Variations in the risk of gastrointestinal hemorrhage with non-steroidal anti-inflammatory drugs and localization of lesions.

The aim of this prospective study was to determine the effect of ulcerogenic drugs in patients with bleeding peptic ulcers and erosions with respect to their age and sex, ulcer history and additional risk factors such as family medical history, alcohol use, smoking, coffee consumption and stress. Of 367 patients with bleeding gastroduodenal lesions admitted during a period of 15 months, 88 (24%) had previously received ulcerogenic drugs. The most frequently taken drugs were aspirin (44.3%), piroxicam (12.3%) and ibuprofen (7.4%). Bleeding lesions were 1.4 times more frequently found in male users than in female users, and 2.1 times more often in male unusers. Males were more commonly receiving drugs than females (59.8%:40.2%), particularly those aged 34 to 54 years. Forty (45.5%) users had previously suffered from ulcer disease, 48 (54.5%) had negative history. There was no additional risk factor in 48%, whereas 58% of the users had one or more risk factors. It may be concluded with great certainty that NSAIDs caused hemorrhage in 13% of all admissions. Among users, a total of 119 different gastric and duodenal lesions were found. Gastric lesions were more common (54%) than duodenal lesions (46%) in males, while in females an inverse ratio was observed (41% of gastric and 59% of duodenal lesions). Among nonusers, gastric lesions were more frequent in females (M:F, 42%:48%), and duodenal lesions in males (M:F, 58%:52%). The number of lesions increased with age in both users and nonusers. Forty-three percent of all drug users had ulcers in the prepyloric region, 23% on the lesser curvature, and 14% at the posterior wall of the gastric corpus. Gastroduodenal erosions were seen in 11% of the males and 1% of the females. In nonusers, ulcers were found on the posterior wall of the corpus (27%), on the lesser curvature (25%) and in the prepyloric region (24%). Bleeding gastroduodenal erosions were found in 4% of the patients. Distribution of bleeding duodenal ulcers was similar in drug users and in nonusers, i.e. anterior wall (45%:44%), posterior wall (28%:27%), lower wall (16%:16%) and upper wall (3%:4%) of the duodenum. NSAIDs had no influence on the localization of duodenal ulcers. In this study, there was no death from ulcer disease with NSAID use. It may be concluded that NSAIDs are a common cause of damage to gastroduodenal mucosa. The risk of drug therapy should be balanced against the risk of the disease.

[The mastocytosis syndrome]. / Sindrom mastocitoze.

A female patient with the history and clinical signs suggesting cutaneous and systemic mastocytosis is reported. The diagnosis of cutaneous mastocytosis was confirmed by the Darier's sign as well as by histologic analysis of the skin. An X-ray film of the bones showed an infiltration of the mast cells into the skeletal system what was also cytologically and histologically proven. The patient was treated only symptomatically because of the benign course of the disease. A current literature data on mastocytosis syndrome are discussed.

[Histamine levels in the blood in patients with malignant tumors]. / Razina histamina u krvi kod bolesnika s malignim tumorom.

The concentration of histamine in blood was determined in 22 patients with solid malignant tumors, 16 hospitalized non-cancer patients and 9 healthy subjects. Patients with cancer (mainly carcinomas of the breast and gastrointestinal tract) were divided into two groups: patients with resected primary tumor without known metastases (group I) and patients with present primary tumor with or without metastases (group II). In comparison with the healthy subjects (histamine concentration 69.0 +/- 6.03 ng.ml-1), cancer patients in both groups had significantly decreased levels of histamine in blood. Also, the concentration of histamine in patients with present tumor (group II; 40.1 +/- 3.48 ng.ml-1) vas significantly lower than in patients with resected primary tumor (49.9 +/- 3.14 ng.ml-1). Furthermore, hospitalized non-cancer patients had lower, but not statistically significant, concentration of histamine (59.7 +/- 6.13 ng.ml-1) than healthy subjects. These findings, together with similar data of other authors, suggest that decreased level of histamine in blood might be a good nonspecific marker for onset and progression of solid malignant tumors.

[Extended indications for osteosynthesis by Küntscher's method]. / Prosirene indikacije osteosinteze po Küntscheru.

Author experiences in the application of endomedullary osteosynthesis according to Küntscher in transversal, oblique and spiral fractures of distal one fifth of tibia, besides the widening of medullar canal, are presented. Indications for the very treatment, that belongs to the so called "extended indications", have not been generally accepted yet. However, the application of this osteosynthesis is completely justified, because after the correct indication, satisfactory results are obtained.

Chronic persistent hepatitis. Long-term prospective study on the natural course of the disease.

Ninety-nine patients with chronic persistent hepatitis were followed up in a prospective study for an average of 6.7 years. Fifty-six patients had positive HBV markers; 29 of these patients had persistent HBs antigenemia, and 4 had persistent HBe antigenemia. No patient developed chronic active hepatitis or cirrhosis of the liver. It can be concluded that chronic persistent hepatitis is a benign non-progressive disease that does not require therapy.

[Surgical treatment of forearm fractures]. / Operativna terapija prijeloma kostiju podlaktice

Ten years of experience and the results of therapy in fractures of forearm bones are presented. Conservative therapy as the majority of surgical methods requires immobilization that results in lately started rehabilitation and because of that in bad functional result too. The development of pseudoarthrosis after these treatments is not rare. By the application of compressive osteosynthesis, negative aspects of other methods are decline, immobilization is not necessary and early rehabilitation enables quicker and complete efficiency of the injured extremity.

[Use of Küntscher's distractor]. / Primjena distraktora po Küntscheru

Kuntscher's distractor is very simply constructed apparatus with a great power of traction, by which remarkable dislocations of shortening of extremity bone fragments can be gradually corrected. It is applied in acute and especially in not correctly grown fractures with shortening and in pseudoarthrosis. By that, closed osteosynthesis according to Küntscher is enabled, and side dislocation of hyperdistended fragments is slightly corrected during the treatment. We have distractor successfully applied in 12 patients with not correctly grown bone fractures, in pseudoarthrosis, and we did a stable osteosynthesis too. It has been usefully applied in contusions of extremities, draining according to Willeneger.