Mark Corson

By Q. Zapotek. Marlboro College.

Phase initiale (J1): localement la paroi oesophagienne ou gastrique est ulcérée etodolac 400 mg without prescription, fragile purchase 300mg etodolac otc, +++ – avec risque de perforation discount 400 mg etodolac with amex, de fistule ou d’hémorragie. Phase de réparation (J2 a J8) : ulcérations recouvertes par des fausses membranes, avec +++ – risque de fistule. Phase de réparation (J8 a J30) : œdème et ulcérations disparaissent, remplacés par une + + fibrose Phase de cicatrisation (après J30) : développement d’une fibrose. Permet d orienter les décisions thérapeutiques (en fonction de la classification endoscopique). What is new in esophageal injury (infection, drug-induced, caustic, stricture, perforation)? The efficiency of sucralfate in corrosive esophagitis: A randomized, prospective study. La mortalité hospitalière globale reste aux alentours de 5 à 15% en dépit des progrès dans sa prise en charge. En 2002, il a été à 248 cas et augment à 430 cas et à 922 cas en 2006 et en 2010 respectivement. L’hématémèse est définit par le rejet du sang par la bouche au cours de vomissement avec ou sans aliments. Le diagnostic étiologique est basé par la gastroscopie faite après stabilisation de l’état hémodynamique. Objective de la prise en charge - Stabiliser l’état hémodynamique - Diagnostiquer l’étiologie et Arrêter le saignement - Prévenir la récidive V. Gastroscopie urgente si : - Absence de signe de choc et préférablement Hb au moins à 7g/dl - Etat de conscience bonne et patient (e) coopératif (ve) si non sédation par un anesthésiste avec l’intubation. Remarque : En l’absence de service d’endoscopie digestive urgente, le (a) patient(e) doivent être transféré en l’ambulance vers un hôpital où disponible l’endoscopie digestive urgente après débuter un traitement specifique pré-endoscopique indiqué plus haut. Transfusion quand Hb < 7 g/dl surtout pour les sujets âgés et taré, 1 culots du sang concentré peut monter Hb à 1 g/dl. Donc pour faire monter Hb à 10 g/dl chez quelqu’un dont Hb au départ à 7 g/dl , il faut donner 3 culots du sang concentré ; pas intérêt de prescrire des médicaments considérés comme « hémostatique » tels que Adrénoxyl, dicinone... Vessie de glace sur le ventre n’est pas recommandée, chaque patient peut le faire s’il veut. Il faut donc faire 2 ème gastroscopie en urgence et traiter la lésion de la même façon que la première fois. Erythromycine en perfusion lente si la gastroscopie urgente va être pratiqué dans quelques heures. Ce traitement n’est pas toujours possible en raison de moyen financié limité des patients. La prise en charge est multidisciplinaire qui doit être coordonné pour avoir le résultat optimal. Médicaments cités dans ce guideline : • Esomeprazole injectable et comprimé, Rabeprazole comprimé, Omeprazole injectable et comprimé, pantoprazole injectable et comprimé, Lanzoprazole comprimé. The value of thrombocytopenia in predicting variceal bleeding among the patients admitted for upper gastrointestinal hemorrhage. Usefulness of clinical parameters and thrombocytopenia in predicting the etiologies of Upper Gastrointestestinal bleeding. L’étiologie et l’efficacité de l’hémostse endoscopique dans la prise en charge de l’hémorragie digestive haute à l’hôpital Calmette. Ligature des varices oesophagiennes avec des “Home-Made kits” multiligatures rechargeables. Le traitement de l’hémorragie digestive par rupture de varices gastriques par l’injection de colle biologique (une série de 12 cas). Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. En plus, 90 % des patients sont vus par le gastro-entérologue, dont environs 10 % qui, ont une hémorragie grave, ont besoins d’être hospitalisés. Physiopathologie La physiopathologie de l´hémorragie digestive basse est basée sur la cause de saignement. Ce sont des anomalies vasculaires dégénératives souvent multiples correspondant à des dilatations des veines sous-muqueuses, des veinules ou des capillaires, qui surviennent surtout après 60 ans. La diverticulose hémorragique représente la première cause de saignement digestif par voie basse aiguë (plus de 40 %). Elles surviennent principalement chez les sujets âgés dans un contexte vasculaire. L’hémorragie est rouge rutilant, contemporaine de la défécation et terminale en jet. Elles provoquent rarement des hémorragies graves sauf en cas de complications 294 Prise En Charge De L’hemorragie Digestive Basse hémorroïdaires (thrombus, hémorragie postopératoire). Etat hémodynamique stable, pas de troubles neurologiques, pas de signes de gravité i. Examen clinique: l’inspection de la marge anale et le touché rectal doit être fait tous les patients pour rechercher des hémorroïdes. Gastroscopie est indiquée sans urgence avec la préparation correcte tous les hématochezies ou les rectorragies de grande abondance pour éliminer la lésion haute. Correction de la coagulopathie par le plasma frais congelé, vitamine K, et/ou la concentration plaquettaire.

To date cheap etodolac 300mg on line, site-specifc biosynthesis of hypericin and hyperforin has not been fully investigated order 400mg etodolac overnight delivery. There are several reports that hy- pericins are localized within specialized glands found predominantly on fowers and leaves buy 300mg etodolac amex, and that hyperforins are localized in the reproductive structures of the plant. An ultrastructural comparison of several Hypericum chemotypes and shoot culture lines was employed in our or other studies in order to reveal if there are any anatomical or morphological differences that occur. Such studies could explain the differences in production of hypericin and hyperforin both in different Hypericum chemotypes and within the same variety, as well as in dif- ferent shoot cultures derived from the seeds of genetically distinct populations of H. In our study, anatomical and ultrastructural differences were examined using light microscopy, scanning electron microscopy, and transmis- sion electron microscopy [46]. The above-cited studies show that hypericin-containing black glands consist of a peripheral sheath of fattened cells surrounding a core of interior cells that are typically dead at maturity. This observation suggests that the peripheral cells are involved in hypericin production. Moreover, an observed developmental phenomenon shows that the peripheral cells undergo a transformation into interior cells. The fact that the size of the peripheral cells may correlate with polyketide metabolite production adds a new hypothesis for the delineation of the actual site of hypericin and hyperforin biosynthesis. This observation confrms other results that apply to intact Hypericum plants [47–49]. Generally, the major biotechnology strategies for plant secondary metabolite production include the following: 1. Use of high producer plants (elite germplasm) for initiation of callus cul- tures. Further improvement of product yields: development of processes for scal- ing-up and bioreactor design. Possible biotransformation: the biotransformation of low-value compounds into high-value end products. Research to date employing these or other strategies has been only marginally successful for many plant-derived natural products. There are several reasons for drawbacks in the use of plant cell biotechnology for the secondary metabo- lite production. To date, only a few compounds have been produced by appli- cation of plant cell cultures in bioreactors, such as the production of Taxol, a chemotherapeutic drug, via plant cell culture [50, 51]. While several kinds of bioreactors have been introduced and recommended by bioengineers for plant cell cultures and secondary metabolite production, only a few industrial ap- plications have been initiated to date. The extensive application of such pro- duction strategies is restricted because of economic and technological issues. It is well known that processes using large-scale plant cell cultures could be economically feasible, provided the cells have a suffciently high growth rates coupled with signifcant metabolite production rates. While this statement promises future prospects for application, some common problems still need to be adequately resolved. Such restrictions in large-scale processing are based on the fact that not all desired natural products can be produced by plant cell biotechnology. Bio- chemical and molecular studies on several model systems (presumably different types of cell cultures) involved may not only answer fundamental questions on how and why these compounds are synthesized, but also, how it will be pos- sible to upregulate their production. Generally, an explanation for the different biosynthetic capacities of either cell suspension or callus cultures is that cells do not produce some compounds until full or partial cell differentiation has occurred. On the other hand, it is possible that the production of some com- pounds could be triggered in a critical situation where the biosynthetic ability of the cells can be turned on under the infuence of biotic or abiotic factors. Critical to cell suspension culture biosynthetic potential is how, and from what part of the intact plant, the cell cultures are derived. If the cells are derived from a reproductive part of the plant that synthesizes a particular metabolite(s), this kind of cell culture may have a higher potential for the production of the de- sired metabolites. This is because the type of culture can be reversed to the initial stage, or be changed to a “non- differentiated or nonproducing” stage, due to the infuence of many physical or chemical parameters. For example, media formulation, optimal physical pa- rameters, or even elicitation, could trigger the biosynthesis and production of some metabolite(s). Selection of a high-producer, a genetically and epigeneti- cally stable model system will have more advantages in future trials. Shoot cultures are very eas- ily grown in liquid Murashige and Skoog medium; even after short cultivation 158 A. Kaufman periods, they form a substantial biomass, approximately 30 g fresh weight in 100 ml of medium. In addition, such a system allows for extensive manipu- lation by elicitors, or other stimulatory agents. There are several reports from our group that show that the yeast cell wall glycoprotein, mannan, as well as cork pieces stimulate hypericin and pseudohy- pericin production in liquid cultivated shoot cultures. It was observed that agar cubes cause signifcant stimulation of the production of all compounds compared to other treatments. There was a fve- fold increase in the levels of hyperforin, about a three-fold increase in those of pseudohypericin, and a two-fold increases in those of hypericin compared to control levels. Based on these results, we have concluded that the stimulatory mechanism of these two agents may act in a similar way, presumably due to a mechanical in- teraction between the agar cubes or cork pieces and the shoot cultures. These agents foat in the medium and thus have immediate contact with shoot culture Fig 7. This is an important fnding because mechanical interactions do arise in bioreactors and may greatly infuence the productivity. Mannan, in contrast, shows the smallest effect of stimulation of the production of these metabolites, as compared to cork pieces or agar cubes.

The leaves are 6 to 11 mm long with a I to 2 cm long petiole generic 400mg etodolac with mastercard, coriaceous cheap etodolac 400mg without prescription, lanceolate to oval purchase 300mg etodolac with mastercard, entire, pubescent at the veins. After the leaf-axillary flower branches drop, a barbed tendril, which is 1 to 2 cm long and woody, is formed. Cultivated stock is harvested, then the leaves and shoots are boiled with Galeopsis segetum water to form a decoction that is pressed and evaporated to See Hempnettle the consistency of syrup. The flavonoid fraction (cyanidanol = (+)- Galium verum catechin) is said to be hepatoprotective in effect. Decoction is used for ulcers of the stomach and oral mucosa, and also Gambir asthma. The effect for diarrhea appears plausible because of Uncaria species the tannin content. J Chem Soc Perkin 1, 57:2245- Mode of Administration: Whole and powdered drug for 9, 1966. Yano S, Horiuchi H, Horie S, Aimi N, Sakai S, Watanabe K, Ca2+ channel blocking effects of hirsutine, an indole alkaloid , Preparation: Tincture: 200 g drug (pounded), 50 g cut from Uncaria genus, in the isolated rat aorta. Biosynthesis of (+)- Schneider G (Eds), Hagers Handbuch der Pharmazeutischen 14Ccatechin by the plant Uncaria gambir Roxb. Koshihara Y, Hikino H, Application of radioligand receptor binding assays in the search •r Hypotensive principles of Uncaria hooks. The anti-inflammatory and liver- Medicinal Parts: The medicinal part of the tree is the resin protective effect. Mimaki Y, Toshimizu N, Yamada K, Sashida Y, Anti- convulsion effects of choto-san and chotoko (Uncariae Uncis Characteristics: The taste is innocuous at first, then becomes cam Ramlus) in mice, and identification of the active principles. Quantitative analysis of tertiary alkaloids in various parts of Uncaria Habitat: The plant is indigenous to Indochina and Sri Lanka. Horiuchi H, Horie S, Aimi N, Sakai S, Watanabe K, Garcinia hanburyi harvested from trees that are at least ten Alkaloids from the leaves of Uncaria homomalla. Yano S, Horiuchi H, Horie S, Aimi N, Sakai S, Watanabe K, Other Names: Camboge, Gutta Cambodia, Gutta Gamba, Alkaloids of Uncaria pterppoda. The Resins (70-75%): consisting mainly of yellow or red-colored petals are longer than the calyx, white or reddish, oblong- benzophenones and xanthones, including morellic acid, spatulate and indistinctly stemmed. The anthers are often isomorellic acid, alpha-gambogic acid (alpha-guttic acid) violet. The fruit is a compressed, orbicular-ovate, 5 to 6 mm long, clearly winged small pod on an erect stem. The basal irritant to intestinal mucous membranes and also exhibits leaves are usually lyrate-pinnatesect. Unproven Uses: Gamboge is used for the treatment of Characteristics: Garden Cress has a radish-like taste. The digestive disorders, in particular constipation, and is used in seeds have a slimy skin and swell in water. Not to be Confused With: Adulterations rarely occur, since it is usually cultivated. It was completely inhibitory in the case of 3 microorganisms, although the antibacterial charac- W teristics depended largely on the age of the plants used. The flowers usually deficiency, liver disease, asthma, hemorrhoids and as an remain in bud form and often do not produce any seed. The plant contains an erect, cause skin blisters and necrosis in higher concentrations. The leaves sometimes misused as an abortifacient because the internal are flat, 4 to 25 mm, straight and broad, with a wedge-shaped administration of mustard oil causes severe anemia of the tip; they can be rough or smooth-edged. The garlic bulb is usually a Mode of Administration: Garden Cress is administered as a compound bulb, and the secondary bulbs are oval in shape. Production: Garlic bulbs, either fresh or carefully dried, consist of the main bulb with several secondary bulbs Iori R, Rollin P, Streicher H. Thtem J, Palmieri S, The myrosinase-glucosinolate interaction mechanism studied using (cloves). Garlic may be harvested in September and October some synthetic competitive inhibitors. Garlic, Allium, Stinking Rose Synthesis and evaluation of some isoquinoline analogues. G Ital propenyl alliin and methylalliin (including their gamma- Med Lav Ergon, 19:10-6, 1997 Jan-Mar. Once cut, the alliin in the freshly harvested bulbs is converted to allicin (diallyl-disulphide- mono-S-oxide). These oils are Garlic oligosulfides, ajoens (dialkyl-trithlaalkane-monoxides) and Allium sativum vinyl dithiins. The antibacterial, antimycotic and tract, Kyolic Hi-Po Formula, High Alicin Garlic, Standard- lipid-reducing effects have been well-documented. A study of the lipid-lowering effect with isolated hepatocytes Flower and Fruit: The plant consists of a cluster of long suggest that garlic extracts are responsible for early inhibi- flowers where the floral axis terminates in a single flower tion of sterol synthesis due to their sulfur-containing and contains few florets (small flowers or buds). The herb is also used for prevention oligosulfides in garlic oil have antiplatelet activity through of age-related vascular changes and arteriosclerosis. The for inflammatory respiratory conditions, whooping cough compounds also exert antithrombotic effects through inhibi- and bronchitis.