Omeprazole is more effective than famotidine for preventing acute gastritis in rats.

PURPOSE: Acute gastric mucosal lesions, which can develop within a few hours after polytrauma, shock, major operations, central nervous system lesions, or severe infection, cause about 33% of cases of gastrointestinal bleeding. We analyzed and compared the effectiveness of famotidine and omeprazole on acute gastric mucosal lesions. METHODS: Thirty male albino Wistar rats were given ketalar anesthesia after 12 h fasting, then immobilized and exposed to stress according to Brodie's protocol, without restricting their respiration. We divided the rats into three groups of ten according to whether they were given famotidine, omeprazole, or normal saline (control group). All rats were ulcer-indexed according to the diameter of their ulcers. The stomach contents were aspirated for acid output and pH analysis, and sent to the laboratory. The total number of mast cells was also counted. RESULTS: Omeprazole was more effective than famotidine in keeping gastric pH high and lowering the total gastric acid output. Lower ulcer indexes in acute gastric mucosal erosions and better protected mucosal integrity were found in the omeprazole-treated rats. CONCLUSION: Omeprazole prevents acute gastric mucosal erosions in rats more effectively than famotidine.

Serum interleukin-6 measurement in the diagnosis of acute appendicitis.

BACKGROUND: Many attempts have been made to determine ways of decreasing the negative laparotomy rate after a clinical diagnosis of acute appendicitis. The aim of the present study was to determine the effectiveness of serum interleukin-6 (IL-6) concentration in the diagnosis of appendicitis, and in the prevention of non-therapeutic laparotomy in patients with right iliac fossa pain. METHODS: Serum IL-6 concentrations were measured at admission in 77 consecutive patients who were operated on for the treatment of acute appendicitis. The final diagnosis was established by histopathological examination. The sensitivity, specificity and accuracy of IL-6 concentrations in the diagnosis of appendicitis were calculated. RESULTS: The negative laparotomy rate was 17% (13/77) in this series. The IL-6 level was elevated in seven of 13 patients (54%; false positive) with a normal appendix. The IL-6 level was normal in 10/64 patients (16%; false negative) with acute appendicitis. The IL-6 level was highly elevated in all patients with perforated appendicitis. The sensitivity, specificity, accuracy, and positive and negative predictive values were calculated as 84, 46, 78, and 89 and 38%, respectively. CONCLUSIONS: Unacceptably high false negative and positive rates decrease the accuracy of the serum IL-6 test for appendicitis. Serum IL-6 measurement is not of benefit in increasing the accuracy of the diagnosis of appendicitis. Serum IL-6 results are not useful for preventing negative laparotomies in the majority of patients with right iliac fossa pain.

Abdominal surgical emergency in the elderly.

BACKGROUND/AIMS: Longer life expectancy has created an increasing demand for surgical care of the elderly. Abdominal surgical emergencies are potentially serious and life-threatening conditions for this group of patients. The aim of this study was to evaluate the records of elderly patients undergoing emergency surgical treatment. METHODS: A total of 181 patients aged 60 years and above who had undergone emergency surgical interventions were retrospectively analysed according to demographic features, indications for emergency surgery, postoperative clinical course and outcome. RESULTS: Sixty-one percent of the patients were male, with an average age of 70.3 (range 60-95) years. Octogenarians constituted 19% of our series. Causes of surgical emergency were acute cholecystitis (31.5%), strangulated hernia (18.2%), hollow viscus perforation (17.1%), bowel obstruction (10.5%), acute mesenteric ischaemia (9.4%), acute appendicitis (8.3%) and upper gastrointestinal haemorrhage (5%). Gallstones had been previously detected by ultrasound in 25 (45.5%) of 55 patients with acute calculous cholecystitis. Thirty (93.8%) of 32 patients were aware of their external hernias prior to incarceration. Twenty seven patients (14.4%) died in the early postoperative period, with acute mesenteric vascular occlusion being the leading cause of death: A higher mortality rate was noted in mesenteric ischaemia (76.5%), gastrointestinal bleeding (22.2%) and in perforation (19.4%) cases, being 36.8% (21/57) in patients with these three severe conditions and 4.8% (6/124) in the remaining patients. CONCLUSIONS: Acute calculous cholecystitis and external strangulated hernias, which are generally preventable, were the most common surgical emergencies. Surgical treatment of acute mesenteric ischaemia, gastrointestinal haemorrhage and peritonitis secondary to free perforation had a worse prognosis in older patients.