摘要:

The problem of acute gallstone pancreatitis is reviewed with respect to pathophysiology, diagnostic approach, and therapeutic strategy. The role of gallstones and anatomic variations of the common bile duct and pancreatic duct are analyzed. The paramount importance of urgent endoscopic retrograde cholangiopancreatography in all cases of suspected acute gallstone pancreatitis is emphasized. Early biliary surgery after recovery from pancreatitis is demonstrated to be the safest strategy to avoid a relapse of the disease and perioperative complications. In patients with common bile duct stones and severe pancreatitis the outcome seems to be improved by immediate endoscopic sphincterotomy and removal of the stones.

ISSN:0253-4886    

DOI:10.1159/000171932

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Data of 45 patients, who underwent pancreaticoduodenectomy and regional lymphadenectomy for ductal adenocarcinoma of the pancreas, were reviewed in a retrospective study. Carcinomas of the papilla of Vater, the distal common bile duct and the duodenum were excluded. Tumors were classified according to the TNM staging (UICC 87) and Kloeppel’s histomorphological grading. DNA content was measured in each tumor by cytophotometry. DNA analysis revealed 11 ‘triploid’ and 34 ‘nontriploid’ tumors. No tumor was located in the ‘diploid’ region. The clinical course of triploid tumors was significantly more malignant than that of nontriploid tumors (p ≤ 0.005). No difference could be found in the outcome of the individual staging and grading groups. An important advantage of DNA analysis in the assessment of prognosis is its objectivity and the possibility of pretherapeutic examination of small biopsy specimens or fine needle aspiration

ISSN:0253-4886    

DOI:10.1159/000171933

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

30 subjects submitted to Billroth II resection for duodenal ulcer were divided in two groups: 15 patients with severe remnant gastritis at endoscopic examination confirmed by histology and 15 control subjects. Total concentrations of bile acids in gastric remnant and bile acid pattern were determined in all subjects. In 15 patients (8 controls and 7 with severe remnant gastritis) a scintigraphy with 99mTc-HIDA to estimate enterogastric reflux with subsequent gastric evacuation of refluxate was performed. Fasting bile acid reflux rate, enterogastric reflux and gastric evacuation of refluxate from the remnant proved to be similar in the two groups. In contrast the qualitative analysis of biliary reflux showed an increase in the amount of deoxycholic acid in patients with severe remnant gastritis (p < 0.05), compared with controls; no differences have been observed as for the amount of other bile acids and taurine and glycine conjugates. Therefore the increase in deoxycholic acid, probably due to bacterial overgrowth reported after gastric surgery, may contribute to develop and maintain gastritis after Billroth II anastomosis. Our findings also support the hypothesis that deoxycholic acid – recently postulated to promote colonic carcinogenesis -may play a role in the increased prevalence of cancer observed in the gastric remnant after gastric surger

ISSN:0253-4886    

DOI:10.1159/000171934

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

An age- and sex-matched comparative study of bone disorders between control and patient groups after gastric surgery was performed with the cooperation of a number of hospitals in Japan. In males after gastric surgery a high incidence of bone atrophy was observed in the 5th and 6th decades. In females, however, there was no marked difference between patient and control groups. Evaluation by operative procedures showed that the incidence of bone atrophy was higher in male patients after Billroth II or total gastrectomy than in the patients after Billroth I gastrectomy.

ISSN:0253-4886    

DOI:10.1159/000171935

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Over a period of 12 years, 1,039 patients were operated on at our hospital for gastroduodenal peptic ulcer. We analyzed the indications for surgery and divided the patients into two groups: subjects operated on for refractory ulcer, and patients operated on for an ulcer complication (bleeding, perforation or stenosis). To analyze the incidence of these indications for surgery, the 12 years of study (1976–1987) were divided into three 4-year periods. Our results show a statistically significant decline (p < 0.001) in the number of refractory ulcers after 1979, mainly concerning surgery for duodenal ulcer (p < 0.001). At the same time we witnessed a statistically significant increase (p < 0.001) in ulcer bleeding, again after 1979. This increase is particularly due to an increase in the incidence of duodenal ulcer bleeding (p < 0.001). Perforation did not undergo any statistically significant modifications over the three periods. Finally we witnessed a decrease in peptic stenosis, with a statistically significant decrease for gastric ulcer (p < 0.02

ISSN:0253-4886    

DOI:10.1159/000171936

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Three patients with malignant biliary obstruction, who developed postoperative hepatic necrosis due to compromise of the hepatic arterial blood flow, are reported. Two patients had major hepatic necrosis following ligation of the common hepatic or right hepatic artery during resection of a hilar cholangiocarcinoma. The 3rd patient suffered temporary ischemia of the liver during total pancreatectomy and developed a necrotic abscess on the left lobe with subsequent atrophy of the left liver. One patient died on the 12th postoperative day. Of the 2 survivors, 1 required extensive right hepatectomy on the 4th postoperative day, while the other had percutaneous drainage of a liver abscess 30 days after surgery. The presenting features of this dangerous complication are described, and the pathogenic mechanisms which render the cholestatic liver particularly prone to ischemic necrosis are discussed. Caution is recommended when hepatic artery ligation is being considered during the course of a difficult operation for biliary obstruction.

ISSN:0253-4886    

DOI:10.1159/000171937

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

During the years 1970–1985, 68 patients were operated upon for acute intestinal ischemia due to superior mesenteric vascular occlusion. Survival rate was 24% (95% confidence limits: 14–35), 36% (13–65) surviving superior mesenteric artery embolus, 25% (13–14) surviving superior mesenteric artery thrombosis and 20% (1–72) surviving superior mesenteric vein thrombosis. Twenty-nine patients had intestinal resection (43%; 29–54) with a survival rate of 48% (29–67) and 4 had vascular procedures with 3 survivors. Prodromal symptoms occurred in 46 (68%; 55–78) from 1 to more than 4 weeks before onset of the abdominal catastrophe, an observation which may allow diagnosis and vascular surgery before onset of severe acute inte

ISSN:0253-4886    

DOI:10.1159/000171938

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

We present 60 patients with gastrointestinal bezoars in the time from 1971 to 1988 inclusive. Their aetiological, diagnostic and therapeutic circumstances were analysed, as well as any bezoar relapses. From the aetiological point of view, most of our patients had previously undergone gastric surgery (78.3 %, of which 62.1 % had received bilateral truncal vagotomy plus a gastric drainage technique). As to diagnosis, 78.3% of our patients began as cases of intestinal obstruction through obturation, and diagnosis was made by means of simple abdomen radiology. In 21.7%, gastric symptomatology was indicated by the presence of a gastric bezoar, with endoscopy being the fundamental exploratory technique used. The most frequently used surgical technique in the cases of intestinal obstruction was enterotomy and removal of the bezoar. Of the gastric bezoar patients (n = 13), 5 received conservative treatment while the remaining 8 underwent surgery with gastrotomy. There were 10 bezoar relapses (16.6%) in our series, who required reoperation.

ISSN:0253-4886    

DOI:10.1159/000171939

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Epithelioid leiomyomas of the gastrointestinal tract are difficult to diagnose before surgery and their malignancy is not readily evaluated. The tumor is of smooth muscle origin, arising from the muscularis propria, and frequently develops in the gastrium, occasionally extending into the gastrocolic ligament or greater omentum. Malignancy is evaluated from the numbers of mitotic cells per 50 high power fields. However, even a tumor with few mitoses may metastatize. Thus, we propose that the malignancy of the tumor should be decided in terms of location, size, pattern of growth, invasion of the mucosa, cellularity, mitotic rate, and anaplasia. We reported a case of epithelioid leiomyoma that was pedunculated, with exogastric expansion. The literature is reviewed.

ISSN:0253-4886    

DOI:10.1159/000171940

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Congenital diaphragmatic hernias are usually diagnosed in childhood. The clinical presentation in adult life is heralded by complications which are sometimes misdiagnosed. In Bochdalek hernia incarceration of stomach, pancreas, omentum, colon and spleen can occur with ischemic necrosis if time elapses. Treatment demands surgical repair of the diaphragmatic defect and sometimes total or partial resection of abdominal organs, so an abdominal approach is preferable.

ISSN:0253-4886    

DOI:10.1159/000171941

出版商:S. Karger AG    

年代:1990

数据来源: Karger