摘要:

Photodynamic therapy (PDT) is a new modality of cancer treatment. It consists of intravenously injecting a patient with a photosensitizing agent and, when this agent has accumulated in tumor cells, decomposing it by exposure to red light produced by an argon dye laser. Toxic compounds produced in this reaction then destroy the malignant cells, while normal tissue is not significantly affected. Most clinical experience with PDT has been gained in the treatment of lung cancer, cancer of the urinary bladder and malignancies of the head and neck region. In gastroenterology, esophageal, gastric and colonic tumors have clinically been treated with PDT. This paper is to review the current use of PDT in the treatment of gastrointestinal tumors.

ISSN:0257-2753    

DOI:10.1159/000171344

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We updated meta-analysis and critical descriptive analysis of randomized clinical trials (RCTs) assessing the value of β-blockers in preventing first bleeding (prophylactic) or rebleed-ing (therapeutic) and on survival of patients with cirrhosis. Both the methods of Peto-Mantel-Haenszel and DerSimonian-Laird were used to assess the heterogeneity and obtain cumulative estimates of treatment effects; the L’Abbé plot was also used for a visual assessment of heterogeneity in the direction of treatment effect. Seven prophylactic and nine therapeutic RCTs were analysed. β-Blockers uniformly reduced the bleeding risk and revealed a trend toward improved survival in non-ascitic, well-compensated patients in both the prophylactic and therapeutic sets of RCTs. Discordant results were found in patients with ascites or in poor functional condi

ISSN:0257-2753    

DOI:10.1159/000171388

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Chronic endoscopic esophageal sclerotherapy represents a primary technique for the prevention of recurrent bleeding in cirrhotic patients who have already experienced one variceal bleeding episode. 131 patients with portal hypertension and a history of esophageal variceal bleeding underwent endoscopic sclerotherapy. 74 of these patients constituted a subgroup which was singled out for special analysis. In these patients, treatment had been started after conservative management of an acute bleeding episode had stopped the bleeding and follow-up data for at least 6 months were available. 90.5% of these patients had nonalcoholic etiology for their portal hypertension. 60.8% of patients developed recurrent varices and 11.1% had recurrent bleeding from esophageal varices. The bleeding risk index, calculated as the number of hemorrhages/patient/months of follow-up, correlated strongly with the number of previous hemorrhages and inversely with hepatic reserve (Child’s class). The bleeding risk index decreased tenfold after sclerotherapeutic obliteration of varices. These data suggest that chronic elective endoscopic sclerotherapy may play a primary role in the management of patients who have bled from esophageal varice

ISSN:0257-2753    

DOI:10.1159/000171389

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Emergency portosystemic shunting has once again become a significant option in the management of bleeding esophageal varices and portal hypertension. The decision to perform such a shunt and the choice of shunt procedure requires a rational assessment of the pathophysiology and hepatoportal hemodynamics of the patient’s disease and the manner in which it is anticipated that the selected procedure may alter portal flow. Since shunt surgery may interfere with hepatic transplantation, the patient’s suitability as a future transplant recipient must also be considered in choosing a shunt procedure. Furthermore, if a shunt is to be performed on an emergency basis to control acute bleeding, this procedure must be done before the patient’s condition deteriorates sufficiently to represent a prohibitive surgical

ISSN:0257-2753    

DOI:10.1159/000171390

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Despite progress in our understanding and management of patients with portal hypertension, the long-term control of variceal bleeding remains a significant challenge. With further clarification of the underlying pathophysiology and technological advances that have facilitated progress in both diagnosis and treatment, the goal of safe, selective management of patients presenting with variceal hemorrhage is closer to realization. While a variety of non-operative therapies have been advocated, shunt surgery remains the most reliable and durable method of controlling the portal hypertension and the bleeding. More than 20 years ago, Warren and Zeppa introduced the concept of selective shunting to prevent recurrent variceal hemorrhage. The distal splenorenal shunt (DSRS) was advocated as an approach that could selectively decompress the esophageal and gastric varices (resulting in effective bleeding control) while maintaining prograde portal flow (presumably leading to a lower incidence of post-shunt encephalopathy and hepatic failure). While the hemodynamic basis for the DSRS remains valid, its selectivity is neither uniform nor durable and this shunt is neither applicable nor effective in all patients bleeding from varices. It remains, however, appropriate and safe therapy in selected cirrhotic patients with variceal hemorrhage. With careful pretreatment assessment (in the context of the advances that have occurred in both operative and anesthetic management), the DSRS retains an important role in the management of patients with variceal bleeding.

ISSN:0257-2753    

DOI:10.1159/000171391

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

For many years now, percutaneous transhepatic and transjugular approaches to the portal vein have been applied by gastroenterologists and radiologists for diagnosis and therapy. In patients with variceal bleeding these techniques were used to obliterate the varices, and have provided the knowledge for further developments, such as the creation of an intrahepatic portosystemic shunt by balloon dilatation of the needle tract between the portal vein and a hepatic vein. The recent development of expandable vascular stents has led to improvements in the efficiency and long-term patency of interventional shunts, and justified their clinical application. The rationales for this new approach to the treatment of portal hypertension are its relative safety, even in Child C patients, and the disabilities such as rebleeding or aggravation of hepatic encephalopathy of other current treatments. Since the first clinical application of the transjugular intrahepatic portosystemic stent-shunt in January 1988, the technique has been improved considerably, and the frequency of its application is increasing rapidly. This article attempts to summarize the current state of knowledge of this interventional technique, which will soon have its place among the various methods of treating portal hypertension.

ISSN:0257-2753    

DOI:10.1159/000171395

出版商:S. Karger AG    

年代:1992

数据来源: Karger

ISSN:0257-2753    

DOI:10.1159/000171393

出版商:S. Karger AG    

年代:1992

数据来源: Karger

ISSN:0257-2753    

DOI:10.1159/000171394

出版商:S. Karger AG    

年代:1992

数据来源: Karger

ISSN:0257-2753    

DOI:10.1159/000171383

出版商:S. Karger AG    

年代:1992

数据来源: Karger