ISSN:0253-4886    

DOI:10.1159/000171714

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

In 18 patients with duodenitis the clinical features were indistinguishable from those of duodenal ulceration. However, both fasting gastrin and basal and stimulated acid outputs were significantly lower in the group with duodenitis than in the group with duodenal ulceration. None of the patients with duodenitis developed duodenal ulceration during a mean follow-up of 16 months.

ISSN:0253-4886    

DOI:10.1159/000171715

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Factors related to outcome were investigated in a consecutive series of 201 gastric cancer patients identified by endoscopy from January 1973 to May 1984 in this institution. Five-year survival rates were found to correlate significantly with tumor stage, lymph node spread, and also with disease localization. Tumors in the distal or middle third of the stomach were associated with a significantly better outcome than tumors in the upper third, extensive tumors or tumors after previous gastric resections. The choice of operative procedures was likewise related to outcome. Patients who had undergone curative resections had by far the best prognosis with a 5-year survival rate of 44%, but this was primarily taken to represent a reflection of a less advanced disease stage rather than an independent prognostic factor. The histologic tumor type did not influence outcome in this series. We confirmed earlier observations that a long history of symptoms cannot be taken as a poor prognostic sign. A more liberal approach to upper gastrointestinal tract endoscopy in patients with unexplained abdominal pain or weight loss should contribute to improve the prognosis. Thus education of patients and primary care physicians rather than diagnostic or therapeutic modalities represent at present a major clinical concern in gastric cancer disease.

ISSN:0253-4886    

DOI:10.1159/000171716

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

In 72 patients with tumours of the ampulla of Vater, the course of the disease was analysed. Surgical specimens were examined microscopically, and special attention was paid to the study of morphological carcinogenesis. The rate of resection of carcinomas was 55%, with a hospital mortality of 6.7% after partial pancreatoduodenectomy and 15.4% after palliative surgery. The average survival rate was 20 months for partial pancreatoduodenectomy and 5 months for the palliative methods. A tumour size exceeding 2 cm and tumour-positive lymph nodes significantly lowered the time of survival. In 82.8% of the examined surgical specimens, medium to severe epithelial dysplasias were found in the non-carcinomatous part of the ampulla; adenoma structures were found in 91.4% of the specimens. It can be assumed that the carcinoma of the ampulla of Vater largely develops from epithelial-dysplastic alterations or adenomas of the ampulla of Vater.

ISSN:0253-4886    

DOI:10.1159/000171717

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Our experience with enterocutaneous fistulas as a complication after operative procedures on the pancreas is based on a retrospective study of the medical records of 543 patients treated at the surgical department of the University of Mainz between 1964 and 1984. Enterocutaneous fistulas occurred with a frequency of 11.8% (64 patients). Operative reintervention became necessary in 25% of these cases (16 out of 64 patients). As there are only few indications which justify reintervention, the decision should be based on both the individual situation and the primary operation performed. Of the 64 patients who developed fistulas, 4 succumbed to the ensuing complications. Conservative management was successful in achieving a complete cure in 75% of the patients, with a treatment time of up to 21 months.

ISSN:0253-4886    

DOI:10.1159/000171718

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

A retrospective study was undertaken to evaluate the current-day role of the plain abdominal radiograph in the diagnosis of acute appendicitis. Although there was good correlation between the number of positive abdominal X rays and patients found to have more severe changes such as gangrene or perforation, a significant number of individuals with less severe inflammatory changes of the appendix had normal X rays. Some patients subsequently found to have a normal appendix at surgery had positive findings on abdominal X ray. It appears that the abdominal X ray is not sufficiently sensitive or specific in helping to diagnose acute appendicitis in its earlier stages and in most cases can probably be eliminated from the work-up.Patients were placed into one of the following four groups according to the severity of the inflammatory process subsequently found at surgery and pathology: (1) normal appendix, (2) pathological changes of acute appendicitis, (3) findings consistent with acute appendicitis as well as inflammatory changes in the peri-appendiceal tissues and (4) severe involvement consisting of gangrenous changes in the appendix with or without perforation (table I). Abdominal X rays were analyzed for the presence of abnormal findings listed in table II.

ISSN:0253-4886    

DOI:10.1159/000171719

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

From 1970 to 1983, we performed 53 Hartmann’s procedures; 92% of them were emergency cases. Cancer of the rectum and pelvic colon complicated by obstruction or peritonitis was the major indication: it occurred in 31 cases (59%). In our series, however, the occurrence of noncancerous lesions (diverticulitis, volvulus, Crohn’s disease and trauma) was considerable, too. Hartmann’s procedure is the best and often only solution in line with the rules of colic surgery. The restoration of intestinal continuity after Hartmann’s procedure is of importance, especially as far as the time of reconstruction is concerned. In our series, the procedure was carried out 36 times (69%) with a delay of 3 months; no deaths o

ISSN:0253-4886    

DOI:10.1159/000171720

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

In patients featuring recurrence after resection for rectal cancer, 30% can take advantage of secondary abdominoperineal resection. Despite being palliative in 9 out of 15 cases, reresections provided a significant improvement in both length and quality of patients’ survival, although operative mortality was not negligible. Fifteen patients underwent a secondary resection. One postoperative death and an average survival of 28.6 ± 11.3 months were reported as opposed to 6.16 ± 6.4 months in cases where there was recurrence after a surgical proced

ISSN:0253-4886    

DOI:10.1159/000171721

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

This study deals with the diagnosis of fecal incontinence established by electromanometric measurements of the anal closure. Two cases are reported, and our data examined in a control group of the same age will be presented. To evaluate the pressures in the rectum and anal canal we used instruments of the urodynamic unit with water-perfused catheters. The results demonstrate that the resting anal canal pressure is lower in incontinent than in continent women. The anal closure pressure during coughing and squeezing becomes negative in incontinent women. These findings are in accordance with the data reported by others. We therefore believe that electromanometric evaluations are important before and after proctologic operations; they help to medically judge the patient’s fitness to wor

ISSN:0253-4886    

DOI:10.1159/000171722

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Following embolization of the superior mesenteric artery with autologous blood clots, local catheter thrombolysis using streptokinase was performed in 14 pigs. In 7 animals the abdomen was kept closed during the time of obstruction (3 h) and subsequent lysis (up to 3 h) until angiography revealed patent vessels. Macroscopic and histologic examination showed small bowel distension and severe mucosal damage in all animals. In a second series of 7 pigs, lysis was performed after 1 2 and 3 h of ischemia. Angiographic and histologic findings were compared with surface oxygen tension and myoelectrical activity. Bowel wall anoxia and disappearance of slow waves were reversible after up to 4 h of ischemia (2 h occlusion, 1–2 h lysis). Persistent anoxia and irreversible disappearance of slow waves in combination with severe mucosal damage were suggestive of pregangrenous alterations of the small bowel despite a normal angiographic pattern beyond 3 h of obstruction and successful lysis. The results demonstrate that angiography alone is of poor predictive value in determining bowel viability in acute intestinal ischemi

ISSN:0253-4886    

DOI:10.1159/000171723

出版商:S. Karger AG    

年代:1986

数据来源: Karger