AIM： The use of low-dose aspirin to prevent cardiovascular disease events is well established. However, the incidence and predictors of upper gastrointestinal bleeding （UGIB） with its use are unknown. We studied pr...AIM： The use of low-dose aspirin to prevent cardiovascular disease events is well established. However, the incidence and predictors of upper gastrointestinal bleeding （UGIB） with its use are unknown. We studied prospectively the incidence and outcome of peptic ulceration in low-dose aspirin users. METHODS： A total of 991 patients with coronary artery disease （CAD） on low-dose aspirin were prospectively followed-up for two years for the occurrence and clinical features of first hospitalized episode of UGIB. RESULTS： UGIB had a bimodal presentation with 45% occurring within four months of aspirin initiation and had an overall prevalence of 1.5% per year. There was no UGIB-related death. Hypertension （OR = 4.6, 95%CI 1.5 - 14.7, P = 0.009）, history of peptic ulceration （OR = 3.1, 95%CI 1.1 - 9.0, P = 0.039）, tertiary education （OR = 3.08, 95%CI 1.1 - 9.0, P = 0.039） and higher lean body mass （P = 0.016） were independent factors associated with UGIB. Use of nitrate did not reduce UGIB. CONCLUSION： The incidence of UGIB in patients with CAD on long-term low-dose aspirin is low, but is accompanied with significant morbidity. With prolonged use of aspirin, UGIB continues to be a problem for those with risk factors and especially in patients with a history of peptic ulcers, in which UGIB tends to occur early after aspirin therapy.展开更多
Objectives: The purpose of this pilot study was to obtain an Australian perspective on evaluating the utility of plain film radiography and computed tomography (CT) to rule out fish bone impaction in the upper aerodig...Objectives: The purpose of this pilot study was to obtain an Australian perspective on evaluating the utility of plain film radiography and computed tomography (CT) to rule out fish bone impaction in the upper aerodigestive tract in the emergency department (ED) setting. Methods: A retrospective multicentre cohort study was conducted. A total of 73 patients met the inclusion criteria. A subgroup of patients underwent CT. We studied the sensitivity and specificity of x-ray and CT along with other demographic variables to determine the likelihood of true fish bone impaction. Results: Out of the 73 patients, 28 patients had true bone impaction. The sensitivity for x-ray was 42.9% and specificity was 73.3%. The sensitivity of CT was 87.5% and specificity was 71.4%. We found a significant difference in the mean age of presentation for true bone and false bone impaction, P = 0.02. Conclusion: Due to the low sensitivity of x-ray we do not recommend the utilisation of plain film radiography to rule out bone impaction Advances in low dose radiation multidetector CT scanners may replace plain film radiography as a screening tool.展开更多
AIM To investigate and summarise the current evidence surrounding management of Bouveret's syndrome(BS).METHODS A MEDLINE search was performed for the BS. The search was conducted independently by two clinicians(Y...AIM To investigate and summarise the current evidence surrounding management of Bouveret's syndrome(BS).METHODS A MEDLINE search was performed for the BS. The search was conducted independently by two clinicians(Yahya ALHabbal and Matthew Ng) in April 2016. A case of BS is also described.RESULTS A total of 315 articles, published from 1967 to 2016, were found. For a clinically meaningful clinical review, articles published before 01/01/1990 and were excluded, leaving 235 unique articles to review. Twenty-seven articles were not available(neither by direct communication nor through inter-library transfer). These were also excluded. The final number of articles reviewed was 208. There were 161 case reports, 13 reviews, 23 images(radiological and clinical images), and 11 letters to editor. Female to male ratio was 1.82. Mean age was 74 years. Treatment modalities included laparotomy in the majority of cases, laparoscopic surgery, endoscopic surgery and shockwave lithotripsy.CONCLUSION There is limited evidence in the literature about the appropriate approach. We suggest an algorithm for management of BS.展开更多
文摘AIM： The use of low-dose aspirin to prevent cardiovascular disease events is well established. However, the incidence and predictors of upper gastrointestinal bleeding （UGIB） with its use are unknown. We studied prospectively the incidence and outcome of peptic ulceration in low-dose aspirin users. METHODS： A total of 991 patients with coronary artery disease （CAD） on low-dose aspirin were prospectively followed-up for two years for the occurrence and clinical features of first hospitalized episode of UGIB. RESULTS： UGIB had a bimodal presentation with 45% occurring within four months of aspirin initiation and had an overall prevalence of 1.5% per year. There was no UGIB-related death. Hypertension （OR = 4.6, 95%CI 1.5 - 14.7, P = 0.009）, history of peptic ulceration （OR = 3.1, 95%CI 1.1 - 9.0, P = 0.039）, tertiary education （OR = 3.08, 95%CI 1.1 - 9.0, P = 0.039） and higher lean body mass （P = 0.016） were independent factors associated with UGIB. Use of nitrate did not reduce UGIB. CONCLUSION： The incidence of UGIB in patients with CAD on long-term low-dose aspirin is low, but is accompanied with significant morbidity. With prolonged use of aspirin, UGIB continues to be a problem for those with risk factors and especially in patients with a history of peptic ulcers, in which UGIB tends to occur early after aspirin therapy.
文摘Objectives: The purpose of this pilot study was to obtain an Australian perspective on evaluating the utility of plain film radiography and computed tomography (CT) to rule out fish bone impaction in the upper aerodigestive tract in the emergency department (ED) setting. Methods: A retrospective multicentre cohort study was conducted. A total of 73 patients met the inclusion criteria. A subgroup of patients underwent CT. We studied the sensitivity and specificity of x-ray and CT along with other demographic variables to determine the likelihood of true fish bone impaction. Results: Out of the 73 patients, 28 patients had true bone impaction. The sensitivity for x-ray was 42.9% and specificity was 73.3%. The sensitivity of CT was 87.5% and specificity was 71.4%. We found a significant difference in the mean age of presentation for true bone and false bone impaction, P = 0.02. Conclusion: Due to the low sensitivity of x-ray we do not recommend the utilisation of plain film radiography to rule out bone impaction Advances in low dose radiation multidetector CT scanners may replace plain film radiography as a screening tool.
文摘AIM To investigate and summarise the current evidence surrounding management of Bouveret's syndrome(BS).METHODS A MEDLINE search was performed for the BS. The search was conducted independently by two clinicians(Yahya ALHabbal and Matthew Ng) in April 2016. A case of BS is also described.RESULTS A total of 315 articles, published from 1967 to 2016, were found. For a clinically meaningful clinical review, articles published before 01/01/1990 and were excluded, leaving 235 unique articles to review. Twenty-seven articles were not available(neither by direct communication nor through inter-library transfer). These were also excluded. The final number of articles reviewed was 208. There were 161 case reports, 13 reviews, 23 images(radiological and clinical images), and 11 letters to editor. Female to male ratio was 1.82. Mean age was 74 years. Treatment modalities included laparotomy in the majority of cases, laparoscopic surgery, endoscopic surgery and shockwave lithotripsy.CONCLUSION There is limited evidence in the literature about the appropriate approach. We suggest an algorithm for management of BS.
