ISSN:0253-4886    

DOI:10.1159/000172572

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:0253-4886    

DOI:10.1159/000172573

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

End-stage liver diseases are associated with profound derangement of hepatic hemodynamics including portal hypertension, portal systemic shunting, reduced portal venous blood flow, elevated hepatic arterial blood flow and hyperdynamic systemic circulation. Orthotopic liver transplantation (OLT), which has increasingly become a therapeutic option for the treatment of end-stage liver diseases, reverses some but not all of these hemodynamic abnormalities. Here we review our current understanding of the physiological control of liver blood flow and the changes that occur in liver disease. The blood flow methodology currently used in both human and animal studies is described. The results of studies on physiologically relevant animal OLT models indicate that OLT per se is without effect on hepatic hemodynamics. The abnormal hemodynamics found in some human patients after OLT would appear to be dependent on the presence of pre-existing portal systemic shunts before transplantation. The mechanism underlying the slow return to normal hepatic hemodynamics in these OLT patients is not fully understood.

ISSN:0253-4886    

DOI:10.1159/000172574

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The safety and lifelong success of vertical banded gastroplasty in treatment of severe obesity is highly dependent upon the technique of the operation. Intra-operative spatial orientation, standardized measurement of the pouch, external outlet calibration and stabilization with polypropylene mesh are all important components of quality control.

ISSN:0253-4886    

DOI:10.1159/000172575

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The technique of the Shouldice hernioplasty is described on the basis of more than 3,000 successfully applied operations at the Surgical University Clinic of Aachen. Local anesthesia is the preferred type of anesthesia in primary (92%) and recurrent (62%) hernias. Essentials of the preparative phase are identification and preservation of the inguinal nerves, resection of the cremaster muscle and exposure of all three hernial sites (lateral, medial and femoral). The hernia is classified intraoperatively using the Aachen classification (L, M, Mc, F, I–II) and a classical four-layer Shouldice repair is done in all primary and small or medium recurrent hernias. Monofilament nonabsorbable running sutures are preferred (polypropylene 0). The 5-year recurrence rates are 1.4% in primary hernias and 3.8% in recurrent repairs. The Shouldice repair is the procedure of choice for all primary and the majority of recurrent hernias. The additional placement of a preperitoneal polypropylene prosthesis is recommended in large or combined recurrent hernia

ISSN:0253-4886    

DOI:10.1159/000172576

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

This cross-sectional study was performed to evaluate the Helicobacter pylori (Hp) status as measured by serology (i.e. IgG antibodies against Hp) in patients surgically treated for perforated gastroduodenal ulcer. Of 104 consecutive patients, 67 (64%) males and 37 (36%) females with a median age of 68 (range 16-89) years and diagnosed between 1987 and 1993, 72 patients (69%) were available for long-term follow-up, of whom 56 (78%) patients completed a questionnaire, and 43 patients (60%) also provided a blood test for measurement of IgG antibodies. A positive serology (i.e. elevated IgG antibodies) was found in 61% of the patients at follow-up. The frequency of symptoms at follow-up in Hp-positive and Hp-negative patients was similar. A significantly higher proportion of Hp-positive patients were smokers (p < 0.01). Although not statistically significant, Hp positivity was associated with higher age and male gender. Our study provides interesting findings at follow-up regarding Hp status in patients surgically treated for this potentially fatal complication of ulcer disease. Further evaluation of the usefullness of Hp serology, and the possible clinical consequences of Hp positivity found during follow-up in this group of patients, remain to be shown in longitudinally studies.

ISSN:0253-4886    

DOI:10.1159/000172577

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Through permanent progress in perioperative management, especially in anesthesiology and technology, the results of gastric cancer surgery have improved during the last years. In our department we experienced a complication rate of 40% and a lethality rate of 8.0% in the period from January 1, 1987, to June 30, 1994, during the treatment of 186 patients. Inspite of the introduction of systematic lymphadenectomy as a standard procedure, the prognosis of gastric cancer could not be improved as impressively as expected. The 5-year survival rate was 28.3%. Only with regard to UICC subgroups II and Ilia, an improvement in survival was seen. In the future we will probably achieve better results in advanced cases with preoperative chemotherapy.

ISSN:0253-4886    

DOI:10.1159/000172578

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Eighteen cases of resected cholangiocellular carcinoma of the liver were investigated to elucidate their clinical features in relation to the macroscopic classification. The tumors were classified into three types according to the macroscopic classification proposed by the Liver Cancer Study Group of Japan: (1) mass-forming type, growing an apparent tumor in the liver; (2) periductal infiltrating type, extending along the intrahepatic bile duct, and (3) intraductal growth type, growing into the bile duct. Abdominal pain was the most frequent symptom in the mass-forming type and the periductal infiltrating type, and fever was the more predominant symptom in the periductal infiltrating type than in the mass-forming type. Hepatolithiasis was found to coexist more frequently with the periductal infiltrating type than with the mass-forming type. A positive surgical margin was more frequently detected in the periductal infiltrating type due to its infiltrating tendency than in the mass-forming type. Two patients with the mass-forming type and 1 patient with the intraductal growth type survived more than 5 years. In conclusion, this macroscopic classification is therefore thought to be useful for both selecting the most appropriate treatment approach as well as for predicting prognosis.

ISSN:0253-4886    

DOI:10.1159/000172579

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Percutaneous liver biopsy is a frequently used technique to diagnose hepatic allograft dysfunction after liver transplantation. One hundred and twenty-four grafts were biopsied under ultrasound control with 5 patients developing hepatic hematomas, 3 subcapsular and intrahepatic, 1 only subcapsular and 1 only intrahepatic. All were managed by conservative treatment and followed by ultrasound and computed tomography scanning without rupture, infection or deleterious effect on the liver allograft. Surgical or radiological drainage in this group of patients was not necessary.

ISSN:0253-4886    

DOI:10.1159/000172580

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The operative results and carcinoembryonic antigen (CEA) doubling times of patients with synchronous hepatic metastasis (group A) and metachronous hepatic metastasis (group B) from colorectal carcinoma were compared. Better survival was exhibited in group A and group B patients who underwent hepatic resection than in those who did not undergo hepatic resection. Group B patients with resectable metastasis also exhibited longer survival times compared to patients with similar CEA doubling times and without hepatic resection. Among the patients who did not undergo hepatic resection, group B showed better survival times than group A after colorectal resection, and the CEA doubling time obtained from 6 patients in group B (83 ± 22 days) was significantly longer than that obtained from 10 patients in group A (55 ± 19 days). The CEA doubling time correlated well with the survival time in unresectable group B patients. The better survival of group B patients may be due not only to the delay in detection of hepatic metastasis but also to the slower growth kinetics of the tumor per se, which were suggested by a longer CEA doubling tim

ISSN:0253-4886    

DOI:10.1159/000172581

出版商:S. Karger AG    

年代:1997

数据来源: Karger