%0 Journal Article
%T Stress ulcers - Cushing ulcers: diagnosis, treatment, prevention
%A R. ˋcerbina
%A G. Ghidirim
%A A. Dolghii
%A V. Lescov
%J Jurnalul de Chirurgie
%D 2012
%I University of Medicine and Pharmacy, Iasi
%X BACKGROUND: Cushing ulcers appear at the 3rd to 5th day after stress situations accompanied with hemorrhage in 5-10%, perforations in 4%. METHODS: Between 2007-2011 in the National Scientific and Practical Center for Emergency Medicine Kishinev, 1917 patients with superior gastric hemorrhages were treated, from which 139 in ICU. RESULTS: In 45 cases were diagnosed Cushing ulcers: men 每 30, women 每 15 with age between 21 years and 87 years. The disease causes were: cerebral vascular diseases 13(28.8%); fractures with hip replacement 每 16 (35.5%); chronic renal insufficiency and septic states - 3 (12.32%); severe head trauma 每 10 (22.2%). The mortality rate was 22.2% (10 patients). Gastroscopy revealed hemorrhages followed by endoscopic hemostasis. For the prophylaxis of hemorrhage relapse all patients underwent repeated endoscopic hemostasis 2 to 3 times. One patient was operated for a perforated bulbar Cushing ulcer and another one due to Forrest IA hemorrhage that didn＊t respond to endoscopic hemostasis 每 Bilroth I antrum resection. Both patients died due to multiple organ dysfunction syndrome (MODS). Patients with Cushing ulcers received anti-ulcer treatment: PPI, H2 blockers in maximum dosages, hemostatic and repeated blood plasma transfusions. CONCLUSIONS: Gastroscopy is obligatory in all patients with severe head trauma, septic states, chronic renal insufficiency and severe cerebral vascular diseases. Anti-ulcer and hemostatic treatment insures ulcer healing and scarring in most of the cases.
%K CUSHING ULCERS
%K DIAGNOSIS
%K TREATMENT
%U http://www.jurnaluldechirurgie.ro/jurnal/docs/jurnal412/art%20010%202012%20nr%204.pdf