ISSN:0253-4886    

DOI:10.1159/000172548

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Pseudomembranous colitis constitutes a typical complication of modern antibiotic therapy. Disturbance of bacterial bowel colonization and outgrowth of toxigenic strains of Clostridium difficile are the major pathogenetic events. The clinical presentation ranges from mild watery diarrhoea to severe conditions with peritonitis, dehydration and multi-organ failure. Since C. difficile has been identified as the responsible pathogen, oral therapy with vancomycin or metronidazole has become the golden standard of medicamentous therapy. Although most cases resolve, some worsen towards a life-threatening state. Ileus, toxic megacolon, colon perforation, rebound tenderness and organ failure call for surgical considerations. Once the surgeon is required, prognosis is dubious. Endoscopic decompression should be part of the therapeutic concept. Diverting procedures and subtotal colectomy have been favoured for surgical intervention, the latter as the only one to eradicate the disease.

ISSN:0253-4886    

DOI:10.1159/000172549

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Alveolar echinococcosis (AE), or alveolar hydatid disease (AHD), is an uncommon parasitic disease which behaves like a malignant tumor of the liver, producing liver necrosis and invading the biliary tract, main hepatic vessels and surrounding structures. Only 25% of the patients are candidates for radical surgical resection, the only currently available definitive treatment. Ortho-topic liver transplantation (OLT) has been performed for terminal AE since the mid-1980s. This article reviews the specific problems related to OLT in AE. They represent a number of relative contraindications. Invasion of the duodenum and pancreas or the right atrium by the parasitic masses, and cerebral metastases, are absolute contraindication to OLT. Today, OLT can be considered in AE patients with chronic Budd-Chiari syndrome, severe secondary biliary cirrhosis, intractable cholangitis and biliary sepsis, or involvement of both lobes where radical resection is not possible. In our series, which comprises 22 of the 28 European patients transplanted for AE, 1- and 5-year actuarial survival are 78 and 65% respectively.

ISSN:0253-4886    

DOI:10.1159/000172550

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Since its description in 1956, Nissen 360° fundoplication has become the surgical treatment of choice for reflux oesophagitis. It is therefore not surprising that the Nissen fundoplication has been adopted by laparoscopic surgeons as the preferred method to deal with reflux oesophagitis via the laparoscopic route. Several large series containing over 100 patients who have undergone this procedure have now been published. The transfer of Nissen fundoplication from open to laparoscopic surgery has raised several areas of controversy. There are differing approaches to patient selection, operative procedure and post-operative care. As regards the operative technique itself, there has been a debate about the best patient position, the best way of providing access to the hiatus, the need for crural repair and for fundal mobilisation by division of short gastric vessels. Whilst recognising the differing approaches to laparoscopic fundoplication, we aim to present our own method of performing the operation with an explanation as to why we have elected to adopt certain techniques in this relatively new area of surgery

ISSN:0253-4886    

DOI:10.1159/000172551

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

We present our surgical technique for treating hepatic hydatidosis. This includes careful evacuation of the hydatid cyst through a wide capsectomy, interlocking suturing of the edges of the remaining cavity and postoperative drainage with negative pressure, closed drainage systems. During the operation, the abdomen is carefully isolated and strict precautions are taken to avoid spillage of hydatid fluid. Technical details on treating cystobiliary communications and exogenous daughter cysts are also described. As shown in our series, this method has very acceptable postoperative results, avoiding the complications of more aggressive operations, applied in other centres for the treatment of hydatid disease.

ISSN:0253-4886    

DOI:10.1159/000172552

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The electric activity of the esophagus was studied in 12 mongrel dogs by means of three electrodes introduced into the upper, middle, and lower third of the esophagus (electroesophagogram). The esophageal pressure was measured by a 6-Fr catheter with side ports. Pacesetter potentials (PPs) were recorded showing the same frequency, amplitude, and velocity of conduction from the three electrodes of each dog on all test days. Action potentials (APs) followed the PPs randomly and were associated with a rise in the intraesophageal pressure. Balloon distension effected an increase of the electric activity proximally to the balloon and a decrease distally. These changes were augmented with increasing balloon distension up to a volume of 20 ml beyond which no electric activity, or a ‘silent’ electroesophagogram, was registered. The caudad direction of PPs and APs was evidenced when after esophageal myotomy the potentials appeared proximally but not distally to the cut. This suggests also the presence of a pacemaker in the cervical esophagus which might initiate the PPs. In conclusion, the study demonstrates that the esophagus possesses an electric activity. It is hypothetized that a pacemaker in the cervical esophagus triggers the PPs which in turn initiate the APs. The latter are associated with esophageal motile activity which increases with balloon distension of the esophagus and might be responsible for transmission of food bolus along the esopha

ISSN:0253-4886    

DOI:10.1159/000172553

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Although the incidence of gastric cancer is decreasing, it is still the fifth leading cause of cancer death in Western countries. The reasons for the poor prognosis and the unresponsiveness to chemotherapy and radiotherapy are not known. Recently, growth factor receptors have been shown to play a role in the carcinogenesis and progression of various types of human cancer. In the present study, we have analyzed expression and colocalization of three closely related growth factor receptors – epidermal growth factor (EGF) receptor, c-erbB-2, and c-erbB-3 – in human gastric cancers. Using Northern blot analysis we found a threefold overexpression of EGF receptor, a twofold overexpression of c-erbB-2, and a 1.25-fold overexpression of c-erbB-3 mRNA in gastric cancer in comparison with normal controls. Immunohistochemical analysis revealed the concomitant presence of EGF receptor, c-erbB-2, and c-erbB-3 in gastric cancer cells, indicating that these receptors may combine to contribute to the malignant transformation of cells and give gastric cancer cells a growth advant

ISSN:0253-4886    

DOI:10.1159/000172554

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Forty-nine gastric carcinoma patients were randomized after total gastrectomy to the Hunt-Lawrence pouch reconstruction (pouch group, 26 patients) or to the Roux-en-Y reconstruction without pouch (control group, 23 patients). Mortality, morbidity, and the quality of life during 24 months were determined. The operative mortality was zero. The total complication rate was increased in the pouch group as compared with the control group (65 vs. 35%; p = 0.03). The clinical anastomotic leakage rate was not significantly different between the groups. Operation time, blood loss, or survival did not differ between the groups. Both the reported and measured eating capacities were significantly better, and postprandial early satiety and dumping were significantly less frequent in the pouch group than in the control group.

ISSN:0253-4886    

DOI:10.1159/000172555

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Previous studies demonstrated the occurrence of bacterial translocation in biliary obstruction (BO). In this study, we investigated the effect of lactulose on the prevention of bacterial translocation in rats with BO. The study was performed in 4 groups of rats consisting of 15 animals each: (1) sham-operated controls, (2) sham-operated lactulose-treated, (3) BO physiologic-saline-treated and (4) BO lactulose-treated rats. Lactulose was given perorally by orogastric intubation in a dose of 2 ml of 33.5% solution/day. Fourteen days after BO, bacterial translocation to the mesenteric lymph nodes (MLN), liver, spleen and portal venous blood (PVB) was investigated. In sham-operated controls, 1 bacterial translocation to the PVB was observed. In the BO physiologic-saline-treated group, the rate of bacterial translocation to the MLN (p < 0.001) and the PVB (p < 0.001) was significantly higher as compared with sham-operated controls and the BO lactulose-treated group. Lactulose treatment caused a significant decrease in the number of gram-negative aerobes and facultative anaerobes (p < 0.001) and a significant increase in the number of lactobacilli (p < 0.05) in the cecal population levels of bacteria in sham-operated and BO groups as compared to sham-operated controls and BO saline-treated groups. In histopathological examinations of the terminal ileum and the cecum, subepithelial edema and mucosal disruption were observed in the BO saline-treated group. Lactulose treatment significantly decreased sub-epithelial edema in the terminal ileum (p = 0.02) and the cecum (p = 0.04), and the surface epithelium was normal in rats with BO treated with lactulose compared to the BO physiologic-saline-treated group. Lactulose treatment significantly increased the mucosal thickness in the terminal ileum and cecum as compared to the nontreated groups (p < 0.01 and p < 0.0001). It is concluded that peroral treatment with lactulose significantly reduced the rate of bacterial translocation to the MLN and PVB in rats with BO.

ISSN:0253-4886    

DOI:10.1159/000172556

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Mirizzi syndrome is a rare complication of long-standing gallstone disease and is defined as a partial or complete common bile duct obstruction caused by an impacted gallstone in the gallbladder neck or cystic duct. A subclassification of Mirizzi syndrome into type-I and II lesions has been proposed. Based on this classification a standardized surgical approach is now proposed. In a retrospective series of 18 cases with Mirizzi syndrome, found among 1,759 cholecystectomies performed since June 1986, we treated 7 type-I and 11 type-II lesions. There were 11 females and 7 males with an average age of 74.8 (range 32-87) years, and there was an increased incidence (27%) of concomitant gallbladder cancer found. All type-I lesions were treated by partial cholecystectomy, and 5 patients had concomitant exploration of the common bile duct with T-tube drainage. All type-II lesions received cholecystocholedochalenteric bypass surgery, namely 8 with a Roux-en-Y enterostomy and 3 with duodenostomy. Two patients (1 type-I+ and 1 type-II lesion) had a laparoscopic approach but needed conversion to open surgery because of severe inflammatory adhesions. There was no postoperative mortality and postoperative morbidity was low at 27% (5 of 18 patients). We had 1 case with postoperative bile leakage and 1 with hemorrhage. Three patients who had had biliary-enteric bypass procedures developed benign hepatic duct strictures which were all treated conservatively using endoscopic stenting. This management strategy has yielded very satisfactory results and laparoscopic surgery has been limited to a very small number of patients with type-I lesions.

ISSN:0253-4886    

DOI:10.1159/000172557

出版商:S. Karger AG    

年代:1997

数据来源: Karger