ABSTRACT
Background: Perforated peptic ulcer is an emergencycondition worldwide. The series comprises study of 100 casesof peptic ulcer perforation by conservative management.Objective: The objective of this study is to find out thetreatment outcome of selective cases of perforated peptic ulcerdisease with conservative measures.Method: This prospective study was conducted at SurgeryDepartment of M. Abdur Rahim Medical College Hospital,Dinajpur, Bangladesh for a period of July 2008 to July 2009.The cases were selected by special inclusion and exclusioncriteria.Results: All patients were presented with acute upperabdominal pain, most were in their fourth decade and came tothe hospital around twenty four hours of their onset of pain.Diagnosis was made on clinical grounds and confirmed byradiological and imaging examinations. Resuscitativemeasures were taken in all cases in the form of IV fluid,nasogastric suction, antibiotics and analgesics. The study wasdesigned to treat all the patients conservatively andaccordingly all were given conservative regimen up to 24hours. There after they were assessed clinically. Greatdeterioration was found in 12 patients and 18 patients showedno improvement who were operated immediately. Conservativemeasures were continued for 70 patients who respondedsmoothly with few minor complications. The mortality was6.33% in the cases treated operatively after failing conservativemanagement.Conclusion: In this series there is a strong associationbetween age of the patient, duration of acute illness andoutcome. It is suggested that treatment of selected cases ofperforated peptic ulcer disease with conservative measures issafe and effective.
ABSTRACT
Fibromyalgia syndrome [FMS] is a chronic musculoskeletal syndrome; almost invariably, symptoms persist at 5-and 10-year follow-ups. The degree of functional impairment is similar to that seen in patients with moderate to severe rheumatoid arthritis. Anti-cyclic citrullinated peptide [anti-CCP] antibody testing is particularly useful in the diagnosis of rheumatoid arthritis, with high specificity, in the early disease process, with the ability to identify patients who are likely to have severe disease and irreversible damage. CRP is a member of the class of acute-phase reactants that its levels rise dramatically during inflammatory processes occurring in the body. The main objective of this study is to determine the frequency of anti CCP-in patients with FM and the association of anti-CCP level with C-RP. This study included 60 patients with FMS according to the ACR 1990 criteria. Their age range was 20-60 years. These patients were then matched by age and sex to 30 healthy control persons with mean age 42.81 +/- 2.16 years. The mean values of ACCP antibodies concentration in serum of patients with FMS were no significant difference as compared to the level in serum of healthy controls [p>0.05], while the mean values of C-RP concentration in serum of patients with FMS were significantly increased than the level in serum of healthy control [p< 0.05]. It is clear from this study that there is no relationship between the levels of ACCP concentration and FMS while C-RP concentration in patients with FMS may be a good indicator to evaluate this disease