Misoprostol is a prostaglandin E1 analogue used to prevent and treat gastric ulcers. It has been commonly used in gynecology and obstetrics, especially for the management of postpartum hemorrhage (PPH). For this purpo...Misoprostol is a prostaglandin E1 analogue used to prevent and treat gastric ulcers. It has been commonly used in gynecology and obstetrics, especially for the management of postpartum hemorrhage (PPH). For this purpose, 1000 μg intrarectal (insertion of five 200 μg tablets) has been recommended as the third line after injectable oxytocin and methylergometrine. We proposed to manufacture a 1000 μg misoprostol suppository by determining formulation, release and stability. The administration facility was also evaluated. Several formulations of misoprostol suppositories were set up and evaluated. Misoprostol tablets and lipophilic bases (Hard fat—Adeps solidus Ph. Eur., Witepsol? H15 and Suppocire? AM and AS2X) were used to obtain suppositories. Surfactants were also tested (polysorbates Tween? 20, Tween? 80 and sodium lauryl sulfate (SLS)). The formula was monitored by the misoprostol release curve with an in vitro test and dosed by a HPLC method. Stability was determined by evaluating the percentage of misoprostol content remaining over the time in suppositories stored at 4℃ and 25℃. Facility of use versus tablets was evaluated by obstetricians of a Swiss regional hospital using a questionnaire. Misoprostol release was facilitated by adding surfactant to the lipophilic base. After 30 minutes, 59% ± 1.4% and 57% ± 8.2% of misoprostol was released with Adeps solidus + 1% SLS and Adeps solidus + 5% Tween 20 respectively. SLS was discarded to the final formula because of its irritating effect. After 7 months, suppositories still contained 94% ± 3.7% misoprostol with storage at 4℃. The administration was considered easier and faster compared with intra rectal use of tablets. The formula, consisting of 5 crushed misoprostol tablets dispersed in a suppository base made of Adeps solidus + 5% Tween? 20, is stable for at least 7 months at 4?C and facilitates the rectal administration of misoprostol in the treatment of PPH.展开更多
目的总结突发无痛性大量便血的卧床患者的临床资料,以期为临床诊治提供参考。方法本研究纳入分析的患者便血出血量大于400 m L,卧床时间为7 d及以上。本院2010年1月至2020年12月诊治的符合研究纳入条件的患者共45例,收集其临床资料,进...目的总结突发无痛性大量便血的卧床患者的临床资料,以期为临床诊治提供参考。方法本研究纳入分析的患者便血出血量大于400 m L,卧床时间为7 d及以上。本院2010年1月至2020年12月诊治的符合研究纳入条件的患者共45例,收集其临床资料,进行回顾性分析并按照出血原因的不同进行归类整理。结果粪性溃疡26例,包括19例多发溃疡、7例单发溃疡,患者平均年龄为(68.3±14.6)岁,中位卧床时间为12.0(9.0,19.3)d,使用抗凝、抗血小板药物的有12例。急性出血性直肠溃疡综合征(AHRUS)15例,包括6例多发溃疡、9例单发溃疡,患者平均年龄为(65.7±11.5)岁,中位卧床时间为10(8,17)d,使用抗凝、抗血小板药物的有7例。粪性溃疡、AHRUS患者采用电子结肠镜下钛夹夹闭止血、经肛门缝合结扎止血或(电子结肠镜下电凝后)凡士林纱布填塞压迫止血等方式处理后,出血完全控制。异物损伤2例,考虑原因分别为开塞露操作不当、灌肠操作,经肛门缝合结扎止血后出血得以控制。直肠憩室1例,予以蛇毒血凝酶灌肠、凡士林纱布填塞压迫止血后出血得以控制。直肠癌1例,予蛇毒血凝酶灌肠、凡士林纱布填塞压迫止血后症状好转,后由于直肠癌基础疾病,患者家属放弃进一步治疗,患者死亡。结论临床中应对突发无痛性大量便血予以足够重视,早期发现并积极处理对患者的临床转归具有重要的意义。对于老年卧床患者、合并严重基础疾病的卧床患者,要注意考虑粪性溃疡、AHRUS的可能。展开更多
BACKGROUND Red dichromatic imaging(RDI)is a novel image-enhanced endoscopy expected to improve the visibility of the bleeding point.However,it has not been thoroughly investigated.CASE SUMMARY A 91-year-old man develo...BACKGROUND Red dichromatic imaging(RDI)is a novel image-enhanced endoscopy expected to improve the visibility of the bleeding point.However,it has not been thoroughly investigated.CASE SUMMARY A 91-year-old man developed a sudden massive hematochezia and underwent emergent colonoscopy.An ulcer with pulsatile bleeding was found on the lower rectum.Due to massive bleeding,the exact location of the bleeding point was not easy to detect with white light imaging(WLI).Upon switching to RDI,the bleeding point appeared in deeper yellow compared to the surrounding blood.Thus,RDI enabled us for easier recognition of the bleeding point,and hemostasis was achieved successfully.Furthermore,we reviewed endoscopic images and evaluated the color difference between the bleeding point and surrounding blood for WLI and RDI.In our case,the color difference of RDI was greater than that of WLI(9.75 vs 6.61),and RDI showed a better distinguished bleeding point from the surrounding blood.CONCLUSION RDI may improve visualization of the bleeding point by providing better contrast in color difference relative to surrounding blood.展开更多
文摘Misoprostol is a prostaglandin E1 analogue used to prevent and treat gastric ulcers. It has been commonly used in gynecology and obstetrics, especially for the management of postpartum hemorrhage (PPH). For this purpose, 1000 μg intrarectal (insertion of five 200 μg tablets) has been recommended as the third line after injectable oxytocin and methylergometrine. We proposed to manufacture a 1000 μg misoprostol suppository by determining formulation, release and stability. The administration facility was also evaluated. Several formulations of misoprostol suppositories were set up and evaluated. Misoprostol tablets and lipophilic bases (Hard fat—Adeps solidus Ph. Eur., Witepsol? H15 and Suppocire? AM and AS2X) were used to obtain suppositories. Surfactants were also tested (polysorbates Tween? 20, Tween? 80 and sodium lauryl sulfate (SLS)). The formula was monitored by the misoprostol release curve with an in vitro test and dosed by a HPLC method. Stability was determined by evaluating the percentage of misoprostol content remaining over the time in suppositories stored at 4℃ and 25℃. Facility of use versus tablets was evaluated by obstetricians of a Swiss regional hospital using a questionnaire. Misoprostol release was facilitated by adding surfactant to the lipophilic base. After 30 minutes, 59% ± 1.4% and 57% ± 8.2% of misoprostol was released with Adeps solidus + 1% SLS and Adeps solidus + 5% Tween 20 respectively. SLS was discarded to the final formula because of its irritating effect. After 7 months, suppositories still contained 94% ± 3.7% misoprostol with storage at 4℃. The administration was considered easier and faster compared with intra rectal use of tablets. The formula, consisting of 5 crushed misoprostol tablets dispersed in a suppository base made of Adeps solidus + 5% Tween? 20, is stable for at least 7 months at 4?C and facilitates the rectal administration of misoprostol in the treatment of PPH.
文摘目的总结突发无痛性大量便血的卧床患者的临床资料,以期为临床诊治提供参考。方法本研究纳入分析的患者便血出血量大于400 m L,卧床时间为7 d及以上。本院2010年1月至2020年12月诊治的符合研究纳入条件的患者共45例,收集其临床资料,进行回顾性分析并按照出血原因的不同进行归类整理。结果粪性溃疡26例,包括19例多发溃疡、7例单发溃疡,患者平均年龄为(68.3±14.6)岁,中位卧床时间为12.0(9.0,19.3)d,使用抗凝、抗血小板药物的有12例。急性出血性直肠溃疡综合征(AHRUS)15例,包括6例多发溃疡、9例单发溃疡,患者平均年龄为(65.7±11.5)岁,中位卧床时间为10(8,17)d,使用抗凝、抗血小板药物的有7例。粪性溃疡、AHRUS患者采用电子结肠镜下钛夹夹闭止血、经肛门缝合结扎止血或(电子结肠镜下电凝后)凡士林纱布填塞压迫止血等方式处理后,出血完全控制。异物损伤2例,考虑原因分别为开塞露操作不当、灌肠操作,经肛门缝合结扎止血后出血得以控制。直肠憩室1例,予以蛇毒血凝酶灌肠、凡士林纱布填塞压迫止血后出血得以控制。直肠癌1例,予蛇毒血凝酶灌肠、凡士林纱布填塞压迫止血后症状好转,后由于直肠癌基础疾病,患者家属放弃进一步治疗,患者死亡。结论临床中应对突发无痛性大量便血予以足够重视,早期发现并积极处理对患者的临床转归具有重要的意义。对于老年卧床患者、合并严重基础疾病的卧床患者,要注意考虑粪性溃疡、AHRUS的可能。
文摘BACKGROUND Red dichromatic imaging(RDI)is a novel image-enhanced endoscopy expected to improve the visibility of the bleeding point.However,it has not been thoroughly investigated.CASE SUMMARY A 91-year-old man developed a sudden massive hematochezia and underwent emergent colonoscopy.An ulcer with pulsatile bleeding was found on the lower rectum.Due to massive bleeding,the exact location of the bleeding point was not easy to detect with white light imaging(WLI).Upon switching to RDI,the bleeding point appeared in deeper yellow compared to the surrounding blood.Thus,RDI enabled us for easier recognition of the bleeding point,and hemostasis was achieved successfully.Furthermore,we reviewed endoscopic images and evaluated the color difference between the bleeding point and surrounding blood for WLI and RDI.In our case,the color difference of RDI was greater than that of WLI(9.75 vs 6.61),and RDI showed a better distinguished bleeding point from the surrounding blood.CONCLUSION RDI may improve visualization of the bleeding point by providing better contrast in color difference relative to surrounding blood.
