ISSN:0253-4886    

DOI:10.1159/000172338

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Albeit there have been numerous reports, but it has still not been completely clarified what the exact role (if any) of pregnancy is in the development of gallstone disease, or its influence in previously existing silent disease. Controversy remains, but a direct relation seems to exist between the number of pregnancies and the appearance of gallstones or sludge, mainly in young mothers. However, in many instances there has been a regression or disappearance of sludge, or even stones after delivery. Physiologically, pregnancy also affects the bile and the gallbladder (structurally and mechanically), probably rendering this combination of effects very lithogenic. In this review, the world literature is discussed and conclusions, as much as data permit, are reached regarding epidemiology, physiology, diagnosis and management of gallstone disease during pregnancy.

ISSN:0253-4886    

DOI:10.1159/000172339

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Radical operations for lower esophageal cancer, including lymph node dissection in the upper, middle and lower mediastinal and the upper abdominal regions were performed through a left oblique thoracolaparotomy and a right posterolateral thoracotomy in 5 cases. A satisfactory surgical view through the oblique thoracolaparotomy insured easy, safe and complete removal of the tumor and the lymph nodes in the lower mediastinal and upper abdominal regions, and additional right posterolateral thoracotomy was useful for the lymph node dissection in the upper and middle mediastinum. Reconstruction was performed by the intrathoracic anastomosis between the upper esophagus and the gastric tube or jejunum using the EEA stapling device. Extubation of a tracheal tube was possible within 3 days after operation in all cases, and no respiratory complication was noted in any case. This new approach for lower esophageal cancer is considered to be useful for easy, safe and complete removal of the tumor and the regional lymph nodes.

ISSN:0253-4886    

DOI:10.1159/000172340

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Beetween 1979 and 1992, 18 patients with esophageal achalasia underwent surgical treatment in our Department of Surgery II. The operative procedure was mainly selected according to the X-ray type while also taking the seriousness of symptoms into consideration. There were 9 patients with spindle type: an anterior myotomy was performed in 7 patients, while the remaining 2 patients exceptionally underwent a subtotal esophagectomy because of the presence of esophageal carcinoma. A fundic patch procedure was performed in 9 patients with either non-spindle-type achalasia or with critical regurgitation. A follow-up study was done by esophagram and endoscopy, and the postoperative quality of life was also evaluated by a questionnaire interview. There were neither procedural complications nor postoperative deaths. In the questionnaire interview of 16 patients, excluding the 2 patients with esophageal carcinoma, the improvement rates of dysphagia, regurgitation, and coughing were 100%, while the improvement rates for heartburn and retrosternal pain were 84.5 and 88.9%, respectively. No evidence of a recurrence of achalasia was detected after an average follow-up period of 8.8 (range 1-13) years. We believe that both anterior myotomy and fundic patch operation are still useful options for the treatment of esophageal achalasia, but only when the patients can be adequately selected on the basis of both the symptoms as well as the objective findings.

ISSN:0253-4886    

DOI:10.1159/000172341

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

This study was performed to evaluate the effect of total parenteral nutrition (TPN) on the postoperative outcome in aged patients (≧ 70 years) with gastric cancer. Patients with normal or mild malnutrition were randomly assigned to two groups: A-1 (n = 20) with postoperative TPN (10 days) and A-2 (n = 20) without TPN, but given intravenous isotonic glucose. Group B (n = 11) having two of the following conditions were selected: > 20% loss of usual body weight, serum albumin < 3.0 g/dl and serum transferrin < 175 mg/dl, cell-mediated immunity multiskin tests < 2 positive. They received preoperative (10 days) and postoperative (2 weeks or longer) TPN. The results showed that anthropometric variables, blood biochemistry and complications were similar in groups A-l and A-2. Group B had significant lower mid-arm muscle circumference and serum protein immediately after surgery and higher anastomotic leakage and infections than groups A-1 and A-2. These findings suggest that TPN had no apparent beneficial effect on the postoperative course in aged patients with normal or mild malnutrition. Those patients (group B) with severe malnutrition were at high risk of anastomotic leakage and infections despite TPN suppor

ISSN:0253-4886    

DOI:10.1159/000172342

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Clinical advantage of terbutaline sulfate (Bricanyl®) was evaluated in 6 patients with anastomotic leakage after gastric operation. Terbutaline sulfate was administered subcutaneously for the purpose of inhibiting exocrine pancreatic secretion during 3 or 4 weeks just after anastomotic leakage was recognized by postoperative upper gastrointestinal series (GIS). We first used the conventional treatment for any anastomotic gastric leakage; intravenous hyperalimentation, nasogastric intubation, antibiotics etc. In addition to these conventional treatments, we added terbutaline sulfate to inhibit pancreatic exocrine secretion. With this treatment, exudates from anastomotic leakage and the levels of pancreatic exocrine enzyme were gradually decreased and eventually the injured anastomosis was completely healed in all cases. In conclusion, treatment with terbutaline sulfate could possibly be useful for stopping anastomotic leakage after gastric operation. The important mechanism by which pancreatic exocrine secretion is inhibited by terbutaline sulfate administration may be due to direct action to the acinar cells of the pancreas

ISSN:0253-4886    

DOI:10.1159/000172343

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Since decision-making in patients with gallstone disease is a very common medical problem, a carefully planned consensus development conference was held to develop a clinical algorithm using an electronically transmitted group response of the panel and the general audience. Only symptomatic patients are candidates for treatment. Minimal diagnostic requirements are ultrasound, determination of leukocytes, alkaline phosphatase and bilirubin in the blood, and preoperative intravenous cholangiography. Detected common duct stones should nowadays be removed by endoscopic retrograde cholangiopancreatography. Symptomatic gallbladder stones are managed by laparascopic cholecystectomy as the new standard treatment. Conventional cholecystectomy should be done in patients with liver cirrhosis and portal hypertension, suspicion of cancer, certain cases of severe, acute or chronic inflammation, severe adhesions in the upper abdomen and pregnancy. Medical stone dissolution and extracorporeal shock-wave lithotripsy should be restricted to a small group of patients with a high surgical risk and who have small, roentgen-negative stones and a patent gallbladder.

ISSN:0253-4886    

DOI:10.1159/000172344

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Intussusception in adults is rare. The authors report 18 cases and illustrate the pathological and clinical findings. Intussusception is usually secondary to a benign small bowel lesion or to a malignant colonic tumour. The diagnosis of ileo-ileocolic intussusception can be made by ultrasonography, by small bowel follow-through examination or by abdominal CT scan. When the colon is affected, barium enema and colonoscopy are very helpful. In the adult, treatment requires surgical intervention.

ISSN:0253-4886    

DOI:10.1159/000172345

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We present a technical variation on Pier’s laparoscopic appendectomy. It consists of skeletonization of the appendix just by the appendix serosa from the tip to the base. Thereby we avoid the continuous changing of instruments involved in the other technique and shorten the operating time. The laparoscopic approach through suprapubic 5-mm trocars provides good cosmetic results. The absence of sophisticated endoscopic surgical instruments (staplers, endo-clips) makes this a relatively low-cost laparoscopic appendectom

ISSN:0253-4886    

DOI:10.1159/000172346

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Pseudomembranous colitis is an increasingly frequent nosocomial infection; it commonly occurs after the use of broad-spectrum antibiotics, that allow overgrowth of Clostridium difficile. Although this microorganism has been associated with relapse of ulcerative colitis, pseudomembranous colitis complicating inflammatory bowel disease is unusual. We report a 63-year-old female with fulminant pseudomembranous colitis complicating ulcerative colitis that required surgery. Colitis due to C. difficile should be considered in patients with ulcerative colitis previously treated with antibiotics.

ISSN:0253-4886    

DOI:10.1159/000172347

出版商:S. Karger AG    

年代:1995

数据来源: Karger