Haematemesis and Melaena

Fa, Jones

doi:10.1136/bmj.2.4524.441

Cited by 98 publications

(11 citation statements)

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“…The increasing number of yearly admissions from bleeding peptic ulcer, and their increasing ages have been reported by Fraenkel and Truelove (1955), Avery Jones (1956), andLarge (1960). Our second series of patients were older, had more chronic ulcers, and more recurrent bleeding.…”

Section: Discussionmentioning

confidence: 92%

“…On the other hand, we may well have been doing more emergency surgery than was necessary. Avery Jones (1956) has emphasized the increase in whole series mortality that may occur in these circumstances. In spite of increasing numbers of older patients with more chronic ulcers, the mortality in Oxford fell from 19 % to 5.3 % (Fraenkel and Truelove, 1955) and in Reading from 7.4% to 5.9 % (Large, 1960), while it remained between 7 % and 8 % at the Central Middlesex Hospital, London (Avery Jones, 1956).…”

Section: Discussionmentioning

confidence: 99%

“…If the patient's condition is not stable after 3 pints of blood, the surgeon is again consulted. Dunphy (1954) (Brandon, 1956 Avery Jones (1947) and amplified by others. The approach has been more aggressive in the second half of our series.…”

Section: The Ulcer Group Asmentioning

confidence: 99%

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Surgery in Bleeding Peptic Ulcers

Ward‐McQuaid¹,

Pease²,

Smith³

et al. 1960

Gut

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This paper records a study of 400 patients admitted for haematemesis and melaena. Emergency surgery was undertaken on selected patients but the overall mortality increased when more frequent emergency operations were performed in the latter half of the series.The proper management of haematemesis and melaena is a constantly recurring problem. Our material consists of 473 patients admitted for haematemesis and melaena between January, 1953, and July, 1958. Four hundred of these (87%) were for proved or suspected peptic ulceration, and the main object of this paper is to discuss the place of surgery in this group. The overall mortality of the ulcer group was 6.25 %. Ninety-eight (24.5 %) were submitted to emergency surgery. The remaining 73 patients (13 %) bled from causes other than ulcer. The Mansfield hospitals serve a population of some 200,000 in a well-defined area. All patients admitted to hospitals and nursing homes for definite haematemesis and melaena are included and classified according to Avery Jones (1956). ANALYSIS OF RESULTSIn the analysis of results, the ulcer group as a whole is considered first, then all patients in the ulcer series operated on in the acute phase or later. Next comes a summary of other operations done for peptic ulcer over the same period. A more detailed account of the emergency operations (that is within 24 hours of bleeding) in the ulcer group and their results follows. The first 200 and the second 200 of the whole peptic ulcer group are then compared. Finally, there is a short section on the causes of bleeding other than an ulcer, and the emergency operations that were done in this group. (58 %) were diagnosed by radiology or at operation. Duodenal ulcers outnumber gastric ulcers by 159 to 70. The acute lesion group (32 %) refers to those patients in whom radiology failed to show an ulcer three weeks or so after admission. The unclassified group (6 %) refers to incompletely investigated patients with strong presumptive evidence of peptic ulceration. The post-operative group (4 %) followed gastro-enterostomy or partial gastrectomy. The whole series mortality is slightly higher for gastric ulcers (10%) than for duodenal ulcers (8.8 %), although the operative mortality was rather higher for duodenal ulcers. The acute lesion group had a mortality of 4.2%. No necropsy was done on the patient who died in the unclassified group. THE ULCER GROUP AS

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Surgery in Bleeding Peptic Ulcers

Ward‐McQuaid¹,

Pease²,

Smith³

et al. 1960

Gut

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“…In htematemesis it has been clearly shown by Avery Jones (1947) and Tanner (1950) that the death rate is highest in patients with a severe attack, especially in elderly patients; furthermore early surgery in these patients can reduce this high mortality. We are in an intermediate stage; we realize that the bulk of our mortality occurs in severe attacks, especially in old patients, and we shall therefore try in future to reduce this mortality by the earlier use of surgery in severe attacks, especially in patients over 60, while the patient is still relatively fit.…”

Section: Practical Implicationsmentioning

confidence: 99%

The Early Course and Prognosis of Ulcerative Colitis [Abridged]

Watkinson

et al. 1965

Proceedings of the Royal Society of Medicine

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“…This is partly due to a widespread belief that under medical treatment the mortality is very low, and partly to a concept that these patients cannot be treated surgically without a very high death rate. Avery Jones (1947), reporting on the results of his large series of cases so carefully treated and so fully investigated, has given us much new information and a very cl-ar picture of the dangers of the disease with which we are dealing. There were 615 cases of peptic ulceration in his series, and the mortality was 7.8%.…”

mentioning

confidence: 99%

Haematemesis as a Surgical Problem

Bohn¹

1949

BMJ

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Haematemesis and Melaena

Cited by 98 publications

References 0 publications

Surgery in Bleeding Peptic Ulcers

Surgery in Bleeding Peptic Ulcers

The Early Course and Prognosis of Ulcerative Colitis [Abridged]

Haematemesis as a Surgical Problem

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