[Planned second-look gastroscopy in patients with bleeding ulcer]. / Planlagt kontrolgastroskopi ved forekomst af blødningsstigmatiseret ulcus.

Preliminary studies have suggested a beneficial effect of second look endoscopy in patients with bleeding peptic ulcer. We have performed a retrospective survey of 70 patients with bleeding peptic ulcer admitted to our department. Planned second look endoscopy and repeated sclerotherapy was standard care. We found 15 of the 70 patients to rebleed after initial sclerotherapy. Overall success rate of endoscopic therapy was 63/70 patients (90%). The most important factor predicting rebleeding was the occurrence of active bleeding at the initial endoscopy. Compared with an expected rebleeding rate derived from the literature of 20-25 patients, the present study suggests a beneficial effect on rebleeding rate of planned second look endoscopy. Future controlled trials should verify this hypothesis.

Planned second look endoscopy in patients with bleeding duodenal or gastric ulcers.

INTRODUCTION: Preliminary studies have suggested a beneficial effect of second look endoscopy in patients with bleeding peptic ulcers. METHODOLOGY: We have performed a retrospective survey of seventy patients with bleeding peptic ulcers admitted to our unit in the period 1 September 1996-31 March 1998. Planned second look endoscopy and repeated sclerotherapy were standard care. The effects were evaluated by comparing the expected number of rebleeders with actual rebleeders. At the same time we assessed predicting factors for rebleeding. RESULTS: Fifteen of the admitted seventy patients were found to rebleed after initial sclerotherapy. The overall success rate of endoscopic therapy was 63/70 patients (90%). Six patients (9%) had to undergo surgery to obtain haemostasis, and one patient died suddenly after the second endoscopic sclerotherapy. Perforation was seen in two patients (3%) and the total mortality (30 days) was 4% (three patients). The most important factor predicting rebleeding was the occurrence of active bleeding at the initial endoscopy. CONCLUSION: From the literature we could expect that twenty to twenty-five patients would rebleed, comparing this with the findings of the present study suggests a beneficial effect on rebleeding rate of patients treated with planned second look endoscopy. Future controlled trails should verify this hypothesis.

[Local recurrence after low anterior resection of rectal cancer]. / Lokalt cancerrecidiv efter lav anterior resektion ved cancer recti.

Among 75 consecutive patients operated upon with anterior resection for rectal adenocarcinoma during a five year period, 29 (39%) developed local cancer recurrence. The total cumulative five-year survival was 49%, but only 17% in those with a local cancer recurrence. The most important risk factors for development of local recurrence were tumour fixation, intraoperative blood transfusion and surgical routine. Local recurrence was seen in 4/23 (17%) after operation performed by a consultant, 1/5 (20%) after a consultant-supervised operation and 24/47 (51%) after operation by a senior registrar (p < 0.02). As a consequence we recommend that operation for rectal cancer should only be performed or supervised by a few specialists in colorectal surgery.

Sleep after laparoscopic cholecystectomy.

The sleep pattern and oxygenation of 10 patients undergoing laparoscopic cholecystectomy were studied on the night before operation and the first night after operation. Operations were performed during general anaesthesia and postoperative analgesia was achieved without the administration of opioids. There were no significant changes in the total time awake or the number of arousals on the postoperative night compared with the night before operation. During the postoperative night, we found a decrease (P = 0.02) in slow wave sleep (SWS) with a corresponding increase in stage 2 sleep (P = 0.01). SWS was absent in four of the patients after operation, whereas in six patients it was within the normal range (5-20% of the night). The proportion of rapid eye movement (REM) sleep was not significantly changed after operation. There were no changes in arterial oxygen saturation on the postoperative compared with the preoperative night. Comparison of our results with previous studies on SWS and REM sleep disturbances after open laparotomy, suggests that the magnitude of surgery or administration of opioids, or both, may be important factors in the development of postoperative sleep disturbances.