摘要:

The surgical treatment of morbid obesity has progressed from the jejunoileal bypass to a small number of gastric restrictive procedures. The principle incorporated is that by limiting intake, weight loss can be produced. At the present time, most procedures incorporate a vertical staple line in the stomach with a lesser curvature aperture into the rest of the gastrointestinal tract. For long-term weight control, the pouch must remain small and the outlet must be prevented from dilating. A review of current procedures comparing and contrasting 2-year results is the thrust of this paper.

ISSN:0253-4886    

DOI:10.1159/000171703

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

During the 16-year period from 1969 to 1985, 42 patients with pancreatic abscesses were studied to determine if recent diagnostic advances have improved the prognosis for patients with this disease. Abscesses developed as a typical complication of acute pancreatitis following alcohol ingestion in 28 patients and was due to biliary tract diseases in 8 cases and to operative procedures in 3 cases; only 3 cases were idiopathic. Clinical findings, laboratory data and x-ray examinations did not allow an early diagnosis. Until 1976, a late diagnosis and therefore a delayed operation was the reason for the high lethality of 59% (13 out of 22 patients). After 1976, the early diagnosis improved thanks to ultrasound examination, and CT scan contributed to decrease the lethality to 20% (4 out of 20 patients). The standard operative procedures consisted of laparotomies and evacuation of debris and pus with consecutive adequate drainage. Additional procedures were performed in 18 cases. Reoperations were necessary in 16 cases, multiple laparotomies had to be carried out in 5 patients because of insufficient drainage retention, of new necrosis, or new abscess formation. The lethality was due to a high rate of preoperative complications of the disease including multiple organ failures. The postoperative morbidity was high. Out of 17 patients, 16 died due to incon-trollable sepsis. Antibiotics are only effective after evacuation of single or multiple abscesses. An intensive care including consequent and exhaustive monitoring of vital functions should also consider a repeated control of ultrasonic examinations.

ISSN:0253-4886    

DOI:10.1159/000171704

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Perforation of the stomach is the most uncommon complication of cancer of the stomach and was found in 9 of 1,620 patients treated over a 23-year period. The 5-year survival rate of 62.8% indicates that aggressive surgical treatment should be applied where possible. In some patients, radical resection is performed as a second procedure after recovery from the acute episode of perforation.

ISSN:0253-4886    

DOI:10.1159/000171705

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Patients who experience upper gastrointestinal bleeding and at endoscopy are found to have a nonbleeding visible vessel within an ulcer crater have been reported to have a 50–100% incidence of rebleeding. Over the past 2 years, we have successfully treated 14 of 15 such patients with a bipolar electrocoagulation device. During the remainder of their hospitalizations, 2 (14%) rebled (1 death) and 2 (14%) underwent surgical procedures (1 death). Six of the twelve nonoperated patients died in the hospital, however only 1 of these died from or experienced rebleeding and only 1 died after less than 2 weeks. While overall mortality was high in these patients, almost all of the deaths were inevitable and not associated with bleeding. Considerations such as safety, portability and relative inexpensiveness make bipolar electrocoagulation an attractive form of transendoscopic therapy worthy of further stud

ISSN:0253-4886    

DOI:10.1159/000171706

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

The clinical spectrum and the diagnostic strategies in 99 patients with non-calculous distal common bile duct (CBD) obstruction seen over a period of 5 years have been studied. A benign stricture was found in 26 patients, 15 had a distal cholangiocarcinoma, 11 a periampullary tumour, 45 cancer of the pancreatic head and 2 duodenal cancer. The presenting symptoms were non-specific and allowed no differentiation between the groups. Similarly, biochemical and radiological findings did not reliably distinguish benign from malignant causes of obstruction. Misdiagnosis was common except in the pancreatic tumour group, with previous surgery undertaken in 38% of the patients. A high resectability rate was found for CBD tumours (80%) and periampullary tumours (73%). High morbidity and mortality rates were found for both resective and palliative surgery. The non-specific symptom pattern in these patients and the high frequency of misdiagnosis points to the need for a thorough pre- and intra-operative diagnostic strategy. An operation should not be performed if the surgeon is not prepared to proceed with elaborate and extended surgery.

ISSN:0253-4886    

DOI:10.1159/000171707

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Intramural hematoma of the small intestine following anticoagulant treatment is an unrecognized abdominal emergency and in most cases a contraindication to surgery. 12 cases of intramural hematoma of the small intestine are presented: single, segmental, jejunal (in 11), submucosal only, or spreading to the intestinal wall and the mesentery, with more or less important hemoperitoneum, regressing spontaneously within 3 weeks. Abdominal pain was noted in 12 cases, intestinal obstruction in 8, subocclusion in 2. The patients’ general condition was good. Locally, pain and periombilical guarding were noted in 12, a mass in 4, a painful bulging or rectal examination in 6. The diagnosis was confirmed by laparotomy in 2 cases by a supposed association with (a) long-term anticoagulant therapy for a major cardiovascular disease (11 cases); (b) a fall in the prothrombin time below 10% (11 cases) and in hematocrit (5 cases); (c) suspect but nonspecific abnormalities of an emergency contrast film of the small intestine in 10 cases, which completely regressed within 3 weeks; and (d) the sedation of all symptoms 2–3 days following the withdrawal of vitamin K antagonists. 10 patients, therefore, were cured by medical treatment alone, 1 underwent laparotomy and 1 a segmental ileal resection. There were no deaths. Vitamin K antagonists were changed to Calciparine to be resumed in 8 cases (on the average upon the 11th day) without complications or recurrence of sympt

ISSN:0253-4886    

DOI:10.1159/000171708

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Eighteen patients suffering from Crohn’s disease complicated by enterovaginal fistula are presented. In 3 patients the fistula originated in the ileum. These patients were cured by segmental resection and anastomosis. In 15 patients the fistula originated in the rectum. Two patients were not treated surgically. In 2 patients local repair was successful. Four patients underwent a primary proctectomy and 4 patients had a proctectomy later on in the course of the disease. Three patients with a healed fistula have diverting enterostomy. On the basis of this series and cases collected from the literature, a plea is made to extend the use of local repair in patients with this complication of Crohn’s dise

ISSN:0253-4886    

DOI:10.1159/000171709

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Mesenteric lymph flow changes induced by the administration of 2 exogenous synthetic gastrointestinal hormones, porcine motilin and bovine neurotensin, were investigated in the cat. Motilin infusion (5–10 µg/kg/h) augmented the intestinal mesenteric lymph flow considerably, and this effect was abolished by concurrent infusion of neurotensin (5 µg/kg/h). The observed lymph flow changes induced by the 2 hormones correlated well chronologically with motility of the proximal intestine in this in vivo feline model. Enhanced contraction of the ileum and colon induced by the administration of neurotensin in this species indicates that species differences exist in this neurotensin response in motility of the distal intest

ISSN:0253-4886    

DOI:10.1159/000171710

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

A fatal case of acute fulminant bleeding in pancreatitis associated with portal hypertension and caused by rupture of the splenic vein is reported, and the pathological and clinical features of this uncommon complication are discussed. One hundred and fifty-nine cases of massive bleeding in pancreatitis reported in the literature of the last 8 decades are also reviewed. Mortality rate and etiology of the bleeding seem to be related, since in chronic pancreatitis it is 34.6%, while in acute pancreatitis it is 60%. When bleeding is caused by splenic vein lesion, the mortality rate is 75 %. In such cases, a rapid diagnosis constitutes the only chance for a successful treatment on condition that therapy is immediately instituted.

ISSN:0253-4886    

DOI:10.1159/000171711

出版商:S. Karger AG    

年代:1985

数据来源: Karger

ISSN:0253-4886    

DOI:10.1159/000171712

出版商:S. Karger AG    

年代:1985

数据来源: Karger