A clinico-pathologic study of peptic ulcer in a chronic disease hospital: I the incidence of fatality and its complications

1. The autopsy incidence of chronic peptic ulcer in 3123 consecutive autopsies in a chronic disease hospital is 3.5 per cent. The autopsy incidence for patients 60 years or older is 4.0 per cent. There is no remarkable sex incidence among the patients of this chronic disease hospital. The ulcers tend to be large, the average size being 2.0 centimeters2. The diagnosis of peptic ulcer in this particular series of 110 patients was often missed because of the paucity of ulcer symptoms, incomplete work-up and inability to demonstrate the lesion by x-ray in a great number of cases. There were 77 undiagnosed cases, 53 having no record of abdominal pain. GI series was done in 41 patients, the peptic ulcer being demonstrated in only 27 instances (65.9%). No GI series was done in 15 patients who had complained of abdominal pain; the ulcer would probably have been seen by x-ray in at least 10 of these 15 patients3. The incidence and fatality of complications, specifically gastro-intestinal hemorrhage and acute perforation, are remarkably high in this study. Hemorrhage occurred in 47.3 per cent and acute perforation in 11.8 per cent of our cases. Forty-eight of our 110 patients (43.6%) died as a result of the complication, namely, hemorrhage in 32.7 per cent and acute perforation with generalized peritonitis in 10.9 per cent. There were only 4 cases of pyloric obstruction requiring a by-pass operation. There was only one instance of malignant transformation of a benign ulcer. The three largest ulcers (all gastric) measuring 6.0, 7.5, and 8.0 centimeters respectively were all benign4. Peptic ulcer in aged patients suffering from other serious diseases is a diagnostic and therapeutic problem. However, with more awareness on the part of the attending physician that vague abdominal discomfort may signify an underlying peptic ulcer, diagnosis will be made more often. With better accuracy in diagnosis, therapy will be less problematical since it can be instituted before complications supervene. Although the operative mortality in elderly patients is comparatively high, a liberal use of surgical treatment of peptic ulcer in this group of patient is justified for two reasons, namely, (1) the disease often proves resistant to the medical regimen, and (2) there is a much higher incidence and mortality of complications in the non-surgically treated cases. (Summary)

The so-called "pulseless disease": report of a case

A 61-year-old female patient is presented as a case of the so-called "pulseless disease." The underlying pathology was a severe arteriosclerosis with thrombosis of the aorta and arteriosclerotic occlusion of its main branches. The patient had two episodes of cerebral infarction and died after the second attack of a superimposed acute bronchopneumonia. It is suggested that the term "pulseless disease" should not be used to designate a disease entity, but rather a manifestation which may be due to various diseases. (Summary)

The so-called "pulseless disease"

A 61-year old female patient is presented as a case of the so-called pulseless disease". The underlying pathology was a severe arteriosclerosis with thrombosis of the aorta and arteriosclerotic occlusion of its main branches. The patient had two episodes of cerebral infarction and died after the second attack of a superimposed acute bronchopneumonia. It is suggested that the term "pulseless disease" should not be used to designate a disease entity, but rather a manifestation which may be due to various diseases.(Summary)

Perfis presóricos de 24 horas durante tratamento com prazosina: comparaçäo cruzada de uma formulaçäo de liberaçäo gradual (SR) com uma formulaçäo convencional / Twenty-four hours pressoric profle during the treatment with prazozyn: comparison between a slow release formulation and the conventional formulation

O paciente hipertenso, em particular, requer um esquema terapêutico simples, por que inicialmente näo apresenta quaisquer sintomas que o lembrem da necessidade de uma ingestäo regular de comprimidos e, além disso, muitas vezes também precisa tomar medicaçöes contra outras doenças. Prazosina é um agente anti-hipertensivo que já tem sido utilizado há muitos anos no tratamento da hieprtensäo, tanto isoladamente como em combinaçäo com outras drogas, geralmente na posologia de 2 doses diárias. O presente artigo relata a eficácia de prazosina em uma nova formulaçäo de liberaçäo gradual, que pode ser administrada em dose única diária