摘要:

It is a general notion that antireflux surgery loses efficacy over the years. However, this has not been our experience with round ligament cardiopexy – the so-called ‘sling approach’. The systematic follow-up protocol was limited to clinicoradiological evaluation since 1966, however, instrumental exploration being optional (only 57% of patients accepted). As recurrences may go unnoticed on conventional exploration, we carried out an objective study of 100 consecutive patients treated 17–24 years before (1965–1971). The first 50 cases (involving the initial failures) were excluded, as were cardiopexies added to operations for lithiasis or ulcers and brachyesophagus with or without stenosis. All patients were subjected to a new protocol: clinicoradiological examination, application of the Frenchay Hospital criteria reduced to three grades (A and B being asymptomatic, they were represented as grade 0), and at least one instrumental exploration (endoscopy, manometry and/or pH-metry), likewise represented by three grades. Twenty asymptomatic patients (operated on over 17 years before) who refused instrumental exploration were excluded. We likewise excluded 16 patients who had died due to unrelated causes, and 19 patients who could not be located. In a first clinicoradiological evaluation, 80 patients were classified in groups A and B (grade 0), 14 in group C (grade 1) and 6 in group R (grade 2). Adding the objective evaluation (2 explorations/patient, average) evidenced no significant changes in this distribution, even without taking into account the 20 excluded asymptomatic cases. Only 3 group C cases converted to R (recurrence; sum of points/number of explorations > 1), as a result of grade 2 endoscopy and pH-metry. In turn, 1 R case with few symptoms converted to group C (endoscopy, manometry and pH-metry grades 1, 0 and 1, respectively). In conclusion, our mean objective follow-up of 21 years shows that cardiopexy offers lasting antireflu

ISSN:0253-4886    

DOI:10.1159/000172031

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Detergent properties of bile salts are thought to account for their capacity to damage the gastrointestinal mucosa. Bile salts are thought to disrupt the mucosal barrier by dissolving the lipid components of cell membranes. We tested this hypothesis by comparing deoxycholate to several classes of detergents (anionic, nonionic, zwitterionic, cationic) in an in vivo perfused rabbit model of esophagitis. Barrier disruption was indicated by elevated transmu-cosal fluxes of glucose, calcium and potassium. Detergent strength was measured by the in vitro release of [3H]cho-lesterol from a mixture of phosphatidylcholine and cholesterol after 1 h of agitation at 37 °C and pH 7.4. We found that all detergents significantly solubilized cholesterol in vitro. The nonionic agents were strong detergents, but did not disrupt the esophageal mucosal barrier. The ionic detergents were also strong detergents, but caused significant barrier disruption in vivo. We conclude that the barrier-disrupting capacity of bile salts is not related to their detergent properties per se, but rather to some other physiochemical property not yet determined

ISSN:0253-4886    

DOI:10.1159/000172032

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

This study analyses the resting pressure of the lower oesophageal sphincter and the motor function of the oesophageal body in 53 patients with gastro-oesophageal reflux disease, diagnosed through clinical data, endoscopy, biopsy and, in some cases, long-term monitoring of intra-oesophageal pH. The patients were divided into two groups: mild oesophagitis (n = 25) and severe oesophagitis (n = 28), and the manometric and pH-metric results obtained were compared with those of a control group comprising 20 healthy volunteers. This analysis concludes that resting sphincter pressure is inversely related to the severity of oesophagitis and acid reflux rate, and that there is a motor alteration in the oesophageal body, with a motor uncoordination model predominating in the mild oesophagitis group, and a hypokinetic motor model in the severe oesophagitis group. Both types of peristaltic dysfunction contribute to the increase in exposure of oesophageal mucosa to the material refluxed, thus aggravating the oesophagitis.

ISSN:0253-4886    

DOI:10.1159/000172033

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Eight patients with gastroduodenal resection and Billroth II reconstruction, symptomatic for slow gastric emptying (Visick III), were studied. Clinical features, scintigraphic gastric emptying and jejunal efferent loop manometry were evaluated. A comparison of the scintigraphic and manometric procedures showed that the incidence of clustered contractions is correlated to gastric emptying rates.

ISSN:0253-4886    

DOI:10.1159/000172034

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Contradictory statements exist regarding the necessity of a preoperative localization in organic hyperinsulinism. In a general inquiry of all surgical clinics with more than 100 beds in the Federal Republic of Germany, we wanted to know the diagnostic procedures and the results in cases of organic hyperinsulinism. Questionnaires were sent to 404 clinics, and 266 (65.8%) responded. In 1988, 108 patients with organic hyperinsulinism were operated on in the Federal Republic of Germany. Two thirds of all clinics used intraoperative sonography, nevertheless nearly all of them additionally performed preoperative localization. With the use of intraoperative sonography, 96.5% of all insulinomas could be found, compared to only 91.3% without it. These results show the importance of intraoperative sonography, as well as the value of the preoperative localization.

ISSN:0253-4886    

DOI:10.1159/000172035

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

A retrospective analysis was made of 115 patients who had undergone laparotomy for ductal cell carcinoma of the pancreas. The purpose of the analysis was to analyze the surgical statistics of patients with cancer of the distal pancreas by comparing them with those of patients with cancer of the proximal pancreas. Twenty-six patients with cancer of the caudal pancreas were predominantly distributed in the advanced stages in comparison with 89 patients with cancer of the head of the pancreas. Nevertheless, the resection rate, operative mortality, early and late postoperative morbidity and postoperative physical performance status were not significantly different in these two groups when patients with the same stage of cancer were compared. Also, the survival rates after resection or after palliative surgery were not significantly different in these two groups. We therefore conclude that the location of cancer of the pancreas does not affect the results of surgery.

ISSN:0253-4886    

DOI:10.1159/000172036

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Variceal hemorrhage is a major cause of death in cirrhotic patients despite treatment by sclerotherapy. Of our first 21 liver transplants, 8 had already suffered from variceal bleeding which was treated successfully by sclerotherapy, but 3 cirrhotic patients, eligible for orthotopic liver transplantation (OLT), had to be operated immediately after an acute episode of bleeding. Two patients underwent OLT and 1 had a portocaval H-graft shunt placed close to the liver, followed 5 weeks later by OLT. When variceal bleeding remains uncontrolled, emergency OLT is a possible alternative, provided the responsible hepatopathy is a valid indication for OLT. When no graft is available and hepatic function allows it, a portocaval H-graft shunt can be proposed since it only slightly increases the technical difficutly of a postponed OLT.

ISSN:0253-4886    

DOI:10.1159/000172037

出版商:S. Karger AG    

年代:1991

数据来源: Karger

ISSN:0253-4886    

DOI:10.1159/000172038

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Subcutaneous perianal fistulas may occur either as a result of a chronic fissure-in-ano or as a variant of the fistula-in-ano formed from abscesses of the anal crypt glands. Sphincterotomy is mandatory in the fissure-fistula complex. Two cases are described which illustrate both etiologies. The differences in clinical presentation, pathology and treatment are discussed.

ISSN:0253-4886    

DOI:10.1159/000172039

出版商:S. Karger AG    

年代:1991

数据来源: Karger

ISSN:0253-4886    

DOI:10.1159/000172040

出版商:S. Karger AG    

年代:1991

数据来源: Karger