摘要:

Several CT scan scores have been proposed to discriminate between splenic injuries requiring surgical intervention, and those that may be treated conservatively. The aim of this study is to compare three selected CT scan scores (Buntain, Mirvis, Resciniti) in their ability to correctly define the proper course of therapy following splenic injury. 44 adult patients presenting an isolated splenic trauma, confirmed by CT scan on admission and treated solely according to clinical criteria, have been studied. The 44 CT scans were retrospectively classified according to the three CT scan scoring systems. Correlation with the treatment performed allows the specificity and sensitivity of each score to be calculated and compared. The best score (Resciniti) uses a combination of parenchymal and intra-abdominal liquid scores. The use of such a scoring system alone to dictate therapy would have resulted in either an increased rate of surgical intervention, or an unacceptable rate of failure of conservative treatment. However, the determination of the expected rate of failure of conservative treatment can be useful in determining the level and frequency of serial surveillance examinations.

ISSN:0253-4886    

DOI:10.1159/000172558

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:0253-4886    

DOI:10.1159/000172559

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Certain strains of Lactobacillus, which have therapeutic and nutritional value, may facilitate the reduction of bacterial translocation in hosts under critical conditions. The effects may vary between different strains of Lactobacillus. The aim of this study was to evaluate and compare the impact of three Lactobacillus strains on methotrexate-induced enterocolitis in rats. From the beginning of the study, rats received an intragastric infusion of an elemental diet alone or supplemented with Lactobacillus plantarum DSM 6595, Lactobacillus rhamnosus DSM 6594, or Lactobacillus acidophilus DSM 20079 in fermented oatbase. Methotrexate (20 mg/kg) was injected intraperitoneally to all animals on the 4th day, and sampling was done on the 7th day. Supplementation of all three Lactobacillus strains significantly lowered the bacterial translocation to mesenteric lymph nodes, liver and blood, which was accompanied by a reduction in overgrown pathogenic bacteria and an increase in lactobacilli in rats with enterocolitis. L. plantarum and L. rhamnosus were more effective in reducing the bacterial translocation and improving the gut mucosal protein, DNA and RNA content than L. acidophilus. The present results may imply that L. plantarum and L. rhamnosus have more significance than L. acidophilus in future bacteriotherapy.

ISSN:0253-4886    

DOI:10.1159/000172560

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The role of angiotensin in the pathophysiology of mesenteric vasospasm raises the question whether angiotensin-converting enzyme (ACE) inhibitors can influence the sequelae of shock on the mesenteric circulation. The purpose of this study was to investigate the effect of captopril on the metabolic consequences of the nonocclusive mesenteric infarct. Thirty pigs were used. The cardiogenic shock was induced by an infusion of 10% hydroxyethyl starch into the pericardium over 10 min. In all groups, except the control group, the ACE inhibitor captopril was given as a bolus of 0.25 mg/kg and then 10 mg/kg/min continuously up to a total of 50 mg. The positive effect of captopril on the mesenteric circulation was verified by a significantly smaller increase of lactate, lesser pH decrease in the superior mesenteric vein. The shock-induced acidosis in the mesenteric circulation was less profound in therapy groups as compared with the control group. Systemic therapy with ACE inhibitor is more effective than local application. The effect of captopril treatment inherently relies on the timing of initiation.

ISSN:0253-4886    

DOI:10.1159/000172561

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

In this study we evaluated changes in anal function and pressures in 16 patients undergoing low anterior resection for a rectal neoplasm. After a significant initial decrease in resting anal (37%) and maximal squeeze pressure (31 %), anal function improved and after 1 year was 86 and 95% of the respective preoperative values (p NS). Defecation frequency (mean ± SD) was significantly higher after 1 year than preoperatively, 3.9 ± 2.2 versus 2.7 ± 2.2 times a day (p = 0.049). In 3 of 9 previously continent patients continence became worse, 1 patient suffering from frequent major soiling. Four of seven patients with minor continence problems regained normal continence. On the whole, the patients’ continence before and after operation was similar. Postoperative continence was not related to anal pressures in the preoperative manometry. However, in 3 patients with worse postoperative continence, anal pressures were normal. In 6 patients with a clinical anastomotic leakage maximal squeeze pressure at the end of follow-up was significantly lower than before operation, but anastomotic leakage had no effect on the patients’ postoperative continence. In conclusion, the study demonstrates a slight decrease in anal pressures which seems not to affect the patients’ postoperative continence. Patients with worse postoperative continence had normal anal pressures and more than half the patients with minor continence problems regained normal continence. Therefore patients should not be denied a low anterior resection if anal pressures are low and/or minor continence proble

ISSN:0253-4886    

DOI:10.1159/000172562

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Thirty-two patients with rectal cancer underwent local excision according to Y. Mason’s procedure. Since local excision does not remove lymph nodes, the risk of metastases must be minimal and therefore the selection of patients careful. Preoperative selection is performed by rectal digital examination, endoscopy, rectal endosonography and sometimes by magnetic resonance imaging. The validity of the local excision can only be established by the definitive postoperative histological assessment. In case of pT1 tumors with ‘low-risk’ histology, results show that survival and local recurrence rate are comparable to those obtained with radical rese

ISSN:0253-4886    

DOI:10.1159/000172563

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Pancreatic schwannoma is a relatively rare tumor originating from the lining cells of the nerve sheath. We report on a benign pancreatic schwannoma located in the pancreatic head and not associated with Recklinghausen’s disease. Based on the results of preoperative investigations and the intraoperative findings, simple resection of the mass was performed. The histology of the resected specimen showed a prevalence of Antoni B-type areas. Endoscopic ultrasonography proved very accurate in the evaluation of the anatomical relationships of the mas

ISSN:0253-4886    

DOI:10.1159/000172564

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

A 70-year-old obese woman underwent a Hartmann’s procedure and partial cystectomy for a large relatively immobile recto-sigmoid tumour which adhered to the urinary bladder. The post-operative recovery was uneventful until the 9th postoperative day when her stoma ceased to function and she became nauseated. Nasogastric suction yielded over 2,000 ml of clear bile-stained fluid in 24 h. On the 12th post-operative day, she was re-operated and, in addition to some adhesions between loops of distal small bowel, a 3.5-cm diameter gallstone was found impacted in the terminal ileum. Through an enterotomy the gallstone was removed. No other stones were palpated. The gallbladder was small and fibrosed. It was impossible to palpate a biliary-enteric communication. Ten days after the second operation gastro-duodenoscopy was performed. A wide fistulous tract was seen arising from the dorsum of the first part of the duodenum. The patient was discharged 25 days after her second operatio

ISSN:0253-4886    

DOI:10.1159/000172565

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Internal herniation through defects in the gastrocolic ligament and lesser omentum is extremely rare. This type of transomental hernia differs from herniation through the greater omentum alone both in terms of the site and direction of the herniation. One such case is presented, together with a brief review of the available literature. The pathogenesis of the omental aperture and the etiological mechanism are briefly discussed.

ISSN:0253-4886    

DOI:10.1159/000172566

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Carcinoma of the ampulla of Vater is closely associated with tubular and villous adenomas of the ampulla. Its prognosis is strongly related to the degree of invasion and nodal involvement. However, the determination of the extent of invasion is not easy. We describe such a case with three-dimensional spread into duodenum and common bile and pancreatic ducts preoperatively detected by hypotonic duodenography, duodenoscopy, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography. The histological examination of an endoscopic biopsy specimen revealed only dysplasia. A resected specimen showed carcinoma of Vater’s ampulla with three-dimensional spread, but the invasion was limited to the epithelial and mucosal layer

ISSN:0253-4886    

DOI:10.1159/000172567

出版商:S. Karger AG    

年代:1997

数据来源: Karger