Helicobacter pylori and nonsteroidal anti-inflammatory drugs in perforations and bleeding of peptic ulcers.

BACKGROUND: This study was designed to assess the relative contribution of H pylori (Hp) infection and NSAID in the pathogenesis of perforation and bleeding of peptic ulcer (PU). MATERIAL/METHODS: Total of 91 PU perforations and 135 active bleeding were examined during last 5 years. At the same time, 1384 age- and gender-matched PU patients without such complications were examined. Furthermore, the effects of various concentrations of aspirin on the growth of Hp isolated from antral mucosa of these PU were examined in vitro. RESULTS: The average rates of Hp prevalence in PU patients with perforation or bleeding in NSAID intake were, respectively, only 50% and 62% as compared to 70.7 and 74% in PU patients non-using NSAID. The Hp prevalence in perforated and bleeding PU at all ages, particularly those at age of 60 years or higher, were significantly lower compared to that found below this age, while no such difference in Hp infection rate was seen in PU not using NSAID. In vitro studies on CagA and VacA positive Hp subjected to culture medium containing aspirin showed a dose dependent reduction in bacterial growth with complete bacteria killing occurring at 500 microg/ml of aspirin. CONCLUSIONS: The Hp prevalence, especially in older PU patients using NSAID, is significantly lower in perforated and bleeding PU compared to that in non-complicated PU, and this could be explained by direct suppression of Hp by NSAID used by these patients.

Sclerosant therapy as first-line treatment for solitary liver cysts.

AIM: The aim was to determine the outcome from percutaneous sclerosing treatment of solitary non-parasitic hepatic cysts. METHODS: The results of treatment of patients with symptomatic solitary non-parasitic hepatic cysts treated between 1995 and 2000 were reviewed. RESULTS: There were 23 women and one man with a median (range) age of 59 (34-79) years. The median (range) diameter of the cysts was 10 (5-24) cm. Five patients were treated by laparoscopic fenestration ab initio as they also required a cholecystectomy because of gallstones. The remaining 19 patients underwent percutaneous sclerotherapy. In one just aspiration was successful without further treatment. In six contrast leaked from the cyst and five of these had laparoscopic fenestration. Twelve patients had sclerosant treatment with good results at a median (range) follow-up of 35 (6-60) months in 10 patients. Good results were also obtained in 10 of the 12 patients who had fenestration.

[Laparoscopic emergency surgery]. / Operacje laparoskopowe ze wskazan naglych.

Up-to-dated concepts about the use of laparoscopy in the "acute abdomen" have been discussed. Most frequently performed procedures in abdominal emergency and trauma were presented. Indications, contra-indications, advantages and drawbacks with regard to own 10 years experience and literature were discussed.

[Acute appendicitis--open or laparoscopic surgery?]. / Ostre zapalenie wyrostka robaczkowego--operacja technika klasyczna czy laparoskopowa?

UNLABELLED: Laparoscopy is used more and more frequently in the treatment of abdominal emergencies including acute appendicitis. This technique has a lot of advantages especially in the group of the young female patients, where the differential diagnosis between gynecological diseases and appendicitis is difficult. AIM OF THE STUDY: The study is designed to compare the results of open and laparoscopic exploration in patients with suspected appendicitis. MATERIAL AND METHODS: From 1998-2001 we performed 278 operations for suspicion of appendicitis in the 2nd Dept. of Surgery of the Jagiellonian University. There were 127 laparoscopic procedures performed in 46 men and 81 women (mean age 28.6 years) and 151 classical exploration in 99 men and 52 women (mean age 37.9 years). We reviewed retrospectively the patients' data analysing age, sex, duration of the procedure, length of the hospital stay, intraoperative and postoperative complication rate. RESULTS: The patients operated classically were older than patients operated laparoscopically. The proportion of male and female patients was reversed in both types of exploration. The female patients composed a majority (2/3) in the case of laparoscopic procedures and minority (1/3) in the case of open operations. The average duration of open appendectomy was 43 min. as compared with 49 min. of laparoscopic procedure, which was however getting shorter in the analysed period. The mean length of the hospital stay was twice shorter after laparoscopic appendectomy (4.8 days vs 8.4 days). There were only 4 (3.15%) complications connected with laparoscopic technique and 34 (22.52%) complications after open appendectomy. There were 12 (9.45%) conversions, most of them in patients with the retrocoecal position of the appendix. The diagnosis of acute appendicitis was confirmed in similar percentage in both operation types (laparoscopy--78.74%, open technique--79.47%). There were also similar proportions of the patients with no macroscopical changes in the appendix and with other abdominal diseases. CONCLUSIONS: Laparoscopy allows for the precise diagnosis and final treatment in most patients with the suspected acute appendicitis. Some patients also avoid laparotomy. Hospital stay is significantly shorter and complication rate is markedly lower among patients operated laparoscopically.

[Laparoscopic surgery of the large intestine]. / Laparoskopowe operacje jelita grubego.

Contemporary concepts regarding the use of laparoscopy in large bowel surgery were presented. Indications, contraindications and limitations of this technique were given. Operative technique of the most common procedures was discussed.

[The decade of laparoscopic cholecystectomy]. / Dekada cholecystectomii laparoskopowej.

The role of laparoscopy in the treatment of gallbladder stones has been discussed. Operative technique, intraoperative difficulties, complications and its treatment were presented. Indications, postoperative course, advantages and drawbacks of minimally invasive techniques in the treatment of cholelithiasis were discussed.

The usefulness of capsulated 13C-urea breath test in diagnosis of Helicobacter pylori infection in patients with upper gastrointestinal bleeding.

BACKGROUND: H. pylori infection and peptic ulcerations and their complications such as bleeding are causally related, but the available methods used in bleeding to confirm active H. pylori lack accuracy. AIM To evaluate the usefulness of 13C-urea breath test (UBT) in diagnosing of H. pylori infection in bleeding patients. PATIENTS AND METHODS: Eighty-one patients with upper gastrointestinal bleeding and 258 matched controls without bleeding were enrolled to the study. UBT was performed using low-dose capsulated 13C-urea and IgG antibodies to H. pylori were determined by ELISA. RESULTS: UBT performed in bleeding patients was positive in 77.7%. In this group anti Hp IgG was positive in 79% of cases and among them gastroscopy showed 40.7% of bleeding duodenal ulcer, 38% bleeding gastric ulcer, and 86% hemorrhagic gastritis. UBT was positive in 90.9%, 77.4%, and in 52.97% cases, respectively, and it was not statistically different from that in non-bleeding controls, duodenal and gastric ulcers and gastritis. All patients with blood or "coffee grounds" in the stomach had both UBT and serology positive. CONCLUSION: The UBT is simple and non-invasive method, which can be successively applied also in patients with upper gastrointestinal bleeding to detect active H. pylori infection prior to emergency endoscopy.

Incidence of complications of peptic ulcers in patients with Helicobacter pylori (Hp) infection and/or NSAID use in the era of Hp eradication.

BACKGROUND: Hp and NSAID are considered as major pathogens in peptic ulcerations and their complications but little is known about the incidence of ulcers and their complications following wide-spread use of Hp eradication. The aims of the study were: 1) to analyze incidence of ulcers and their complications, bleeding and perforations at time when the Hp eradication has been used in ulcer therapy, and 2) to assess the impact of Hp infection and NSAID use on the incidence of ulcers and complications. MATERIAL/METHODS: From 1996 to 2001, 381 patients with complications of peptic ulcers were admitted to the emergency surgery, including 273 patients with bleeding ulcers and 108 with perforations out of a sample of 6515 dyspeptic patients examined with upper endoscopy and 13C-urea breath test (UBT). RESULTS: The rate of ulcer bleeding and perforations, remained relatively constant throughout the study period. NSAID use in that group increased form 15.8% in 1999 to 19.4% in 2001. The incidence of Hp in patients with complications assessed by UBT or CLO was 76.7%, while the incidence of Hp in 7920 patients ranged form 72.8% in 1996 to 53.8% in 2001. There were 1940 (29.7%) patients with duodenal and/or gastric ulcer diagnosed by upper gastroscopy. The decline in the prevalence of peptic ulcer from about 44% to 8% occurred over the same time. A slight increase in the number of ulcer resulting from NSAID use was observed so was the number of ulcers without Hp or NSAID (idiopathic). CONCLUSIONS: Despite decreased Hp prevalence, the incidence of ulcers complications remained unchanged probably due to increased use of NSAID and the appearance of idiopathic ulcers.

Case presentation of gastrinoma combined with gastric carcinoid with the longest survival record -- Zollinger-Ellison syndrome: pathophysiology, diagnosis and therapy.

BACKGROUND: Zollinger-Ellison syndrome is a very rare disease caused by tumor with gastrin producing cells accompanied by hypergastrinemia leading to gastric hypersecretion and peptic ulcers and their complications. CASE STUDY: Female case of gastrinoma (Zollinger-Ellison syndrome; Z-E) with a record of 38 yrs of survival. Acute gastro-duodenal ulcers started at 28 yr of age and Z-E was diagnosed by using gastrin assays. Basal and maximal acid outputs and ratio of basal/maximal outputs were away over normal limits. Because of ulcer recurrence and complications, patient was subjected to several gastric surgeries but refused total gastrectomy. She was also treated with many H2-receptor (R) antagonists and proton-pump inhibitors (PPI), each new drug being initially highly effective but then showing declining efficacy except when PPI, lansoprazole was used. The gastrin level rose in the course of disease from initial high value of 2000 pg/mL to the extreme 4500 ng/mL at present. During the last 2 yrs, metastasis mainly to liver developed and they were successfully treated by synthetic octapeptide derivative of somatostatin and, as a result, metastatis partly reduced and plasma gastrin drasticly decreased. Biopsy taken from liver metastasis showed the presence of typical gastrinoma cells with gastrin and chromogranin, while that from oxyntic mucosa revealed the ECL-cell hyperplasia with carcinoid tumors and unexpected gastric atrophy. CONCLUSIONS: This phenomenal case described in this article might be the new proven evidence needed by gastroenterologists to overturn the traditional treatment using total gastrectomy as a treatment of choice to the partial gastrectomy combined with proton pump inhibitors.

[Laparoscopy in abdominal emergencies]. / Laparoskopia ze wskazan doraznych.

Up-to-dated concepts about the use of laparoscopy in the "acute abdomen" have been discussed. Most frequently performed procedures in abdominal emergencies and trauma were presented. Indications, contraindications, advantages and drawbacks with regard to own experience and literature were discussed.

[Minimally invasive endocrine surgery]. / Minimalnie inwazyjna chirurgia endokrynologiczna.

Contemporary concepts regarding the use of endoscopic techniques in endocrine surgery have been presented. Laparoscopic adrenalectomy as a generally accepted method of treatment of benign adrenal tumours was discussed. Indications and technique of transperitoneal and retroperitoneal access were given. Operations of hormonally active tumours of the pancreas, parathyroids and thyroid were presented.

[Percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis patients with dysphagia. A preliminary report]. / Przezskórna gastrostomia endoskopowa u chorych ze stwardnieniem bocznym zanikowym i dysfagia. Doniesienie wstepne.

Percutaneous endoscopic gastrostomy (PEG) has been proposed as symptomatic treatment of dysphagia in amyotrophic lateral sclerosis (ALS) patients. The aim of our study was to assess the safety and complications and survival after PEG implantations in 13 ALS patients. We discuss the factors related to survival in two groups: dead (6 out of 13 patients) and alive (7 out of 13) after PEG implantations. We demonstrate that the PEG procedure is quite safe and forced vital capacity (FVC) is a major factor related to survival after PEG implantation in studied patients.