[Epigastric pain caused by a gastric wall abscess]. / Epigastrische pijn door een maagwandabces.

BACKGROUND: Gastric wall abscesses are rare, but mortality rates from this type of gastritis are high. A foreign body or mucosal damage is often the cause of the abscess. Most patients have nonspecific symptoms, including general malaise and abdominal pain, sometimes accompanied by fever and weight loss. CASE DESCRIPTION: After various tests a 45-year-old man with epigastric pain was shown to have a gastric wall abscess. After endoscopic drainage of the abscess, followed by intravenous antibiotics, he made a complete recovery. CONCLUSION: Gastric wall abscesses are rare, but should be included in the differential diagnosis in patients with epigastric pain, because of their high mortality rate. Endoscopic ultrasonography is the preferred diagnostic method. Endoscopic ultrasound-guided drainage, with or without placement of a drain, followed by intravenous antibiotics is the treatment of choice.

Death and venous thromboembolism after lower extremity amputation.

BACKGROUND: Lower extremity amputation is often performed in patients with end-stage vascular disease and is considered a high-risk procedure. Uncertainty exists about the rate of venous thromboembolism (VTE) in these patients. OBJECTIVES: To establish the incidence of death and venous thromboembolism after lower extremity amputation. METHODS: A prospective cohort study was performed to establish the incidences of death and VTE after lower extremity amputation, as detected by bilateral complete compression ultrasonography and ventilation-perfusion scintigraphy performed preoperatively and around day 14 postoperatively. Standard low-molecular-weight heparin thromboprophylaxis was given during the study period. A secondary outcome was the incidences of mortality and symptomatic venous thromboembolic complications during 8 weeks of postoperative follow-up. RESULTS: Forty-nine patients (53 amputations) were ultimately included in the intention-to-treat analysis. Five patients died within the 2-week period and an additional seven patients died during the 8 weeks clinical follow-up period. The total mortality rate therefore was 12 of 53 amputations [22.6%; 95% confidence interval (CI), 12.3-36.2%]. Six patients developed pulmonary embolisms (of which two were fatal) and one patient developed an asymptomatic contralateral distal deep venous thrombosis, resulting in a total VTE rate of 7 out of 53 amputations (13.2%; 95% CI, 5.47-25.3%). CONCLUSION: Lower extremity amputation is accompanied by a high mortality rate from sepsis, and respiratory and vascular causes. This study shows that VTE substantially contributes to the morbidity and mortality after lower extremity amputation despite adequate pharmacological thromboprophylaxis in this vulnerable population of patients.

Treatment of alloy-electroplating wastewater by an automated solvent extraction technique.

Electroplating with highly toxic metals is being gradually replaced by alloy or mixed-metal electroplating. We developed a solvent extraction method for the treatment of waste rinsewater generated in Zn-Co alloy electroplating, based on the studies of the extraction properties. An alkyl ester of an alkylphosphonic acid (PC-88A) or a dialky phosphinic acid (Cyanex 272) was used as the extractant. The two metals were co-extracted into the organic solvent and then separately recovered in a simple process. The feasibility of the process was demonstrated with automated mixer-settler solvent extraction units.