摘要:

In a consecutive series of 310 cholecystectomies performed for gallstones, dissection of the operative area disclosed 75 patients (24%) who had 84 potential anatomic hazards which could have led to a bile duct injury. There were 49 hazards related to the arterial supply, 8 to the position of the Hartmann pouch, and 27 were related to the anatomic features of the cystic duct or of the other extahepatic bile ducts. The practical significance of these hazards in terms of prevention of bile duct injury during cholecystectomy is discussed.

ISSN:0253-4886    

DOI:10.1159/000171689

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Acute pancreatitis occurred in 7 patients 3 days to 8 years after renal transplantation. Three patients had or developed biliary calculi which may have been responsible for the disease and 3 patients had cytomegalovirus infections with rising antibody titres. Two patients had more than 1 attack, 1 patient died and 1 patient, during an episode of acute pancreatitis, suffered rejection of the renal allograft which had to be removed. Aetiology, management and the place of surgery are discussed with reference to 1 patient, in whom interventional radiology successfully avoided the need for further surgery.

ISSN:0253-4886    

DOI:10.1159/000171690

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

During a 9-year period (1971–1979), 208 traumatic splenectomies were registered in northern Israel. 191 (92%) could be followed retrospectively for a mean period of 7.75 years after splenectomy. The mean age was 30.4 years. 3 (1.7%) had infectious complications caused by Streptococcus pneumoniae, and 2 (1.16%) died of the infectio

ISSN:0253-4886    

DOI:10.1159/000171691

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

In an attempt to identify the mechanisms by which the carcinoembryonic antigen (CEA) of gastric cancer tissue origin is secreted into the sera, we determined CEA positivity in tissues and sera of individual patients and compared these data with tumour size, histological classification, postoperative staging, grading, and survival times. CEA was demonstrated in tissues of 93 patients by the indirect immunoperoxidase technique and in sera of 83 patients by an enzymoimmunoassay. CEA was found in 96% of the tumours with the highest intensity of staining in signet-ring cell carcinomas. 25% of patients had elevated serum levels ( > 5.0 ng/ml). Serum levels were clearly influenced by tumour stage, tissular staining intensity and tumour size, but not by histological classifications or tumour grade. Stage III and IV patients with elevated CEA serum levels had a significantly lower survival time (p = 0.0046) than patients with normal levels. These observations are only partly valid for signet-ring cell carcinomas, for which CEA serum estimations are of limited value.

ISSN:0253-4886    

DOI:10.1159/000171692

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

During the last four decades a definite shift has taken place in the location of neoplasms of the large bowel, as reflected by several series of patients in the United States. Currently, there is a greater percentage of right colon adenocarcinomas and polyps, especially when the female and elderly population is examined. These findings have significant implication for prevention, diagnosis and treatment during the coming decades.

ISSN:0253-4886    

DOI:10.1159/000171693

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

The rat model of azoxymethane-induced colonic carcinogenesis was evaluated for the occurrence of an adenoma-carcinoma sequence analogous to that in human beings. Male 10-week-old Fischer 344 rats were given 10 weekly subcutaneous injections of azoxymethane at a dose of 15 mg/kg. Every 2 weeks after the first dose, 5 animals were necropsied. A colon tumor was identified first at week 10. At week 16, at least 60% of the rats generally had a colon tumor. The mean size of the tumors tended to increase progressively during the study. Histopathologic examination showed invasion of the muscularis mucosae or deeper layers of the colonic wall in 74% of the tumors. Invasion was unrelated to the size of the tumors, being identified in even the smallest tumors of 1–2 mm of diameter. Invasion was also unrelated to the severity of dysplasia in the tumors, occurring in 83 % of the tumors with low-grade dysplasia, but in 69% of the tumors with high-grade dysplasia. No tumor showed the histopathologic features of an adenoma giving rise to an invasive carcinoma. The findings indicate that an adenoma-carcinoma sequence analogous to that in human beings does not occur in the rat model of azoxymethane-induced colonic carcinogenesi

ISSN:0253-4886    

DOI:10.1159/000171694

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

The anatomical level reached by the fully inserted flexible sigmoidoscope (60 cm) determines the effective potential of the instrument in the detection of left colon diseases. We performed flexible fiberoptic sigmoidoscopy (FFS) in 50 patients, without the help of fluoroscopy and without trying to reduce the bendings of the sigmoid colon. After having inserted the instrument, the endoscopist would define the section reached: sigma, sigmoid-descending colon junction, descending colon, splenic flexure. Barium sulphate was then injected through the fiberoptic sigmoidoscope in order to verify the level: the exact anatomical localization of the tip of the instrument was therefore determined by means of fluoroscopy. 90% of the investigations visualized the whole sigmoid colon, and in 52% more than 50% of the descending colon was studied; the splenic flexure was reached in only 22% of cases. Worse results, i.e. the visualization of only the sigmoid colon, were achieved in old and overweight patients, who had previously undergone abdominal or pelvic surgery. The paper concludes underlining the great diagnostic potential of FFS in the screening and early diagnosis of left colon diseases. FFS should become the surgeon’s first instrumental investigation even in his own surgery, as the technique is easy to perform, fairly inexpensive and requires simple preparatio

ISSN:0253-4886    

DOI:10.1159/000171695

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

A clinical study was carried out in 717 resected cases of rectal carcinoma. Abdomino-perineal excisions were performed in 75% of the cases and low anterior resection in 25%. Regional lymph nodes were divided into 3 groups (N1, N2 and N3), and operative grades were classified as R1, R2 and R3 according to complete dissection of the corresponding lymph node groups. The 5-year survival rate was 48.8% in the Rl grade, 58.7% in R2 and 67.7% in R3. Even within each stage of cancer advance, the 5-year survival rate was better, as lymphadenectomy was more extensive. Local recurrence within 5 years after rectal surgery occurred in 28% of the cases in the R1 grade, in 19% of R2 and in 10.7% of R3 patients. The rate of urinary disturbance was 6.1, 24.5 and 27.5%, respectively. The rate of sexual dysfunction was 38.2, 68.1 and 76.7%, respectively. Statistically there was no significance in each of the factors mentioned above between abdomino-perineal excision and low anterior resection, but there was a significant difference between the R1 and R3 grade. Extensive lymphadenectomy is indicated for advanced cancer of the rectum, but a more careful maneuver is mandatory in order to protect the pelvic nerves.

ISSN:0253-4886    

DOI:10.1159/000171696

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

A review of the world literature yielded 95 cases of leiomyosarcoma of the esophagus. Another case has been added. The symptoms of esophageal leiomyosarcoma and squamous cell carcinoma are approximately the same. This rare tumor tends to be polypoid, rarely invasive and metastatic. Surgical resection with esophagogastric anastomosis is the best treatment, with a 5-year survival rate of 27.4%.

ISSN:0253-4886    

DOI:10.1159/000171697

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

A gastric diverticulum is an unusual anomaly of the alimentary tract. Of the two types, congenital and acquired, the former is far more common. The majority of congenital diverticula protrude from the posterior gastric wall just inferior to the gastroesophageal junction. While most gastric diverticula are asymptomatic, some are associated with epigastric discomfort that can be medically controlled. A distinct minority result in devastating complications such as perforation or hemorrhage. The preoperative diagnosis of a bleeding gastric diverticulum mandates aggressive lavage and thorough endoscopy of the stomach to include a retroflexed view of the cardiac portion of the stomach. Surgical amputation of the bleeding juxtacardiac diverticulum is the treatment of choice.

ISSN:0253-4886    

DOI:10.1159/000171698

出版商:S. Karger AG    

年代:1985

数据来源: Karger