Mortality after remote surgery for benign gastroduodenal disease.

Mortality was studied after partial gastrectomy in a cohort of 1575 patients operated on because of benign gastroduodenal disease 29 to 59 years ago. The final status was confirmed in all but 8.4% of the cohort. At the close of the study 78% of the traced population were dead. Overall mortality was significantly higher than in the general population of southern Sweden (standardised mortality ratio = 1.10; 95% confidence intervals 1.03 to 1.17). Excess deaths resulted from neoplasms in the stomach, pancreas, male genital organs, and respiratory organs, as well as from respiratory diseases and suicide. Patients operated on before the age of 45 had a 60% increase in overall mortality during the first 19 years after surgery, mainly because of cardiovascular disease and suicide, whereas among those operated on after this age mortality was comparable to that in the reference population. The 75% increased death rate in cardiovascular disease during the first 19 years after surgery in patients operated on at young age, dramatically decreased during the years thereafter. An increased risk of death caused by malignancy was apparent more than 20 years postoperatively, irrespective of age at surgery. Excess deaths resulting from gastrointestinal malignancies, mainly gastric and pancreatic carcinoma, outnumbered the increased number of deaths resulting from cancer in the respiratory organs.

Tranexamic acid in gastric and duodenal bleeding.

In this prospective, randomized, double-blind study the effect of the antifibrinolytic drug tranexamic acid was compared with that of placebo in 154 patients bleeding from verified benign lesions in the stomach and/or duodenum. Three out of 72 patients receiving tranexamic acid underwent emergency surgery, in contrast to 15 out of 82 in the placebo group (p = 0.010). Nineteen patients receiving placebo rebled during admission, as compared with 10 in the treatment group (p = 0.097). The blood transfusion requirement was significantly reduced by tranexamic acid (p = 0.018). Side effects were seen in six patients, of which an uncomplicated deep venous thrombosis was the most severe. It was concluded that tranexamic acid reduces the blood transfusion requirement and the need for emergency surgery in patients bleeding from a benign gastric or duodenal lesion.

Tranexamic acid as an aid to reducing blood transfusion requirements in gastric and duodenal bleeding.

A prospective randomised double blind study examined the effect of the antifibrinolytic drug tranexamic acid compared with placebo in 154 patients bleeding from verified benign lesions in the stomach or duodenum or both. Three out of 72 patients receiving tranexamic acid underwent emergency surgery compared with 15 out of 82 given placebo (p = 0.010). Nineteen patients receiving placebo rebled during their admission as compared with 10 in the active treatment group (p = 0.097). Blood transfusion requirements were significantly reduced by tranexamic acid (p = 0.018). Side effects occurred in six patients, of which an uncomplicated deep venous thrombosis was the most severe. Tranexamic acid reduces the blood transfusion requirement and need for emergency surgery in patients bleeding from a benign gastric or duodenal lesion.

An experimental model for the detection and localisation of gastrointestinal bleeding using 99mTc-DTPA.

99mTc-DTPA was successfully used to detect simultaneously gastrointestinal bleeding sites in experimentally created mucosal ulcers in the colon and stomach of rabbits. Unlike the other radiopharmaceuticals that are currently used, 99mTc-DTPA was rapidly cleared from the vascular, hepatic and splenic circulation. The overall background radioactivity was low. 99mTc-DTPA appears to be an ideal agent for detection and localisation of gastrointestinal bleeding sites.