摘要:

A review of 1,000 appendectomies is presented. Age, sex, morbidity, mortality, pathological diagnosis, white blood count, body temperature and length of hospitalization were evaluated and correlated with similar studies reported over a 5-year period. Overall negative appendectomy rate was 21 %. Rate of perforation was 13 % overall, but 23% among children under 10 years of age and 17% in patients over 50. Overall mortality rate was 0.3%. We found white blood cell count and body temperature to be of limited diagnostic value. Overall length of hospitalization for patients with inflamed appendix was 8 days; during the last 5 years a decrease in hospitalization time was noted. No change in diagnostic accuracy was found, although a reduction in perforation rate was noted since 1976. Acute appendicitis and its complications will continue to be a daily surgical problem. We do not yet have an accurate means of diagnosis, and therefore the decision to operate will continue to be based on clinical grounds with minimal reliance on laboratory findings.

ISSN:0253-4886    

DOI:10.1159/000171677

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

The incidence of post-operative septic complications occurring in 46 patients with pancreatic malignancy and in 49 patients with chronic benign pancreatic disease has been assessed. Infection was more common in patients with benign disease and correlated closely with the presence of bacteria in the bile. Risk factors associated with the development of post-operative infection included jaundice, nutritional impairment, diabetes, previous biliary or pancreatic surgery, alcohol abuse and the use of invasive radiological procedures for pre-operative assessment. Biliary carriage of Candidaalbicans was high in patients with pancreatic disease and was a frequent, unexpected cause of post-operative septic complications.

ISSN:0253-4886    

DOI:10.1159/000171678

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

In order to resolve the argument as to whether endotoxin is taken up into portal blood in healthy people, simultaneous portal and systemic venous blood samples were taken from 17 patients undergoing elective upper abdominal surgery and assayed for endotoxin using a chromogenic substrate assay. Systemic blood samples from 119 control subjects were also tested. 116 of the controls (97.4%) had plasma endotoxin values below 0.15 optical density (OD) units (trace amounts). Endotoxin was undetectable in systemic samples from surgical patients and in 14 of 17 portal samples. 3 samples had endotoxin values below 0.05 OD units. We have found no evidence of significant uptake of endotoxin into portal blood in the absence of intestinal disease.

ISSN:0253-4886    

DOI:10.1159/000171679

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

During 1958–1984, 76 patients with esophageal achalasia were treated at our clinic. The techniques of Heller and Wendel or the modified Girard technique have been successfully performed on 56 cases without any postoperative accidents. In 43 (77%) of theses cases, the operation was performed by the modified Girard method with a successful result. The technical point of the modified Girard method consists in a long myotomy, while the mucosa valve, created by horizontal suture, works as a reflux-preventing valve. Here we report the details and follow up studies of this metho

ISSN:0253-4886    

DOI:10.1159/000171680

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Intraoperative ultrasonography of the pancreas (IUSP) was performed in 32 cases. In 9 patients with a normal pancreas, demonstration of vessels and ducts was always possible in a homogenous parenchyma. In 23 patients with pancreatic disease, ultrasonic exploration confirmed pre- or intraoperative diagnosis in 22 cases and in 1 case showed a chronic pancreatitis instead of the suspected carcinoma. Additional informations were provided in 56% of the cases. IUSP avoided dissection in 30% of the cases by detection of tumor invasion or by precise localization of necrosis. In only 1 case of a calcified pancreas was the exploration incomplete and interpretation uneasy. This type of intraoperative investigation reliably completes the most usual explorations. We found this technique particularly useful in localizing small lesions, in determining vascular connections of masses and in searching for tumoral involvement.

ISSN:0253-4886    

DOI:10.1159/000171681

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

The records of 13 adult patients operated on for a choledochal cyst were reviewed. The cyst was saccular in 6 patients and fusiform in 7. A fusiform enlargement of the main intrahepatic ducts was associated in 5 cases. In 5 patients the pancreatico-biliary ductal union occurred at a high position, forming an abnormally long common terminal duct. 11 patients underwent an excision of the cyst with Roux-en-Y hepaticojejunostomy. Microscopically, the wall of the cyst consisted of fibrous tissue usually devoid of epithelium and muscle layer. Recovery was uneventfull with good late results in most patients. A precise knowledge of its radiological features is necessary to recognize this anomaly and manage it adequately.

ISSN:0253-4886    

DOI:10.1159/000171682

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Ascites retransfusion or peritoneovenous shunting is used for the relief of ascites refractory to standard medical treatment. In one third of patients, intravascular coagulopathy has been observed after shunt insertion; bleeding led to a postoperative lethality of about 20%. The pathophysiology of this complication has remained unknown so far. Since conventional parameters failed to predict the incidence of coagulation abnormalities, we studied the role of plasminogen in ascitic fluid. Forty-four patients underwent ascites retransfusion, either extracorporeal (n = 16) or by peritoneovenous shunting (n = 28). All patients with plasminogen levels below 0.7 CTA U/ml showed signs of fibrinolysis during retransfusion, 5 of them bled. The patients with a plasminogen concentration above 0.7 CTA U/ml had no coagulation abnormalities. An increase in plasminogen concentration was induced by injections of dexamethasone intraperitoneally. If the concentration reached 0.7 CTA U/ml prior to retransfusion, no coagulation abnormalities occurred. We conclude that the plasminogen concentration in ascitic fluid is a reliable prognostic parameter for the occurrence of coagulopathy after ascites retransfusion.

ISSN:0253-4886    

DOI:10.1159/000171683

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

We describe 3 patients with primary sclerosing cholangitis and symptomatic pancreatic disease. There is good evidence for a true association between primary sclerosing cholangitis and pancreatitis. The possible causes for this association are discussed. The symptoms of pancreatic disease in primary sclerosing cholangitis may be easily misattributed. We recommend pancreatography in all patients with a diagnosis of primary sclerosing cholangitis.

ISSN:0253-4886    

DOI:10.1159/000171684

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Of a total of 5,745 colon and rectum operations performed from 1963 to 1984, there were 396 anterior resections among 1,568 rectal carcinomas treated from 1971 to 1984. Since 1977 the percentage of anterior resections has increased to a maximum of 46.8% in 1980. The introduction of the stapler extended the indication. But the increasing number of local recurrent tumors stopped the further increase of resections, which has been about 40 % since 1980. The rate of local recurrent tumors after abdominoperineal resections was 10% for years. The hand and the machine suture techniques have the same complication incidence (leakage rate: 14.2 and 13.9%, respectively). The indication for resection has to be set according to staging and grading of the tumors. Below Dukes B3 and, in case of high-graded malignancy, excision of the rectum is carried out even if anterior resection is possible.

ISSN:0253-4886    

DOI:10.1159/000171685

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

A pancreatic pseudocyst with mediastinal extension is reported and 27 patients previously reported are reviewed. The most common presenting symptoms are abdominal or chest pain and dysphagia. The findings of a mediastinal mass associated with pancreatitis strongly suggest that pancreatic aetiology should be sought. Careful radiological assessment is most important. Internal drainage of the mediastinal portion of the pseudocyst is the procedure of choice.

ISSN:0253-4886    

DOI:10.1159/000171686

出版商:S. Karger AG    

年代:1985

数据来源: Karger