[Vagotomy in the surgery of perforated pyloroduodenal ulcer]

Under analysis are results of the surgical treatment of 300 patients with perforating pyloroduodenal ulcers. The correct selection of patients for the operation gives best nearest and especially long-term results of vagotomy with antrum resection. The amount of recurrences after a simple suturing of the ulcer in 164 patients was 50%, while after vagotomy with/without various draining operations it was 3.7%. Postoperative lethality after vagotomy was not great, long-term results being considerably better than after the operations of simple suturing the ulcer.

[Surgical treatment of "silent" ulcers of the stomach and duodenum complicated by perforation]

Patients with perforating "silent" ulcers and patients with continuous ulcer histories must be subjected to similar surgical treatment. In most cases it may be truncal vagotomy with draining operation on the stomach. Operation of suturing the perforating ulcer is thought to be expedient in patients with acute ulcers (they make up not more than 25%), with severe concomitant diseases, in the terminal phase of diffuse peritonitis and when performed by surgeons with insufficient experience.

[Features of the surgical treatment of postbulbar ulcers of the duodenum]

The article describes main principles of the operative treatment of 42 patients with postbulbar ulcers. Choice of the surgical method was individualized: resection for the "exclusion" was used in 25 patients, gastric resection with the excision of the ulcer--in 11 patients, organ preserving operations--in 5 patients. The operations made for the "exclusion" gave most favourable immediate and long-term results. Technical details of the operations are described.

[Characteristics of prostanoid synthesis in patients with duodenal ulcer complicated by a history of hemorrhage]

After inhibition of the cyclooxygenase pathway of arachidonic acid metabolism by means of indomethacin or aspirin the initially low aggregation activity of thrombocytes was not distinctly decreased, the antiaggregatory function of the blood vessels endothelium was not suppressed, secretion of bicarbonates was 1.5-2-fold less distinctly inhibited as well as secretion of acid and pepsin with gastric juice was less distinctly stimulated in patients with duodenal ulcer accompanied by hemorrhage as compared with healthy persons or the patients with non-complicated form of duodenal ulcer. At the same time, inhibition of bicarbonate secretion correlated with the antiaggregative activity of the blood vessel wall. The data obtained suggest that cyclooxygenase pathway of prostaglandin synthesis was distinctly impaired in the patients with hemorrhagic complications. Alterations in hemostatic and secretory parameters, caused by indomethacin or aspirin, should be considered in prognostic evaluation of the patients with duodenal ulcer, which had an increased risk of hemorrhagic complications.

Non-steroidal anti-inflammatory drugs and life threatening complications of peptic ulceration

Two hundred and thirty five consecutive patients with a life threatening complication of peptic ulceration, who either died or required emergency surgery, have been studied over a 36 month period. Seventy eight of these high risk patients died; 25 at home, 19 in hospital without surgery and 34 postoperatively. Ninety eight patients had bleeding ulcers, 132 perforated ulcers and five had both bleeding and perforated ulcers. One hundred and forty one of these 235 patients (60%) were taking a non-steroidal anti-inflammatory drugs (NSAID) and the individual agents have been listed. The overall incidence of NSAID use in a hospital control group was 9.9%. The first sign of an ulcer was a life threatening complication in 58.2% of patients taking a NSAID. Nearly 80% of all ulcer related deaths occurred in patients using an anti-inflammatory agent. Patients using these drugs were older, with more pre-existing medical conditions and had larger ulcers than those not taking NSAIDs. The mortality associated with a peptic ulcer complication in patients taking a NSAID was more than twice that in patients with no such drug history. There appears to be a relationship between the development of a life threatening complication of peptic ulceration and NSAID ingestion. Much of the associated mortality and morbidity may be potentially avoidable.

[Determination of the degree of surgical risk in treating peptic gastrointestinal hemorrhages]

Based on a complex analysis of case histories of 817 patients operated upon for ulcerous gastro-intestinal bleedings the authors have developed a system of the assessment of a degree of operative risk. High risk degree of the forthcoming surgery necessitates its shorter duration and less traumatic character as well as careful management of the patients in the nearest postoperative period.

Peptic ulceration in leukaemia

Two children with leukaemia are described who successfully underwent oversewing of perforated duodenal ulcers which probably were secondary to immunosuppression and steroid therapy. This is only the second report of ulceration in childhood leukaemia. Stress ulceration in children responds favourably to conservative surgery and removal of the insult. Ulcer prophylaxis with antacids or Cimetidine should be initiated in patients being subjected to combined immunosuppression and high-dose steroids, particularly during bone marrow transplantation.

Endoscopic injection of adrenalin in bleeding peptic ulcers

Endoscopic injection of actively bleeding peptic ulcers with adrenalin was performed in 37 patients. Initial hemostasis was achieved in all. Five patients rebled and three required emergency surgery. Definitive hemostasis was achieved in 34 (92%). No significant local or systemic complication was observed. The technique in our patients was safe and deserves further comparative study with other methods of endoscopic hemostasis.

Posterior duodenal ulcer: acute free perforation into the lesser sac

Perforation of a peptic ulcer located on the posterior wall of the duodenum is very rare. We present here three cases with acute and free perforation of a posterior duodenal ulcer with a fatal outcome. To the best of our knowledge such an acute free perforation has not been previously published.