ABSTRACT
AIM: To improve the outcomes in patients with perforated duodenal ulcers. MATERIAL AND METHODS: Cohort study included 456 patients with perforated duodenal ulcer. High risk of mortality was determined in 9% of patients (n=40) considering Boey diagnostic criteria (1982, 1987). There were 19 women and 21 men aged 59±2.8 years. RESULTS: Perforated duodenal ulcer was followed by overall mortality near 3.8%. In high risk group this value was 17.5% (7 out of 40 patients) while expected mortality was 45.5-100% in these patients in view of Boey criteria. The main causes of death were multiple organ failure, pulmonary embolism and acute myocardial infarction. CONCLUSION: Minimally invasive surgery including step-by-step procedures (mini-laparotomy, laparoscopy and navigation) are the key to improve the outcomes in patients with perforated duodenal ulcer.
Subject(s)
Duodenal Ulcer/complications , Peptic Ulcer Perforation/diagnosis , Female , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures/methods , Peptic Ulcer Perforation/mortality , Peptic Ulcer Perforation/surgery , Retrospective Studies , Risk AssessmentABSTRACT
The aim of our study was to assess the causes of renal failure in patients with prostatic adenoma (PA) and outcomes after draining of the urinary bladder. A retrospective study comprised 239 PA patients with a serum creatinine level over 120 mcmol/l. Outcomes were assessed after 3-5 day and 2.5 month bladder draining. The Spearman test was used for statistical analysis. We found that age, prostate volume, PA growth pattern, urinary tract infection, concomitant pathology (arterial hypertension, diabetes mellitus, atherosclerosis) do not correlate with a serum creatinine level. The presence of bilateral retention of the upper urinary tract was associated with a higher serum creatinine level. There is a significant correlation between lowering of a serum creatinine concentration after bladder draining and the level of upper urinary tract retention.
Subject(s)
Creatinine/blood , Prostatic Hyperplasia/complications , Renal Insufficiency/etiology , Aged , Case-Control Studies , Comorbidity , Data Interpretation, Statistical , Humans , Male , Prognosis , Prostatic Hyperplasia/blood , Prostatic Hyperplasia/diagnosis , Prostatic Hyperplasia/epidemiology , Prostatic Hyperplasia/physiopathology , Prostatic Hyperplasia/surgery , Renal Insufficiency/blood , Renal Insufficiency/diagnosis , Renal Insufficiency/epidemiology , Renal Insufficiency/physiopathology , Retrospective Studies , Time Factors , Urodynamics/physiologyABSTRACT
The purpose of the study was to compare myocardial perfusion assessed by electron beam computed tomography (EBCT) with that obtained by 99mTc-sestamibi single photon emission computed tomography (SPECT) in patients with old myocardial infarction and control subjects at rest. A total of 42 patients with suspected and known ischaemic heart disease (IHD) were included in the study. 20 pts had a history of Q-wave myocardial infarction (MI), 12 pts had an old non-Q-wave MI and 10 served as controls (without perfusion defects on SPECT images at rest). Assessment of the myocardial perfusion by EBCT was performed using the short axis view and multislice mode (MSM) during injection of 50 ml of the nonionic contrast medium at 4 ml/s via cubital vein. Perfusion defects were localized by SPECT according to 6-segment model of the LV (septal, anterior, lateral, posterior, inferior and apical). Overall concordance between EBCT and SPECT was 67% for normal versus abnormal perfusion. Agreement between the 2 methods for each of the 6 segments was 81% (K = 0.62) for the anterior segment, 71% (K = 0.42) for the septal segment, 71% (K = 0.43) for the apical, 69% (K = 0.3) for the lateral segment, 48% (K = 0.13) for the posterior segment and 60% (K = -0.13) for the inferior segment. Discrepancies between the two of techniques were most notable in the posterior region. Beam hardening during passage of the contrast medium through the heart chambers and descending aorta is possible explanation of the artifacts on EBCT images. This study demonstrates that nowadays EBCT is not yet alternative to SPECT in the assessment of the myocardial perfusion in patients and further improvements of scanning techniques are necessary.
