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1.
Surg Infect (Larchmt) ; 23(2): 174-177, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35021885

RESUMO

Background: It is unclear if the addition of antifungal therapy for perforated peptic ulcers (PPU) leads to improved outcomes. We hypothesized that empiric antifungal therapy is associated with better clinical outcomes in critically ill patients with PPU. Patients and Methods: The 2001-2012 Medical Information Mart for Intensive Care (MIMIC-III) database was searched for patients with PPU and the included subjects were divided into two groups depending on receipt of antifungal therapy. Propensity score matching by surgical intervention, mechanical ventilation (MV), and vasopressor administration was then performed and clinically important outcomes were compared. Multiple logistic regression was performed to calculate the odds of a composite end point (defined as "alive, hospital-free, and infection-free at 30 days"). Results: A total of 89 patients with PPU were included, of whom 52 (58%) received empiric antifungal therapy. Propensity score matching resulted in 37 pairs. On logistic regression controlling for surgery, vasopressors, and MV, receipt of antifungal therapy was not associated with higher odds (odds ratio [OR], 1.5; 95% confidence interval [CI], 0.5-4.7; p = 0.4798) of the composite end point. Conclusions: In critically ill patients with perforated peptic ulcer, receipt of antifungal therapy, regardless of surgical intervention, was not associated with improved clinical outcomes. Selection bias is possible and therefore randomized controlled trials are required to confirm/refute causality.


Assuntos
Antifúngicos , Úlcera Péptica Perfurada , Antifúngicos/uso terapêutico , Humanos , Modelos Logísticos , Razão de Chances , Úlcera Péptica Perfurada/complicações , Úlcera Péptica Perfurada/tratamento farmacológico , Úlcera Péptica Perfurada/cirurgia , Pontuação de Propensão
2.
Rev Med Interne ; 41(2): 130-133, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-31635978

RESUMO

INTRODUCTION: Encapsulating peritonitis is a rare but severe chronic fibrotic condition related to the development of a white fibrous membrane surrounding the digestive tract. Idiopathic forms have been described, however the disease is most often secondary to peritoneal dialysis or more rarely to surgery. Treatment is difficult and not codified. CASE REPORT: We report here the observation of a 36-year-old patient whose diagnosis of encapsulating peritonitis was made after a long sub-occlusive history, eight years after a gastric ulcer perforation. DISCUSSION: We discuss the possible etiologies and we present a focus on this rare and little-known entity.


Assuntos
Obstrução Intestinal/diagnóstico , Fibrose Peritoneal/diagnóstico , Peritonite/diagnóstico , Adulto , Diagnóstico Tardio , Diagnóstico Diferencial , Humanos , Obstrução Intestinal/complicações , Obstrução Intestinal/tratamento farmacológico , Obstrução Intestinal/cirurgia , Laparotomia , Masculino , Úlcera Péptica/complicações , Úlcera Péptica/diagnóstico , Úlcera Péptica/tratamento farmacológico , Úlcera Péptica/cirurgia , Úlcera Péptica Perfurada/complicações , Úlcera Péptica Perfurada/diagnóstico , Úlcera Péptica Perfurada/tratamento farmacológico , Úlcera Péptica Perfurada/cirurgia , Fibrose Peritoneal/tratamento farmacológico , Fibrose Peritoneal/cirurgia , Peritonite/complicações , Peritonite/tratamento farmacológico , Peritonite/cirurgia , Tamoxifeno/uso terapêutico
4.
Klin Khir ; (3): 16-9, 2016 Mar.
Artigo em Russo | MEDLINE | ID: mdl-27514084

RESUMO

Results of operative treatment of 437 patients with complicated gastroduodenal ulcer were summarized. The modern views on the problem of conservative therapy for gas- troduodenal ulcer were presented. A rational individual approach with a certain terms is necessary for conservative treatment of gastroduodenal ulcer. A real way for improve- ment of the patients treatment results--it is a combination of effective conservative treatment with a timely established indications for a planned operative treatment before dangerous complications occur.


Assuntos
Hemorragia Gastrointestinal/cirurgia , Neoplasias Gastrointestinais/cirurgia , Úlcera Péptica Perfurada/cirurgia , Úlcera Péptica/cirurgia , Úlcera Gástrica/cirurgia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Gerenciamento Clínico , Feminino , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/patologia , Neoplasias Gastrointestinais/tratamento farmacológico , Neoplasias Gastrointestinais/etiologia , Neoplasias Gastrointestinais/patologia , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Humanos , Masculino , Úlcera Péptica/complicações , Úlcera Péptica/tratamento farmacológico , Úlcera Péptica/patologia , Úlcera Péptica Perfurada/tratamento farmacológico , Úlcera Péptica Perfurada/etiologia , Úlcera Péptica Perfurada/patologia , Inibidores da Bomba de Prótons/uso terapêutico , Estudos Retrospectivos , Úlcera Gástrica/complicações , Úlcera Gástrica/tratamento farmacológico , Úlcera Gástrica/patologia , Resultado do Tratamento
5.
Saudi J Gastroenterol ; 22(4): 309-15, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27488326

RESUMO

OBJECTIVES: Comparison of Helicobacter pylori eradication rates, side effects, compliance, cost, and ulcer recurrence of sequential therapy (ST) with that of concomitant therapy (CT) in patients with perforated duodenal ulcer following simple omental patch closure. METHODS: Sixty-eight patients with perforated duodenal ulcer treated with simple closure and found to be H. pylori positive on three months follow-up were randomized to receive either ST or CT for H. pylori eradication. Urease test and Giemsa stain were used to assess for H. pylori eradication status. Follow-up endoscopies were done after 3 months, 6 months, and 1 year to evaluate the ulcer recurrence. RESULTS: H. pylori eradication rates were similar in ST and CT groups on intention-to-treat (ITT) analysis (71.43% vs 81.80%,P = 0.40). Similar eradication rates were also found in per-protocol (PP) analysis (86.20% vs 90%,P = 0.71). Ulcer recurrence rate in ST groups and CT groups at 3 months (17.14% vs 6.06%,P = 0.26), 6 months (22.86% vs 9.09%,P = 0.19), and at 1 year (25.71% vs 15.15%,P = 0.37) of follow-up was also similar by ITT analysis. Compliance and side effects to therapies were comparable between the groups. The most common side effects were diarrhoea and metallic taste in ST and CT groups, respectively. A complete course of ST costs Indian Rupees (INR) 570.00, whereas CT costs INR 1080.00. CONCLUSION: H. pylori eradication rates, side effects, compliance, cost, and ulcer recurrences were similar between the two groups. The ST was more economical compared with CT.


Assuntos
Antibacterianos/administração & dosagem , Úlcera Duodenal/complicações , Infecções por Helicobacter/tratamento farmacológico , Úlcera Péptica Perfurada/microbiologia , Adulto , Erradicação de Doenças , Esquema de Medicação , Quimioterapia Combinada , Úlcera Duodenal/tratamento farmacológico , Úlcera Duodenal/microbiologia , Duodenoscopia , Feminino , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/patologia , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica Perfurada/tratamento farmacológico , Úlcera Péptica Perfurada/patologia , Úlcera Péptica Perfurada/cirurgia , Estudos Prospectivos , Recidiva , Resultado do Tratamento
6.
Intern Med ; 53(10): 1043-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24827482

RESUMO

An 88-year-old Japanese woman was admitted to our hospital for abdominal pain with a raised inflammatory reaction. Esophagogastroduodenoscopy (EGD) and computed tomography (CT) showed a duodenal ulcer punching a liver cyst. Since neither ascites nor free air were detected on CT and her family did not wish for aggressive medical treatment, the patient received clinical observation and conservative management. Antibiotic and proton-pump inhibitor therapy was effective, and she exhibited an uneventful recovery. A reexamination of EGD and CT confirmed that the fistulous tract between the liver cyst and duodenum was blockaded.


Assuntos
Cistos/complicações , Úlcera Duodenal/complicações , Hepatopatias/complicações , Úlcera Péptica Perfurada/complicações , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Cefoperazona/uso terapêutico , Cistos/tratamento farmacológico , Quimioterapia Combinada , Úlcera Duodenal/tratamento farmacológico , Endoscopia do Sistema Digestório , Feminino , Humanos , Hepatopatias/tratamento farmacológico , Omeprazol/uso terapêutico , Úlcera Péptica Perfurada/tratamento farmacológico , Inibidores da Bomba de Prótons/uso terapêutico , Sulbactam/uso terapêutico , Tomografia Computadorizada por Raios X
7.
Asian J Surg ; 37(3): 148-53, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24393814

RESUMO

BACKGROUND: Although nonoperative management for perforated peptic ulcer (PPU) has been used for several decades, the indication is still unclear. A clinicoradiological score was sought to predict who can benefit from it. METHODS: A clinicoradiological protocol for the assessment of patients presenting with PPU was used. A logistic regression model was applied to identify determinant variables and construct a clinical score that would identify patients who can be successfully treated with nonoperative management. RESULTS: Of 241 consecutive patients with PPU, 107 successfully received nonoperative management, and 134 required surgery. In multivariable analysis, the following four variables correlated with surgery and were given one point each toward the clinical score: age ≥70 years, fluid collection detection by ultrasound, contrast extravasation detection by water-soluble contrast examination, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥8. Eighty-five percent of patients with a score of 1 or less were successfully treated with nonoperative management, whereas 23 of 29 patients with a score of 3 or more required surgery. The area under the receiver operating characteristic curve was 0.804 (95% confidence interval = 0.717-0.891). CONCLUSION: By combining clinical, radiological parameters, and APACHE II score, the clinical score allowed early identification of PPU patients who can benefit from nonoperative management.


Assuntos
Úlcera Péptica Perfurada/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica Perfurada/tratamento farmacológico
8.
Ugeskr Laeger ; 175(9): 586-7, 2013 Feb 25.
Artigo em Dinamarquês | MEDLINE | ID: mdl-23608012

RESUMO

Roux-en-Y gastric bypass (RYGBP) is an increasingly used procedure when treating morbid obesity. Due to the extensive gastrointestinal rearrangement, diagnostic evaluation of patients with gastric bypass and acute abdominal pain can be difficult. We present a case of a perforated duodenal ulcer in a RYGBP operated patient, where free abdominal fluid, but hardly any pneumoperitoneum was seen on a computed tomography. Free intraperitoneal fluid is an important finding and should give suspicion of the need for emergency surgery in RYGBP operated patients with abdominal pain.


Assuntos
Úlcera Duodenal/complicações , Derivação Gástrica/efeitos adversos , Úlcera Péptica Perfurada/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Dor Abdominal/etiologia , Adulto , Líquido Ascítico/diagnóstico por imagem , Humanos , Masculino , Obesidade Mórbida/cirurgia , Úlcera Péptica Perfurada/complicações , Úlcera Péptica Perfurada/diagnóstico por imagem , Úlcera Péptica Perfurada/tratamento farmacológico , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/tratamento farmacológico , Tomografia Computadorizada por Raios X
9.
Ulus Travma Acil Cerrahi Derg ; 18(4): 339-43, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23139002

RESUMO

BACKGROUND: Medical treatment has played an important role in the reduction of peptic ulcer perforation (PUP). The goal of this study was to evaluate the effect of fasting on PUP. METHODS: A retrospective analysis of 229 patients who were operated due to PUP between 1999-2009 was made. Patients were divided into two groups. Group I (n=188) included the patients who were operated in other periods of the year, while Group II (n=41) included the patients who were operated during Ramadan, the Muslim period of fasting. Patients in Group II were analyzed in terms of duration of fasting. RESULTS: The increase in surgeries per group was higher in Group II than Group I (p<0.05). Predisposing factors, anti-ulcer drug usage and demographic variables were seen to have no role in this difference. Duration of fasting may have a minimal effect on the perforation. CONCLUSION: The results of this study demonstrate that PUP is detected as relatively higher during Ramadan among those who are fasting for more than 12 hours daily. We suggest that people with predisposing factors should be informed before making a decision to fast.


Assuntos
Jejum , Úlcera Péptica Perfurada/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antiulcerosos/uso terapêutico , Jejum/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica Perfurada/tratamento farmacológico , Úlcera Péptica Perfurada/cirurgia , Religião , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
10.
Mali Med ; 27(1): 19-22, 2012.
Artigo em Francês | MEDLINE | ID: mdl-22947296

RESUMO

AIMS: To determine the most frequent causes of the digestive perforations and to evaluate the surgical procedures, the morbidity and mortality. PATIENTS AND METHODS: It was about a retrospective descriptive study, over 5 year's period in a visceral service of CHU du Point G, Bamako. Were included in the study all the patients operated for digestive perforation and hospitalized in the service of surgery "A". Were not included in the study patient operated not presenting a digestive perforation. Per operational etiologies of the perforations and their frequency were determined, as well as the morbidity and morbidity and mortality. RESULTS: Files of 202 patients were collected. The average age of the patients was 28.3 ± 15.5 years with extremes of 6 and 71 years. The frequency of digestive perforations was higher in the age from 11 to 20 years (29.7%). The average time of consultation was of 7± 6 days. Abdominal pains, nauseas and vomiting, matter and gas stop (48.5%) were the most current functional signs. A "wood belly" abdomen was found in 72,3% of the cases. The radiography of abdomen without preparation found a diffuse greyness (64.7%), a pneumoperitoine (30.7%). A double antibiotic therapy was made in all the cases. A median laparotomy was practiced in 98,5%, and laparoscopy in 3 cases (1.5%). A single perforation was found among 172 patients (85,1%). Morbidity, all confused causes, was made of 30 cases of parietal suppurations (14.8%). Total mortality was 74%. According to aetiologies it was 10.3% in the typhic perforations, 4.6% in the appendicular perforations and 4.9% in the perforations of gastroduodenal ulcers. CONCLUSION: The most frequent aetiologies of digestive perforation in our context were the typhoid fever, acute appendicitis and the gastroduodenal ulcer. The résection - joining and peritoneal toilet were the most practised procedure. The main factor of bad outcome remains the diagnostic delay burdening morbidity and mortality.


Assuntos
Perfuração Intestinal/epidemiologia , Úlcera Péptica Perfurada/epidemiologia , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Apendicite/complicações , Criança , Terapia Combinada , Diagnóstico Tardio , Neoplasias do Sistema Digestório/complicações , Feminino , Mortalidade Hospitalar , Hospitais Universitários/estatística & dados numéricos , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/tratamento farmacológico , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Laparotomia , Masculino , Mali/epidemiologia , Pessoa de Meia-Idade , Úlcera Péptica Perfurada/diagnóstico , Úlcera Péptica Perfurada/tratamento farmacológico , Úlcera Péptica Perfurada/cirurgia , Estudos Retrospectivos , Estômago/lesões , Ruptura Gástrica/tratamento farmacológico , Ruptura Gástrica/epidemiologia , Ruptura Gástrica/cirurgia , Técnicas de Sutura , Febre Tifoide/complicações , Adulto Jovem
11.
Helicobacter ; 17(2): 148-52, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22404446

RESUMO

BACKGROUND: The most common complications of peptic ulcer are bleeding and perforation. In many regions, definitive acid reduction surgery has given way to simple closure and Helicobacter pylori eradication. AIM: To perform a systematic review and meta-analysis to ask whether this change in practice is in fact justified. MATERIALS AND METHODS: A search on the Cochrane Controlled Trials Register, Medline, and Embase was made for controlled trials of duodenal ulcer perforation patients using simple closure method plus postoperative H. pylori eradication therapy versus simple closure plus antisecretory non-eradication therapy. The long-term results for prevention of ulcer recurrence were compared. RESULTS: The pooled incidence of 1-year ulcer recurrence in H. pylori eradication group was 5.2% [95% confidence interval (CI) of 0.7 and 9.7], which is significantly lower than that of the control group (35.2%) with 95% CI of 0.25 and 0.45. The pooled relative risk was 0.15 with 95% CI of 0.06 and 0.37. CONCLUSIONS: Helicobacter pylori eradication after simple closure of duodenal ulcer perforation gives better result than the operation plus antisecretory non-eradication therapy for prevention of ulcer recurrence. All duodenal ulcer perforation patients should be tested for H. pylori infection, and eradication therapy is required in all infected patients.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/cirurgia , Úlcera Péptica Perfurada/tratamento farmacológico , Úlcera Péptica Perfurada/cirurgia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/isolamento & purificação , Helicobacter pylori/fisiologia , Humanos , Úlcera Péptica Perfurada/microbiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
Rev. cuba. cir ; 48(2)abr.-jun. 2009. tab
Artigo em Espanhol | LILACS, CUMED | ID: lil-534562

RESUMO

INTRODUCCIÓN. En nuestro hospital la úlcera péptica perforada tiene una elevada morbilidad y mortalidad, mayor del 20 por ciento en los últimos 5 años, lo que nos motivó a realizar este trabajo. MÉTODOS. Se realizó un estudio descriptivo y prospectivo de los pacientes tratados por úlcera péptica perforada en el Servicio de Cirugía General del Hospital Universitario Manuel Ascunce Domenech de Camagüey, durante los años 2006 y 2007. RESULTADOS. La úlcera péptica perforada predominó en los hombres entre 40 y 59 años de edad. El 41,2 por ciento tenían antecedentes de úlcera péptica, aunque solo la mitad recibía tratamiento médico. La mayoría de los pacientes fueron atendidos entre 13 y 24 h del inicio de su cuadro clínico, y hubo pocos casos de shock, deshidratación u otra enfermedad grave asociada. La úlcera duodenal perforada fue la más frecuente (67,6 por ciento) y la sutura y la epiploplastia fueron las técnicas quirúrgicas más usadas. La mortalidad fue del 5,9 por ciento, debida a falla múltiple de órganos y sepsis respiratoria grave. CONCLUSIONES. El índice de complicaciones y la mortalidad en nuestra serie fueron bajos, dada la adopción de medidas encaminadas a tratar adecuadamente el shock y las enfermedades graves asociadas, a disminuir el tiempo preoperatorio y a revisar las técnicas quirúrgicas empleadas, incluido el lavado peritoneal(AU)


INTRODUCTION: In our hospital, performed peptic ulcer has a high morbidity and mortality, greater than 20 percent during last 5 years, motivating us to perform this paper. METHODS: Authors made a prospective and descriptive study of patients treated by performed peptic ulcer in General Surgery Service of Manuel Ascunce Domenech University Hospital of Camaguey province during 2006 and 2007. RESULTS: Perforated peptic ulcer had a predominance in men aged between 40 and 59. The 41, 2 percent of them had backgrounds of peptic ulcer although only half received medical treatment. Most of patients were seen between 13 and 24 hours of clinical picture start, and there were few shock cases, dehydration or another associated severe disease. Perforated peptic ulcer was the more frequent (67, 6 percent) suture and epiploplasty, were the more used surgical techniques. Mortality was of 5,9 percent due to multiple organ failure and severe respiratory sepsis. CONCLUSIONS: Index of complications and mortality in our series were low, according to application of measures aimed to treat properly shock and the associated severe diseases, to decrease preoperative time, and to review surgical techniques used, including peritoneal lavage(AU)


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Úlcera Péptica Perfurada/tratamento farmacológico , Úlcera Péptica Perfurada/cirurgia , Lavagem Peritoneal/métodos , Epidemiologia Descritiva , Estudos Prospectivos
13.
Swiss Med Wkly ; 137(23-24): 337-40, 2007 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-17629803

RESUMO

BACKGROUND: Conservative treatment of perforated gastroduodenal ulcer has been shown to be associated with good results in patients whose general condition is good. However, its use in patients not eligible for surgical repair has not been supported. The aim of this study is to evaluate the results of conservative treatment in these patients in the era of proton pump inhibitor. MATERIAL AND METHODS: In the period 1978-2004, 533 patients were admitted for perforated gastroduodenal ulcer. 503 patients underwent surgery, while 30 (median age 79 [42-98] years) were allocated to conservative treatment due to poor general condition. Conservative treatment consisted of nasogastric aspiration, antibiotics and antisecretory therapy (H2-blockers from 1978-1995, 11 patients, and proton pump inhibitors (PPI) from 1996, 19 patients). Endpoints were: hospital morbidity and mortality and hospital stay. RESULTS: Overall morbidity and mortality were 33% and 30%. Median hospital stay was 11 days (range 0-32). General complications developed in 73% versus 16% of patients (p = 0.023) and mortality was 64% versus 11% (p = 0.008) for the H2-blocker and PPI groups respectively. On multivariate analysis mortality correlated with presence of shock at admission and type of antisecretory therapy. CONCLUSION: In the era of PPI conservative treatment for perforated ulcer is possible with acceptable morbidity and mortality in patients not eligible for surgical repair. However, presence of shock at admission was associated with high mortality and, even in these patients, militates in favour of a surgical approach.


Assuntos
Antibacterianos/uso terapêutico , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Úlcera Péptica Perfurada/tratamento farmacológico , Úlcera Péptica/complicações , Úlcera Péptica/tratamento farmacológico , Inibidores da Bomba de Prótons , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Intubação Gastrointestinal , Tempo de Internação , Pessoa de Meia-Idade , Úlcera Péptica/mortalidade , Úlcera Péptica Perfurada/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
14.
Rev Med Chir Soc Med Nat Iasi ; 110(3): 604-8, 2006.
Artigo em Romano | MEDLINE | ID: mdl-17571552

RESUMO

Experimental and clinical data support the role of oxidative stress in the development of gastro-duodenal inflammatory lesions and peptic ulcer. Although quite common, stress ulcer remains a minor concern in the The authors review the literature data and perform a retrospective study on 205 personal cases of gastroduodenal ulcers, diagnosed and operated in the period 1986-2005. Of these, 58 (28.29%) were perforated ulcers, including 4 cases (6.8%) caused by various psychic traumas. All the patients presented symptoms and signs characteristic for perforated ulcer and were undoubtedly of psychogenic cause. The surgical treatment consisted in the closure of the perforation and peritoneal drainage. Besides medical treatment of peptic ulcer disease consisting of antisecretory drugs, antioxidants and sedatives were used. Postoperative follow-up showed a rapid and uneventful recovery in all cases. In conclusion, surgery is the mainstay of treatment in perforated ulcer, but additional stress therapy promotes healing and may reduce postoperative morbidity in cases with certain involvement of psychic trauma.


Assuntos
Úlcera Duodenal/cirurgia , Úlcera Péptica Perfurada/cirurgia , Úlcera Gástrica/cirurgia , Adulto , Idoso , Antiulcerosos/uso terapêutico , Antioxidantes/uso terapêutico , Quimioterapia Combinada , Úlcera Duodenal/tratamento farmacológico , Humanos , Hipnóticos e Sedativos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Úlcera Péptica Perfurada/tratamento farmacológico , Estudos Retrospectivos , Úlcera Gástrica/tratamento farmacológico , Resultado do Tratamento
15.
World J Surg ; 29(10): 1299-310, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16132404

RESUMO

The primary goal of this study was to describe epidemiology and management strategies of the perforated duodenal ulcer, as well as the most common methods of laparoscopic perforated duodenal ulcer repair. The secondary goal was to demonstrate the value of prospective and retrospective studies regarding the early results of surgery and the risk factors. The tertiary goal was to emphasize the benefits of this operation, and the fourth goal was to clarify the possible risk factors associated with laparoscopic repair of the duodenal ulcer. The Medline/Pubmed database was used. Review was done after evaluation of 96 retrieved full-text articles. Thirteen prospective and twelve retrospective studies were selected, grouped, and summarized. The spectrum of the retrospective studies' results are as follows: median overall morbidity rate 10.5 %, median conversion rate 7%, median hospital stay 7 days, and median postoperative mortality rate 0%. The following is the spectrum of results of the prospective studies: median overall morbidity rate was slightly less (6%); the median conversion rate was higher (15%); the median hospital stay was shorter (5 days) and the postoperative mortality was higher (3%). The risk factors identified were the same. Shock, delayed presentation (> 24 hours), confounding medical condition, age > 70 years, poor laparoscopic expertise, ASA III-IV, and Boey score should be considered preoperative laparoscopic repair risk factors. Each of these factors independently should qualify as a criterion for open repair due to higher intraoperative risks as well as postoperative morbidity. Inadequate ulcer localization, large perforation size (defined by some as > 6 mm diameter, and by others as > 10 mm), and ulcers with friable edges are also considered as conversion risk factors.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Úlcera Duodenal/cirurgia , Laparoscopia/métodos , Úlcera Péptica Perfurada/cirurgia , Complicações Pós-Operatórias , Úlcera Duodenal/tratamento farmacológico , Úlcera Duodenal/epidemiologia , Humanos , Úlcera Péptica Perfurada/tratamento farmacológico , Úlcera Péptica Perfurada/epidemiologia , Fatores de Risco
16.
World J Surg ; 29(7): 849-52, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15951925

RESUMO

Simple closure followed by Helicobacter pylori (Hp) eradication has become the most used procedure in perforated ulcer treatment. However, its efficacy and safety are still to be determined. To assess recurrence and re-perforation rates, and as a secondary objective, to analyze Hp infection rates in perforated ulcer patients and controls, we conducted a prospective study. Ninety-two consecutive patients (ages: 19-96 years) were operated on between 1996 and 2002, and treated by simple closure followed by Hp eradication and NSAID avoidance. The data were prospectively collected in a database. Hp infection was diagnosed in 68 patients (73.9%). Thirty-four patients (37%) consumed nonsteroidal anti-inflammatory drugs (NSAIDs), and 23 (25%) had both Hp infection and NSAID antecedents. The perforation was gastric in 4 cases and pre-pyloric, pyloric or duodenal in 88. There were postoperative complications in 24 patients (26%) and 4 patients died (4.3%). Hp eradication was shown in 46 patients. There was clinical ulcer recurrence in 4 (4.3%); in 3 of them recurrence manifested as re-perforation, all in gastric locations. Overall relapse and re-perforation 1-year crude rates were 6.1% and 4.1%, respectively. Crude rates for non-gastric ulcer recurrence were 0 at 1 year and 2.6% at 2 years and for non-gastric ulcer re-perforation rates were 0 at 1 and 2 years. This therapeutic strategy is associated with a low rate of recurrence and no re-perforations in case of duodenal, pyloric, or pre-pyloric perforated ulcers, but it is not acceptable for perforated gastric ulcers.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Úlcera Péptica Perfurada/tratamento farmacológico , Úlcera Péptica Perfurada/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Antiulcerosos/uso terapêutico , Feminino , Infecções por Helicobacter/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica Perfurada/etiologia , Estudos Prospectivos , Recidiva , Reoperação , Resultado do Tratamento
17.
Ann Chir ; 129(10): 578-82, 2004 Dec.
Artigo em Francês | MEDLINE | ID: mdl-15581818

RESUMO

BACKGROUND: The conservative management of perforated peptic ulcer has not gained widespread acceptance despite introduction of proton-pomp inhibitors because surgical procedures can achieve immediate closure by eventually using a laparoscopic approach. The aim of this prospective study was to evaluate the results of Taylor's method and to identify predictive factors of failure of medical treatment in patients presenting with perforated peptic ulcer. METHOD: Between 1990 and 2000, 82 consecutive patients, with diagnosis of perforated peptic ulcer were prospectively included in this study. They were initially treated with non-operative procedure (nasogastric suction and intravenous administration of H2-blockers or proton-pomp inhibitors). No clinical improvement after 24 hours required a surgical treatment. Predictive factors of failure of non-operative treatment were tested in univariate or multivariate analysis. RESULTS: Clinical improvement was obtained with non-operative treatment in 54% of the patients (44/82). The overall mortality rate was 1%. In univariate analysis, significant predictive factors of failure of non-operative treatment were: size of pneumoperitoneum, heart beat >94 bpm, abdominal meteorism, pain at digital rectal exam, and age >59 years. In multivariate analysis, the significant factors were the size of pneumoperitoneum, heart beat, and abdominal meteorism. The association of these criteria: size of pneumoperitoneum >size of the first lumbar vertebra, heart beat >94 bpm, pain at digital rectal exam and age > 59 years , led to surgical treatment in all cases. CONCLUSION: These results suggest that more than 50% of patients with perforated peptic ulcer respond to conservative treatment without surgery and that the association of few criteria (size of pneumoperitoneum, heart beat, pain at digital rectal exam and age) require emergency surgery.


Assuntos
Inibidores Enzimáticos/uso terapêutico , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Úlcera Péptica Perfurada/tratamento farmacológico , Úlcera Gástrica/tratamento farmacológico , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Dor , Exame Físico , Pneumoperitônio , Estudos Prospectivos , Inibidores da Bomba de Prótons , Sucção , Resultado do Tratamento
18.
J Assoc Physicians India ; 52: 207-9, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15636310

RESUMO

AIM OF STUDY: Quality of life (QOL) as outcome during treatment of acid peptic disease has been studied, but, peptic perforation, which is the commonest complication of acid peptic disease, has not been studied in the light of QOL outcome. The present-study addresses the important issue of QOL after peptic perforations. METHODS: This prospective study was carried on 51 adult consecutive survivors of peptic perforation managed in Gastrointestinal Surgery Unit, Department of Surgery, Government NSCB Medical College and Hospital, Jabalpur (MP) India. These underwent exploratory laparotomy with repair of perforation, and subsequently were discharged on anti-ulcer therapy (Pantoprazole 40 mg once a day) for 6 weeks. The instrument chosen to study their QOL was gastrointestinal quality of life index (GIQLI). Patients were assessed before they underwent surgery and 3 months and 6 months after operation. RESULTS: The overall GIQLI score (t = 20.1, p < 0.00 at 3 months; t = 8.2, p < 0.001 at 6 months) as well as its G I core (t = 14.5, p < 0.001 at 3 months; t = 7.3, p < 0.001 at 6 months), G I disease specific (t = 12.9, p < 0.001 at 3 months; t = 2.6, p < 0.02 at 6 months), psychological (t = 15.4, p < 0.001 at 3 months; t = 3.5, p < 0.001 at 6 months) and physical and social components (t = 10.9, p < 0.001 at 3 months; t = 4.2, p < 0.001 at 6 months) significantly increased over 3 and 6 months of follow-up, reflecting improvement in quality of life as perceived by the patients. Variations in the pattern of recovery, based on age and gender were not seen in the present study. CONCLUSION: Peptic perforation does not result in any long lasting impairment of QOL and the QOL improves to near normal in 6 months time after the perforation.


Assuntos
Omeprazol/análogos & derivados , Avaliação de Resultados em Cuidados de Saúde , Úlcera Péptica Perfurada/fisiopatologia , Úlcera Péptica Perfurada/cirurgia , Qualidade de Vida , Perfil de Impacto da Doença , 2-Piridinilmetilsulfinilbenzimidazóis , Adulto , Idoso , Idoso de 80 Anos ou mais , Antiulcerosos/uso terapêutico , Benzimidazóis/uso terapêutico , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Omeprazol/uso terapêutico , Pantoprazol , Úlcera Péptica Perfurada/tratamento farmacológico , Estudos Prospectivos , Sulfóxidos/uso terapêutico , Inquéritos e Questionários
19.
Arch Pediatr ; 10(1): 31-3, 2003 Jan.
Artigo em Francês | MEDLINE | ID: mdl-12818777

RESUMO

UNLABELLED: Perforated gastric ulcer is unusual in children. We report a case in a girl with an unexpected evolution. CASE REPORT: A 13-year-old girl was admitted for abdominal pain. She had no particular personal history but her father had a perforated ulcer. On admission she was not painful, her abdomen was soft on palpation. The white blood cell count was 1.7 x 10(3)/mm3. A right pneumoperitoneum was seen on an abdominal X-ray film. Because of her good general status and the normalization of the abdominal X ray film six hours later, no surgical exploration was performed. On the fourth day, a gastrointestinal endoscopy showed an anterior gastric ulcer which was perforated. Biopsies did not isolate H. pylori. The patient was given a treatment with amoxicillin-metronidazole (7 d) and oméprazole (7 weeks). An endoscopic control, one month later, showed a total healing of the gastric ulcer. CONCLUSION: Peptic ulcerations and their complications are underdiagnosed in childhood. This could lead to delay in diagnosis or inappropriate treatment specially in case of perforation.


Assuntos
Úlcera Péptica Perfurada/patologia , Úlcera Gástrica/complicações , Adolescente , Antiulcerosos/uso terapêutico , Endoscopia Gastrointestinal , Feminino , Humanos , Úlcera Péptica Perfurada/tratamento farmacológico , Pneumoperitônio/etiologia , Úlcera Gástrica/tratamento farmacológico , Resultado do Tratamento
20.
Klin Med (Mosk) ; 80(9): 52-4, 2002.
Artigo em Russo | MEDLINE | ID: mdl-12416227

RESUMO

Benefit of monotherapy of duodenal ulcers by lanzap in 36 patients was compared to that of combined therapy including panitidin in 26 patients. Lanzap brought about ulcer healing within 7-10 days in 55.6%, within 14-16 days ulcer scarring was observed in 35 patients (97.2%). Ulcer healing progressed depending on ulcer size. Combined treatment with ranitidine promoted ulcer scarring in 14-16 days in 73% patients. Lanzap monotherapy in preoperative period promoted fast healing of ulcer defect anf provided optimal conditions for surgery.


Assuntos
Antiulcerosos/uso terapêutico , Úlcera Duodenal/complicações , Omeprazol/análogos & derivados , Omeprazol/uso terapêutico , Úlcera Péptica Hemorrágica/terapia , Úlcera Péptica Perfurada/terapia , Inibidores da Bomba de Prótons , Ranitidina/uso terapêutico , 2-Piridinilmetilsulfinilbenzimidazóis , Antiulcerosos/administração & dosagem , Quimioterapia Combinada , Úlcera Duodenal/tratamento farmacológico , Úlcera Duodenal/cirurgia , Seguimentos , Humanos , Lansoprazol , Omeprazol/administração & dosagem , Úlcera Péptica Hemorrágica/tratamento farmacológico , Úlcera Péptica Hemorrágica/cirurgia , Úlcera Péptica Perfurada/tratamento farmacológico , Úlcera Péptica Perfurada/cirurgia , Cuidados Pós-Operatórios , Ranitidina/administração & dosagem , Fatores de Tempo
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