Platelet to Lymphocyte Ratio Associated with Prolonged Hospital Length of Stay Postpeptic Ulcer Perforation Repair: An Observational Descriptive Analysis.

BACKGROUND: The predictive role of platelet to lymphocyte ratio (P/LR) in patients with perforated peptic ulcer (PPU) is not well-studied. We aimed to investigate the association between the P/LR ratio and the hospital length of stay (HLOS) for surgically treated PPU. METHOD: This is a retrospective observational study for surgically treated adult cases of PPU at Hamad Medical Corporation during the period from January 2012 to August 2017. Patients were categorized into two groups based on their HLOS (I week). The receiver operating characteristic (ROC) curve was plotted to determine the cutoff value for lymphocyte count, neutrophil to lymphocyte ratio, and P/LR ratio for predicting the prolonged hospitalization. RESULTS: One hundred and fifty-two patients were included in the study. The majority were young males. The mean age was 38.3 ± 12.7 years. Perforated duodenal ulcer (139 patients) exceeded perforated gastric ulcer (13 patients). The HLOS > 1 week was observed in 14.5% of cases. Older age (p = 0.01), higher preoperative WBC (p = 0.03), lower lymphocyte count (p = 0.01), and higher P/LR ratio (p = 0.005) were evident in the HLOS > 1 week group. The optimal cutoff value of P/LR was 311.2 with AUC 0.702 and negative predictive value of 93% for the prediction of prolonged hospitalization. Two patients died with a mean P/LR ratio of 640.8 ± 135.5 vs. 336.6 ± 258.9 in the survivors. CONCLUSION: High preoperative P/LR value predicts prolonged HLOS in patients with repaired perforated peptic ulcer. Further larger multicenter studies are needed to support the study findings.

Low serum albumin may predict the need for gastric resection in patients with perforated peptic ulcer.

PURPOSE: Perforated peptic ulcer (PPU) is a common surgical emergency and treatment involves omental patch repair (PR). Gastric resection (GR) is reserved for difficult pathologies. We audit the outcomes of GR at our institution and evaluate the pre-operative factors predicting the need for GR. METHODS: This is a single-institution, retrospective study of patients with PPU who underwent surgery from 2004 to 2012. Demographics, clinical presentation and intra-operative findings were studied to identify factors predicting the need for GR in PPU. An audit of clinical outcomes and mortality for all patients with GR is reported. RESULTS: 537 (89.6 %) patients underwent PR and 62 (10.4 %) patients GR. Old age (p < 0.0001), female sex (p = 0.0123), non-steroidal anti-inflammatory drugs (NSAIDs) usage (p = 0.0008), previous history of peptic ulcer disease (PUD) (p = 0.0159), low hemoglobin (p < 0.0001), low serum albumin (p < 0.0001), high serum creatinine (p = 0.0030), high urea (p = 0.0006) and large ulcer size (p < 0.0001) predict the need for GR. On multivariate analysis only low serum albumin (OR 5.57, 95 % CI 1.56-19.84, p = 0.008) predicted the need for GR. The presence of Helicobacter pylori infection was protective against GR (OR 0.25, 95 %CI 0.14-0.44, p < 0.0001). Morbidity and mortality of GR was 27.7 and 24.2 %, respectively. CONCLUSION: GR is needed in one in ten cases of PPU. Low serum albumin predicted the need for GR on multivariate analysis. Morbidity and mortality of GR remains high.

Is the neutrophil-to-lymphocyte ratio a potential diagnostic marker for peptic ulcer perforation? A retrospective cohort study.

OBJECTIVES: Peptic ulcer perforation (PUP) accounts for 5% of all abdominal emergencies and is recognized as a gastrointestinal emergency requiring rapid and efficient clinical evaluation and treatment. The mortality rate ranges from 10% to 40% among patients with perforation. In the present retrospective study, we examined the potential utility of the neutrophil-to-lymphocyte ratio (NLR) in early diagnosis of PUP; we asked whether this ratio allowed PUP and peptic ulcer disease to be distinguished. METHODS: We enrolled the following patients: 58 with PUP, 62 with noncomplicated peptic ulcer diseases (NCPU), and 62 controls, between May 2010 and 2015. Patients who underwent surgical repair to treat PUP were included in the study group. Another group consisted of NCPU patients who had a noncomplicated peptic ulcer. The control group consisted of patients presenting with nonspecific abdominal pain to the emergency department. RESULTS: The mortality rate was 5.2% in the PUP group. The white blood cell count, C-reactive protein, and NLRs were higher in the PUP compared to the other groups (P<.001 for all). The white blood cell count and NLR did not differ between the NCPU and control groups. The sensitivities, specificities, positive predictive values, and negative predictive values of the NLRs were 68.0%, 88.0%, 82.9%, and 72.9%, respectively. CONCLUSIONS: We suggest that preoperative NLR aids in the diagnosis of PUP and can be used to distinguish this condition from peptic ulcer disease. Thus, the NLR should be calculated in addition to the clinical examination.

[[Efficacy of abdominal sanation, using superoxyodysmutase in the treatment of peritonitis for restoration of the kioneys functional activity].]

Results of treatment of 40 patients, suffering diffuse peritonitis in a terminal stage, were analyzed. In 20 patients (main group) the abdominal cavity sanation was done, using superoxyddysmutase solution. Concentration of uric acid, urea, creatinine, general bilirubin, C-reactive protein in the blood serum have had normalized more rapidly, than in a control group, witnessing satisfactory renal function present.

Perforated peptic ulcer: different ethnic, climatic and fasting risk factors for morbidity in Al-ain medical district, United Arab Emirates.

AIM: To evaluate risk factors, morbidity and mortality rates of perforated peptic ulcer (PPU) and to investigate factors affecting postoperative complications of PPU. BACKGROUND: The incidence of PPU has remained constant, simple closure with omental patch repair being the mainstay of treatment. PATIENTS AND METHODS: One hundred and nineteen patients admitted to Al-Ain Hospital with PPU between January 2000 and March 2004 was studied retrospectively; two with deficient data were excluded from the analysis. Logistic regression was used to define factors affecting postoperative complications. RESULTS: The mean age of patients was 35.3 years (range, 20-65). 45.7% of patients were Bangladeshi, and 85.3% originated from the Indian subcontinent. One patient, subsequently found to have a perforated gastric cancer, died. In 116 patients, 26 complications were recorded in 20 patients (17.2%). Common risk factors for perforation were smoking, history of peptic ulcer disease (PUD) and use of non-steroidal anti-inflammatory drugs (NSAIDs). A significantly increased risk of perforation was evident during the daytime fasting month of Ramadan. An increase in the acute physiology and chronic health evaluation (APACHE) II score (p = 0.047) and a reduced white blood cell count (0.04) were highly significant for the prediction of postoperative complications. CONCLUSION: Patients with dyspeptic symptoms and a history of previous PUD should be considered for prophylactic treatment to prevent ulcer recurrence during prolonged daytime fasting in Ramadan, especially during the winter time.

Analysis of risk factors predicting (affecting) mortality and morbidity of peptic ulcer perforations.

The goal of this study is to identify invariable risk factors predicting the morbidity and mortality of a serious complication of peptic ulcer perforation (PUP). One hundred fifty-four patients were operated for PUP. We selected 147 patients who underwent primary repair and omentoplasty for PUP. The Boey score used to determine the high mortality risk after open surgery for PUP. The mortality rates were 0%, 12%, 32%, and 63% in the patients who had zero, one, two, and three factors, respectively (P < 0.001). Total postoperative mortality was 13.6% (20/147). Complications occurred in 48 (32.7%) of a total of 147 patients. Age, pulse rate at admission, and creatinine levels can be independent factors associated with prognosis in PUP.

Gastric body partition to avoid ulcerogenic risk and hypergastrinemia.

BACKGROUND: For treatment of giant perforated peptic ulcers, we hypothesized that partitioning of the gastric body instead of the antrum would prevent hypergastrinemia and minimize ulcerogenic risk. By maintaining part of the acid-secreting gastric body in continuity with the excluded distal stomach, gastrin-secreting cells in the antrum would still be inhibited by gastric acid secretion from the gastric body. METHODS: We studied (1) gastric body partition with gastrojejunostomy in 8 critically ill patients with giant perforated peptic ulcers and (2) the influence of gastric partition on serum gastrin in 18 dogs with gastric antral partition + gastrojejunostomy, or gastric body partition + gastrojejunostomy, or gastrotomy. RESULTS: No patient developed major postoperative complications. Serum gastrin levels were normal in 6 patients but showed an abnormal increase in 2 patients 1 month after gastric body partition. Serum gastrin levels had returned to the normal range at postoperative follow-up after 2 years. In the animal study, serum gastrin levels and the number of G-cells in the excluded antrum and acid-secreting parietal cells in the gastric body were increased when evaluated on day 60 postoperatively or after antral partition, compared with preoperative data in the same group. These changes did not occur in the group undergoing partition of the gastric body and the group undergoing gastrostomy. Postoperative serum gastrin levels, and the number of G-cells and parietal cells also was significantly greater in the antral partition group than in the other 2 groups. No ulcer was found in any dog in the gastric body partition and gastrostomy groups, but ulcers occurred in 4 dogs in the antral partition group, all of whom died of ulcer perforation. CONCLUSIONS: Gastric body partition + gastrojejunostomy is a simple, dependable procedure for patients with perforated giant peptic ulcers. This procedure does not require extreme expertise and can be performed in a very short time, even by a trainee general surgeon in emergency.

[The characteristics of the morphofunctional state of the erythrocytes in peptic ulcer depending on the nature of the complications]. / Osoblyvosti morfofunktsional'noho stanu erytrotsytiv pry vyrazkovii khvorobi zalezhno vid kharakteru uskladnennia.

In 64 patients with complicated peptic ulcer particular features were studied of morphofunctional status of erythrocytes depending on the type of the complication set in (acute gastrointestinal hemorrhage, penetration, perforation, stenosis). It has been found out that changes in peroxidated resistance of erythrocytes, in their power of being capable of deformation and aggregate formation, and in viscosity of the erythrocyte suspension were at their greatest in those patients presenting with peptic ulcer complicated by acute gastrointestinal hemorrhage.

A randomized comparison of acute phase response and endotoxemia in patients with perforated peptic ulcers receiving laparoscopic or open patch repair.

BACKGROUND: In patients with peritonitis from perforated peptic ulcers, we compared acute stress responses, endotoxemia, and bacteremia following laparoscopic or open surgery. PATIENTS AND METHODS: Consecutive patients with peritonitis from perforated peptic ulcers were randomized to receive laparoscopic sutured or open omental repair. Undiluted peritoneal fluid was obtained at surgery for quantitative bacterial and endotoxin (Limulus Amoebocyte Lysate) assay. Serial blood samples were taken at 0, 30, 60, 90, 120, and 180 minutes, and at 12, 24, 48, 72, and 120 hours for determinations of quantitative bacterial and endotoxin assays, interleukin-6 (IL-6), C-reactive protein (CRP), and cortisol. RESULTS: Twenty-two patients were randomized: laparoscopy group (n = 12), open repair group (n = 10). Conversions were required in 3 patients assigned to laparoscopy, leaving 9 patients for analysis. The two groups were comparable in their demographic data, median duration of perforation (13.5 hours versus 10 hours), severity of peritoneal contamination as indicated by viable bacterial count (5.9 x 102 versus 1.5 x 10(2) colony forming unit/mL) and endotoxin concentration in peritoneal fluid (27.2 versus 24.6 EU/mL). No significant endotoxemia or bacteremia was detected in these patients. Median interleukin-6 was highest at 0 hour (1520 versus 962 pg/mL) and fell rapidly following surgery. C-reactive protein peaked at 24 hours and plateaued thereafter. Cortisol was highest intraoperatively and fell thereafter. No difference was noted between the two treatment groups with respect to these inflammatory markers (IL-6 P = 0.19, CRP P = 0.14, cortisol P = 0.56, multivariate analysis of variance). CONCLUSION: Endotoxemia and bacteremia are insignificant in most patients with perforated peptic ulcers. In patients with perforated peptic ulcers, laparoscopic patch repair does not reduce acute stress responses when compared with open surgery.

[The effect of the surgical trauma on the postoperative course in duodenal ulcer patients]. / Vliianie operatsionnoi travmy na posleoperatsionnoe techenie u bol'nykh iazvoi dvenadtsatiperstnoi kishki.

The effect of various types of operative interventions on the course of the early postoperative period was studied in 419 patients with duodenal ulcer. The blood biochemical values and hemodynamic parameters were studied. The indications for operation were absolute in 128 and relative in 291 patients. It was established that under conditions of a specialized medical institution the negative aspects of surgical treatment of duodenal ulcer may be brought to minimum both in patients with absolute and in those with relative indications for operation.

[Erythrocyte function in patients with complicated peptic ulcer]. / Funktsional'noe sostoianie éritrotsitov u bol'nykh s oslozhnennoi iazvennoi bolezn'iu.

A study of 63 patients with uncomplicated forms of ulcer of the duodenum revealed an increased aggregation activity of erythrocytes, reduction of their capacity to deformation, abnormal stability to oxygen hemolysis, increase of lipid peroxidation in erythrocytes. These disorders of the functional state of erythrocytes depended on the character of complication of the ulcer disease and are related to activation of the processes of lipid peroxidation. Antioxidant drugs are indicated.

Value of monitoring serum gastrin after renal transplantation.

Serum concentration of gastrin was measured before and after renal transplantation in 97 consecutive patients in order to assess possible correlations to gastrointestinal bleeding, allograft function, or graft rejection. In patients with transient signs of allograft rejection (N = 29) or upper gastrointestinal bleeding (N = 12) there was a nonsignificant trend towards higher postoperative gastrin levels, and in patients in whom the graft was removed (N = 29), this tendency was more pronounced (p = 0.06). The study demonstrated that monitoring of serum concentrations of gastrin following renal transplantation is of little clinical value. However, increased gastrin levels in serum may indicate that graftectomy may be the ultimate result.

Hypermagnesemia and perforated viscus.

Reported is an unusual case of hypermagnesemia secondary to exogenous intake in the presence of a perforated viscus and normal renal function. The patient's neurological and cardiovascular complications resolved with repair of a duodenal ulcer and correction of hypermagnesemia. The presentation of hypermagnesemia can be subtle, but should be considered in patients with gastrointestinal complications who present in shock.

Preoperative serum creatinine as a predictor of survival in perforated gastroduodenal ulcer.

Factors affecting survival were retrospectively analyzed in 89 patients (50 men) operated upon for perforated peptic ulcer. Mean age was 52 years. Only 18 per cent had no history of significant medical illness; almost 26 per cent were termed immune suppressed from high-dose steroid therapy or the presence of diffuse, metastatic cancer. The estimated interval between perforation and operation was over 24 hours in one-third. Preoperative serum creatinine, determined in 83 patients, ranged from 0.1 to 6.4 mg/dl (mean, 1.5 mg/dl); no patients were dialysis-dependent. At celiotomy, 75 per cent underwent ulcer plication only; the remainder had a definitive acid reduction procedure. Stepwise logistic regression analysis revealed that a normal preoperative serum creatinine (less than 1.5 mg/dl) was the most powerful predictor of survival (P less than 0.00001), followed by absence of immune suppression, and age under 60 years. The interval between perforation and operation, the site of perforation, and the type of operation did not statistically affect survival.

[Free amino acids in the blood serum of patients with complicated forms of peptic ulcer before and after surgery]. / Svobodnye aminokisloty v syvorotke krovi u bol'nykh oslozhnennymi formami iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki do i posle operatsii.

Free aminoacids were studied in the serum of portal and peripheral blood of 54 patients with complicated ulcer disease of the stomach and duodenum. It was established that a disbalance of FFA was more pronounced in the portal blood serum after resection of the stomach in the early postoperative period. The changes revealed should be taken into consideration in the period of preoperative preparation and rehabilitation.