The widely differing mortality rates of severe gastroduodenal hemorrhage reported in the literature (10-30%), are due to very inhomogeneous patient groups. The purpose of this study was therefore to rank various clinical and endoscopical factors by giving them points from 0 to 6, both to establish comparable groups and to use them as prognostic parameters for a potential fatality rate. One hundred and ninety-three patients with severe gastroduodenal bleeding, verified at emergency gastroscopy immediately after admission, were admitted to this prospective study. The statistical assessment of the prognosis for these 8 factors revealed a linear correlation between increasing score and mortality rate for the following risk factors: patient age, activity and intensity of hemorrhage, type and number of associated illnesses, various therapeutic procedures. Only the type of the source and the site of the hemorrhage did not correlate well. By adding up the points of all risk factors for every patient we calculated the overall score and established a correlation to the mortality rate: A definite statistical correlation was demonstrated between increasing score and fatal outcome. If a patient with a score of less than 20 points did survive in 100%, the mortality rate increased linearly to 83.3% in patients with a score of 40 points. Using this scoring system it is possible to establish comparable groups of patients - which seems indispensable for a critical examination of various therapeutic procedures. Furthermore, this score can serve as a predictor of the probability of a fatal outcome shortly after patient admission.

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We report a case of a doubled gallbladder missed in preoperative ultrasound and laparoscopic cholecystectomy but demonstrated by endoscopic retrograde cholangiography (ERC) postoperatively.

This prospective study compares 3 different consecutive treatment protocols of gastroduodenal hemorrhage. Three hundred sixty-one patients underwent emergency endoscopy as the basis for further treatment. Clinical and endoscopic findings, such as site and type of the bleeding source, bleeding activity and intensity, age, and concomitant diseases of the patient were scored between 0 and 6 points, the higher number indicating a higher risk. The mean values of the total score of the 7 risk factors were comparable in the 3 treatment protocols. In period I (n = 77), a total of 16 patients (20.8%) underwent emergency operations because of severe bleeding, 27 (35%) were operated on after cessation of the bleeding, and 34 (44.2%) were treated conservatively. The mortality was 16.9%. In period II (n = 116), patients with actively bleeding lesions (n = 38) underwent endoscopic sclerotherapy, with a primary rate of hemostasis in 95%. As a result, the rate of emergency surgery could be reduced to 12.9% and the mortality for the entire group was reduced to 9.5%. The problem in this protocol was the rate of recurrent bleeding after primary endoscopic hemostasis: 13/116 (11.2%). Eleven of the 13 rebleeders presented with a lesion either on the back wall of the duodenum or with a visible vessel. In period III (n = 168), a total of 83 patients (50%) underwent endoscopic injection therapy with a primary success in 93%. Sixteen patients (9.5%) with lesions of high rebleeding risk (duodenal ulcer on the posterior wall or visible vessel) were scheduled for urgent elective operation after volume resuscitation within 24 hours of emergency endoscopy (mortality, 6.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

Two hundred and twenty patients with a total of 412 gall bladder stones of between 8 and 38 mm in size were treated with extracorporeal shock wave lithotripsy, using the overhead module Lithostrar Plus. Fifty six per cent of stones were solitary (mean (SD) diameter 23 (5) mm) and 9 5% of the patients had more than three stones. Stones were successfuliy disintegrated in 218 patients (fragmentation size <5 mm in 80%, <10 mm in 19%). Some 65% of patients required one treatment and the rest two or three. A mean (SD) of4100 (1800) (24) years were treated. The onset of symptoms of gall stones had occurred 5-5 (2 3) years previously. The mean (SD) size of the stones was 19 (6) mm. A total of 412 stones were found in these patients -124 had a solitary stone and 118 had between two and a maximum of five radiolucent stones.