title: Percutaneous injection of hemostatic agents for active liver hemorrhage.
abstract: BACKGROUND
  Active hemorrhage arising from hepatic injury can be life-threatening and require immediate attention. At present, nonoperative management of abdominal solid organ injuries has become the usual method of care. The purpose of this study was to determine whether hemocoagulase injection alone guided by contrast-enhanced ultrasonography (CEUS) could control active bleeding in rabbit liver.
  
  
  METHODS
  The livers of 30 rabbits were punctured with an 18-gauge semiautomatic biopsy needle to create an active bleeding liver model, which was confirmed with CEUS. The animals were randomly divided into two groups: a treatment group (n=15) and a control group (n=15). In the treatment group, hemocoagulase was injected into the bleeding site under CEUS guidance. In the control group, the active bleeding site was treated with normal saline. When these treatment procedures had been performed, lactated Ringer's solution was given to both groups to maintain the mean arterial pressure at 70 mmHg for 1 hour. The intraperitoneal blood loss, hematocrit, mean heart rate, and macroscopic and microscopic examinations were analyzed at the end of the study.
  
  
  RESULTS
  CEUS showed hypoechoic and anechoic perfusion defects in active bleeding liver models. Macroscopic and microscopic examinations also supported the results. After the hemocoagulase injection, the former bleeding site appeared on CEUS as an area devoid of contrast. The blood loss was lower in the treatment group than in the control group (38.0+/-16.6 ml versus 107.9+/-20.8 ml; t=10.172, P<0.05). The mean hematocrit value and the heart rate were higher in the treatment group than in the control group (hematocrit: 23.9+/-3.8% versus 18.8+/-4.1%; t=3.541, P<0.05; heart rate: 250+/-18 versus 223+/-15; t=4.551, P<0.01).
  
  
  CONCLUSIONS
  Hemocoagulase injection alone under the guidance of CEUS is a simple and quick method to control blood loss in active liver bleeding.
authors.affiliation: Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Tang
authors.forename: Nian-Song
authors.initials: NS
authors.lastname: Qian
authors.forename: Wen
authors.initials: W
authors.lastname: Luo
authors.forename: Zeng-Hui
authors.initials: ZH
authors.lastname: Han
authors.forename: Ming
authors.initials: M
authors.lastname: Yu
authors.forename: Xin
authors.initials: X
authors.lastname: Meng
authors.forename: Jian-Guo
authors.initials: JG
authors.lastname: He
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Zhou
mesh_terms: D000818:Animals; D012103:Batroxobin / Q000008:administration & dosage / Q000627:therapeutic use*; D006339:Heart Rate; D006400:Hematocrit; D006470:Hemorrhage / Q000188:drug therapy*; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D007267:Injections; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries*; D023421:Models, Animal; D011817:Rabbits; D014463:Ultrasonography
chemical_list: D006490:Hemostatics; D012103:Batroxobin