-Reactive Protein and Indicators of the Body’s Immune System and Their Relationship With the Clinical Picture in Elderly Patients With Ulcerative Gastrointestinal Bleeding

The Efficacy of Hemostatic Radiotherapy for Advanced Malignancies Assessed by World Health Organization Bleeding Status

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