摘要:

Mesenteric cysts are unusual abdominal tumors. The clinical presentation of patients with mesenteric cysts is variable and often mimics other intra-abdominal disease processes. In an effort to assess our management of these patients, the medical records of all patients with a diagnosis of mesenteric cyst seen at the Pennsylvania State University, Milton S. Hershey Medical Center, from 1973 through 1988 were reviewed. Patients with omental or retroperitoneal cysts were excluded from this study. The diagnosis was established either by laparotomy or autopsy in 9 patients, 6 women and 3 men with a mean age of 49.6 years. The mean duration of symptoms was 2.4 months (range 5 days to 8.4 months). The most common symptoms were abdominal pain, nausea and early satiety; however, 4 patients were completely asymptomatic. Ultrasound and CT scans were the most helpful diagnostic tests. At elective laparotomy, cysts were managed by enucleation or incontinuity bowel resection. Cysts were found most commonly in the small bowel mesentery (44%) and volumes ranged from 1 to 4,890 cm3 (average 890 cm3). Pathologic examination showed the cyst fluid to be serous in 6 patients and chylous in 2 patients without malignant changes. However, in 1 patient whose cyst was filled with hemorrhagic gelatinous material, histology confirmed a low-grade leiomyoblastoma. There were no operative mortalities and no evidence of recurrence during a mean follow-up period of 44 months. We conclude that because of the definite risk of neoplastic disease, all patients diagnosed with mesenteric cysts either preoperatively or incidentally at laparotomy should undergo enucleation or incontinuity resection as the treatment of choice for mesenteric cysts.

ISSN:0253-4886    

DOI:10.1159/000171944

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

This study deals with the anal closure function after total perineal rupture during delivery. 33 women suffering from such a birth trauma immediately repaired after the injury were examined by the modified Holschneider-Metzler score and by clinical digital palpation and manometric investigation of the anal function 2 years after delivery. There were no statistical differences in the score point values compared with the data of control volunteers of the same age. After perineal rupture the digital palpation of anal sphincters showed similar findings in most of the patients compared with the controls. The manometric values demonstrate a small tendency to decrease in patients after perineal rupture. Only the maximum anal basal pressure at rest and the length of the high-pressure zone during coughing are significantly diminished in the investigation group. We want to underline the importance of an exact repair of the anal sphincter immediately after delivery and the necessity of physiotherapeutic exercises of the pelvic floor. In such cases there are no or only small disturbances of anorectal function. Examinations of women after total perineal rupture must include case history, rectal digital palpation and manometric investigations of the anorectum.

ISSN:0253-4886    

DOI:10.1159/000171945

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Familial adenomatous polyposis (FAP) is a well-recognized precancerous lesion for which large bowel resection is the only possibility of obtaining a cure. The senior author’s personal experience with the surgical treatment of 12 patients suffering from this disease is analyzed, and forms the basis for a discussion of what might be considered the ‘ideal’ approach. A restorative proctocolectomy with ileoanal anastomosis (technique I) was performed in 4 patients; total colectomy followed by ileorectal anastomosis (technique II) in 5, and panproctocolectomy with a definitive Brooke ileostomy in 3 (technique III). There was no operative mortality. Two patients from technique II (40%) developed rectal cancer 4 and 5 years after surgery, respectively, for which an abdominoperineal proctectomy with a conventional ileostomy was performed. The long-term results among patients of technique I, in terms of anorectal function, are excellent, suggesting that this modality is probably the most appropriate approach to FAP when dealing with a patient under 45 years o

ISSN:0253-4886    

DOI:10.1159/000171946

出版商:S. Karger AG    

年代:1990

数据来源: Karger

ISSN:0253-4886    

DOI:10.1159/000171947

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

The unsatisfactory results in the nonsurgical treatment of esophageal variceal bleeding may now lead to a renewed interest in surgical treatment, either portasystemic shunts or a direct surgical approach to esophageal varices. On the other hand, a new and important fact is the extension of liver transplantation to include selected patients with alcoholic cirrhosis. In this respect, hemostatic procedures, such as balloon tamponade and endoscopic sclerotherapy, are preferable. If a portasystemic shunt is necessary, it should avoid using the portal vein itself, although the experience of our group has suggested that the transplantation can be performed whatever the type of shunt, without too much difficulty.

ISSN:0253-4886    

DOI:10.1159/000171948

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

From October 1976 to November 1988, 121 pancreatic transplantations (TX) were performed in 114 insulin-dependent diabetes patients (IDD; 71 males and 43 females, mean age 37 years, mean duration of IDD 23 years). 101 transplantations were simultaneous kidney and pancreas TX, 13 were pancreas TX alone, and 7 were nonsimultaneous double TX. Surgical techniques used were duct obstruction by neoprene injection of segmental grafts in 107 patients and 14 pancreaticoduodenal transplantations with enteric drainage. Actuarial survival of kidney and pancreas was, respectively, 77 and 48% at 1 year and 67 and 40% at 2 years. Results gradually improved with new immunosuppression using quadruple therapy. Losses of pancreatic grafts were due to rejection (27 cases), thrombosis (24 cases), pancreatitis (3 cases), and death with a functional graft (18 cases). In November 1988, 43 patients have functional grafts and are off insulin. Amelioration of neuropathy was observed in most patients; however, this may be due to normalization of renal function.

ISSN:0253-4886    

DOI:10.1159/000171949

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

This study is concerned with a western series of 521 squamous cell carcinomas of the thoracic esophagus treated over a recent 9-year period. Six points of the preoperative work-up are discussed: (1) total endoscopy; (2) respiratory function; (3) hepatic function as most of the patients were heavy smokers and alcoholic; (4) nutritional status; (5) CT scan, and (6) ultrasonography in order to assess the value of preoperative renutrition and the true correlation between surgical findings and CT scan and ultrasonography. When no curative resection can be performed, the discussion is centered on the effectiveness of chemotherapy and of palliative surgery. As far as curative resection is concerned, the indications of cervical and intrathoracic anastomoses and ‘en bloc’ posterior mediastinectomy versus blunt dissection are discussed. The mortality rate in this series of 235 curative resections was 6.4% due to pulmonary infection and fistulas. The late results are studied according to the Japanese classification. The overall 5-year actuarial survival is 19% and 30% for the group of curative resection in stages 0, I and

ISSN:0253-4886    

DOI:10.1159/000171950

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Biliary cysts of the liver are more frequently recognized by noninvasive imaging procedures such as ultrasonography or CT scan. They are usually small and asymptomatic and require no treatment. The aim of this study was to discuss when a surgical treatment may be recommended, and what procedure to perform, on the basis of 16 patients operated on from 1970 to 1988. Preoperative diagnosis of biliary cyst were made before operation in 13 cases. In 3 cases the incorrect diagnosis of a hydatic cyst, a hepatic metastasis, and a pancreatic pseudocyst was made. Unroofing of the cyst without dranage of the residual cavity was performed in all the cases but 2. In 1 case with an associated cholangiocarcinoma a hepatic resection was performed, and in another case with a small right centrolobar hepatic cyst nothing was done. Postoperative course and long-term follow-up (6 months to 10 years) were uneventful. This experience suggests that patients with biliary cysts have to be operated on only if (1) the cyst is symptomatic, which is a rare, (2) the cyst is very large and troublesome, and (3) there is doubt regarding hepatic metastasis or hydatic cyst. Unroofing without drainage is the procedure of choice.

ISSN:0253-4886    

DOI:10.1159/000171951

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

From 1972 to 1986, 246 patients, with a large majority of alcoholics, were operated on for chronic pancreatitis. Mean age was 44.2 ± 23.4 years and the male/female sex ratio was 217/29. In 223, 22 and 1 patients, 1, 2 or 3 laparotomies were performed, respectively. In 12 patients laparotomy was only explorative. In all others, at each laparotomy, 1 surgical procedure was performed in 207 patients, 2 procedures in 42, 3 procedures in 8 and 4 procedures in 1. These various procedures were as follows: external drainage: 17; biliary, gastric, pancreatic, cystic internal diversions: 142; distal pancreatectomy: 51; pancreaticoduodenectomy: 47; total pancreatectomy: 1. Abdominal pain was the most frequent symptom (60%). Morphological features other than pancreatic abnormalities were frequent: biliary and duodenal obstructions account for 40 and 23.5% of the surgical indications, respectively. The choice among these numerous surgical options are presented in detail and discussed. Overall operative mortality was 7.7% (patients), 7% (laparotomy), 9% in the resection group and 5.8% in the other group. Our best long-term results were observed after the Whipple procedure with a 15-year survival rate of 74.5%

ISSN:0253-4886    

DOI:10.1159/000171952

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Between January 1968 and January 1988, we treated 51 patients with carcinoma in the upper third of the biliary tract. 38 of these patients had tumor resection, which was successful in 23 cases (60.5%). The remaining patients received some form of palliative therapy. The 30-day mortality rate following resection was 8.7%, while the mortality rate after palliative surgery was 25%. Mean survival following resection was 26 months, while the mean survival of patients after palliative treatment was only 7.6 months. We concluded that carcinoma in the upper third of the biliary tract should always be explored in order to plan surgical resection.

ISSN:0253-4886    

DOI:10.1159/000171953

出版商:S. Karger AG    

年代:1990

数据来源: Karger