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Biomedical subjects

P Wara

Publications and source records attributed to P Wara.

At least 55 records · Page 3Linked to original sources
PubMed1985

Clinical factors predisposing to major ulcer bleeding. A logistic regression analysis.

In a consecutive series of patients with bleeding from peptic ulcer, a logistic regression analysis was used to evaluate clinical factors as predictors of major hemorrhage. A hemodynamic assessment distinguished between self-limiting hemorrhage requiring no treatment (190 patients) and major bleeding necessitating emergency surgery (86 patients). Most data, including patient age and sex, previous bleeding, and pulse rate, blood pressure and hematocrit on admission, were poor predictors of major ulcer bleeding. A few variables--onset of hemorrhage, appearance of hematemesis and site of ulcer--were statistically of predictive importance, but clinically only in combination. When one of the selected predictor variables was present, the risk of major hemorrhage did not statistically exceed the prior probability. When combined in pairs, the probability increased, primarily when duodenal ulcer or red hematemesis was present. When the patients presented with three of the selected predictor variables, the probability of major ulcer hemorrhage was markedly increased. However, only 8% of the patients presented with three of the selected variables. Clinical factors, therefore, contribute in general little in prediction of major hemorrhage form peptic ulcer.

Adolescent↗
PubMed1985

Endoscopic electrocoagulation of major bleeding from peptic ulcer.

Endoscopic electrocoagulation with a liquid monopolar probe was exclusively attempted in 77 patients with major bleeding from peptic ulcer assessed as requiring emergency surgery. Endoscopy failed to control bleeding in 14 patients (18%), who proceeded directly to surgery. Initial endoscopic hemostasis was obtained in 63 patients, but hemorrhage recurred in 18 (29%). Rebleeding required surgery in 11 patients and another patient died prior to surgery. Permanent endoscopic control was achieved in 51 patients (66%). Without difference in transfusion requirement, endoscopy was most likely to succeed in patients with superficial acute ulcer, onset of bleeding in hospital, gastric ulcer, no earlier history of dyspepsia and in patients with previous ulcer surgery. Endoscopy was less likely to succeed in patients with chronic duodenal ulcer or earlier dyspepsia, though it controlled major bleeding in more than half of such patients. Profuse bleeding, and in particular poor access in a narrowed duodenal bulb, were important determinants of endoscopic failure. Of the patients with permanent endoscopic hemostasis, 8% subsequently underwent elective ulcer surgery. Endoscopic electrocoagulation is safe and has potential to control major bleeding, obviating emergency surgery, in two-thirds of the cases. As the less invasive method, endoscopy should be attempted before surgery, particularly in patients regarded as poor surgical risks or with no history of dyspepsia.

Adolescent↗
PubMed1984

Possible mechanism of hemostasis effected by electrocoagulation.

Forty acute gastric ulcers were created in 10 rabbits. The bleeding was controlled by monopolar electrocoagulation in 20 ulcers, the remaining ulcers were left untreated as controls. Spontaneous intravascular thrombosis was precluded by heparinization. A histological assessment in the acute stage revealed significant morphological alterations in electrocoagulated ulcers, with fibrin deposition, decreased tissue stainability and swelling of the vessel walls, indicating heat-induced damage including cells of the vessel walls. An intravascular occlusive fibrin thrombosis demonstrated in all coagulated ulcers is suggested to be the probable mechanism of hemostasis.

Animals↗
PubMed1983

The value of parietal cell vagotomy compared to simple closure in a selective approach to perforated duodenal ulcer. Operative morbidity and recurrence rate.

Of 168 consecutive patients presenting with a perforated duodenal, pyloric or prepyloric ulcer, 123 patients were judged fit or suitable for parietal cell vagotomy (PCV). It was, however, only added to simple closure in 67 patients with a previous history of dyspepsia prone to develop recurrent ulceration, whereas 56 patients with no previous symptoms and an established low risk of recurrence were managed by simple closure only. In the comparable groups, postoperative morbidity did not differ, entailing mortality rates of 4.5% and 5.3% following PCV or simple closure only. An overall clinical grading of 106 patients (91%) followed up (median 4 years, range 1-10 years) revealed equally good results. In patients with previous dyspepsia and an established high recurrence rate if managed by simple closure only, a satisfactory reduction of the recurrence rate was found when PCV was added to suture closure (cumulative recurrence rate 20.7 +/- SD 69 compared to 29% +/- SD 9.4 following simple closure in patients with no previous dyspeptic symptoms). It is concluded that in patients with a perforating duodenal ulcer deemed fit or suitable for PCV, assessed by good clinical judgement, PCV does not carry an added risk and provides a fairly good protection against recurrent ulceration.

Adolescent↗
PubMed1983

Factors influencing mortality in patients with bleeding ulcer. Review of 7 years' experience preceding therapeutic endoscopy.

Over a seven-year period 369 patients with a median age of 67 years were admitted with bleeding peptic ulcer and 41% of the patients required emergency surgery. In 37 low risk patients (24%), defined as patients younger than 70 years without a complicating disease, the mortality rate following emergency surgery was 11% compared to 36% in 118 poor-risk patients (p less than 0.005). A preexisting complicating illness, postoperative complications, and absent history of dyspepsia were calculated to be the three most important factors determining fatal outcome. Age, onset of hemorrhage during hospitalization or prior to admission, previous ulcer surgery, previous bleeds, preoperative endoscopy, site of the ulcer, timing of surgery, and transfusion requirements had comparatively less bearing on the outcome. Hematocrit exceeding 37 in the postoperative period, however, was associated with a significantly increased risk of cardiopulmonary insufficiency. Though surgery controls life-threatening hemorrhage, it is badly tolerated in the many poor-risk patients, and an evaluation of other efficient methods carrying a lower risk of lethal complications seems justified.

Adult↗
PubMed1981

The outcome of staged management of complicated diverticular disease of the sigmoid colon.

In a retrospective study, 83 consecutive patients with indication for a staged treatment of complicated diverticular disease were reviewed. There was a considerable overall morbidity rate following construction of the colostomy, colonic resection, and colostomy closure. However, only 58% underwent a resection of the diseased segment, and even fewer (46%) obtained an eventual restoration of the colon continuity. This was primarily due to an unacceptable high mortality rate when patients with general peritonitis were managed by a proximal colostomy and drainage only. Subsequently, advanced age and associated major illness in patients with a planned three-stage management were the most important factors, determining the deficient completion of the staged treatment. Due to the permanence of many transverse colostomies but also to the fact that serious anastomotic complications, including fatal consequences, occurred despite a defunctioning colostomy, one should re-evaluate the need for a proximal colostomy in patients at high risk, considering resection and an end sigmoid colostomy which is the superior permanent stoma if reconstruction fails to come.

Adult↗
PubMed1980

Endoscopic electrocoagulation--an alternative to operative hemostasis in active gastroduodenal bleeding?

Endoscopic electrocoagulation was considered in 69 patients with active gastroduodenal bleeding including 60 patients with peptid ulcer. Permanent hemostasis was achieved in 56 patients (81%), including 16 patients with clinical indication for surgical intervention. Electrocoagulation failed or could not be applied in 13 patients, requiring operative hemostasis in 11 patients. Though no replacing emergency, endoscopic electrocoagulation can be successful, especially if it is applied in quiescent phase of massive, life-threatening hemorrhage, and should be considered before a possible emergency operation, especially in patients with no previous ulcer disease, in the presence of some other severe illness, or in patients of advanced age.

Adolescent↗
PubMed1980

Endoscopic electrocoagulation combined with cimetidine. A pilot study of the applicability in active bleeding from gastroduodenal ulcer.

Preliminary results of endoscopic electrocoagulation combined with Cimetidine are reported in a prospective series of 60 consecutive patients presenting with active bleeding from gastroduodenal ulcer. Coagulation was considered during the initial diagnostic emergency endoscopy, which revealed an accurate identificaion of the bleeding source in 59 patients. Coagulation was accomplished without local complication in 53 patients. Permanent electrohaemostasis was achieved in 47 patients (78%), including 14 patients with clinical indication for surgical intervention. Coagulation could not be applied or failed in 13 patients, requiring operative haemostasis in 11 patients. Though not replacing emergency operation, endoscopic electrocoagulation combined with Cimetidine could be considered an alternative, particularly in patients of advanced age or in the presence of other severe illness.

Adolescent↗
PubMed1979

A long-term follow-up of patients resected for benign esophageal stricture using the Inkwell esophagogastrostomy.

A total of 45 patients have undergone an Inkwell esophagogastrostomy after resection of a benign esophageal stricture. Nineteen patients were available for a long-term follow-up study, showing evidence of gastroesophageal reflux in 16 patients. Due to the high incidence of reflux and subsequent morphologic changes, there was a not negligible late disability. The Inkwell esophagogastrostomy can no longer be recommended in the treatment of an underlying reflux-induced lesion, strictures included.

Adolescent↗
PubMed1979

Mycotic aneurysm. Report of two cases.

Reference is made to two cases of mycotic aneurysm with different peripheral localizations, arising from a bacterial endocarditis. The cause, localizations, complications and histological findings are discussed.

Adult↗
PubMedDate not supplied

Proximal fecal diversion: review of ten years' experience.

In a retrospective study, the clinical course of 250 patients subjected to 257 transverse colostomies was reviewed in an effort to evaluate the problems associated with proximal fecal diversion. Morbidity following stomal construction was 28 per cent, with a significant increase when performed in infants or as an emergency. Two-thirds of the colostomies were emergencies, chiefly due to obstruction and free perforation which was associated with a mortality rate of 12 and 48 per cent respectively. In 102 patients undergoing definite colorectal resection with a previous or simultaneous transverse colostomy, the overall morbidity rate was 58 per cent including a leakage rate of 22.5 per cent. Despite a proximal defunctioning colostomy, surgical intervention was required in 12.7 per cent with a fatal outcome due to peritonitis in 3.9 per cent. Colostomy closure was associated with a morbidity rate of 57 per cent, comprising a leakage rate of 10 per cent and a mortality rate of 1.7 per cent. Apart from incurable cancer and deaths prior to closure every third patient kept the transverse colostomy permanently. Advanced age and poor condition of patients not proceeding to a definite treatment, or an underlying benign lesion were the three most determining factors. The present results indicate a too extensive use of transverse colostomy, emphasizing the need for a circumspect initial selection of patients for diversionary procedures.

Adolescent↗