Perforated peptic ulcer disease: A review of history and treatment

Background: In the last one hundred years much has been written on peptic ulcer disease and the treatment options for one of its most common complications: perforation. The reason for reviewing the literature was evaluating most common ideas on how to treat perforated peptic ulcers (PPU) in general, opinions on conservative treatment and surgical treatment and summarizing ideas about necessary pre-, per- and postoperative proceedings. Method: All relevant articles found by Medline, Ovid and PubMed search were used. Results: A hundred articles written between 1929 and 2009 were reviewed. Of these, 9 were about the history of treatment, 7 about conservative treatment, and 26 were about the surgical procedure of which 8 were addressing laparoscopic correction. Overall there is no consensus, but some advice is given. For conservative treatment there are only a few indications. Use of an omental patch is recommended, irrigation and drainage are not. Laparoscopic correction of PPU as well as for definitive ulcer surgery has many advantages. Conclusions: Surgery for PPU is still a subject of debate despite more than an era of published expertise, indicating the need for establishing guidelines. Copyrigh

Perforated Peptic Ulcer: new insights

Much has been written on perforated peptic ulcer (PPU) during the last hundred years. In 1500, when necropsies were first allowed, often a small hole was found in the anterior wall of the stomach, giving an explanation for symptoms of acute abdominal pain, nausea, vomiting which often led to death within a few hours or days. Laparoscopic surgery, also called minimal invasive surgery or keyhole surgery is a surgical technique in which operations are performed through

119— The Role of Post-Encoding Retrieval on Cognitive and Neural Representations of Spatial Environments

Spatial memory is an important ability for navigating around one’s surrounding environment. However, due to the challenges of developing experimental paradigms that utilize large scale, real-world environments, little research has analyzed, in detail, the development of cognitive maps over time. Past research in rodents has shown that hippocampal place-cells replay during periods of quiet wakefulness, suggesting that mental replay of recent spatial experiences is tied to the development of cognitive maps. In humans, we hypothesize that the development of cognitive maps could therefore be manipulated by having participants selectively recall recent navigational experiences. We analyzed the development of cognitive maps for novel, real-world spatial environments in two groups, a spatial sequencing group (SSG) and rote-retrieval group (RRG), over a period of 2 weeks using Google Street View software. After navigating through the environment, participants’ spatial memories were tested with either rote retrieval or spatial sequencing recognition tests. Our preliminary results suggest the RRG was more successful navigating previously learned routes than the SSG with more practice on the trained routes, whereas the SSG may have developed some ability to discover shortcuts by being encouraged to think more broadly about the routes they were learning, and not rely on memorization

Trends in Diagnosis and Surgical Management of Patients with Perforated Peptic Ulcer

Introduction While the laparoscopic treatment of perforated peptic ulcers (PPU) has been shown to be feasible and safe, its implementation into routine clinical practice has been slow. Only a few studies have evaluated its overall utility. The aim of this study was to investigate changes in surgical management of PPU and associated outcomes. Material and Methods The study was a retrospective, single institution, population-based review of all patients undergoing surgery for PPU between 2003 and 2009. Patient demographics, diagnostic evaluation, management, and outcomes were evaluated. Results Included were 114 patients with a median age of 67 years (range, 20–100). Women comprised 59% and were older (p<0.001), had more comorbidities (p=0.002), and had a higher Boey risk score (p=0.036) compared to men. Perforation location was gastric/pyloric in 72% and duodenal in 28% of patients. Pneumoperitoneum was diagnosed by plain abdominal x-ray in 30 of 41 patients (75%) and by abdominal computerized tomography (CT) in 76 of 77 patients (98%; p<0.001). Laparoscopic treatment was initiated in 48 patients (42%) and completed in 36 patients (75% of attempted cases). Laparoscopic treatment rate increased from 7% to 46% during the study period (p=0.02). Median operation time was shorter in patients treated via laparotomy (70 min) compared to laparoscopy (82 min) and those converted from laparoscopy to laparotomy (105 min; p=0.017). Postoperative complications occurred in 56 patients (49%). Overall 30-day postoperative mortality was 16%. No statistically significant differences were found in morbidity and mortality between open versus laparoscopic repair. Conclusion This study demonstrates an increased use of CT as the primary diagnostic tool for PPU and of laparoscopic repair in its surgical treatment. These changes in management are not associated with altered outcomes

Comparison of Closure of Gastric Perforation Ulcers With Biodegradable Lactide-Glycolide-Caprolactone or Omental Patches

Results of both methods of gastric closure (omental and biodegradable patch) were similar suggesting that a biodegradable patch glued to the outside of the stomach may be a viable alternative for closure of perforations of the digestive tract

Accurate mobile remote sensing of XCO₂ and XCH₄ latitudinal transects from aboard a research vessel

A portable Fourier Transform Spectrometer (FTS), model EM27/SUN, is deployed onboard the research vessel Polarstern to measure the column-average dry air mole fractions of carbon dioxide (XCO2) and methane (XCH4) by means of direct sunlight absorption spectrometry. We report on technical developments as well as data calibration and reduction measures required to achieve the targeted accuracy of fractions of a percent in retrieved XCO2 and XCH4 while operating the instrument under field conditions onboard the moving platform during a six week cruise through the Atlantic from Cape Town (South Africa, 34° S, 18° E) to Bremerhaven (Germany, 54° N, 19° E). We demonstrate that our solar tracker typically achieves a tracking precision of better than 0.05° toward the center of the sun throughout the ship cruise which facilitates accurate XCO2 and XCH4 retrievals even under harsh ambient wind conditions. We define several quality filters that screen spectra e.g. when the field-of-view is partially obstructed by ship structures or when the lines-of-sight cross the ship exhaust plume. The measurements in clean oceanic air, can be used to characterize a spurious airmass dependency. After the campaign, deployment of the spectrometer side-by-side the TCCON (Total Carbon Column Observing Network) instrument at Karlsruhe, Germany, allows for determining a calibration factor that makes the entire campaign record traceable to World Meteorological Organization (WMO) standards. Comparisons to observations of the GOSAT satellite and concentration fields modeled by the European Centre for Medium-Range Weather Forecasts (ECMWF) within the project Monitoring of Atmospheric Composition and Climate – Interim Implementation (MACC-II) demonstrate that the observational setup is well suited to provide validation opportunities above the ocean and along interhemispheric transects