ISSN:0253-4886    

DOI:10.1159/000172047

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Postprandial portal vein flow (PVF) was measured using duplex ultrasound in healthy controls, patients with nonshunted portal hypertension and patients with distal splenorenal shunts (DSRS). In the fasting state, PVF was significantly greater in patients with portal hypertension (1,077 ± 45 ml/min) than in controls (672 ± 16 ml/min, p < 0.005) or in patients with DSRS (280 ± 30 ml/min, p < 0.005) and significantly greater in controls than in the DSRS group. After eating, only the controls showed significant increases in PVF (128 ± 8, 103 ± 9, and 47 ± 3% increase above fasting PVF at 30, 90, and 150 min, respectively; all p < 0.005). In portal hypertensive patients, eating did not result in a consistent change in PVF. In the fasting state, 6 DSRS patients had prograde flow and 4 had retrograde flow. Shunt patients with prograde flow had a response in PVF after eating similar to that seen in nonshunted portal hypertension patients (4 with increased and 2 with unchanged flow). None of the shunt patients with retrograde flow developed prograde flow after eating. In conclusion: (1) fasting PVF is greater in portal hypertension patients and less in DSRS patients compared to controls; (2) eating results in increased PVF in controls but no consistent response is seen in portal hypertension or in DSRS patients, and (3) DSRS patients with retrograde PVF do not convert to prograde flow after e

ISSN:0253-4886    

DOI:10.1159/000172048

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Transjugular intrahepatic portosystemic stent shunt (TIPSS) is a new non-operative treatment of portal hypertension. The technique is based on the transjugular introduction of an expandable vascular stent which is implanted into the liver parenchyma between a main branch of the portal vein and a hepatic vein. Twelve patients with liver cirrhosis and recurrent variceal hemorrhage, who were excluded from operative treatment, were included in a pilot study. All patients either refused surgery or were considered poor surgical candidates. TIPSS was successfully established in 9 of the patients (75%). 58% of the patients survived 12 months and 50% 24 months. Variceal rebleeding occurred in 1 patient. Aggravation of hepatic encephalopathy was found in 1 patient. The results of this pilot study indicate that TIPSS controls variceal bleedings effectively during a follow-up of up to 2 years. It may be suitable for patients with advanced liver disease and high operative risk. It also does not limit later consideration for liver transplantation. During the course of the study, refinements of the technique have led to an even safer procedure which generally can be completed in 1 -2 h.

ISSN:0253-4886    

DOI:10.1159/000172049

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Analysis of lymph node metastasis in 100 patients with proximal gastric cancer who underwent curative total gastrectomy revealed that spread to the peripyloric nodes, which cannot be dissected adequately in proximal gastrectomy, does not occur before serosal invasion. Thus 28 patients who underwent proximal gastrectomy and 25 who underwent total gastrectomy for early cancer of the proximal stomach were compared to determine whether proximal or total gastrectomy is superior in treatment. No difference in the length of operation, operative blood loss or postoperative complications, including anastomotic leakage, was observed. However, the metabolic consequences of gastric resection in the two groups were similar, as determined by changes in body weight, serum hemoglobin and total serum protein concentrations. Diarrhea (32%) and reflux (28%) were more common following proximal gastrectomy, and postprandial fullness (21 %) following total gastrectomy. Available evidence does not support the claim that proximal gastrectomy is superior because of physiologic advantages accrued by retaining a gastric remnant.

ISSN:0253-4886    

DOI:10.1159/000172050

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

161 patients were operated on for duodenal ulcer between 1980 and l·Vagotomy and Jaboulay’s gastroduodenostomy (GD) were performed in 81 while vagotomy was combined with gastrojejunostomy (GJ) in 80. Mean age was 46 years for the GD group and 42.1 years for the GJ group. 17 patients were lost to follow-up, making 144 patients available for a retrospective analysis. There was no mortality in this series. 3 patients developed recurrent ulcer. 1 patient from the GJ group suffered from diarrhoea (4-5 motions/day). The two groups, when compared for the incidence of recurrence, dumping, diarrhoea and also by Visick grading, failed to show a statistically significant differen

ISSN:0253-4886    

DOI:10.1159/000172051

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A follow-up of 2,700 cholecystectomies disclosed 33 cases of residual stones (1.2%). A significant decrease in the rate of residual stones occurred in the last 2 years of the study (0.4%). Most residual stones occurred in patients with multiple choledochal stones found during the primary procedure. Since 1980 all residual stones were treated by percutaneous or endoscopic techniques, without mortality. Diminishing risks of treatment for residual stones following cholecystectomy significantly increase the costbenefit ratio of this procedure.

ISSN:0253-4886    

DOI:10.1159/000172052

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Failure of conservative treatment of acute cholecystitis to control infection of the gallbladder bile and/or increased tension within its lumen calls for emergency surgery. Since cholecystectomy in the emergency situation carries morbidity and mortality rates higher than those of the elective situation and cholecystostomy has the disadvantages of increased incidence of wound infection, prolonged hospital stay and the need for a second operation, this study was designed to examine whether at failure of conservative treatment of acute cholecystitis, drainage of the gallbladder into the second part of the duodenum by a synthetic tube graft is a convenient procedure. This procedure was performed in 6 consecutive patients (4 women and 2 men) without any complications, particularly intraperitoneal leakage and wound infection, and all patients were discharged home on the 5th postoperative day. A scintigraphic scan 6 weeks after the operation showed patency of the graft. All patients remained well without any complaints over follow-up for 1 year and expressed no interest in undergoing an elective cholecystectomy. It is, therefore, concluded that when the conservative treatment of acute cholecystitis fails, internal drainage of the gallbladder by a tube graft has advantages over both cholecystectomy and cholecystostomy.

ISSN:0253-4886    

DOI:10.1159/000172053

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We have performed a randomised trial of caudal anaesthesia against none in a group of patients either having minor anal surgery alone (group 1 n = 26), or major pelvic surgery with laparotomy involving an anal procedure (group 2, n = 13). Standard general anaesthesia without heparin was used in all patients. Results were assessed by monitoring analgesic opiate requirements over 24 h using a continuous intravenous delivery pump. In group 1 (haemorrhoidectomy 15, anorectal myectomy 11), 14 received caudal anaesthesia (1 mg Marcaine/kg, 0.5% solution) and 12 did not. The median opiate requirements in the first 3 after operation were 0 mg (caudal anaesthesia) and 15 mg (no caudal anaesthesia; Mann-Whitney U = 21, p < 0.002). Median total opiate requirements in 24 h was 19 mg (caudal anaesthesia) compared with 38 mg (no caudal anaesthesia; Mann-Whitney U = 26, p < 0.02). In group 2 (pouch anal anastomosis 11, rectopexy with postnatal repair 2), 7 received caudal anaesthesia and 6 did not. The median 24-hour opiate requirements were 126 and 106 mg, respectively (NS). Two patients required urethral catheterisation after caudal anaesthesia and one complained of headache. Caudal anaesthesia significantly reduces the analgesic requirements after minor anal surgery but had no influence on analgesic requirements after pelvic and anal surgery involving a laparotomy.

ISSN:0253-4886    

DOI:10.1159/000172054

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We have previously reported that the manipulation of VX2 tumors in the rabbit liver significantly evoked lung metastases, and correlated with the frequency of hepatic venous permeation. However, liver metastasis was nil despite the frequent appearance of portal permeation. Later we performed a study in order to attempt to explain this contradiction. The rabbits were divided into two groups and given 1 × 105 VX2 tumor cells, either systemiwcally (group A, n = 5) or intraportally (group B, n = 5). On day 14, there were microscopically 10.4 ± 7.6 pulmonary nodules/cm2 in group A and 1.0 ± 0.9 hepatic nodules/cm2 in group B (p < 0.05). Therefore, in the mechanism of tumor metastasis, both organ specificity as well as the drainage vessels of the tumor appear to be importa

ISSN:0253-4886    

DOI:10.1159/000172055

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

In the present study the effects of local bowel perfusion on anastomotic healing of experimental colonic anastomoses were evaluated in 54 female chinchilla rabbits. Local ischemia was induced by devascularization of the sigmoid colon. Animals were randomly allocated to 4 operative groups. In the animals of group 1 a colo-colonic anastomosis was performed in an area graded as ischemia grade A (intact perfusion). Animals of group 2 received a colo-colonic anastomosis in the sigmoid colon segment, graded as ischemia grade B (marginal perfusion). Group 3 received pretreatment with neomycin and was otherwise treated like group 2. Animals of group 4 a colo-colonic anastomosis was performed in the ischemia grade-C region (total ischemia). The rate of anastomotic leakage was monitored by periodic double contrast enemas. The experiment was terminated on the 8th postoperative day, and microangiography to assess revascularization was performed followed by assessment of perianastomotic adhesions. The rate of anastomotic failure as well as the occurrence of anastomotic failure over time highly depended on the severity of ischemia. Bowel sterilization by neomycin significantly reduced the rate of anastomotic leakage. The development of perianastomotic adhesions correlated with the severity of ischemia. Microangiography suggested that revascularization originated in the perianastomotic adhesions.

ISSN:0253-4886    

DOI:10.1159/000172056

出版商:S. Karger AG    

年代:1992

数据来源: Karger