AIM:To evaluate the main factors associated with mortality in patients undergoing surgery for perforated peptic ulcer referred to an academic department of general surgery in a large southern Italian city. METHODS:One...AIM:To evaluate the main factors associated with mortality in patients undergoing surgery for perforated peptic ulcer referred to an academic department of general surgery in a large southern Italian city. METHODS:One hundred and forty-nine consecutive patients (M:F ratio=110:39,mean age 52 yrs,range 16-95) with peptic ulcer disease were investigated for clinical history (including age,sex,previous history of peptic ulcer,associated diseases,delayed abdominal surgery,ulcer site,operation type,shock on admission,postoperative general complications, and intra-abdominal and/or wound infections),serum analyses and radiological findings. RESULTS:The overall mortality rate was 4.0%.Among all factors,an age above 65 years,one or more associated diseases,delayed abdominal surgery,shock on admission, postoperative abdominal complications and/or wound infections,were significantly associated (x^2) with increased mortality in patients undergoing surgery (0.0001<P<0.03). CONCLUSION:Factors such as concomitant diseases,shock on admission,delayed surgery,and postoperative abdominal and wound infections are significantly associated with fatal outcomes and need careful evaluation within the general workup of patients admitted for perforated peptic ulcer.展开更多
AIM:To assess the efficacy of allopurinol to prevent hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography(PEP).METHODS:One hundred and seventy patients were enrolled and randomized to ...AIM:To assess the efficacy of allopurinol to prevent hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography(PEP).METHODS:One hundred and seventy patients were enrolled and randomized to two groups:a study group(n=85)who received 300 mg of oral allopurinol at 15 h and 3 h before endoscopic retrograde cholangiopancreatography(ERCP)and a control group(n=85)receiving an oral placebo at the same times.Main Outcome Measurements included serum amylase levels and the number severity of the episodes of pancreatitis.Serum amylase levels were classified as normal(<150 IU/L)or hyperamylasemia(>151 IU/L).Episodes of PEP were classified following Ranson's criteria and CT severity index.RESULTS:Gender distribution was similar between groups.Mean age was 53.5±18.9 years for study group and 52.8±19.8 years for controls.Also,the distribution of benign pathology was similar between groups.Hyperamylasemia was more common in the control group(P=0.003).Mild PEP developed in two patients from the study group(2.3%)and eight(9.4%) from control group(P=0.04),seven episodes were observed in high-risk patients of the control group(25%) and one in the allopurinol group(3.3%,P=0.02).Risk factors for PEP were precut sphincterotomy(P=0.02),pancreatic duct manipulation(P=0.002)and multiple procedures(P=0.000).There were no deaths or side effects.CONCLUSION:Oral allopurinol before ERCP decreased the incidences of hyperamylasemia and pancreatitis in patients submitted to high-risk procedures.展开更多
文摘AIM:To evaluate the main factors associated with mortality in patients undergoing surgery for perforated peptic ulcer referred to an academic department of general surgery in a large southern Italian city. METHODS:One hundred and forty-nine consecutive patients (M:F ratio=110:39,mean age 52 yrs,range 16-95) with peptic ulcer disease were investigated for clinical history (including age,sex,previous history of peptic ulcer,associated diseases,delayed abdominal surgery,ulcer site,operation type,shock on admission,postoperative general complications, and intra-abdominal and/or wound infections),serum analyses and radiological findings. RESULTS:The overall mortality rate was 4.0%.Among all factors,an age above 65 years,one or more associated diseases,delayed abdominal surgery,shock on admission, postoperative abdominal complications and/or wound infections,were significantly associated (x^2) with increased mortality in patients undergoing surgery (0.0001<P<0.03). CONCLUSION:Factors such as concomitant diseases,shock on admission,delayed surgery,and postoperative abdominal and wound infections are significantly associated with fatal outcomes and need careful evaluation within the general workup of patients admitted for perforated peptic ulcer.
基金Supported by Economic resources of the Department of Gastroenterology and Endoscopythe Research Unit in Clinical Epidemiology
文摘AIM:To assess the efficacy of allopurinol to prevent hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography(PEP).METHODS:One hundred and seventy patients were enrolled and randomized to two groups:a study group(n=85)who received 300 mg of oral allopurinol at 15 h and 3 h before endoscopic retrograde cholangiopancreatography(ERCP)and a control group(n=85)receiving an oral placebo at the same times.Main Outcome Measurements included serum amylase levels and the number severity of the episodes of pancreatitis.Serum amylase levels were classified as normal(<150 IU/L)or hyperamylasemia(>151 IU/L).Episodes of PEP were classified following Ranson's criteria and CT severity index.RESULTS:Gender distribution was similar between groups.Mean age was 53.5±18.9 years for study group and 52.8±19.8 years for controls.Also,the distribution of benign pathology was similar between groups.Hyperamylasemia was more common in the control group(P=0.003).Mild PEP developed in two patients from the study group(2.3%)and eight(9.4%) from control group(P=0.04),seven episodes were observed in high-risk patients of the control group(25%) and one in the allopurinol group(3.3%,P=0.02).Risk factors for PEP were precut sphincterotomy(P=0.02),pancreatic duct manipulation(P=0.002)and multiple procedures(P=0.000).There were no deaths or side effects.CONCLUSION:Oral allopurinol before ERCP decreased the incidences of hyperamylasemia and pancreatitis in patients submitted to high-risk procedures.
