Scandinavian journal of gastroenterology. Supplement
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Scand. J. Gastroenterol. Suppl. · Jan 1984
The ulcer risk in reflux preventive gastric operations. An experimental study.
The ulcer risk of duodenogastric antireflux operations following gastric resection was analyzed experimentally in 162 rats. After gastric resection a Roux-Y gastrojejunostomy or jejunal transposition of various length were done. 10 month postoperatively a follow-up was performed consisting of endoscopy, analysis of gastrin and gastric secretion, gastric emptying tests and histamine stimulation. A high incidence of stomal ulceration was found, which was directly related to the length of the interposed jejunal segment. ⋯ The aetiology of these ulcers seems to be acid related, because all reflux-free stomachs showed a very low pH. Reflux preventive operations are demonstrated to be a modification of the Mann-Williamson experiment. They should be used carefully or avoided.
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In 62 patients the late results of isoperistaltic jejunal interposition in reconstructive ulcer surgery are analyzed 1.5 to 9.5 years postoperatively (mean 3.1 years); a follow up was possible in 58 patients. 38 (65.5%) had a Visick I or II result; 16 (28%) a fair result (Visick III) and 4 a poor result (Visick IV). 12 of the 58 followed up patients developed a jejunal stomal ulceration in the mean time. These ulcerations were mostly (60%) asymptomatic, superficial and nonbleeding. The histology of the gastric remnant remained unchanged in the most patients and didn't show any benefit of bile diverting operation. ⋯ Similar reports are found in the literature. Even an additional vagotomy doesn't prevent the ulcer formation sufficiently in every case. In conclusion reflux-preventive jejunal interposition is shown to be heavily ulcer-prone, it should be used in reconstructive ulcer surgery very carefully only with short (15 cm) segments and additional vagotomy.
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Scand. J. Gastroenterol. Suppl. · Jan 1984
ReviewFactors that might influence the outcome of studies on the aetiology and epidemiology of acute pelvic inflammatory disease.
An overview is presented of the various factors that might influence the outcome of aetiological and epidemiological studies of pelvic infections in women. Some diversities of opinion in these respects might be explained by i.a. inprecise definitions, lack of simple and specific diagnostic methods, differences in patient selection and laboratory techniques.
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Problems of infections in the intensive care unit (ICU) center on patients admitted because of sepsis, patients with compromised host defenses and patients subject to invasive procedures. The mortality rate in septic shock is high, 47% in our own study. Escherichia coli was found in half the cases. ⋯ Use of corticosteroids and cimetidine may impair defence mechanisms. The use and abuse of antibiotics is vital to the successful control and treatment of infections in the ICU. Infection has been quoted as the most important single factor which determines the outcome of the intensive care patient.