摘要:

In the course of a questionnaire the operative results of the last 5 years on a total of 1,200 patients with carcinoma of the cardia from 22 surgical departments in Europe were evaluated. The resection rate averaged 63% (30–97%). Most participants (86.4%) primarily regarded a locally nonresectable tumor as an argument against resection; 45.5% performed resection of the tumor in spite of distant metastases. The most preferred approach was the abdomino-left-side-thoracic procedure with 1 incision. In tumor stages I and II nearly 82% of the participants performed total gastrectomy (stages III and IV: 64%). Distal esophageal resection was done by the same percentage (81.8%) in early as well as in late tumor stages. The type of reconstruction most frequently used was the intrathoracic esophagojejunostomy. 77.3% of the participants performed a parenteral hyperalimentation preoperatively. None used postoperative radiation therapy; only 22.7% routinely administered postoperative chemotherapy. The rate of anastomotic insufficiency averaged 9%, the mean hospital mortality rate amounted to 12%. Despite the high standard of surgical treatment, the long-term results with a mean 2-year survival rate of 33.6% and an average 5-year survival rate of 14.8% are still not satisfyin

ISSN:0253-4886    

DOI:10.1159/000171662

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

In 499 patients with advanced rectal carcinomas (infiltration at least into the muscularis propria), a prospective study of the factors influencing the occurrence of local recurrence was undertaken. The statistical analysis involved a multivariate procedure employing logistic regression. Local recurrence was observed in 20.6% of the patients. Statistically significant factors were found to be: (a) therapy-independent, tumor-specific factors, and (b) the surgical procedure. Among the former, lymphatic spread, the depth of infiltration and localization of the primary lesion above or below the peritoneal reflection were of importance. If, in low anterior resections, the distal margin of clearance does not exceed 3 cm (measured in the fresh, unstretched, surgical specimen, and corresponding to about 5 cm in situ), the incidence rate of local recurrence increases significantly. If, however, such a margin of clearance is adhered to, the results obtained equal those seen in abdominoperineal excision of the rectum. Therefore, in low anterior resection of advanced rectal carcinomas the concept of a distal margin of clearance of more than 3 cm in the fresh, unstretched, surgical specimen should be retained.

ISSN:0253-4886    

DOI:10.1159/000171663

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

The ability of hepatobiliary scanning (99mTc HID A) to distinguish gallstone (GS) from non-gallstone (NGS) pancreatitis was investigated in 29 patients. 4 patients had repeat scans during a recurrent attack (33 scans in 29 patients). 15 patients (17 scans) had GS – in 13 scans the gallbladder was not visualized (sensitivity = 76.5%) compared to 2 of the 16 scans in patients with NGS (specificity = 87.5%). The duodenum was not visualized in 2 (11.8%) and 4 (25%) scans in the GS and NGS groups, respectively. Isotope appeared in the duodenum at 25.7 ± 9.2 min (mean ± SD) in the GS group and 33.3 ± 10.5 in the NSG group (p < 0.02). Hepatobiliary scanning provides a dynamic study of bile excretion in acute pancreatitis, but cannot be used alone to confidently diagnose the presence of gallst

ISSN:0253-4886    

DOI:10.1159/000171664

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Total pepsin activity and gastric acid secretion have been estimated in the resting basal and maximally stimulated gastric juice in groups of normal controls, patients with gastric ulcer, duodenal ulcer and gastric carcinoma. Stimulated pepsin and acid secretion showed a significant stepwise reduction from patients with duodenal ulcer to normal controls, patients with gastric ulcer and those with gastric carcinoma. Electrophoresis of pepsin in all samples of gastric juice was undertaken and showed differences in the distribution of pepsin bands in patients with gastric carcinoma compared with all other groups. Pepsin band 6 was seen almost exclusively in these patients and did not occur in any normal controls. Changes in pepsin banding were more marked when extensive atrophic gastritis was present in the stomach. This study suggests further investigation of pepsin should be undertaken to determine the relationship of these changes to gastric malignancy.

ISSN:0253-4886    

DOI:10.1159/000171665

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

5 patients with drug-associated recurrent pancreatitis are presented. The drugs concerned were paracetamol (2 patients), sulphasalazine, mefenamic acid and methyldopa. The literature is reviewed. Patients with pancreatitis of uncertain aetiology should have a careful drug history taken before classifying them as idiopathic.

ISSN:0253-4886    

DOI:10.1159/000171666

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

In an effort to increase the cure rate of carcinoma of the head of the pancreas involving the portal system and/or associated arteries, en bloc radical pancreatectomy with associated vascular structures was performed. Twenty-one patients treated by en bloc pancreatectomy had 1-, 2-, and 3-year survival rates of 32.4, 16.2, and 8.2%, respectively, as compared to 15 patients undergoing standard pancreatectomy with 1- and 2-year survival rates of 13.2 and 0%, respectively. Although long-term survival after radical pancreatectomy is limited at present, this procedure often seems to afford the best hope of curing patients with deeply invasive carcinoma of the pancreas.

ISSN:0253-4886    

DOI:10.1159/000171667

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

The postoperative convalescence and return to normal life were evaluated in 43 patients over 70 years of age who underwent total gastrectomy. In the aged, preoperative abnormal findings and postoperative complications were more frequent than in younger patients. The rate of death in aged patients experiencing postoperative complications was 25%. On the other hand, while postoperative convalescence and return to normal life were delayed in aged patients who had been curatively operated, the return to normal life was relatively good. Based on our results we suggest that total gastrectomy should not be ruled out in aged patients.

ISSN:0253-4886    

DOI:10.1159/000171668

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Diagnosis and treatment of a patient with gastrocolic fistula in chronic intestinal ischaemia are reported. A gastrocolic fistula secondary to occlusion of splanchnic arteries has not been described before. The surgical management consisted of a revascularization procedure of the superior mesenteric artery and the common hepatic artery by a sequential saphenous graft from the right common iliac artery. Occlusion of splanchnic arteries should be excluded prior to surgery for benign gastrocolic fistula.

ISSN:0253-4886    

DOI:10.1159/000171669

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

The authors report 6 cases of spontaneous hemoperitoneum due to rupture of a hepatoma. This complication occurs most often in cirrhotic liver and reveals the tumor. Diagnosis can then only be made during autopsy or urgent laparotomy. Hepatic resection is most often highly problematic or impracticable owing to cirrhosis or the tumor involving both lobes. Among palliative operations, ligation of the hepatic artery seems to be an elective procedure. It enabled the authors to stop the bleeding in 2 cases and obtain a survival of more than 1 year in 1 case.

ISSN:0253-4886    

DOI:10.1159/000171670

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

A case of intestinal evisceration through the anus due to spontaneous rupture of the rectosigmoid is reported. The patient was a 76-year-old widow with habitual constipation. The episode of evisceration occurred during effort. Emergency laparotomy was carried out and a 6-cm tear was found in the anterior wall of the rectum. No fecal soilage was observed in the peritoneal cavity. The laceration was closed in two layers. A colostomy was not performed. The postoperative course was satisfactory. Increased abdominal pressure may have been the cause of the rupture. Anemia and hypoproteinemia were observed in the patient. These may have been contributing factors.

ISSN:0253-4886    

DOI:10.1159/000171671

出版商:S. Karger AG    

年代:1985

数据来源: Karger