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Biomedical subjects

P Wara

Publications and source records attributed to P Wara.

At least 37 records · Page 2Linked to original sources
PubMed1994

Late outcome of bleeding gastric ulcer. Five to eight years' follow-up.

BACKGROUND: Gastric ulcer haemorrhage is associated with a high immediate mortality, but few data exist on the late prognosis of these patients. The aim of this study was to determine the long-term recurrence rate and late outcome in patients with gastric ulcer complicated with bleeding. METHODS: In a prospective follow-up study 90 consecutive patients with a bleeding gastric ulcer discharged after non-operative treatment (bleeding controlled by endoscopic electrocoagulation or ceased spontaneously) were followed up once every year for 5-8 years (median, 6.5 years). RESULTS: Recurrent ulcer was seen in 17 patients, repeat haemorrhage being the presenting symptom in 13 of them. The estimated cumulative recurrence rate after 2, 5, and 8 years was 10%, 19% and 33%, respectively. Recurrence rate was unaffected by sex, complicating disease, and non-steroidal anti-inflammatory drugs (NSAIDs) ingestion before and after the index bleeding episode. The recurrence rate of patients with a history of ulcer before the index bleeding episode did not differ from that of patients with no previous ulcer history. A significantly increased risk of recurrence was seen in patients with previous bleed as opposed to patients with previous non-bleeding ulcer (p < 0.05). The cumulative survival rate was significantly reduced compared with the expected survival rate of the sex- and age-matched background population (p < 0.01), primarily because of diseases not related to the ulcer disease. CONCLUSION: Bleeding gastric ulcer is associated with a relatively low long-term recurrence rate, except in a few patients with a history of previous bleeding ulcer, who have an increased risk of recurrence. Patients with bleeding gastric ulcer have an excess mortality not related to the ulcer disease.

Aged↗
PubMed1994

Peptic ulcer hemorrhage: factors predisposing to recurrence.

Two hundred and eighty patients with stigmata of recent or active bleeding from a peptic ulcer were followed up after endoscopic or conservative medical treatment. Of the patients 53% had no history of dyspeptic symptoms, but 17% and 10% had a history of uncomplicated ulcer or bleeding ulcer, respectively, before the index admission. After 8 years of follow-up the estimated recurrence rate was 29% (95% confidence limits, 12-47%). At recurrence 65% of the patients presented with a rebleed and 12% with a perforation. By means of a logistic regression analysis, a previous history of ulcer haemorrhage was identified as the only predictor associated with a significantly increased risk of recurrence. The recurrence rate in 253 patients presenting with a first bleed at the index admission was 23%, compared with 73% in 27 patients with a history of bleeding before the index admission (p = 0.001). The rate of recurrence was not influenced by a history of previous uncomplicated ulcer disease or dyspeptic symptoms, the severity of the index bleed, the methods of management of the index bleed, age, use of non-steroidal anti-inflammatory drugs, or long-term treatment with cimetidine.

Adult↗
PubMed1993

[Laparoscopic parietal cell vagotomy. Preliminary results].

The results from 11 laparoscopic parietal cell vagotomies are presented. The procedure could be carried out in all patients. The median day of discharge after the procedure was day 1 (range 1-16), median convalescence time 7 (range 4-50) days. One patient required re-operation due to a perforation at the lesser curvature. This complication is ascribed to the learning phase. If a sufficient reduction in gastric acid secretion can be documented in a larger series of patients, laparoscopic parietal cell vagotomy should be considered a serious alternative to conservative treatment.

Adult↗
PubMed1992

A double-blinded multicenter trial of somatostatin in the treatment of acute pancreatitis.

To evaluate the effect of somatostatin in the treatment of acute pancreatitis, 63 patients were randomly allocated to continuous intravenous infusion for three days of 250 micrograms of somatostatin (Dura Scan, Odense, Denmark) per hour (n = 33), or placebo (n = 30). Patients with a first attack of pancreatitis, serum amylase level of more than 450 units per liter and symptoms for less than 24 hours were eligible for participation in the study. Apart from a slightly significant faster decrease in serum amylase concentrations, we were unable to demonstrate any significant benefit from somatostatin with regard to paraclinical values and clinical course.

Acute Disease↗
PubMed1992

Burst abdomen--clinical features and factors influencing mortality.

The hospital records of 198 patients with wound dehiscence following gastrointestinal surgery were reviewed (median age 66 years, male:female ratio 2.5:1). The median time from primary surgery to wound dehiscence was six days (1-24 days). The postoperative course prior to dehiscence was uneventful in half of the patients, and two-thirds had evidence of bowel function. The overall mortality rate following dehiscence was 24%. The most common cause of death was cardiorespiratory insufficiency (58%) and peritoneal sepsis (15%). Factors without influence on mortality were: 1) Complicating illness prior to surgery. 2) Primary disease. 3) Emergency surgery. 4) Contamination of the wound. 5) Postoperative complications prior to rupture. 6) Absence of bowel function. 7) Complete or incomplete rupture of the wound. Mortality, however, was higher in females, in patients with longitudinally versus transverse incisions, and in elderly patients. Late incisional hernia or sinus reactions occurred in 34 patients (23%).

Abdomen↗
PubMed1991

[Laparoscopic cholecystectomy. The first 45 operations].

During a period of 13 weeks, 45 patients with symptom-producing gall bladder stones (attacks of gall stone colic n = 39 (87%); acute cholecystitis n = 6 (13%)), corresponding to approximately 85% of the total number of gall bladder stone patients during the period were selected for laparoscopic cholecystectomy. Two patients had previously undergone upper abdominal operations and had adhesions and one patient suffered from cirrhosis of the liver with portal hypertension. It proved necessary to convert five of the laparoscopic cholecystectomies to open cholecystectomies (11%) on account of technical difficulties (severe acute changes due to cholecystitis (n = 3), indeterminable anatomical conditions (n = 1) and one case of liver metastases (n = 1)). The median duration of operation was 90 minutes with a range from 30 to 360 minutes. Peroperative cholangiography was not undertaken routinely. No cases of forgotten stones in the common bile duct occurred. No deaths occurred and, in all, three slight complications occurred (7%): two patients had haematoma in the abdominal wall and one patient minimal leakage of bile from the stump of the gall bladder on account of insufficient ligation of the cystic duct. This patient was treated with an endoscopically placed drain in the common bile duct for two weeks, after which she was well. No lesions of the common bile duct occurred. None of the complications required laparotomy. The median duration of hospitalization was 24 hours with a range from one to 14 days. All of the patients were at work or could manage their usual activities after 14 days. The median duration of sick leave was seven days.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Endoscopic treatment of bleeding peptic ulcer.

Several endoscopic modalities have the potential of controlling major, life-threatening ulcer bleeding. Although none of the modalities has emerged to be more efficacious than the other, current evidence favours thermal methods and injection therapy. When successful, the endoscopic methods are equally safe (associated with a risk of perforation less than 2%), although a rebleeding rate of 10-30% is of concern. Endoscopic therapy is in general operator-dependent, and the experience of a team is probably more important than the choice of equipment. Selection of patients for endoscopic therapy should be based on the identification of high-risk patients who tolerate rebleeding or surgery poorly, and high-risk lesions likely to rebleed. Endoscopic therapy for ulcer bleeding is simply a new way of applying surgery. Realizing this, it is difficult to understand why therapeutic endoscopy for bleeding ulcer has not yet been widely adopted by surgeons.

Duodenoscopy↗
PubMed1989

Late radiation injury of the colon and rectum. Surgical management and outcome.

After a median latency of 2 years, the initial late colorectal radiation injuries in 182 patients were: stricture (37 percent), minor lesions (36 percent), rectovaginal fistula (22 percent), and gangrene or other fistulas (5 percent). Due to progression, new colorectal injuries, primarily stricture (55 percent) and fistula (42 percent), occurred in 68 patients (37 percent). Resection provided the best results. However, the resectability rate was low (46 percent) and resection was primarily performed in patients with a circumscript well-defined stricture of the proximal rectum or sigmoid colon with an anastomotic leakage rate of 5 percent. The prevailing management of 78 patients with fistula or stricture with synchronous fistula was defunctioning colostomy, primarily end-sigmoidostomy, providing fair results in half of the patients. Stomal complications occurred in 15 percent. The radiation-induced colorectal mortality was 8 percent. Colorectal fistula and associated radiation injuries of the urinary tract, and especially of the small bowel, were the major determinants of fatal outcome, yielding an overall radiation-induced mortality of 25 percent. After a median observation time of 13 years, half of the patients were alive at follow-up; 56 percent of these had a fair outcome whereas the remaining patients continued to have mild symptoms responding to conservative measures (34 percent) or disabling symptoms (10 percent).

Adult↗
PubMed1989

Late radiation injuries of the small intestine--management and outcome.

A series of 86 patients with late radiation-induced lesions, mainly stricture, of the small bowel is reviewed. The median interval from radiotherapy to manifestation of enteropathy was 2 (1/4 to 43) years. Progression of the lesions necessitated further treatment in 35 of the 70 patients who survived the initial attack. Bowel resection was followed by leakage from 12% of ileo-ileal and ileo-colic anastomoses. Mortality was 34% from the enteropathy and 8% from coexisting damage to the rectum or urinary tract. Factors significantly influencing mortality were pre-irradiation laparotomy, emergency surgery, and surgery to deal with a segment of irradiated intestine left in situ at initial operation. Age, stage of primary malignancy and coexisting rectal or urinary tract lesions did not significantly influence the outcome. After a median of 10 years' observation the outcome was classified as favourable in only 28% of cases, while 30% had slight to moderate symptoms or had died of unrelated causes. When surgery is required for radiation-related lesions of the small intestine, the aim should be a one-stage definitive procedure, as management of subsequently progressing lesions is associated with substantially increased mortality.

Adolescent↗
PubMed1987

Incidence, diagnosis, and natural course of upper gastrointestinal hemorrhage. Prognostic value of clinical factors and endoscopy.

Upper gastrointestinal bleeding is a common emergency, with a constant annual incidence of 90 patients per 100,000 population. Peptic ulcer marked by stigmata of hemorrhage is the commonest source of bleeding (51%), followed by varices (11%), esophagitis (10%), and erosions (5%). Most hemorrhages stop bleeding spontaneously (82%), whereas 18% present with major bleeding, mostly due to erosion of an artery in the ulcer base, requiring hemostatic intervention. Thirty per cent of the peptic ulcers bleed massively, constituting 89% of all major bleeds. Non-ulcer lesions rarely bleed massively (4%). Clinical factors including bleeding pattern before admission and endoscopically observed stigmata of hemorrhage including the visible vessel have been shown to be poor predictors of major hemorrhage. Hemodynamic monitoring remains the most reliable method for distinguishing between patients with major bleeding and need for emergency surgery and patients who will stop bleeding spontaneously.

Esophageal Diseases↗
PubMed1987

Endoscopic control of major ulcer bleeding.

Emergency surgery for bleeding ulcer still carries a significant risk. Moreover, most patients with major ulcer bleeding are poor surgical risks. Non-surgical methods that are safe and reliably control major bleeding are therefore much warranted. The most promising of various non-operative methods under investigation seems to be endoscopic application of heat delivered by laser, heater probe, or electrocoagulation. In the present study monopolar electrocoagulation with a wet probe reliably controlled major ulcer bleeding in 51 (66%) of 77 patients hemodynamically assessed as requiring emergency surgery. The endoscopic success rate in patients with gastric or duodenal ulcer was 76% and 56%, respectively. It was particularly high (87%) in 23 patients, 17 of whom fulfilled clinical criteria of having stress ulcers. The mortality rate in patients with endoscopically controlled bleeding did not differ from that in 190 patients with spontaneous cessation of ulcer bleeding (8% and 6%, respectively), none of which exsanguinated.

Duodenoscopy↗
PubMed1986

Spontaneous rupture of the urine bladder. Report of three cases.

Non-traumatic spontaneous rupture of the urine bladder is a rare occurrence. The clinical features of three cases are reported. Although admitted as abdominal emergencies there was a considerable delay in operative treatment in two patients. The reasons are discussed.

Adult↗
PubMed1986

Endoscopic management of the bleeding ulcer. A survey.

The study was performed to evaluate the prognostic and therapeutic value of endoscopy in patients with bleeding ulcer. Before endoscopic control of ulcer bleeding was introduced 373 patients with bleeding ulcer and a median age of 67 years were studied retrospectively. Emergency surgery was required in 155 patients. The surgical mortality was 11% in 37 low risk patients, but 36% in 118 poor risk patients. There was a trend to improved outcome after introduction of diagnostic endoscopy but only in patients with hemorrhage managed conservatively. Surgical mortality remained unchanged. Ranked in order of prognostic importance, a complicating disorder, postoperative complications, overtransfusion, and absent past history of ulcer dyspepsia were identified as the most important determinants of fatal outcome. Age, onset of hemorrhage at home or in hospital, previous ulcer surgery, previous bleeds, ulcer site, and sex had comparatively less bearing on outcome. It was concluded that although surgery was efficient in preventing exsanguination, it was poorly tolerated in poor surgical risks who constituted 76% of the patients in need of emergency control of ulcer bleeding. The results indicate that the search for non-surgical methods is justified. In a pilot study, endoscopic electrocoagulation was applied to control ulcer bleeding in 60 patients. The experience from the study served as basis for a prospective study in an attempt to assess the prognostic and therapeutic potential of endoscopy in the management of bleeding ulcer and to define indications for emergency endoscopy. The histomorphologic effect of electrocoagulation employed to stop bleeding from acute gastric ulcers in rabbits suggested that intravascular occlusive fibrin thrombosis is the probable mechanism of hemostasis. In the prospective study, 539 consecutive patients admitted with hematemesis and melena underwent emergency endoscopy. Peptic ulcer, identified as the bleeding source in 51% of these patients, was the predominant lesion most liable to hemorrhage assessed as requiring emergency surgery. Black hematemesis with melena, occurring in 13% of the patients, was the best predictor of ulcer bleeding. Red hematemesis with melena (26%) was the most important predictor of major bleeding. Black hematemesis with melena was found to be as important as red hematemesis without melena (22%) in predicting major ulcer bleeding. In contrast, melena (18%) and, in particular, black hematemesis without melena (20%) were poor predictors of ulcer bleeding as well as of major bleeding.(ABSTRACT TRUNCATED AT 400 WORDS)

Electrocoagulation↗
PubMed1985

Nutritional intake after colorectal surgery: a comparison of a traditional and a new post-operative regimen.

The energy and protein intake was studied for 12 days after colorectal surgery in 36 patients. Eighteen patients followed a traditional management with nasogastric suction until bowel movements occurred after which a liquid diet, protective diet and normal food were successively administered. In a subsequent period a new regimen was introduced. Nasogastric suction was not used. Instead, 18 patients received liquid diet from the first post-operative day and normal food, when the patient wanted to eat it. In addition, the nutritional intake was supplemented by protein-enriched refreshing drinks and milk products between the meals. The new regimen was tolerated without discomfort and resulted in a significant increase in protein intake (43 g/day vs. 26 g/day, p<0.001) and energy intake (78% vs. 71% of the basal metabolic rate, p<0.05). The increase was most pronounced in the first 4 days after the operation. Finally, the weight loss was significantly lower on the new regimen (1.8 kg vs. 3.9 kg, p<0.001).

Journal Article↗
PubMed1985

Endoscopic prediction of major rebleeding--a prospective study of stigmata of hemorrhage in bleeding ulcer.

Two hundred fifty patients with stigmata of active or recent hemorrhage from peptic ulcer were studied. Stigmata, subgrouped according to bleeding status and the presence or absence of a visible vessel, were related to the subsequent clinical course of hemorrhage. Sixty patients (24%) rebled massively and required emergency hemostasis. At the initial endoscopy a visible vessel was a relatively rare finding (21%). Less than one-third of the visible vessels rebled massively. None of the stigmata or subgroups of stigmata emerged as reliable predictors of major rebleeding. Bleeding status and ulcer site, however, were observed to influence the relative importance of a visible vessel. When a visible vessel was identified in patients with oozing, overlying clot, or gastric or duodenal ulcer, the probability of major rebleeding increased, but not significantly. However, when a visible vessel was identified in patients without other stigmata or in patients with prepyloric ulcer or older stigmata, there was a decreased probability of major rebleeding. Older stigmata was a superior predictor of self-limited hemorrhage.

Aged↗
PubMed1985

Bleeding pattern before admission as guideline for emergency endoscopy.

In a prospective study of 539 patients admitted because of hematemesis and melena the bleeding pattern before admission was compared with the findings obtained on emergency endoscopy and the subsequent clinical course. Ranked in order of prognostic importance, red hematemesis with melena, black hematemesis with melena, and red hematemesis alone increased the probability of massive hemorrhage. Moreover, black hematemesis with melena was the superior predictor of bleeding ulcer, the commonest lesion carrying the risk of massive hemorrhage. In contrast, in patients with melena or black hematemesis alone massive hemorrhage occurred comparatively infrequently. The order of prognostic importance was supported by the transfusion requirement. In screening for a potentially life-threatening ulcer hemorrhage, emergency endoscopy is recommended in patients with black hematemesis with melena or with red hematemesis with or without melena. In patients presenting with black hematemesis or melena alone endoscopy may be postponed to the next convenient daytime.

Adolescent↗