ISSN:0253-4886    

DOI:10.1159/000172485

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The value of laparoscopic appendectomy may not be immediately obvious in comparison to the treatment of gallstone disease. For open appendectomy the overall morbidity is 10-20% (wound infection rate 3-8.5%, intra-abdominal abscess rate 4.3%) and mortality 0.8% (more at the extremes of age). Adhesions between the greater omentum, the cecum and the abdominal wall will occur in 80-90% followed by late bowel obstruction in 2-5% of patients. This can be reduced by using laparoscopic appendectomy and the negative appendectomy rate can be diminished to 7.5%. The laparoscopic advantages are less postoperative pain, shorter hospital stay, less absence from work, less postoperative morbidity, fewer adhesions and superior cosmetic results. The disadvantages of the laparoscopic approach are increased costs, increased operating time, and complications arising from the approach itself. In the review of the literature all prospective randomised series are summarized and it can be concluded that laparoscopic appendectomy is a safe and feasible option for the management of acute appendicitis and will play a major role in the future in dealing with acute appendicitis and right lower quadrant pain.

ISSN:0253-4886    

DOI:10.1159/000172486

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Colo-anal anastomosis represents the only surgical method allowing both resection of the distal third of the rectum and re-establishment of intestinal continuity. Technically similar to a low anterior resection, a transanal approach is used for the distal dissection as this is the only way to ensure that the mucosal excision continues as far as the dentate line. Intestinal continuity is then restored by fashioning a colo-anal anastomosis under direct vision. Alternatively, a colonic reservoir can be created in the form of a J and a pouchanal anastomosis fashioned. A proven technique for this surgical procedure is discussed.

ISSN:0253-4886    

DOI:10.1159/000172487

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

We examined the effectiveness of a new laboratory tool – the leukocyte adhesiveness/aggregation test – in the diagnosis of acute appendicitis. A total of 63 patients, mean age 32 (range 10-85) years, admitted for right lower quadrant abdominal pain were assessed clinically, and laboratory tests were performed. Forty-one of the 63 patients were operated on. Ten (15.8%) were found intra-operatively to have a normal appendix, and the remainder had appendicitis. White blood count, number of neutrophils and monocytes, and leukocyte adhesiveness/aggregation were statistically significant in the 28 patients with frank appendicitis. The aim of this paper is the presentation of the leukocyte adhesiveness/aggregation test as an important tool for more precise diagnosis of acute appendici

ISSN:0253-4886    

DOI:10.1159/000172488

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Objective: Pancreatic ischemia plays an important role in the initiation and outcome of acute pancreatitis. Somatostatin, widely used for its treatment, is also given for gastrointestinal bleeding control, since it operates by decreasing the splanchnic blood flow. The present study was thus conducted in rats to evaluate the influence of the somatostatin analogue, octreotide, given as prophylaxis or treatment, on pancreatic tissue perfusion during recovery from experimental acute pancreatitis. Method: 32 rats were divided into 4 groups: sham operation plus octreotide (group O, n = 8), pancreatitis induction (group P, n = 8), pancreatitis induction plus octreotide (group P+O, n = 8), and octreotide prior to pancreatitis induction (group O+P, n = 8). Acute pancreatitis was induced by sodium taurocholate infusion in a closed duodenal loop and pancreatic tissue perfusion was assessed by means of the laser-Doppler technique at 0, 30, 60 min and 12 h after the initial measurement. Results: All animals exhibited an equal reduction in pancreatic tissue perfusion of about 45% the initial value at 30 min, having either been subjected to pancreatitis (groups P and P+O) or octreotide treatment only (groups·and O+P). At 60 min both groups O+P and P+O exhibited a further reduction (p < 0.001) to 31.61 ± 8.78 and 32.42 ± 5.44% the initial values, while groups·and P remained at 44.18 ± 2.77 and 44.12 ± 2.58% the initial values. At 12 h group·presented pancreatic perfusion equal to 33.37 ± 14.38% the initial value and group P a perfusion of 23.16 ± 3.78%, while groups O+P and P+O exhibited an extreme decline in pancreatic perfusion, the diminution being 11.08 ± 3.77 and 10.97 ± 1.79% the initial values, respectively (p < 0.0001). Conclusions: Octreotide, given either as prophylaxis or treatment, seems to aggravate the already decreased pancreatic perfusion due to the onset of pa

ISSN:0253-4886    

DOI:10.1159/000172489

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Octreotide is a potent inhibitor of exocrine pancreatic secretion and has an analgesic effect in several nondigestive disorders, suggesting that it could be useful in the treatment of pain in chronic pancreatitis. Twenty-seven consecutive patients with chronic pancreatitis and persistent pain were studied. Fourteen had a pancreatic pseudocyst, the mean diameter of which was 7.5 cm (range 5-14 cm). Octreotide was administered subcutaneously at a dosage of 0.1 mg three times daily for 1 week. In 19 of the 27 patients studied, octreotide had no significant effect on pain. These 19 comprised the 13 patients without pseudocyst and 6 of the 14 who did have them. In these latter 6 patients, the size of the pseudocyst remained unchanged during octreotide treatment. In the remaining 8 patients, all with pseudocyst, pain disappeared completely after 2-5 days of treatment. The disappearance of pain occurred concomitant with a reduction in the size of the pseudocyst. The results suggest that octreotide can be an effective analgesic agent in a subset of chronic pancreatitis patients in whom pain is due to the presence of a pseudocyst. In patients with persistent pain not associated with a pancreatic pseudocyst, octreotide seems to be ineffective.

ISSN:0253-4886    

DOI:10.1159/000172490

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

In this study, biological and morphological changes in three synthetic absorbable suture materials, namely poliglecaprone 25 (Monocryl), polyglactin 910 (coated Vicryl), and polydiaxanone (PDSII), in acidic and alkaline buffer solutions, bile, and pancreatic juice, and tissue reactions to these materials were compared. The natural absorbable suture, chromic catgut, was used as a control. When the sutures were immersed in acidic and alkaline pH buffer solutions, bile, and pancreatic juice, the decreases in the tensile strength of Monocryl in pancreatic juice and PDS II in the acidic solution were marked. Bile had little specific effect on Monocryl or coated Vicryl. When the sutures were used in surgery of the biliary tract and the pancreas, tissue reactions, evaluated on the basis of the degrees of granulation and fibrosis, were milder in Monocryl than coated Vicryl. These results suggest that Monocryl sutures can be a possible choice in surgery of the biliary tract. In the selection of sutures, it is important to remember that preserving tensile strength and the tissue reactions may differ greatly depending on the tissue in which they are used.

ISSN:0253-4886    

DOI:10.1159/000172491

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

After ileal J pouch-anal anastomosis, a residual septum in the J reservoir occasionally causes evacuation difficulties and obstructive symptoms. In our experience, 10 of 134 ileoanal anastomosis patients developed this complication, which is known as the apical pouch bridge (APB) syndrome. In our APB syndrome patients, defecography revealed a flap valve-like movement of the mucosal bridge, a change of the ano-rectal angle, and increased residual volume. Endoscopy showed a thickened apical pouch bridge with mild inflammation. The APB syndrome features frequent stools and soiling without a significant difference on anal manometry compared to the normal group. The symptoms of this syndrome are improved by division of the mucosal bridge. This pitfall should be taken into consideration by surgeons when constructing an ileal J pouch.

ISSN:0253-4886    

DOI:10.1159/000172492

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

This study was designed to examine the effect of sepsis on the hepatic functions, particularly from the view point of hepatic lysosomal functions. Endotoxemia was produced in rats by intravenous injection of endotoxin (1 mg/kg), and at 6 h after the injection of endotoxin, we studied (1) the hepatic secretion of lysosomal enzymes (β-glucuronidase, β-galactosidase and N-acetyl-β-glucosaminidase) into bile in the isolated perfused rat liver model; (2) the aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT) and lysosomal enzyme levels in the effluent in the isolated liver model; (3) hepatic lysosomal fragility in an in vitro incubation study; (4) protective effect of a new synthetic protease inhibitor, sepinostat mesilate (FUT-187) against hepatic injuries induced by endotoxin. Decreased hepatic secretion of lysosomal enzymes into bile and accelerated hepatic lysosomal fragility were observed in endotoxemia. FUT-187 showed significant protective effects against these hepatic injuries induced by endotoxin. These results indicate that impaired hepatic functions, depressed hepatic secretion of lysosomal enzymes into bile, and increased hepatic lysosomal fragility, seem to be closely related to the hepatic injuries induced by endotoxin. These results also indicate that some unknown protease activities, which are susceptible to inhibition by FUT-187, seem to play an important role in the development of hepatic injuries induced by endotox

ISSN:0253-4886    

DOI:10.1159/000172493

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The authors report on an unusual case of a large symptomatic focal nodular hyperplasia (FNH) of the liver with multiple well-demarcated areas of anemic infarction presenting diagnostic difficulties because of their size and special radiologic features. A classical radiologic work-up (sonography, CT scan, angiography) first led to an erroneous diagnosis of a malignant liver tumor. There was then magnetic resonance imaging with application of the new liver magnetic resonance contrast agent, Endorem® which rendered the presence of malignancy unlikely and suggested the correct diagnosis of a partly necrotic FNH. The liver mass was removed by resection of segment I. Histology confirmed the diagnosis of FNH and demonstrated large areas of infarction inside the lesion characterized by coagulation necrosis. Infarction in FNH is a rare event. Pathogenic mechanisms are suggested. Recent views concerning diagnosis and treatment of FNH are briefly discussed

ISSN:0253-4886    

DOI:10.1159/000172494

出版商:S. Karger AG    

年代:1996

数据来源: Karger