ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.00569.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.00604.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundPancreatic pseudocysts may produce pain, or biliary or duodenal obstruction. Those over 6 cm in diameter or associated with chronic pancreatitis are unlikely to resolve and usually require intervention. There are a number of treatment modalities available and this paper reviews the role of endoscopic drainage.MethodsAll articles and case reports quoted on Medline (National Library of Medicine, Washington DC, USA) containing the text words ‘endoscopy’ and ‘pseudocyst’, and citations from these references were reviewed.ResultsEndoscopic drainage is technically feasible in around 50 per cent of pancreatic pseudocysts associated with chronic pancreatitis. Successful drainage occurred in 82–89 per cent. The major complication is bleeding which required surgery for control in 5 per cent of procedures. One death attributable to the procedure has been reported. Recurrence rates range from 6 to 18 per cent with up to 4 years' follow‐up. As in open surgery, recurrence is highest with drainage via the stomach.ConclusionEndoscokic drainage provides a minimally invasive approach to pseudocyst management, with success and recurrence rates similar to those of open surgery but with lower morbidity and mortality rates. It should be considered the treatment of choice for pseudocysts less than 1 cm thick which bulge into the stomach or duodenum, or for those which communicate with the main panc

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.00561.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundBiliary disease during pregnancy is rare and the management of cholecystitis during pregnancy is controversial. Cholecystectomy in the pregnant patient has generally been avoided because of the reported high incidence of associated fetal loss. Recent developments relating to diagnostic and anaesthetic management have altered the overall approach to symptomatic biliary tract disease in pregnant patients.MethodsThe literature was reviewed using Medline searches for cholelithiasis in pregnancy, to include pathophysiology, diagnosis and management.Resultsand conclusion Surgery should be performed only for complicated non‐resolving biliary tract disease during pregnancy as in over 90 per cent of patients the acute process will resolve with conservative management. For patients requiring operative intervention, laparoscopic cholecystectomy has emerged as a safe and effective method of treatmen

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.00599.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundDespite gastric cancer being common, its prognosis has not been improved significantly in recent years. Now, greater insight has been gained into the biological properties of tumour cells, how they become malignant and what mechanisms they may use to invade and metastasize. This involves tumour‐associated protease systems, loss or mutation of adhesion molecules and changes in genetics. The view of gastric cancer is changing: it is not only a solid tumour but also exhibits a minimal residual disease component even in the early stages of disease. Such biological tumour characteristics may provide new prognostic factors and also potential new therapeutic options.MethodsThis is an update of prognostic factors in gastric cancer, emphasizing new biological features, some of which have been investigated by this group over the past few years. Current results are discussed in the light of 212 references obtained from the Medline database from 1979 to 1907.ResultsThere is high probability that some of the factors reviewed, such asc‐erbB‐2, individual course and phenotyping of disseminated tumour cells will become significant new prognostic variables. This is true also, to a lesser extent, of cathepsin D, matrix metalloproteinase 2 combined with activators or tissue inhibitor of metalloproteinases 2, CD44, E‐cadherin, p53 andcripto. Plasminogen activator inhibitor 1 (PAI‐l), a member of the urokinase‐type plasminogen activator (uPA) system, can already be defined as an established new prognostic factor in gastric cancer.ConclusionPAI‐I should be considered prognostically in addition to established tumour classifications. Moreover, the uPA system is a target for future therapeutic concepts. Further analysis of factors describing tumour biology should lead to new, functionally orientated, tumour classifications in g

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.00619.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundParenteral nutrition is well established for providing nutritional support in acute pancreatitis while avoiding pancreatic stimulation. However, it is associated with complications and high cost. Benefits of enteral feeding in other disease states prompted a comparison of early enteral feeding with total parenteral nutrition in this clinical setting.MethodsThirty‐eight patients with acute severe pancreatitis were randomized into two groups. The first (n= 18) received enteral nutrition through a nasoenteric tube with a semi‐elemental diet, while the second group (n= 20) received parenteral nutrition through a central venous catheter. Safety was assessed by clinical course of disease, laboratory findings and incidence of complications. Efficacy was determined by nitrogen balance. The cost of nutritional support was calculated.ResultsEnteral feeding was well tolerated without adverse effects on the course of the disease. Patients who received enteral feeding experienced fewer total complications (P<0·05) and were at lower risk of developing septic complications (P<0·01) than those receiving parenteral nutrition. The cost of nutritional support was three times higher in patients who received parenteral nutrition.ConclusionThis study suggests that early enteral nutrition should be used preferentially in patients with severe acute pancrea

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02851.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundThis study tested the hypothesis that gastric intramucosal pH (pHi) can predict death in severe acute pancreatitis.MethodsSeventeen consecutive patients with predicted severe acute pancreatitis were studied prospectively. Four died from complications related to pancreatitis. Gastric pHi was measured by nasogastric tonometry at least every 12 h for the first 48 h after admission and then on a daily basis during the first week.ResultsThe lowest pHi recorded during the first 48 h was significantly less in those admitted to the intensive care unit than that in those who remained on the surgical ward (P= 0·0015) and in non‐survivors compared with the survivors (P= 0·009). A receiver‐operator characteristic curve defined a pHi of 7·25 as the optimal cut‐off point to predict death (sensitivity 100 per cent, specificity 77 per cent, overall predictive value 82 per cent).ConclusionThese results suggest that splanchnic ischaemia may be an important determinant of outcome in patients with severe acute panc

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02852.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundSince the first attempts at resection of Klatskin tumours, an increasingly aggressive surgical treatment has been proposed. Results obtained after examination of the specimen have shown that a significant proportion of resections were palliative. Curative resection appears to be difficult to perform selectively.MethodsThis retrospective study evaluates the results of a surgically‐oriented management of hilar bile duct cancers. Thirty‐nine patients were operated on in the period 1982‐1994. Eighteen resections were carried out, requiring liver resection in 13 cases. Pathology of the specimen showed that the resection had been curative in 14 cases. The remaining 21 patients had surgical palliation, i.e. bypass and/or stenting.ResultsIn the resection group, there was no death but four patients suffered severe complications. The 1‐ and 5‐year survival rates were 67 and 47 per cent respectively, with a median survival of 26 months. In the palliation group, the mortality rate was 14 per cent and median survival was 7 months.ConclusionIn the absence of evident contraindications, surgical exploration is worthwhile as it allows detection of the cases where curative resection is possible. Curative resection often requires a major hepatectomy, but mortality and morbidity may be kept low, and it offers a real hop

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02864.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundOne of the potential drawbacks of laparoscopic cholecystectomy is lack of experience with open cholecystectomy. The aim of this study was to examine the effect of a no‐conversion policy on patient outcome following laparoscopic cholecystectomy.MethodsOne hundred and sixty‐one patients underwent laparoscopic cholecystectomy in the no‐conversion period and were compared with 127 operated on during a period in which there was a low threshold for conversion from laparoscopic to open cholecystectomy. All operations in the no‐conversion period were performed by surgeons in training assisted by one consultant.ResultsOne patient in the no‐conversion group had a gallbladder carcinoma and the operation was converted to open surgery. All others underwent total cholecystectomy except for one patient who had part of a severely diseased gallbladder leftin situ. Operating time was significantly lower, median 65versus50 min (P= 0·004), as was postoperative hospital stay, 3versus2 days (P= 0·001), in favour of the no‐conversion group. There was no bile duct injury and postoperative complications were similar in both groups (6versus8 per cent;Pnot significant).ConclusionLaparoscopic cholecystectomy can be performed safely without converting to open cholecystectomy. As surgeons become more experienced with laparoscopic cholecystectomy, the need to perform open cholecystectomy in an elective setting

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02854.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundThe main argument for laparoscopic cholecystectomy in preference to open cholecystectomy appears to be based on less traumatic incisions inflicted on the abdominal wall. To investigate the effects of different incision lengths on patients following elective open cholecystectomy, a randomized clinical study was conducted.MethodsIn this study 130 patients were randomly assigned to undergo either open cholecystectomy through a transverse subcostal incision of mean length 5·8 cm, so called minicholecystectomy (65 patients), or to undergo conventional cholecystectomy through a paracostal incision of mean length 13·1 cm (65 patients). The perception of pain after operation was measured by a visual analogue scale. To register late complications the mean(s.d.) hospitalization period after operation was extended to 11·5(1·2) days in the minicholecystectomy group and 15·4(2·5) days in the conventional cholecystectomy group.ResultsThe perceived pain and analgesic requirements were found to be similar in both groups. Twelve of 65 patients in the minicholecystectomy group and four of 65 in the conventional cholecystectomy group developed wound haematoma.ConclusionOn the basis of this prospective randomized study, the hypothesis that a smaller incision length on the abdominal wall could lower the level of perceived pain, and therefore decrease the postoperative analgesic intake after minicholecystectomy, could not be conf

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02814.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY