ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00915.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00916.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

A series of 46 consecutive patients with obstructive jaundice have been referred to a surgical unit with a special interest in hepatobiliary surgery. The cases were evenly divided between benign and malignant causes. The hospital mortality was 13% (six cases), and the mortality was also evenly divided between the two subgroups. A scoring system has been devised to rate 12 easily measured clinical and pathological parameters, and a regression analysis used to measure the contribution made by each parameter to hospital morbidity and mortality and to later mortality over a 5 year period. Previous bile duct trauma and liver damage were the major determinants of hospital morbidity, while bile duct trauma, liver disease, acute pancreatitis and increasing age were the significant determinants of hospital mortality. Malignancy and cirrhosis determined late mortality. A plea is made for the early referral of high risk patients to specialized units, particularly when bile duct trauma is involved.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00917.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Two cases of peri‐ampullary villous adenomas involving the common bile duct are reported. The pathology of benign duodenal tumours is discussed, and the possibility of common bile duct involvement, albeit uncommon, is stressed. Obtaining an endoscopic histologic diagnosis is important in planning appropriate operative treatment. Although benign, these tumours should be removed; they are a cause of serious symptoms and have proven premalignant potential. Endoscopic removal is usually not possible. Endoscopy for dyspepsia should include examination of the second part of duodenum, to avoid overlooking duodenal tumour

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00918.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Primary sclerosing cholangitis is an uncommon condition, generally considered to carry a poor prognosis. Based on the distribution of the biliary strictures, treatment groups can be defined. Those patients with localized hilar or predominantly extrahepatic strictures are most likely to be suitable for biliary–enteric bypass and the use of surgical techniques developed for the management of high bile duct strictures are allowing improvement in the results of surgery in this form of the disease. After 3 months to 3 years follow‐up (median 16 months) nine of 12 patients treated by surgical biliary decompression are asymptoma

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00919.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Twenty‐five cases of choledochal cysts operated at the University Hospital between 1969 and 1981 were reviewed. Nineteen of the patients were females. An accurate pre‐operative diagnosis of choledochal cyst was made in 10 patients (40%). We have found the99Tcm‐diethyl‐IDA (EHIDA) scan to be the safest and most sensitive diagnostic tool. In recent years excision has been performed whenever possible in view of reports of malignancy developing in the cyst wall. It has a lower morbidity and re‐operation rate compared to internal drainage. In excision we advise the use of a cuff of the cyst wall for a wider anastomosis. As the biliary tract shrinks and retracts into the porta following excision of the cyst, stricture formation may still occur despite a wide an

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00920.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Eight cases of major haemobilia have been seen by the Surgical Hepatobiliary service at Westmead Hospital between 1979 and 1984. Two occurred following blunt abdominal trauma, three after percutaneous biliary drainage or liver biopsy, two in association with postoperative haemorrhagic pancreatitis and one because of an abscess complicating hepatic hydatid disease. Coeliac and superior mesenteric angiography were carried out in all patients, and false aneurysms were demonstrated in seven of the eight. A marked coagulopathy was present in the remaining patient, in whom bleeding stopped without intervention when the coagulopathy was reversed. Those with false aneurysms were treated by radiologically controlled transarterial embolization with gelfoam, acrylate or Gianturco coils, and bleeding was controlled in all. There was one death from overwhelming sepsis in the patient with the hepatic abscess. It is concluded that percutaneous radiologically controlled embolization is the treatment of choice for most cases of haemobilia, except when there is major hepatic sepsis.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00921.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

In a prospective study of liver function tests in cholestatic jaundice, the median serum level of alkaline phosphatase (ALP) in 129 patients with cancer involving ektrahepatic ducts and liver (556 IU/l) was significantly higher (P<0.001) than that in 121 patients without cancer (264 IU/1). Of patients with an ALP level of greater than 10 x N, 88% had cancer whereas serum levels of ALP of less than 3 x N were observed in only 9% of patients with cancer but in 45% of those without cancer, most of whom had bile duct stones. A high serum level of ALP is associated with cancer involving extrahepatic ducts and liver.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00922.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Eight cases of the Zollinger–Ellison syndrome were diagnosed at St Vincent's Hospital in the period 1966–84. Although a rare tumour, its true incidence is almost certainly greater than the number of cases represented in this series. The Zollinger–Ellison syndrome should be suspected in all cases of recurrent peptic ulceration, in cases of peptic oesophagitis not responding to medical treatment, in some cases of diarrhoea and in those cases of peptic ulceration associated with hypercalcaemia. Rarely the gastrinoma may first present as a mass in the head of the pancreas causing obstructive jaundice. Diagnosis has been made easier by estimation of fasting serum gastrins and the use of the secretin test. Localization is difficult. The treatment of the condition remains contentious. In those cases shown to be harbouring a so‐called solitary gastrinoma, laparotomy should be performed with a view to resection. If the gastrinoma cannot be localized then it is reasonable to use H2 blocking agents to control hypersecretion. The presence of hypercalcaemia due to hyperparathyroidism must be controlled by parathyroidectomy. Total gastrectomy is reserved for those few cases who for one reason or another are not controlled by adequate H2 blocking therapy. In the presence of malignant gastrinoma with metastatic disease, hypersecretion is controlled by the use of H2 blocking agents. In this group cytotoxic chemotherapy may be used in an attempt to control the mass effects of the

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00923.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Phaeochromocytoma is an unusual tumour which is eminently curable by surgical means. It is difficult to diagnose clinically because it mimics other illnesses. The clinical features of 13 cases of phaeochromocytoma diagnosed at St Vincent's Hospital, Melbourne, between 1969 and 1984 are briefly described. This review emphasizes the several major improvements in both diagnostic and localizing tests which have occurred over the 16 year period of the series. These include the clonidine suppression test and plasma and urine catecholamine estimations in diagnosis and techniques such as CT scanning and the I131‐meta‐iodobenzyl‐guanidine scan used for localization of the tumour. Careful pre‐operative preparation, based on adequate alpha blockade and intra‐operative monitoring, is essential for the safe and successful removal of the tumour, which was eventually accomplished for all 12 cases in which removal was attempted. However, the most important step in the diagnosis and treatment of phaeochromocytoma is the initial consideration of the diagnosis. This step depends on the level of awareness of the disorder amongst c

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1985.tb00924.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY