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Query: UMLS:C0038358 (gastric ulcer)
 5,179 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A series of 349 survivors of perforated peptic ulcer was followed for periods of up to 23 years. Almost nine out of every 10 patients suffered from dyspepsia during follow-up. Subsequent elective gastroduodenal surgery was required in more than a quarter of the cases. The surgery rate for gastric ulcer was more than one and a half times that for pyloroduodenal ulcer, and for females almost double that for males. The highest rate of all was for females with gastric ulcer, of whom almost one half came for surgery. One in five patients bled during follow-up. One in eight developed stenosis of the stomach of duodenum, and one in 11 perforated again. There was a significantly increased incidence of subsequent perforation and stenosis in those with an initial perforation of 5 mm or more in diameter. Gastric carcinoma occurred in less than 2% of cases and was restricted to cases of pyloroduodenal perforation. When complications occurred, the majority did so within five years. Only 15% of the 262 patients about whom complete information was available had no complications on follow-up. The indications for definitive surgery at perforation should be extended to include perforated gastric ulcer in the female, particularly if the ulcer is large.
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PMID:Perforated peptic ulcer long-term follow-up. 126 34

Over the last 25 years there has been a considerable decrease in the prevalence of peptic ulcer worldwide. Since the introduction of potent anti-ulcer drugs the number of elective operations for peptic ulcer (PU) has decreased considerably, whereas the number of emergency operations has remained largely unchanged. The current incidence of PU perforation is 4-10 per 100,000 population. Perforation accounts for 40-50% of emergency operations for PU. Currently one third to over one half of patients presenting with PU perforation are aged over 65, with an increasing percentage of female patients and gastric ulcer perforations. There appears to be a correlation between PU perforation and ingestion of non-steroidal antiinflammatory drugs (NSAIDS), especially in women over the age of 65. About 50% of patients presenting with perforation of PU do not report a previous history of ulcer dyspepsia or treatment with anti-ulcer drugs. Many authors think the lack of a PU history reported by many patients is unreliable and may lead to erroneous conclusions in about half of patients. Mortality of PU perforation is currently 10-20% in most series, with a higher mortality of 10-40% for perforated gastric ulcer (GU) compared to duodenal ulcer (DU), for which mortality rates of 0-10% are currently reported. A number of centers report an increase in PU perforation mortality: this is due to an increased number of elderly patients in whom ulcer perforation mortality is enhanced by preexistent or concomitant diseases of other organs and systems. In the treatment of PU perforation the discussion centers around the choice between simple closure of the perforation and definitive ulcer surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Current status of therapy for gastroduodenal ulcer]. 197 Sep 9

During the 12 years from 1975 to 1986 at University of Alberta Hospital, Edmonton, 36 patients were found to have a perforated gastric ulcer. A review of their operative treatment revealed that only one patient had a definitive gastric resection despite reports in the literature recommending the procedure. This study was undertaken to determine if simple closure was appropriate treatment for the majority of these patients. Even the enthusiasts of gastric resection would agree that advanced patient age, serious underlying disease and delay in treatment are contraindications to the procedure for perforated gastric ulcer. We found that 28 (78%) of the 36 patients had one or more of these contraindications. Thus, the high-risk nature of the patients presenting to our institution with perforated gastric ulcer explains the frequent use of simple closure in these cases. The data from this study indicate that the profile of patients presenting with perforated benign gastric ulcer needs to be defined before generalizations regarding surgical treatment are made.
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PMID:Perforated benign gastric ulcer: the case for simple closure. 292 Mar 24

65 patients with a complication of a gastric ulcer without any known ulcerative noxa had been treated surgically. In 2 of 3 patients, bleeding or perforation occurred without a longer history of ulcer. In bleeding ulcer, we performed a partial gastric resection, only in older patients a simple suture of the bleeding source. Therefore, mortality of simple suture was higher than of partial gastric resection (overall 13.9%). Perforation of gastric ulcer had only been oversewn with good results. In the last years, we did not see any indication for performing a selective proximal vagotomy in complicated gastric ulcer. The overall mortality rate of perforated gastric ulcer was 17.2%. There was no ulcer recurrence, neither in the group of gastric resection for gastric ulcer bleeding nor in the group of oversewing for gastric ulcer perforation.
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PMID:[Choice of method and long-term results of therapy for complicated gastric ulcers]. 665 29

Between 1988 and 1997 in 226 patients (169 males--75.2% and 57 females--24.8%) surgical treatment was performed due to duodenal ulcer perforation (205 cases--90.7%) or gastric ulcer perforation (21 cases--9.3%, including 3 cases of perforated gastric cancer). Mean age was 51.5 years (19-94 years). In perforated duodenal ulcer the main procedure was truncal vagotomy with pyloroplasty performed in 95.6%, and simple ulcer suture in 4.4%. In perforated gastric ulcer the main procedure was Billroth I (Rydygier) stomach resection performed in 76.18%, and simple ulcer suture in 23.82%. A group of patients who died in perioperative period (29 cases--12.8%) was selected and compared to a group of others regarding age, sex, smoking, alcohol abuse, time elapsing between first symptoms and surgical treatment, use of NSAIDs, location and size of perforation hole, type of surgical procedures. On that basis 4 risk factors of disease in perioperative period due to perforated ulcer surgery were appointed: 1. Age--mean age of patients who died was 67 years (vs. 48.9 years among successfully treated), perioperative mortality in patients over 60 years old was 35.4%, and in patients over 70 years old was 50%). 2. Presence of three or more coexisting diseases--54.54% risk of disease (vs. 2.5% in patients with less than three or without coexisting diseases). 3. Delay in surgical treatment over 24 hours--48.15% of diseases vs. 7.04% in patients undergoing surgery within the first 24 hours following perforation. 4. Septic shock--80% of diseases.
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PMID:[Perioperative mortality for perforated duodenal and gastric ulcer--analysis of 226 patients]. 1044 7

The case of a 57-year-old woman with a fatal liver rupture due to a necrotizing perihepatic abscess caused by a perforated gastric ulcer is presented. The ulcer had been treated successfully by surgical intervention 8 days before. The autopsy revealed a large perihepatic abscess and multiple ruptures of Glisson's capsule with a large subcapsular hematoma and underlying lacerations of the liver parenchyma. The patient had no history of previous abdominal trauma and the known etiological factors for spontaneous liver rupture were excluded by the autopsy findings or by clinical and laboratory data. No liver penetration by the gastric ulcer was found at autopsy and there were no clinical signs or symptoms for an infection or any degenerative or inflammatory diseases. Histologically abundant vegetable fibers, identified as stomach contents and a dense infiltrate of lymphocytes and granulocytes were found in the perihepatic abscess next to Glisson's capsule. Below Glisson's capsule there were hemorrhages, focal hepatocellular necrosis and a mixed cell inflammatory infiltration. In the present case, preceding perforation of the gastric ulcer with leaking of gastric acid into the peritoneal cavity resulted in peptic digestion of Glisson's capsule. Vascular lesions of the affected parts of Glisson's capsule and the liver parenchyma underneath resulted in intrahepatic hemorrhage and an increase in intrahepatic pressure with subsequent liver rupture. To the authors' knowledge no similar case of spontaneous liver rupture due to perforation of a gastric ulcer has been reported previously.
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PMID:Non-traumatic liver rupture due to a perforated gastric ulcer. 1046 Apr 26

The present study reports clinical and laboratory data of patients with Bartter syndrome at diagnosis and follow-up with emphasis on the long-term benefits and side effects of the pharmacological therapy, which includes indomethacin and potassium supplementation. We followed 12 children, 6 boys, with a median age at diagnosis of 24.5 months (range 7-137 months) and at the end of the study 157.5 months (range 26.0-224.0 months). All children presented with polyuria and polydipsia, dehydration, and metabolic and electrolyte disturbances with failure to thrive. However, at study entry 5 of 12 patients also had hypophosphatemia, which disappeared after a mean time of 50+/-22.4 months, 3 of 12 had nephrocalcinosis, and 2 of 12 had typical renal cysts. Despite treatment, hypokalemia was persistent in some patients. During long-term follow-up we observed recovery of growth velocity and adequate metabolic and electrolyte balance. However, we noticed renal and gastrointestinal complications: 2 patients had a perforated gastric ulcer, 1 had a gastric ulcer, and gastritis was detected in 3 children. A decreased glomerular filtration rate was observed in 2 patients during follow-up. Our data emphasize the need for regular surveillance of renal function and gastrointestinal endoscopy in these patients. As an alternative to indomethacin, we present our satisfactory preliminary results with rofecoxib.
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PMID:Bartter syndrome: benefits and side effects of long-term treatment. 1520 26

Modern surgery is usually considered to have begun in nineteenth century Europe. One of the most famous contributors to gastric cancer surgery was the Polish surgeon Ludwik Rydygier, born in 1850. He initiated new methods in several fields, such as gastrointestinal surgery, orthopedics, gynecology, and urology. He was the second surgeon in the world to perform an antral resection, which he carried out on November 16, 1880. The patient, a 64-year-old man, suffered from pyloric cancer and died 12 hours after the procedure as a result of postoperative shock. The next pyloric resection was performed by Billroth in Vienna in 1881. In the nineteenth century few gastric resections were performed for peptic ulcer. The first successful antral resection for gastric ulcer penetrating to the pancreas was also performed by Ludwik Rydygier, in 1881. For many years Rydygier advocated resection in the treatment of gastric ulcers, although it was considered too dangerous for benign disease. He eventually proposed four indications for gastric resection: antral cancer, gastric ulcer, perforated gastric ulcer, and bleeding ulcers. Another operation performed for the first time by Ludwik Rydygier was gastroenterostomy, in a patient with a duodenal ulcer. In the following years other types of partial gastric resection and total gastrectomy were introduced. In 1992 the Ludwik Rydygier Association was founded in Krakow to commemorate the achievements of and pay tribute to this great surgeon. The Eighth International Gastric Cancer Congress will take place in 2009 in Krakow, where Ludwik Rydygier built a new surgical clinic in 1889.
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PMID:Ludwik Rydygier--contributor to modern surgery. 1913 78

A retrospective analysis of 365 completed patient records received by the duty surgical hospital with perforated gastric ulcer and duodenal ulcer. All the patients were operated on urgently. Diagnosis of purulent peritonitis was set 17% of patients, "serous"--47.4%, "seroplastic"- 35.6%. 75.3%, perform suturing of perforated openings, regardless of the form of peritonitis. The remaining 24.7%--interventions that address as a perforation, and the impact on the pathogenesis of peptic ulcer. When radical surgery, which were performed in selected patients even with purulent peritonitis, deaths were reported. And when suturing the ulcer defect lethality was 14.5%. In this group of patients were comparable in age and severity of general condition. It is concluded that that the operations of suturing perforated ulcers were used unnecessarily broad, and the majority of patients admitted to hospital with a perforated stomach ulcer and duodenum may increase the volume of surgical benefit for radical treatment of complications as well as most of peptic ulcer.
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PMID:[Is it possible to expand the indications for primary radical operations for perforated gastric and duodenal ulcer?]. 2049 9

Mucormycosis, is an emerging fungal infection in immunocompromised and diabetic individuals, usually affects rhino-orbito-cerebral, cutaneous and pulmonary regions. But mucormycosis in immunocompetent environment is rare and occurrence of gastric mucormycosis is unusual. We report a case of 19 year old female, with no pre-existing co-morbidities, presented with fever, dysentery, vomiting, and melena for 4 days. On evaluation she was found to have pancytopenia, acute kidney injury, hemolytic anemia, coagulopathy and hepatic derangement and treated with hemodialysis, plasmapheresis along with antibiotics and packed cell RBC transfusion. Upper gastrointestinal endoscopy revealed presence of extensive esophageal and gastric ulcer. In view of persistent bleeding despite endoscopic sclerotherapy, repetition of upper gastrointestinal endoscopy and CT abdomen with oral contrast was done, which revealed perforated gastric ulcer. Exploratory laparotomy and excision of ulcer was done. The biopsy of gastric ulcer had shown the presence of granulomatous necrotic areas positive for mucormycosis. Then she was managed with amphotericin-B, posoconazole with which she improved.
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PMID:Gastric Mucormycosis with Hemolytic Uremic Syndrome. 2760 99


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