An analysis has been made of 235 deaths that occurred among 1905 patients with peptic ulcer who constituted a random sample of the occurrence of ulcer disease in an area of Denmark comprising half a million inhabitants. The disease itself, according to the death certificate, was considered the primary cause of death in 10% of the cases; half of these had been operated on immediately before death. The other patients died more frequently than expected from the following causes: chronic bronchitis, pulmonary emphysema, cancer of the lung, cirrhosis of the liver, and cancer of the pancreas. Although the comorbidity with chronic bronchitis and emphysema was especially pronounced in patients with gastric ulcer, the association with liver cirrhosis and cancer of the pancreas occurred only in patients with duodenal ulcer. In women the mortality rate attributable to cardiac and vascular diseases was lower than expected. No excess coincidence of suicide was found. Berkson's fallacy is considered to be of much less importance as a possible explanation of the comorbidity found in the present study than in the majority of publications concerned with this question.
[Show abstract][Hide abstract] ABSTRACT: Ascitic fluid leukocytosis occurring in the cirrhotic patient in the absence of positive peritoneal cultures is often difficult to explain. A unique case of a patient with alcoholic cirrhosis, sterile ascites, and ascitic fluid leukocytosis demonstrated prior to the perforation of a duodenal ulcer has been presented. Based on the patient's clinical course and the pathological events in peptic ulceration of the stomach and duodenum, it is possible to postulate an explanation for the sterile ascitic fluid leukocytosis observed in this patient.
[Show abstract][Hide abstract] ABSTRACT: The incidence of suicide in a consecutive series of 1,000 patients, who underwent Billroth II resection for duodenal ulcer, has been estimated. After an observation period of 21–29 years 13.7% of those who had died had committed suicide. The psychiatric morbidity in this ulcer group was found to be very high. Among the psychiatric diseases alcoholism was dominating, but also non-psychotic conditions such as neurosis and psychopathy were frequent. Fifty per cent of the persons who had committed suicide were alcoholics, and the alcohol abuse seemed to develop after surgery.
Gastric resection for duodenal ulcer may have pathogenetic importance in the development of alcoholism, which is known as a predictor of suicide. The importance of considering psychiatric disturbances in the postoperative follow-up is stressed.
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