DNA typing of the gastric mucosa of patients with chronic duodenal ulcer

The work involved a molecular biological technique (ISSR-PCR) using ISSR-primer S-2, with structure (AGC) 6G. Changes in the gastric mucosa in chronic duodenal ulcer disease against the background of severe chronic atrophic gastritis have been analyzed. Noteworthy is the fact that there is a strong correlation between the degree of dysplasia of the epithelium of the gastric mucosa and the mitotic index, the Pearson's correlation coefficient rxy was 0.853, respectively. A strong and very strong correlation relationship between the indicators of the degree of dysplasia of the epithelium of the gastric mucosa by phenotypic characteristics and indicators of DNA typing of samples of the gastric mucosa, the Pearson's correlation coefficient rxy was 0.863, respectively. DNA profiles of the gastric mucosa of patients with duodenal ulcer according to the results of typing by the ISSR-PCR method ranging from 520 to 620 bp. had the character of microsatellite expansions and differed from the profile of the norm, which is evidence of precancerous changes.

A rare cause of gastric outlet obstruction

Gastric outlet obstruction is the clinical and pathophysiological consequence of any disease process that produces mechanical impediment to gastric emptying. It may be acute from inflammatory swelling and peristaltic dysfunction or chronic from cicatrix. Chronic inflammation of the duodenum may lead to recurrent episodes of healing followed by repair and scarring ultimately leading to fibrosis and stenosis of the duodenal lumen. We would like to present a unique case of an elderly lady presenting with intractable vomiting over 3 months, gradually progressive which aggravated on consuming solids initially to consuming liquids later. After thorough investigations a provisional diagnosis of chronic duodenal ulcer with gastric outlet obstruction probably due to cicatrix was made. On laparotomy there was a chronic scarred duodenal ulcer following a previously contained perforation which was causing the gastric outlet obstruction. Cholecystectomy, duodenoplasty and loop gastrojejunostomy was performed with no complications post-operatively. This is a rare case of previous contained duodenal perforation causing gastric outlet obstruction.

THE WAY OF RECONSTRUCTIVE SURGERY IN CHRONIC DUODENAL ULCER, COMPLICATED BY BLEEDING WITH SEVERE BLOOD LOSS AFTER RETROCOLIC GASTROJEJUNOSTOMY

Currently, surgical treatment of gastrointestinal bleeding is based primarily on topical preoperative identification of their source. In this regard, the treatment of patients with bleeding from unknown sources is a difficult task and is accompanied by a high mortality rate. In such cases, in the absence of confirmation of gastrointestinal bleeding source, treatment should base on the clinical pic- ture. A successful case of surgical treatment of patient with chronic duodenal ulcer, complicated with bleeding after retrocolic gastroenteroanastomy is described.

Relationship of Various Prognostic Factors with Outcome of Treatment of Chronic Duodenal Ulcer Perforation Patients

Background: In acute abdominal conditions, chronic duodenal ulcer perforation is a very common surgical emergency that overwhelm the surgical ward throughout the year. Especially in the tropics and more in our country, peptic ulcer disease causes a major health problem. Objectives: To assess the usefulness of the prognostic factors in terms of morbidity and mortality in the treatment of perforated duodenal ulcer patient. Methods: This was a prospective study during the period from January 2003 to December 2003 in M.A.G. Osmani Medical College Hospital, Sylhet. The study included 100 cases of perforated chronic duodenal ulcer. Patients were randomly collected from all surgical units of SOMCH, Sylhet. Operation was done by simple closure with omental graft in all cases. Data analyzed by appropriate statistical method (Mean, SD & l2 test). Results: Highly significant relationship was found between increased age (>50 years) of patients with perforated duodenal ulcer and mortality (p<0.001). Lethality rate was higher in patients operated after 24 hours of onset of symptom in relation to patients operated within 24 hours of onset of symptom, (p<0.05). Different postoperative complications were prevalent in patients operated after 24 hours of onset of symptom, on the other hand complication rate was low in patients operated within 24 hours (p<0.001). There was also longer hospital stay in lately operated patients (more above median) than patients operated within 24 hrs (p<0.001). Mortality was higher in cases of purulent peritoneal fluid, where as it was nil in case of billous and serosanguinous fluid (p<0.001). More complications were developed in patients with purulent peritoneal fluid in comparison to billous and serosanguinous nature (p<0.001). There was more mortality in patients with preoperative shock in comparison with no features of shock (p<0.001). More complications were noted in patients with preoperative shock than in patients with no features of shock (p<0.01). Conclusion: Delayed operation, preoperative shock, more age and gross peritoneal sepsis bear a direct relationship with outcome of treatment chronic duodenal ulcer perforation patients.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i2.21060