Current status of management of benign bleeding peptic ulcer in Al-Gamhouria Teaching Hospital, Aden, Yemen

We aimed to explore and analyze current status of bleeding peptic ulcers in surgical patients. The study was carried out at the Surgical Department of Al-Gamhouria Teaching Hospital, Aden-Yemen. It was divided into 2 parts. Group [A] patients, admitted with bleeding peptic ulcers during the period May 1998 to April 2003, were retrospectively evaluated, and the prospective group [B] that included patients admitted during the period May 2003 to April 2006. One hundred and twenty patients were enrolled in the study; 75% were in group [A] and 25% in [B]. Men were [103] and women [17], with a ratio of [6.1:1]. Overall mean age was 43.4 years [ranging 17 to 70 years] with 23 patients [19.17%] over 60 years. Endoscopic activity within the first 24 hours in group [A] was [55.56%] and zero in [B]. Ratio of bleeding duodenal to gastric ulcers was [2:1]. Bleeding was massive and /or recurred in [32.5%] of patients, with transfusion of 3-9 units of blood [mean - 5.38]. Surgery was performed only in the retrospective group - in [11.11%]. Hospital stay time was for group [A] and [B] 17.5 and 9 days respectively. Overall death rate was [8.33%]; it was less in group [A] than [B] - [6.67%] and [13.3%] respectively. In patients treated only conservatively, death rates in [A] and [B] were [7.5%] and [13.3%] respectively. Nevertheless, death rates were statistically not significant. Overall outlook was quite alarming. Lack of good administration, limited resources, and lack of necessary equipments played the major role in improper management of these patients. To improve the situation, it is recommended to prepare guidelines and establish a well equipped and well functioning endoscopy unit

significance of ultrasound in diagnosing gallstone disease

The efficacy and sensitivity of transabdominal ultrasonography [TUS] for detecting gallstones in patients with biliary colic and biliary tract diseases was studied. A prospective study was carried out between February 2003 and February 2007, in the Surgical Department of Al-Gamhouria Teaching Hospital. Patients with Ultrasound diagnosis of gallbladder [GB] and common bile duct [CBD] stones diseases [including 2 cases with biliary colic like pain and negative TUS result] were admitted to the hospital for cholecystectomy and, in indicated cases for choledochotomy. Presence or absence of stones were noted. CT-scanning was ordered in patients with obstructive jaundice. The computer program Quickcalcs of Graphpad software was applied for data processing [http:/graphpad.com/quickcalcs]. TUS was performed on 114 consecutive patients; 103 [90.35%] were women and 11 [9.65%] were men. The ages ranged between 20 to 80 years, with mean age of 43.62 years. For gallbladder stones; there were 108 True Positive, 2 True Negative, 3 False Positive and one False Negative scans, yielding 94.74% sensitivity, 66.67% specificity, and 96.49% accuracy. Positive Predictive Value [PPV] for gallbladder stones was 16.66% and Negative Predictive Value [NPV] was 97.22%. Nine patients out of 114 [7.9%] had associated with common bile duct obstruction, 6 women [5.26%] and 3 men [2.63%], with 7 True Positive, one False Positive, and one False Negative results for choledocholithiasis, yielding 77.78% sensitivity, 92.11% specificity, and 98.25% accuracy. PPV was 45.78%, whereas NPV was 97.98%. The Ultrasound provided an effective and reliable means for the diagnosis of GB and CBD stone diseases