The gastric disease of Napoleon Bonaparte: brief report for the bicentenary of Napoleon's death on St. Helena in 1821.

After the defeat at the battle of Waterloo on June 18, 1815, Napoleon Bonaparte was sent into exile to the Island of St. Helena where he died 6 years later on May 5, 1821. One day after his death, Napoleon's personal physician, Dr. Francesco Antommarchi, performed the autopsy in the presence of Napoleon's exile companions and the British medical doctors. Two hundred years later, mysteries still surround the cause of his death and different hypotheses have been postulated in the medical and historical literature. The main reasons seem to be the presence of several autopsy reports, their interpretation and perhaps the greed for thrill and mystery. Therefore, for the bicentenary of Napoleon's death, an international consortium of gastrointestinal pathologists assembled to analyse Napoleon's autopsy reports based on the level of medical evidence and to investigate if the autopsy reports really do not allow a final statement.

W. Dean Warren, MD, FACS, Father of Selective Shunts for Variceal Hemorrhage: Lessons Learned.

Dr Dean Warren was born in 1924 and died prematurely from cancer in 1989. He was a man of uncommon intelligence, wit, collegiality, integrity, honesty, and a true leader in American surgery. In 1966, he and his colleagues (Drs Zeppa and Fomon) presented a new concept for surgical shunts to control variceal hemorrhage while maintaining portal perfusion or hepatopetal blood flow. He termed this new shunt the distal splenorenal shunt (DSRS), which was the first selective shunt invented. The DSRS selective shunt was a brilliant improvement over the total shunt concept proposed by Nicolai Eck and was practiced worldwide during the 1980s. In a space of 2 decades, Dr Warren's pioneering work would show that the selective DSRS was superior to total shunts for treatment of portal hypertension, but that endoscopic sclerotherapy was a better first-line treatment for variceal hemorrhage than his own creation. His absolute adherence to the principles he espoused in his presidential address to the Society for Surgery of the Alimentary Tract in 1973 were employed in his research and treatment of patients. This paper details Dr Warren's extraordinary research accomplishments and sets a lesson for us that well-designed clinical trials including randomization are essential in the advancement of the care of surgical patients.

Perforations and bleeding in a population-based cohort of all registered colonoscopies in Sweden from 2001 to 2013.

Background: The rates of perforation and bleeding are important quality measures of colonoscopy performance. Objective: The objective of this article is to assess the frequency of colonoscopy-related bleeding and perforation in Swedish counties and to relate these findings to patient characteristics. Method: Data on 593,308 colonoscopies performed on adults from 2001 to 2013 were retrieved from Swedish inpatient and outpatient registers. Covariates were assessed in a multivariate Poisson regression model. The correlation between perforation and bleeding was calculated with Pearson's bivariate correlation formula. Results: The relative frequency of bleeding and perforation vary across counties (bleeding: 0.02%-0.27%; perforation: 0.02%-0.27%). There were significant positive correlations between the relative frequency of bleeding and perforation at the county level, both including (r = 0.792, p < 0.001) and excluding polypectomies r = 0.814 (p < 0.001). The relative risks of these conditions in the counties ranged from 0.12, p < 0.001, to 1.53, p = 0.05 (bleeding) and from 0.17, p = 0.002, to 2.42, p < 0.001 (perforation). Conclusions: There are substantial differences in colonoscopy performance in Sweden. These differences do not seem to be explained by patient characteristics.

Bleeding with the artificial heart: Gastrointestinal hemorrhage in CF-LVAD patients.

Continuous-flow left ventricular assist devices (CF-LVADs) have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or, more recently, as destination therapy. However, its implantations carries a risk of complications including infection, device malfunction, arrhythmias, right ventricular failure, thromboembolic disease, postoperative and nonsurgical bleeding. A significant number of left ventricular assist devices (LVAD) recipients may experience recurrent gastrointestinal hemorrhage, mainly due to combination of antiplatelet and vitamin K antagonist therapy, activation of fibrinolytic pathway, acquired von Willebrand factor deficiency, and tendency to develop small intestinal angiodysplasias due to increased rotary speed of the pump. Gastrointestinal bleeding in LVAD patients remains a source of increased morbidity including the need for blood transfusions, extended hospital stays, multiple readmissions, and overall mortality. Management of gastrointestinal bleeding in LVAD patients involves multidisciplinary approach in stabilizing the patients, addressing risk factors and performing structured endoluminal evaluation with focus on upper gastrointestinal tract including jejunum to find and eradicate culprit lesion. Medical and procedural intervention is largely successful and universal bleeding cessation occurs in transplanted patients.

Balloon-occluded retrograde transvenous obliteration of gastric varices: conception, evolution, and history.

The idea of transvenous obliteration of varices that complicate portal hypertension dates back to the 1970s. The clinical use of this minimally invasive procedure was probably lost with the advent of transjugular intrahepatic portosystemic shunt shortly afterward. The concept of retrograde obliteration of a gastrorenal shunt through the left renal vein originated from Olson et al at Indiana University. However, the Japanese (Kanagawa et al and subsequent authors) defined, developed, and technically perfected the clinical implementation of balloon-occluded retrograde transvenous obliteration. The evolution of balloon-occluded retrograde transvenous obliteration has come full circle, now gaining popularity in the United States, especially in patients who are not candidates for transjugular intrahepatic portosystemic shunt.

[Historical schedule of management of bleeding from the upper part of gastrointestinal tract]. / Rys historyczny postepowania w krwawieniu z górnego odcinka przewodu pokarmowego.

Treatment of bleeding from the upper part of gastrointestinal tract were changed many times. First there were waiting (Hipocrates, Sydenham, Stahl), next transfusion of the blood were initiated (Denis, Blundell, Dieffenbach, Bierkowski, Dungren, Hirszfeld). Big (Rydygier) and small (Dragstedt) operations procedures were attempted. Discovery of endoscopy of gastrointestinal tract (Mikulicz) and initiation of elastic scopes (Hirschowitz) and exploration inhibitor of histamine receptors (H2) and proton pump inhibitors with recognition of role Helicobacter pylori in bleeding were permitted elaborate actual schemas of proceedings.

[Development of diagnostic methods in upper gastrointestinal tract bleeding]. / Rozwój diagnostyki krwawien z górnego odcinka przewodu pokarmowego.

Since the first description of upper gastrointestinal bleeding, presented as ground coffee vomiting and melena by Galen Claudius in 200 A.D., we have been observing dynamic progress in the diagnostics of this disease. This article presents modern methods and diagnostic examinations used to detect and localise the bleeding source.

Bleeding oesophageal varices.

BACKGROUND: The Danish contribution to evaluation and treatment of bleeding oesophageal varices. METHODS: Danish papers dealing with portal hypertension and oesophageal varices have been reviewed and set in relation to international publications. RESULTS: The Danish papers have mainly contributed with controlled clinical trials concerning both primary and secondary prophylaxis. Furthermore, they have dealt with pathophysiologic, clinical and experimental studies concerning portal haemodynamics and the evolution and treatment of variceal bleeding. CONCLUSION: The Danish studies have been well designed and are frequently cited. Further prospective randomized studies in the new treatment modalities are encouraged.