Bleeding peptic ulcer: An evolving role for surgical intervention

Abstract Early surgical intervention was previously advocated in patients > 60 years with bleeding peptic ulcer presenting with haemodynamic instability or ongoing transfusion requirements. It is, however, well recognized that emergency surgical intervention with its inherent risks must be reserved for highly selected patients in whom endoscopy initially fails to control exsanquinating haemorrhage or in whom life-threatening bleeding recurs. Therapeutic endoscopy for bleeding ulcer has led to a remarkable decline in rebleeding rates, the need for emergency surgery and mortality. Octogenarians are at risk, particularly when ulcer size exceeds 2 cm. Poor surgical candidates make up two-thirds of patients with major ulcer bleeding and operation is to be avoided if at all possible. Medical therapy with proton pump inhibitor and subsequent eradication of Helicobacter pylori following endoscopic treatment has been shown to be beneficial to outcomes. Should surgery be deemed necessary, it is likely that laparoscopic techniques to control bleeding, with or without the addition of an acid-reducing procedure, will find a role in haemodynamically stable patients undergoing operation on an early elective basis.     

Iopamidol and meglumine diatrizoate: comparison of effects on patient discomfort during aortofemoral arteriography

Iopamidol was compared with Renografin-60 (meglumine diatrizoate, Squibb) in a controlled, randomized double-blind study of 40 patients undergoing peripheral arteriography for arteriosclerotic occlusive disease to determine which agent caused less discomfort. Each patient was evaluated for objective signs of discomfort and subjective feelings of pain and heat. Monitoring was achieved by multiple physical examinations, chemical tests, electrocardiograms, and intra-arterial pressure recordings. It is concluded that iopamidol is safe and causes significantly less patient discomfort than Renografin-60.     

Are burn wound biopsies obsolete? A comparative study of bacterial quantitation in burn patients using the absorbent disc and biopsy techniques

A study of bacterial quantitation in burn wounds was undertaken to compare a new absorbent paper disc technique with the standard burn wound biopsy technique. In the first part of the study 228 paired samples were used to compare the two methods; a high correlation coefficient was found with the four most commonly encountered bacteria, and both methods showed a high specificity and sensitivity for each of the organisms. In the second portion of the study, the discs were compared with burn wound biopsies that had been divided into their superficial and deep segments. Thirty paired samples were studied and again the correlation was high, indicating that the disc technique also measured the organisms found in the deeper tissue levels. The absorbent disc technique is simple, convenient, noninvasive, inexpensive, and yields reproducible results. These findings indicate that burn wound biopsies may no longer be required for infection monitoring in the burn patient.     

Fetal gallstones

Routine obstetric ultrasound (US) examinations in a 33-year-old woman revealed a normal fetal gallbladder at 24 menstrual weeks but multiple structures in the gallbladder with findings typical of gallstones at 37 menstrual weeks. No other abnormalities were present. Three days after a term delivery, an abdominal US examination again demonstrated multiple gallstones. When the infant was 6 weeks old, a follow-up abdominal US study showed no evidence of gallstones. This case, as well as one previously reported, demonstrates that findings typical of gallstones may be seen in the fetus, and that these structures may spontaneously resolve.     

PREVALENCE OF MITRAL VALVE PROLAPSE IN HONG KONG CHINESE A CLINICAL AND AUTOPSY STUDY

The prevalence of mitral valve pro.lapse in Chinese was determined by screening 156 heal- thy subjects and by patholobic examination of 86 adult autopsies. Mitral valve prolapse was found in 7.7% in the clinical study and 5.8% in the autopsy study. A slight female preponderance was noted.     

Emergency free tissue transfer for reconstruction of acute upper extremity wounds

The accepted method of treatment for acute, contaminated, upper extremity wounds is serial débridement and delayed closure. Emergency free tissue transfer challenges these concepts by advocating radical débridement and early closure of these wounds. The use of emergency free tissue transfer in the upper extremity allows early motion and possibly lowers the rates of infection, nonunion, flap failure, and the length of hospital stay. The decision to carry out emergency free tissue transfer is made after evaluating the patient's systemic condition and the following factors: (1) extent of débridement, (2) bacterial load, (3) fracture type, (4) anatomical location of the wound, and (5) presence of exposed vital structures. When conditions are ideal, emergency free tissue transfer may be the best choice for closure of acute, contaminated, upper extremity wounds.     

Toxische Kombinationseffekte bei herzwirksamen Reinglykosiden

Ohne Zusammenfassung

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Toxic effects of combinations of pure cardiac-active glycosides