摘要:

The number of gastric cancer patients undergoing surgery at the Kitasato University Department of Surgery during the last 12.5 years totals 1,151. In 989 of these patients, that is, 86%, it was possible to excise the cancer. The incidence of early gastric cancer among these patients was 355. Thus, 37 % of cancer patients subjected to an excision operation had early stage gastric cancer. The next assessment criteria were the spread of the cancer and the long-term survival rate. Thus, for the cancer patients in whom the cancer remained within the gastric mucosa, the (10-year) survival rate was 101.9%. However, for those whose cancer had spread to the submucosa, the corresponding figure was 90.2%. It is, therefore, clear that surgery in early stage gastric cancer provides extremely satisfactory results.

ISSN:0253-4886    

DOI:10.1159/000171773

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Between 1968 and 1981, 138 patients (101 male and 37 female) with a mean age of 38 years were operated on for chronic pancreatitis at the Department of General Surgery, University of Göttingen. Pathogenetic factors were alcohol abuse in 65%, biliary diseases in 14% and unknown in 20%. Surgical therapy included 51 resections (37%) (4 total pancreatectomies, 24 Whipple’s procedures and 23 left pancreatectomy). Drainage operations were performed in 68 patients (49%) (24 pancreaticojejunostomies and 44 cystojejunostomies). Intervention of neighboring organs were performed 23 times. The mean follow-up period was 10 years (4–14 years), the late mortality rate in drainage operations (15 and 19%) was twice as high as after resection procedures (7.5%). Recurrences occurred in 16 % after resections but in 41 % after drainage operations. Latent or manifest diabetes was observed in 21 % after drainage operations but in 63% in the resection group. From these data we conclude that both alcohol withdrawal and the type of planned operations are important factors in the prognosis of chronic pancreat

ISSN:0253-4886    

DOI:10.1159/000171774

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

In order to elucidate the influence of bile duct obstruction on gastric inhibitory polypeptide (GIP) response, 7 anesthetized dogs were given an intraduodenal infusion of 1 g/kg glucose before and again 2 weeks after common bile duct ligation. Blood glucose and GIP responses following glucose loading of the jaundiced animals were significantly higher compared to the control animals in the femoral and portal blood but, nevertheless, the insulin responses were significantly lower not only in the femoral blood but also in the portal blood. These results suggest that bile duct obstruction causes a high GIP level and insulin hyposecretion resulting in abnormal glucose tolerance.

ISSN:0253-4886    

DOI:10.1159/000171775

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Abdominal ultrasound (US) can detect extraintestinal and intestinal manifestations and complications of Crohn’s disease. However, the clinical value of routine examination of all patients with inflammatory bowel disease is not known. A total of 100 patients (70% outpatients) with inflammatory bowel disease – 74 Crohn’s disease (CD) and 26 ulcerative colitis (UC) – was studied by US without knowledge of clinical or laboratory data except the diagnosis of inflammatory bowel disease. 39% of the patients with CD showed intestinal abnormalities (target sign: 18%, bowel conglomerates 5%, bowel wall diameter > 5 mm: 20%, prestenotic dilatation: 1%), while 35% of patients with UC had such abnormalities (19% target sign and 27% increased bowel wall diameter). Gallstones were found in 12% of patients with CD and 4% of those with UC. Cholecystectomy had been performed in 7 and 4%, respectively. Renal stones were found in 4 and 8%, liver abnormalities in 19% of both patient groups. Overall, in 30 and 27% at least one extraintestinal abnormality was seen. No clear correlation of disease activity with the occurrence of intestinal or extraintestinal findings was found in CD while bowel abnormalities were more likely to be detected in patients with active UC. None of the laboratory parameters assessed predicted the finding of gallstones, renal stones or liver abnormalities. Renal stones occurred more often in patients with ileal resection and longer duration of disease. US was found to be useful in the routine investigation of patients with inflammatory bowel disease since it detects a considerable number of extraintestinal complications. In addition, it can demonstrate intestinal abnormalities and complications and might be an additional noninvasive method to assess disease activit

ISSN:0253-4886    

DOI:10.1159/000171776

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Paraneoplastic syndromes have been known for many years, but hepatic tumors have been incriminated only rarely in their pathogenesis. We report 3 patients with hepatic tumors and paraneoplastic syndromes. The first suffered from a hepatoma inducing dysfibrinogenemia and hypercalcemia without any bone metastases and with a normal parathormone level. The second had an isolated hepatic metastasis from a locally cured adenocarcinoma of the colon and severe sensorimotor polyneuritis culminating in tetraparesis. The third presented with hepatoma, the source of ectopic renin secretion causing severe arterial hypertension. All those paraneoplastic syndromes vanished rapidly and completely after tumor resection. Those syndromes were successfully used to monitor early recurrences of the tumors.

ISSN:0253-4886    

DOI:10.1159/000171777

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

In order to identify factors which are useful in predicting death due to liver failure following Sugiura’s procedure for esophageal varices, data were collected retrospectively from 41 cirrhotic patients. It was suggested that four factors such as Child’s score, plasma indocyanine green metabolizing rate, ratio of blood glucose at 60 and 120 min in an oral glucose tolerance test and the molar ratio (VAL + Leu + Ileu)/(Phe + Tyr) had predictive values for a 2-year survival by a multiple linear regression analysis of 11 preoperative factors. A simple scoring system derived from the combination of these four prognostic factors aided to predict outcome in 82% of patients dying of liver failure within 2 years and in 92% of those surviving more than 2 years after the operation. This scoring system was prospectively applied in 10 consecutive patients undergoing Sugiura’s procedure, and it successfully predicted their out

ISSN:0253-4886    

DOI:10.1159/000171778

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Long-term enteral nutrition of patients has proved to be of value not only in cases of esophageal stenosis but in disorders of deglutition due to other causes as well. Endoscopic methods are helpful because of their very low risk. We developed a technique of endoscopic gastrostomy in which a large feeding catheter is pulled through the gastric and abdominal walls perorally following puncture of the stomach with a trocar. The benefits of this method are its safety, the possibility of simultaneous enteral feeding and gastric decompression and the avoidance of tube-induced reflux esophagitis secondary to prolonged nasogastric intubation. Thus indications can be extended to patients in poor general condition and to those in whom gastrostomy is expected to be needed for a short period only.

ISSN:0253-4886    

DOI:10.1159/000171779

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

We previously reported a new technique for handling the EEA stapler for anastomosis of the cervical esophagus and the retrosternally shifted gastric tube after subtotal esophagectomy for cancer of the esophagus. This report describes the results of the application of the technique in 15 patients.

ISSN:0253-4886    

DOI:10.1159/000171780

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

The effects of guar gum on postprandial blood glucose concentrations in patients with postprandial symptoms (3 had dumping) 5–10 years after proximal selective vagotomy were studied. Eight subjects ingested 150 ml of a 50% glucose solution containing 5 g of guar gum and 7 subjects ingested 150 ml of a 50% glucose solution containing 5 g of wheat flour as placebo. Fifteen asymptomatic patients served as the control group. The results showed that guar gum decreased the postprandial rise and also slowed down the reversion of blood glucose concentrations to fasting levels. Changes of postprandial blood glucose concentration are one of the indicators of the unknown mechanism of the postprandial symptoms in patients after proximal selective vagotom

ISSN:0253-4886    

DOI:10.1159/000171781

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

To clarify the clinical problems of side-to-side choledochoduodenostomy as an adjunct to surgical management of cholelithiasis, the operative results of 82 patients treated in our clinic during the past 10 years were studied. There were 73 patients with extrahepatic bile duct stone and 9 with intra- and extrahepatic bile duct stone. Their mean age was 64 years, and the ratio of males to females was 1.2:1. The operative mortality rate was 4.9%; early complications developed in 7% of the patients. Of all patients who were discharged, 32% developed late complications, and 22%, including 3 patients with sump syndrome, revealed ascending cholangitis. During follow-up, 13 patients died, 6 of them of cholangitis. A relationship between the occurrence of cholangitis and the size of anastomosis was investigated, but there was no obvious connection between them. Six (7.3%) patients underwent reoperations caused by cholangitis, residual or recurrent stones and stenosis of anastomosis. Good to excellent long-term results were seen in 78% of all patients, while fair to poor results were observed in the rest. Especially, results in patients with intra- and extrahepatic bile duct stones were poor. These results suggest that it is necessary to carefully consider the indication of this procedure for patients with cholelithiasis.

ISSN:0253-4886    

DOI:10.1159/000171782

出版商:S. Karger AG    

年代:1987

数据来源: Karger