Chronic fibroinflammatory pancreatitis causes irreparable damage to the pancreatic parenchyma. This frequently results in food restrictions, painkiller addiction, and serious quality of life impairment in children. We observed a 13-year-old girl who had previously been hospitalized multiple times and had undergone acute pancreatitis arrived with excruciating abdominal pain and recurrent hematemesis. A chronic intra-pseudocyst bleed and an ampulla of Vater hemorrhage were discovered during an upper gastrointestinal endoscopy. A 3×2×1 cm pancreatic head pseudocyst was discovered on the magnetic resonance cholangiopancreatography, however the computed tomography scan revealed a pancreatic head pseudocyst, pancreatic duct stones, and substantial peripancreatic inflammation. The multidisciplinary team determined that Frey’s surgery was the most efficient method to minimize her suffering. No complications occurred during the healing phase following surgery, and two years later, neither recurrence bleeding nor abdominal pain appeared. In summary, Frey’s method is a secure and efficient intervention when applied by a multidisciplinary team.

The oral cavity is rich in blood flow, which can cause excessive bleeding. Excessive bleeding in oral cavity is rare, but if the cause of the bleeding is not found, the patient's life may be at risk. Therefore, in the case of excessive bleeding, the dentist should consider the cause and provide appropriate first treatment. Hydrofluoric acid is widely used as a material for pre-treatment of ceramics before oral restoration for prosthetics and conservative dentistry. Since hydrofluoric acid is very reactive, when it comes into contact with tissues, even very diluted 0.1% hydrofluoric acid can cause very painful 2-3 degree burns, which heal very slowly. Negative reactions and even deaths of hydrofluoric acid have been reported in other fields, but there are very few case reports of complications related to hydrofluoric acid in the dental field. In this article, we report a case of excessive gingival bleeding after restorative treatment and discuss the effects of hydrofluoric acid on oral soft tissues and blood vessels and its prevention

To accurately determine the resection margin for maxillary cancer, it is important to closely examine the extent of tumor infiltration into the maxilla, nasal cavity, maxillary sinus, palate, and surrounding tissues. Various methods have been described for the resection of maxillary tumors, such as alveolectomy, partial maxillectomy, subtotal maxillectomy, total maxillectomy, and extended maxillectomy. The objective of this study was to introduce external carotid artery (ECA) ligation on the ipsilateral side, a perioperative bleeding control method with fewer complications. Incidence of major bleeding during maxillectomy is a rare but potentially life-threatening complication. Cases of temporary bleeding from an internal maxillary artery or other sites can be stopped, packed, and compressed. However, bleeding control is eventually achieved by ligation of the ECA or selective embolization. Herein, we report the case of a 60-year-old male with squamous cell carcinoma of the right maxilla, which was eventually treated with subtotal maxillectomy along with an elective ECA ligation for intraoperative bleeding control. The procedure produced no preoperative or postoperative bleeding. ECA ligation is a simple, effective, safe, and (at the operator’s discretion) recommended method of perioperative bleeding control during maxillectomy.

Thromboelastography or rotational thromboelastometry, is being increasingly utilized in cardiac surgery of late. However, it is an indirect test and is not available in all centers. Low fibrinogen levels before and after cardiopulmonary bypass (CPB) have been described to be associated with postoperative bleeding in cardiac surgery. This study explored the usefulness of reduction ratio of the fibrinogen levels before CPB (preCPB) and after CPB (postCPB) in predicting postoperative hemorrhage. A retrospective, observational study of adult patients who underwent cardiac surgery with CPB between February 2014 and January 2016 was conducted, which included a total of 264 patients. The fibrinogen levels were measured twice, preCPB and postCPB, and the fibrinogen reduction ratio was acquired [(preCPB − postCPB)/preCPB]. Postoperative blood loss, which was defined as the blood collected from the chest drain for 12 hours following arrival at the intensive care unit, was considered severe if it was more than 1,000 mL. A multivariate analysis showed that fibrinogen reduction ratio, sex, and postCPB platelet count were significantly associated with severe postoperative bleeding. However, the pre- and postCPB fibrinogen levels were not significantly associated with severe bleeding. Furthermore, a fibrinogen reduction ratio of > 41.3% was independently associated with postoperative severe bleeding, with an odds ratio of 3.472 (1.483–8.162). These results suggest that the reduction ratio of pre- and postCPB fibrinogen levels may be utilized in predicting postoperative bleeding.

내시경역행담췌관조영술(ERCP)은 췌담도 질환의 진단과 치료에 필수적인 시술이며, 내시경유두괄약근절개술(EST)은 ERCP를 성공하기 위한 관문이다. EST를 시행하기 위한 장비의 발전에도 불구하고, EST 후 발생한 출혈은 여전히 치명적인 합병증으로 남아있다. EST 직후에 발생한 출혈은 내시경 시야를 방해하여 성공적인 ERCP를 마칠 수 없게 하며, EST 후 지연형 출혈의 경우에는 혈담즙과 이에 의한 담도염, 심지어 혈역학적 쇼크까지 유발할 수 있으므로 주의가 필요하다. 다행히도 대부분의 출혈은 자발적으로 멈추지만, 임상적으로 의미 있는 출혈량이 있거나, 지속적인 출혈에서는 1차적으로 내시경 지혈술이 필요하다. 에피네프린을 혼합한 식염수의 주사, 전기응고법, 클립이나 밴드를 이용한 기계적 지혈법까지 다양한 내시경적 지혈법이 있으며, 이러한 방법은 대부분 위장관 출혈의 지혈술에서 사용되는 방법을 가져온 것이다. ERCP를 시행하는 의사는 다양한 내시경적 지혈술을 모두 숙지하고 있어야, 한가지 지혈술로 실패한 경우에 다른 방법의 지혈술로 전환을 할 수 있어야한다. 또한 내시경적 지혈술에 실패한 경우에는 혈관조영술이나 수술로 출혈을 치료할 수 있는 결정을 할 수 있어야만 한다.

The purpose of this study was to evaluate the effect of single antiplatelet treatment on delayed bleeding, in patients undergoing dental extraction. A total of 154 teeth were extracted in 94 patients with ongoing antiplatelet treatment, who were taking single antiplatelet of either aspirin or clopidogrel. All patients underwent simple dental extraction; local hemostasis was performed with gauze-biting, suturing, and/or application of a local hemostatic agent. Delayed bleeding was recorded in 5 teeth out of a total of 154 teeth after extraction, the incidence of postoperative delayed bleeding being 3.2%. The bleeding was controlled by the patients themselves, through application of pressure with additional gauze-biting. No one visited the doctor or emergency room for hemostasis. These results confirmed that patients taking single antiplatelet drugs may have teeth extracted safely without interruption of the antiplatelet treatment.

Bleeding from pancreatic pseudocyst is a rare complication. Furthermore, massive upper gastrointestinal (GI) bleeding from gastro-cystic fistula formation and intracystic bleeding are both extremely rare and are also potentially fatal. A 53-year-old male was referred to the emergency room with melena and hematemesis. An urgent endoscopy revealed a massive gastric hematoma but showed no specific bleeding focus. Gastrocystic fistula formation and intracystic bleeding leakage to the stomach were suspicious in the follow-up endoscopy. A contrast-enhanced computed tomography scan demonstrated splenic artery pseudoaneurysm and extravasation of contrast media into the cyst that was abutted to the greater curvature side of the stomach. A splenic artery embolization was performed and no further bleeding occurred after embolization. Upper GI bleeding from gastro-cystic fistula and intracystic bleeding are rare but possible. Therefore, this possibility should be considered in the unknown cause of an upper GI bleeding in a patient with pancreatic pseudocyst.

신장암은 비뇨기과 악성 종양 중 두번째로 많은 빈도를 차지하며 다양한 임상 양상을 갖는다. 그 중 약 1/3은 진단 당시 전이성 암으로 발견된다. 3,4 전이가 호발하는 부위는 폐, 뼈, 림프절과 간 등을 포함하며 드물게 췌장으로 전이를 동반한다고 알려져 있다. 8 췌장 전이의 경우 반수 이상에서는 증상이 없고 증세를 보이는 경우는 복통, 체중 감소, 지방변으로 내원하며 드물게 담도 폐쇄에 의한 증상으로 내원하게 된다. 출혈로 내원하는 경우도 전체의 40% 정도가 되지만 췌장의 자연 출혈로 인해 담관염을 유발하는 경우는 드물다. 10 저자 들은 신장암의 전이성 췌장암과 이로 인한 출혈이 담관염을 유발할 수 있음을 보여주는 흥미로운 증례를 경험하였기에 이를 문헌고찰과 함께 보고하는 바이다.

내시경역행담췌관조영술은 췌담도질환의 진단과 치료에 있어서 널리 사용되는 방법으로 췌장염이나 출혈과 같은 합병증이 많이 발생한다. EPBD는 출혈의 합병증 측면에 있어서 내시경 괄약근 절개술과 비교하여 장점을 가지고 있어서 응고장애가 있는 환자들에서 사용되곤 하며 대량 출혈이 발생하는 경우는 드물다고 알려져 있다. 우상복부 통증으로 내원한 68세 여자가 원위부 양성 담관 협착에 대해 EPBD를 시행한 이후의 출혈이 확인되었고 혈관조영술을 통한 색전술 로 지혈하였으나 대량 출혈로 인한 대사성 뇌병증이 발생하 였다가 지지적 치료로 호전되었다. EPBD를 시행한 이후 대사성 뇌병증을 유발하는 대량 출혈이 발생된 증례는 이전에 보고된 적이 없기에 저자들은 이를 문헌고찰과 함께 보고한다.

Angiosarcoma is an extremely rare sarcoma arising from oral mucosa. We report a case of angiosarcoma in the right maxillary gingiva causing excessive bleeding. The lesion exhibited typical histologic features of angiosarcoma, showing infiltrative proliferation of polygonal endothelial cells and arborizing blood vessels. Tumor cells showed expression of CD 31 and factor VIII, but no expression of CD 34 antigen. The patient expired due to severe bleeding in the oral cavity.

The influence of mineral admixture content on the bleeding of cement-based grouts. Replacement of fly ash increased the bleeding, but the increase of the content of blast furnace slag as well as silica fume led to the reduction in the bleeding. Especially 15% replacement of silica fume showed the best performance against normal bleeding as well as channel bleeding.

The goals of palliative chemotherapy are to improve overall survival and the quality of life through relief of symptoms. On the other hand, chemotherapy has many side effects, such as, myelosupression, neuropathy, gastro-intestinal symptoms, and infertility. On the many known side effects of chemotherapy, bleeding occurs in approximately 6-10% of patients with advanced cancer. Most of bleeding associated with chemotherapy is due to local vessel damage and systemic process, such as, disseminatated intravascular coagulopathy or abnormalities in platelet function or number. This symptom led to worse progression of quality of life and severe stress state in patient and their attendant. Here, the authors report a case of chemotherapy- related bleeding in maxillary cancer patient and successful achievement of hemostasis using interventional endovascular therapy.