摘要:

Respiratory movement of the membranous part of the trachea was investigated using cineradiography 3 days and 1 month after operation in 10 patients who underwent thoracic esophagectomy through a right thoracotomy without reconstruction via the posterior mediastinal route, 2 patients who underwent thoracic esophagectomy through bilateral thoracotomy with reconstruction via the posterior mediastinal route (BIL) and 4 patients who underwent lobectomy for right lung cancer (LC). Respiratory movement in the first group was significantly more amplified than in the LC group. In the BIL group, respiratory movement was comparable to that in the LC group. Respiratory movement was amplified after thoracic esophagectomy without replacement of the resected esophagus with the alimentary tract posterior to the trachea, especially in the early postoperative period.

ISSN:0253-4886    

DOI:10.1159/000172210

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

In the last 15 years we operated on 618 patients for acute cholecystitis, of whom 60 were 80 years of age or more. Most of the ever-increasing number of patients within the hospital population who suffer from this disease belong to the over-80 age-group. Acute biliary complications are the major cause of serious morbidity in these patients. The major conclusions of the study were: (1) Acute cholecystitis in patients aged 80 years or more has increased by almost 300% over the last 15 years. (2) Comparison of patients aged 80 years or more with a younger patient group showed that the former had a higher incidence of diabetes mellitus (33.3 vs. 5.5%, p < 0.001), jaundice (26.6 vs. 14.8%, p < 0.001), common bile duct stones (41.6 vs. 21.1%, p < 0.001) and gangrenous changes in the gallbladder wall (38.3 vs. 24.9%, p < 0.05). Older patients also had higher mortality (11.6 vs. 1.6%, p < 0.001). The results in this series show a higher rate of risk factors in aged patients suffering from cholecystitis combined with a higher rate of mortality. It seems that a prompt operative approach could lessen the grave results in this group. Alternative nonsurgical methods should, at present, be restricted to very poor-risk patients as well as patients refusing surgery.

ISSN:0253-4886    

DOI:10.1159/000172211

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

A laparoscopically assisted procedure for the reversal of Hartmann’s colostomy was undertaken in 6 patients. The procedure was successfully done in 3 of them. The technique started with an external resection of the colostomy and the mobilization of the left colon, followed by a laparoscopic preparation of the rectal stump and a laparoscopically assisted stapled anastomosis. No morbidity and no mortality were noted, the mean operative time with laparoscopy being comparable to that with the open technique. Laparoscopic reversal of Hartmann’s procedure remains a difficult operation that has to be converted to an open procedure in 50% of the cases. When it can be achieved without conversion, the laparoscopic reversal procedure is safe and effective and can be undertaken in selected patients. Its value has to be confirmed by controlled stud

ISSN:0253-4886    

DOI:10.1159/000172212

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The results of treatment of anorectal fistula by electrocauterization in 24 patients were compared with those obtained by ‘laying-open’ operation in another 24 patients. The two groups were matched for age, sex, fistula type and follow-up duration. In the cautery group, a fistula cautery probe was introduced into the fistulous track and the electric current was switched on for a few seconds. The laying-open operation was done in the classical way. In the electrocauterization group, recurrence occurred in 3 patients (12.5%). The procedure was done under local anesthesia, as an outpatient procedure. Mild analgesics were given to 8 patients. No antibiotics were administered. Continence was not affected. In the group undergoing laying-open operation, recurrence occurred in 4 patients (16.7%). The procedure was performed under general anesthesia with a mean hospital stay of 2.2 days. Analgesics and antibiotics were given to all patients. Temporary continence disorders occurred in 3 patients; 1 patient remained incontinent for flatus and fluid stools. In conclusion, electrocauterization for anorectal fistula is a simple, easy, safe and effective procedure. Moreover it is less expensive and performed on an outpatient ba

ISSN:0253-4886    

DOI:10.1159/000172213

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

A prospective randomized trial compared post-anal repair (n = 12), anterior levatorplasty (n = 12) and total pelvic floor repair (TPFR) (n = 12) for women with post-obstetric neuropathic faecal incontinence. Anal manometry and videoproctography were performed before and after operation. At 24 months, the quality of continence after TPFR was significantly better than for the other procedures tested. Anal sphincter pressures were not influenced by any of the operations. Only TPFR lengthened the anal canal, raised the pelvic floor and improved pelvic floor movements. These data suggest that TPFR is the best form of operation on the levator ani for women with neuropathic faecal incontinence.

ISSN:0253-4886    

DOI:10.1159/000172214

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

A 67-year-old female with a known paraesophageal hernia presented with dysphagia and weight loss. Workup revealed distal esophageal obstruction without a mass lesion. At operation a distal esophageal adenocarcinoma was identified and resected.

ISSN:0253-4886    

DOI:10.1159/000172215

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The word ‘bezoar’ is derived from the Arabic ‘badzehr’ which means antidote or counterpoison. Trichobezoars (hair) and phytobezoars (vegetable matter) may be found in the gastrointestinal tract of humans. In this case report we present two cases with bezoar and their treatment. A 36-year-old mentally retarded woman was admitted to the hospital and referred to the surgery clinic since an epigastric mass was palpated. The major complaint of the patient was loss of hair and an epigastric discomfort was sometimes present. The bezoar was visualized with a gastroscopic examination. It was extracted through a gastrostomy incision after laparotomy. The alopecia of the patient was found to be related to trichophagy. The other case was a 42-year-old man with complaints of epigastric pain and dyspepsia. He had received H2 receptor blocker treatment for 1 month. He gave a history of persimmon ingestion 3 weeks prior to the hospital admission and since then his complaints were augmented. With a gastroscopic examination a phytobezoar coexisting with gastric ulcer disease was found. We performed subtotal gastrectomy and Billroth II procedure since gastric malignancy could not be ruled out with the frozen section invest

ISSN:0253-4886    

DOI:10.1159/000172216

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

A 76-year-old Japanese woman underwent en bloc resection of the gallbladder, inferior portion of the medial lobe of the liver and regional lymph nodes for a giant polypoid cancer of the gallbladder. The tumor measured 10.0 × 4.5 × 3.5 cm with a fine stalk, 10 mm in diameter. Postoperative histopathological examination of the tumor revealed poorly differentiated tubular adenocarcinoma. This large-sized pendulous form of cancer of the gallbladder is very rare, and the benefit of complete resection in such a case has not been investigated ye

ISSN:0253-4886    

DOI:10.1159/000172217

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The papillary-cystic tumor of the pancreas (PCTP) is a rare, curable and not widely known tumor. In this report, a PCTP is presented. The histologic and clinical features of this tumor are discussed considering the literature.

ISSN:0253-4886    

DOI:10.1159/000172218

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

A case of hepatocellular carcinoma developing from the left portion of the caudate lobe (Spiegel lobe) was reported. The resection of the Spiegel lobe is generally difficult without combined left lobectomy or extensive rotation of the liver. In this patient, it appeared particularly difficult since the liver could barely be rotated medially due to the markedly enlarged left lobe. However, surgery was successfully performed with minimal mobilization and rotation of the liver, by dissecting the short hepatic veins through the foramen of Winslow from the right side of the hepatoduodenal ligament.

ISSN:0253-4886    

DOI:10.1159/000172219

出版商:S. Karger AG    

年代:1994

数据来源: Karger