ISSN:0253-4886    

DOI:10.1159/000172503

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

In addition to organ transplantation, the immunomodulating effect of allogeneic blood transfusion might also have consequences for patients with malignancies or other surgical patients requiring blood transfusion. It has been suggested that this effect of allogeneic blood transfusion could adversely affect the prognosis of patients with a malignant disorder or increase the susceptibility for postoperative infections. These deleterious effects of allogeneic blood transfusion, which are suspected to be mediated by the induction of immunosuppression are further discussed in this review. We conclude that, whenever a detrimental effect of blood transfusions on cancer prognosis or the incidence of postoperative infectious complications exists, this relationship is not causal, but reflects the circumstances which necessitate the transfusion.

ISSN:0253-4886    

DOI:10.1159/000172504

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Despite exciting progress in the understanding of advanced gastro-intestinal cancer, the prognosis of these diseases is still poor because of limited treatment options. Curative surgery is often not possible or worthwhile due to tumour spread. Systemic chemotherapy typically shows low response rates of short duration, and a potential palliative benefit is limited by systemic toxicity. This problem could be circumvented by local chemotherapy administration, and this review will summarize the actual role of regional intra-arterial chemotherapy in the treatment of advanced gastro-intestinal cancer. Due to its beneficial effect on survival and quality of life, hepatic artery infusion chemotherapy is a viable option for the treatment of non-resectable metastases confined to the liver from colorectal cancer. Regional chemotherapy for locally or regionally advanced or recurrent cancer of stomach, pancreas, or rectum must still be regarded as an experimental treatment with sometimes impressive pain relief. When systemic chemotherapy and radiotherapy have failed in non-resectable (recurrent) rectal cancer, regional chemotherapy via internal iliac arteries may provide satisfactory palliation. The response rates of intra-arterial chemotherapy in gastro-intestinal cancer are better than, or at least as good as, those of all other palliative treatment modalities. In terms of survival, besides one controlled trial showing better survival after liver infusion, the role of regional chemotherapy needs to be further evaluated.

ISSN:0253-4886    

DOI:10.1159/000172505

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The complex immunological challenge of transplanting small bowel has been a long-lost battle. Until our days, when greatest advances in the field of immunology and cellular biology, couped with perfection of microsurgical techniques, have provided the perfect ground to the ideal transplant model, the mere thought of intestinal transplantation was a synonym of deception. Until now. New encouraging reports show that better immunosuppressive drugs provide a better recipient preparation for acceptance of small bowel grafts. Understanding of the process of antigen recognition, processing and in general the whole activation pathway of the recipient immune system has opened the door to new amazing discoveries. The γδT cells are found in high quantities in mesenteric lymph nodes and Peyer’s patches of portal vein-immunized/ drained recipients of small bowel transplants. These cells have been correlated with the production of type 2 cytokines (like IL-4) which concomitantly have been linked with the enhancement of survival in this transplant model. Moreover, when restimulated in vitro, these cells are a great source of this same cytokines. Finally, adoptive transfer of γδT cells to naive animals produced prolonged survival when compared to those receiving cells from i.v.c. immunized/drained animals. In this paper the world literature is reviewed, while special attention is given to the understanding of the antigen presentation process and its repercussion in the final outcome of small bowel transplants, providing the basis for the understanding of the general concepts of transplantation and specifically to how different models of small bowel transplantation have yielded the current invaluable knowledge of the immunology involved in such matters. Eventually, complete success in clinical small bowel transplantation is virtually a re

ISSN:0253-4886    

DOI:10.1159/000172506

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Preoperative evaluation and surgical technique of extended left hepatectomy are described in detail.

ISSN:0253-4886    

DOI:10.1159/000172507

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Twenty patients with complete rectal prolapse were divided into 2 equal groups and subjected to clinical examination, barium enema and colonoscopy. Of group A, 2 patients were fully continent, 3 incontinent to flatus, 1 to liquid stool and 4 to solid stool. Three patients of group B were fully continent, 1 incontinent to flatus, 2 to liquid stool and 4 to solid stool. Group A was subjected to Shank’s puborectoplasty and followed up for 8-20 months. No recurrences were recorded; mucosal prolapse occurred in 1 patient. The patients who were incontinent to flatus and liquid stool preoperatively, became fully continent. The patients who were incontinent to solid stool became fully continent except for 1 who remained incontinent to liquid stool and 2 others who remained occasionally incontinent to flatus. 50% of the patients with preoperative constipation improved significantly. Group B patients underwent simple suture rectopexy. A follow-up of 8-20 months revealed: 1 complete recurrence, 2 mucosal prolapses, 1 incisional hernia and 1 patient with sinus formation; in all cases operative intervention was needed. In addition, intraoperative blood transfusion was indicated in 2 patients. Deep venous thrombosis of the femoral vein occurred in 1 patient. Three patients remained incontinent to stool (2 to solid, 1 to liquid), 2 became only incontinent to flatus and 4 fully continent. The problem of constipation remaine

ISSN:0253-4886    

DOI:10.1159/000172508

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

A retrospective study was designed to compare the accuracy and potential advantages of laparoscopy vs. laparotomy in the management of abdominal stab wounds. Thirty-five patients with abdominal stab wounds and scheduled for abdominal surgical exploration based on clinical evaluation were included. Hemodynamically unstable patients were excluded from the evaluation, laparotomy being performed immediately. Laparotomy was performed in 18 and laparoscopy in 17 patients. Penetrating wounds were observed in 65% of the patients (66.6% for laparotomy and 64.7% for laparoscopy). The diagnostic accuracy of laparoscopy was 100%, and laparotomy 89%. Four patients operated on by laparoscopy were converted to laparotomy (22%): in 2 patients to ascertain the origin of hemorrhage, and in 2 patients to suture a bowel laceration. No mortality was noted. Morbidity was observed in 4 patients managed by laparotomy: delirium tremens; pulmonary infection; missed small bowel injury, and stress bleeding ulcus. The postoperative hospital stay was significantly shorter for the patients explored by laparoscopy than for those explored by laparotomy (5.6 vs. 10.2 days, p = 0.02). We conclude that laparoscopy is a safe and accurate method for the evaluation of abdominal stab wounds. It avoids unnecessary laparotomy in 78% of cases. It led to less morbidity and shorter hospital stay than laparotomy. Further evaluation is required to determine the potential to treat major acute lesions by laparoscopy.

ISSN:0253-4886    

DOI:10.1159/000172509

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The aim of this paper is to demonstrate a simple surgical treatment of duodenal fistulae and iatrogenic duodenal injuries. Medical records of 4 patients submitted to investigation and surgical treatment for either duodenal fistulae or iatrogenic duodenal lesions were retrospectively reviewed. One patient died of multiorgan failure due to uncontrolled sepsis 12 days after operation. Postmortem investigation showed no subsequent leakage. Three of the patients survived with good clinical results. Closure of duodenal fistulae and repair of duodenal injuries by a serosal patching procedure is safe, simple and effective.

ISSN:0253-4886    

DOI:10.1159/000172510

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The clinical time course from onset until full clinical presentation of acute respiratory distress syndrome (ARDS) is largely unknown. The main reason is the inhomogeneity of patients who develop ARDS, especially septic patients or trauma victims. Furthermore the initiating event that leads to ARDS in those patients is unknown. We therefore investigated the time course of ARDS in a homogeneous group of patients undergoing esophageal resection (n = 40, 9 patients or 22.5% developed ARDS) utilizing a validated lung injury score. The full clinical picture of ARDS with diffuse alveolar infiltration and deterioration of pulmonary function develops 5-6 days after esophagectomy. Radiological changes are most pronounced in the lower quadrants. Total thoracic compliance was lowest 3 weeks after esophagectomy, possibly as a sign of the late or fibrotic stage of ARDS.

ISSN:0253-4886    

DOI:10.1159/000172511

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

In the last 10 years we have treated 450 consecutive patients symptomatically affected by 1st- or 2nd-degree hemorrhoids with rubber band ligation. The patients were divided into 2 groups: group A, 216 patients treated from 1983 to 1989, and group B, 234 patients treated from 1990 to 1993. In group A multiple ligations (2 or 3) were made in a single session. In the group B one ligation at a time was performed. In group A satisfactory results were obtained in 78% of the cases, whereas in group B the results were good in 91% of patients (p < 0.01). Complications also decreased: bleeding decreased from 25 to 5% and pain from 22 to 9% (p < 0.01). Sepsis was present in 30% of the group-A cases, but was never seen in group B. In conclusion rubber band ligation offers better results if it is made with one ligation at a time, repeating the operation every 4 weeks.

ISSN:0253-4886    

DOI:10.1159/000172512

出版商:S. Karger AG    

年代:1997

数据来源: Karger