Perforated peptic ulcer: main factors of morbidity and mortality.

World J Surg. 2003 Jul;27(7):782-7. Perforated peptic ulcer: main factors of morbidity and mortality. Noguiera C, Silva AS, Santos JN, Silva AG, Ferreira J, Matos E, Vilaça H. Surgery Department, Surgery 1, Hospital Geral de Santo António, Instituto de Ciencias Biomédicas Abel Salazar, Largo do Prof. Abel Salazar, 4099-001 Oporto, Portugal. Abstract It is well stated in the literature that medical treatment for peptic ulcer is based on a combination of proton pump inhibitors (PPIs) and antibiotics to eradicate Helicobacter pylori. This treatment is associated with a high rate of immediate success and a low rate of recurrence at 12 months, although it is not effective in all patients. Peptic ulcer (PU) perforation is a serious problem that leads to high complication and mortality rates. Surgical treatment, with its various possibilities, constitutes the ideal treatment. Surgical intervention in these cases, however, can be directed to treating the perforation alone, or it can offer definitive treatment of the ulcer itself. With the hope of establishing why such complications and mortality were seen in the patients in our hospital population, we gathered the facts about PU perforations and the types of surgery performed. We studied 210 consecutive patients (150 men, 60 women) who had undergone surgery at our hospital because of perforation between January 1, 1990 and December 31, 2000. The patients' median age was 53.0 +/- 20.6 years (men 47.7 +/- 17.3 years; women 66.3 +/- 22.0 years). Altogether, 86 patients had significant associated illnesses, 62 were admitted more than 24 hours after the perforation, and 25 were admitted in shock. We performed resections in 10 patients; 88 patients were treated by suturing the perforation with or without a patch of epiploon; and 112 underwent a troncular vagotomy with drainage (VT + Dr). A total of 21 patients died (10%). Significant risk factors that led to complications were identified by statistical studies. They were a perforation that had been present more than 24 hours, the coexistence of significant associated illnesses, and resection surgery. The significant risk factors that led to death were the presence of shock at admission, the coexistence of significant illnesses, and resection surgery. There was no statistically significant difference concerning morbidity and mortality between simple closure of the perforation and definitive surgery (VT + Dr). PMID: 14509505 [PubMed - indexed for MEDLINE

Sedimentological and provenance response to Cambrian closure of the Clymene ocean: the upper Alto Paraguai Group, Paraguay belt, Brazil

Final Gondwana amalgamation was marked by the closure of the Neoproterozoic Clymene ocean between the Amazonia craton and central Gondwana. The events which occurred in the last stage of this closure were recorded in the upper Alto Paraguai Group in the foreland of the Paraguay orogen. Outcrop-based facies analysis of the siliciclastic rocks of upper Alto Paraguai Group, composed of the Sepotuba and Diamantino Formations, was carried out in the Diamantino region, within the eastern part of the Barra dos Bugres basin, Mato Grosso state, central-western Brazil. The Sepotuba Formation is composed of sandy shales with planar to wave lamination interbedded with fine-grained sandstone with climbing ripple cross-lamination, planar lamination, swaley cross-stratification and tangential to sigmoidal cross-bedding with mud drapes, related to marine offshore deposits. The lower Diamantino Formation is composed of a monotonous, laterally continuous for hundreds of metres, interbedded siltstone and fine-grained sandstone succession with regular parallel lamination, climbing ripple cross-lamination and ripple-bedding interpreted as distal turbidites. The upper part of this formation consists of fine to medium-grained sandstones with sigmoidal cross-bedding, planar lamination, climbing ripple cross-lamination, symmetrical to asymmetrical and linguoid ripple marks arranged in lobate sand bodies. These facies are interbedded with thick siltstone in coarsening upward large-scale cycles related to a delta system. The Sepotuba Formation characterises the last transgressive deposits of the Paraguay basin representing the final stage of a marine incursion of the Clymene ocean. The progression of orogenesis in the hinterland resulted in the confinement of the Sepotuba sea as a foredeep sub-basin against the edge of the Amazon craton. Turbidites were generated during the deepening of the basin. The successive filling of the basin was associated with progradation of deltaic lobes from the southeast, in a wide lake or a restricted sea that formed after 541 ± 7. Ma. Southeastern to east dominant Neoproterozoic source regions were confirmed by zircon grains that yielded ages around 600 to 540. Ma, that are interpreted to be from granites in the Paraguay orogen. This overall regressive succession recorded in the Alto Paraguai Group represents the filling up of a foredeep basin after the final amalgamation of western Gondwana in the earliest Phanerozoic. © 2011 International Association for Gondwana Research.José Bandeira, Ben McGee, Afonso C.R. Nogueira, Alan S. Collins and Ricardo Trindad

Endoscopic Ear Surgery, an Issue of Otolaryngologic Clinics, 1st Edition

The subject of Endoscopic Ear Surgery is a cutting edge subject and this is one of the first practical guides on this subject. Presented here in Otolaryngologic Clinics are topics on Endoscopic Anatomy, Ventilation Routes, as well as the Endoscopic Management of Cholesteatomas, Neuromas and Inner ear surgery, Endoscopic Ear Surgery for Tympanic Perforations, for Otosclerosis, for Cochlear Implants, each topic discussing the current indications, advantages, disadvantages, instruments needed, surgical technique, and complications. The Editors take part in the International Working Group on Endoscopic Ear Surgery and bring to the Otolaryngologic Clinics the most practical and recent information for surgeons from their scientific and clinical presentations at ENT academy meetings in the United States and around the globe

Amphetamines for Attention Deficit Hyperactivity Disorder (ADHD) in adults.

Attention Deficit Hyperactivity Disorder (ADHD) is a childhood onset psychiatric disorder that can persist into adulthood in up to 50% of patients. From a clinical point of view, ADHD is characterized by hyperactivity, mood instability, irritability, difficulties in maintaining attention, lack of organization and impulsive behaviours. The presence of other disorders occurring at the the same time is also common, especially mood disorders and substance abuse. It seems that amphetamines could reverse the underlying neurological problems that feature in ADHD, and so improve ADHD symptoms. We found seven studies, which enrolled 1091 patients. These studies compared amphetamines to placebo and three of them also compared amphetamines with other drugs: guanfacine, modafinil and paroxetine. Three amphetamine derivatives were investigated: dexamphetamine, lisdexamphetamine and mixed amphetamine salts (MAS). Treatment length ranged from two to 20 weeks. All amphetamines improved ADHD symptoms but overall they did not make people more likely to stay in treatment and were associated with a higher risk of treatment ending early due to adverse events. One type of amphetamine, mixed amphetamine salts, did, however, increase retention in treatment. We found no evidence that higher doses worked better than lower ones. We did not find any difference in effectiveness between immediate-release and sustained-release formulations. Therefore, it appears that short-term treatment with amphetamines reduces ADHD symptoms, but studies assessing the effects of amphetamines for longer periods of time are needed.This resource was contributed by The National Documentation Centre on Drug Use

Data from: Bourgeois behaviour and freeloading in the colonial orb-web spider Parawixia bistriata (Araneae, Araneidae)

Spiders of the tropical American colonial orb weaver Parawixia bistriata form a communal bivouac in daytime. At sunset, they leave the bivouac and construct individual, defended webs within a large, communally built scaffolding of permanent, thick silk lines between trees and bushes. Once spiders started building a web, they repelled other spiders walking on nearby scaffolding with a “bounce” behavior. In nearly all cases (93%), this resulted in the intruder leaving without a fight, akin to the “bourgeois strategy,” in which residents win and intruders retreat without escalated contests. However, a few spiders (6.5%) did not build a web due to lack of available space. Webless spiders were less likely to leave when bounced (only 42% left) and instead attempted to “freeload,” awaiting the capture of prey items in nearby webs. Our simple model shows that webless spiders should change their strategy from bourgeois to freeloading satellite as potential web sites become increasingly occupied

Raw data for Table A2 and Figure 3

Raw behavioural field observations used to produce Table A2 and Fig.

Reattachment of subgingivally fractured central incisor with an open apex

WOS: 000247138900013PubMed ID: 17511842A case report of a 6-year-old girl with a fractured maxillary left central incisor with an open apex is presented. The procedure used to repair the fracture included flap surgery with an intrasulcular incision and endodontic treatment. The patient was called for 3 months regular follow-up to check the root formation. At the end of 32 months just before the root was obturated by guttaperka, she fractured the same tooth. Flap surgery was repeated and the tooth was restored. The root canal was obturated with a root filling paste and guttaperka as the apex was closed. Examination 10 months after treatment revealed good periodontal health, aesthetics and normal function