Somatostatin and ranitidine in the treatment of non-variceal upper gastrointestinal bleeding: a prospective, randomized, double-blind, controlled study.

BACKGROUND/AIMS: The aim of this study was to compare the efficacy of somatostatin vs. ranitidine in controlling acute non-variceal gastrointestinal bleeding. METHODOLOGY: A total of 48 patients with acute upper gastrointestinal bleeding due to duodenal or gastric ulcer were divided into 2 groups. Group I consisted of 15 patients with Forrest IB and Group II consisted of 30 patients with Forrest II. Two regimens were randomly allocated to all patients within half an hour after the endoscopic procedure: 1) somatostatin-UCB 250 mcg i.v. bolus followed by continuous i.v. infusion at a rate of 6 mg/d for 72 h, or 2) ranitidine 300 mg/d by continuous i.v. infusion for 72 h. RESULTS: In Group I, although mean blood transfusion requirements (no. of units) were lower in patients treated with somatostatin than in those treated with ranitidine, this was not statistically significant (mean +/- SD: 2.56 +/- 3.05 vs. 5.17 +/- 4.96, respectively; P > 0.05); the time of bleeding stop was shorter in the somatostatin group than in the ranitidine group (mean +/- SD: 3.24 +/- 2.45 vs. 11.25 +/- 11.63, respectively; P = 0.0383). The rebleeding and the mortality rates did not differ between the treatment groups in both Group I and Group II. CONCLUSIONS: Somatostatin is more effective than ranitidine in controlling acute non-variceal gastrointestinal bleeding in patients with Forrest IB bleeding activity. Somatostatin has no additional benefit in those with Forrest II bleeding activity.

Management of suppuration in regional lymph nodes secondary to BCG vaccination.

We describe 50 patients with suppurative regional lymphadenitis following intradermal BCG vaccination. For non-drained suppurations we performed needle aspiration in twenty-three patients (aspiration group). Of the remaining 27 patients (drainage group) 16 had spontaneous drainage and 11 incisional drainage. In the drainage group, 17 patients were followed up conservatively. Ten patients from the drainage group and 3 patients from the aspiration group (drained after needle aspiration) accepted total surgical excision to terminate the drainage. Twenty of twenty-three patients in the aspiration group recovered after needle aspiration. Average period of cessation of drainage and healing of wound was 7.5 weeks in patients with drainage (spontaneous and incisional). Healing was complete after total surgical excision of draining suppurations in all of 11 patients. We concluded that simple needle aspiration was sufficient for the treatment of suppurating but non-drained BCG lymphadenitis. For suppurating lymph nodes that were surgically (not recommended) or spontaneously drained, a more invasive procedure, total surgical excision, was proposed to terminate the long and disturbing drainage period.

Endoscopic management of Dieulafoy lesions of the stomach: a case study of 26 patients.

BACKGROUND AND STUDY AIMS: We studied the clinical features and therapeutic outcome in patients with a diagnosis of Dieulafoy lesion. PATIENTS AND METHODS: Twenty-six patients who had upper gastrointestinal bleeding from Dieulafoy lesions received endoscopic therapy. The clinical and endoscopic features, and the outcome of therapy, were analysed retrospectively. RESULTS: Hemostasis was attempted by hemoclipping in 18 patients, heater probe in six patients and ethanol injection in two patients. The initial therapy was successful in 22 (84.6%) cases. Hemostasis was achieved with additional endoscopic therapy in three cases (11,5%). Surgical treatment was needed only in one case, owing to uncontrolled bleeding. One patient died during the hospital stay from a cause unrelated to the Dieulafoy lesion. There were no side effects related to endoscopic therapy. None of these patients presented with rebleeding from Dieulafoy lesions over a mean long-term follow-up of 36 months. CONCLUSIONS: Bleeding from Dieulafoy lesions can be managed successfully by endoscopic methods, and these should be regarded as the first choice in their management. We emphasize the role of hemoclipping, a mechanical method, for the endoscopic treatment of these lesions.