[Acute upper gastrointestinal nonvariceal bleeding--how to determine low risk patients for rebleeding and mortality after endoscopic sclerotherapy?]

INTRODUCTION

Successful endoscopic sclerotherapy is effective in securing hemostasis for bleeding lesions and remains the first line and only needed therapy for most of the patients (pts), but bleeding reoccurs in 10% to 30% pts, and 4% to 14% of the pts die after acute nonvariceal upper gastrointestinal bleeding (UGIB). The need for hospitalization and its duration for all the bleeding pts is still a controversial question.

AIM

To create the simple scoring system able to determine low risk pts for rebleeding and mortality by establishing the relative importance of risk factors for rebleeding and mortality after successful endoscopic sclerotherapy of acute nonvariceal UGIB.

PATIENTS AND METHODS

Prospective study included 3 15 pts who where admitted to hospital because of acute nonvariceal UGIB. All of them underwent gastroscopy with successful sclerotherapy within 12 hours after the admission. We investigated the episode of rebleeding and death during the initial hospitalization, and analyzed the following parameters: age, gender, drug intake, shock, bleeding stigmata, location of bleeding lesion and comorbidity.

RESULTS

Rebleeding occurred in 53 pts (16.8%) and was determined by shock, bleeding stigmata and comorbidity. Eleven pts (3.5%) died and shock, rebleeding and comorbidity were all independent, statistically significant predictors of pts' mortality. The numerical scores for determination of pts with different risk levels for rebleeding and mortality have been developed using the significant predictors of rebleeding and death. The score values for rebleeding ranged from 3 to 9 and pts with values < or = 4 had low risk of rebleeding. We identified 59 pts (18.7% of all) with score for rebleeding < or = 4. Score values for mortality risk ranged from 3 to 8 and the values < 5 revealed negligible risk of death. In our group we found 290 pts (92.1% of all) with low mortality score values.

CONCLUSION

Following the successful initial endoscopic sclerotherapy, these scores can help to identify pts with low risk of rebleeding and negligible risk of death, so they can be treated as outpatients.

Acute Fatty Liver of Pregnancy - An Underlying Condition for Herpes Simplex Type 2 Fulminant Hepatitis Necessitating Liver Transplantation

The infrequent occurrence of herpes simplex virus (HSV) hepatitis in healthy women in comparison with the high prevalence of HSV infections suggests that, in addition to deranged immunity, an underlying condition in the liver might be necessary to develop HSV hepatitis. We report the case of a 28-year-old pregnant woman in the 28 (th) week of gestation. Following HSV type 2 infection of the uterine cervix, acute liver failure developed, necessitating urgent liver transplantation. In addition to fulminant HSV type 2 hepatitis, the explanted liver also showed the histological features of acute fatty liver of pregnancy. The presented case suggests a possible pathogenetic role of acute fatty liver of pregnancy in the development of fulminant HSV hepatitis following recurrent infection with HSV in healthy pregnant women. We believe that early histopathological diagnosis, followed by specific antiviral treatment and liver transplantation in selected patients may improve the clinical outcome of otherwise almost uniformly fatal HSV hepatitis.

Prognostic factors: classification approaches in patients with lung cancer

With the proliferation of potential prognostic factors for lung cancer, it is becoming increasingly more difficult to integrate the information provided by these factors into a single accurate prediction of clinical outcome. Here we reviewed five classification methods for their capabilities in classification of 200 patients with lung cancer into distinct prognostic groups using survival outcome as a criteria. The source of patient data for this study is a Lung Tumour Registry from Institute for Lung Diseases, University Clinical Hospital, Belgrade. Almost all developed classification algorithms determined prognostic groups according to biochemical tumour markers LDH and alkaline phosphatase, producing most significant split, instead of commonly used staging variables. The choice of which approach to use for a given classification problem depends not only on statistical properties of method, but also on medical considerations, such as whether more differential findings are given greater weight and the applicability of a classification rule.

The diffusion of computer-based information technology into health institutions of Republic of Serbia (FR Yugoslavia)

The basic purpose of this study was to analyze the diffusion of computer-based information technology into the health care institutions of the Republic of Serbia in the year 1994, and to compare the results with a similar investigation in 1992 in order to determine the state and progress of its development. The instrument of investigation was a questionnaire with 24 questions, distributed to all the independent health institutions in Serbia (total 238). The overall response rate was 40.8%. Of the number of responding health institutions, 92.8% own computers which are in use, six PCs on average, and on average use two application softwares, obligatory one for accounting and billing. In conclusion, health care institutions in the Republic of Serbia are unsatisfactorily equipped with information technology and without the developed institutional information system, except on the level of the project. So, careful planning, selection, implementation and management with national coordination will be needed to ensure the appropriate use of technology and information systems in health care.

[Health care delivery in the period of crises by means of EPI design methodology]

New methods "Rapid health assessment" fulfill the request for a methodologically clear and efficient way of gaining the recent data, using relatively limited resources. The aim of the study was an assessment of health care delivery and problems in its realization and the population health status, in the period of crises (and of 1993/begining of 1994). The study showed that first effects of crises are shown in the field of health care delivery and than in the population health status. The difficulties were not the same for all, children and urgent cases had less problems than others. The morbidity structure among children and adults was changed. The morbidity structure among children and adults was changed in comparison with routine statistical data. The period of crises has been too short to draw any definitive conclusions.

[Some aspects on medical research systems at the medical school in Belgrade]

The ongoing development of new technologies is rapidly expanding the number and/or quality of medical researches. In order to evaluate the situation in our country we analysed master - degree and doctoral thesis that have been done at the Belgrade Medical School in 1987., 1990. and 1994. year. These years have been chosen because of medical knowledge's known rate of exponential growth. According to the main tasks of medical research: data management system and data analyses, we classified medical researches in two major categories: prospective and retrospective. The crucial difference is whether or not the investigators collect new data for analyses. First has been discovered in 11 doctoral and 10 master theses out of 225 reviewed. Medical researchers use variety of different database management systems and statistical techniques to store, retrieve and analyse data. These were identified in respectively 23 percent and 24 percent. Beside these major research activities we were interested in usage of application programmes such as text processors or graphical packages that were found in 28 percent and 20 percent of analysed theses. In summary, technological advances in computer hardware and software have reduced the barriers to long - term storage and processing of rich biomedical data. The development of new techniques for analysing such a data also encourages the discovery and validation of new medical relationships.