Risk factors predicting operative mortality in perforated peptic ulcer disease.

Following the introduction of H2-blockers and proton pump inhibitors, there has been a sharp decrease in elective peptic ulcer surgery. However, emergency operations for complications such as perforation are on the rise. This study was undertaken to review the factors which determine mortality following emergency surgery for peptic ulcer perforation. A prospective study of all patients who underwent surgery at our institute for peptic ulcer perforation between September 1999 and August 2001 was carried out. One hundred seventy-four patients underwent surgery for perforated peptic ulcer. Risk of death was related to age more than 60 years, shock at presentation, delay more than 24 hours prior to surgery and size of perforation more than 5 mm. Perforated peptic ulcer disease remains a frequent clinical problem associated with a significant postoperative mortality.

Value of core needle biopsy in the diagnosis of soft tissue tumours.

We performed a prospective study to determine the accuracy of core needle biopsy in the diagnosis and grading of soft tissue tumours and to study the morbidity of core needle biopsy. Forty one cases of soft tissue tumours, 24 of them malignant and 17 benign, were biopsied with an 18G core needle. Core needle biopsy reports were compared with the final histopathological report after definitive procedure or incisional biopsy. 85.3% of core biopsies yielded adequate sample. Core needle biopsy had a sensitivity of 90%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 88.23%. Overall accuracy for diagnosis of malignancy was 94.28%, 77.7% of tumours were correctly subtyped and none of them were histologically graded. There was no immediate complication of haemorrhage in any of the cases. Thus, we conclude that core needle biopsy is equivalent to incisional biopsy in diagnostic accuracy and being simple, less expensive and unlikely to compromise further management, can be used in place of open biopsy of soft tissue tumours.