摘要:

The charts of 200 patients with acute inflammatory gallbladder disease were reviewed. Forty-eight patients were found with grangrenous, perforated or acalculous cholecystitis. These three conditions resulting from an ischemic gallbladder, differ from simple acute cholecystitis in its pathogenesis, laboratory findings and clinical course. Gangrenous and perforated cholecystitis accompany chronic systemic vascular compromise, whereas acalculous cholecystitis is found in a severe acute low-flow state. Awareness, together with careful clinical history, physical examination, selective blood tests and high-quality ultrasound, all contribute in the accurate diagnosis of this neglected condition. Intensive perioperative management is recommended.

ISSN:0253-4886    

DOI:10.1159/000172129

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Serial changes of hemodynamic parameters were investigated using a Swan-Ganz catheter in 14 patients undergoing laparoscopic cholecystectomy (LAP) and 12 patients undergoing mini-laparotomy cholecystectomy (mini-LAP). Systemic blood pressure, pulmonary arterial pressure, heart rate, central venous pressure, pulmonary capillary wedge pressure and cardiac output in the LAP group were not significantly different from those in the mini-LAP group. Urine output during 30-60 min after the initial pneumoperitoneum in the LAP group was significantly lower than in the mini-LAP group.

ISSN:0253-4886    

DOI:10.1159/000172130

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

A group of 152 patients who underwent surgery for liver hydatid disease from 1982 to 1992 was studied. In all cases, the cysts were evacuated, part of the cyst wall was excised and the cavity edges were hemostatically sewn over. The residual cavity was obliterated and drained. Eight of these patients (5.2%) developed external biliary fistulas. In 2 cases the fistula stopped draining within 40 days. Six patients required reoperation due to septic complications (2 cases), long-standing high output fistula (1 case), obstructive jaundice (1 case) and a wide cavity-biliary tree communication (2 cases). At reoperation in all cases, suture of the communication between the residual cavity and the biliary tree was performed with further obliteration and drainage of the residual cavity. In 3 cases the common bile duct was explored, and in 1 patient a choledochoduodenostomy was performed. Four fistulas stopped draining in 4-6 weeks and two 10-16 weeks postoperatively. We conclude that in patients with large calcified hydatid cysts of the liver, partial capsectomy and suture of the communication between the residual cavity and biliary tree are essential steps to avoid biliary-cutaneous fistula formation. The initial treatment of biliary-cutaneous fistula is conservative but, if the fistula persists, stent insertion or endoscopic sphincterotomy is indicated. Should this fail, reoperation is unavoidable.

ISSN:0253-4886    

DOI:10.1159/000172131

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

From January 1980 until December 1991, all complying patients suffering from early uncomplicated postoperative intestinal obstruction were managed according to a stepwise treatment protocol including intestinal tube decompression as second echelon attempt. The population undergoing intestinal tube decompression comprised 34 patients. In 20, tube decompression was successful, whereas in 14 this procedure failed to relieve obstruction and relaparotomy had to be carried out. Retrospective data analysis disclosed the dominant role of suction system malfunction in this study, hypothetically reducing the incidence of truly therapy-resistant adhesions to approximately 12%. Thus, suction system supervision and proposed biomedical engineering research promise future success rates of close to 90%.

ISSN:0253-4886    

DOI:10.1159/000172132

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

The influence of Picolax bowel preparation on the risk of explosive colonic gas was studied in 35 patients. The mean concentration of explosive hydrogen was 1% (0-8%) and methane was 3% (0-17.3%). Three samples contained > 4% potentially combustible hydrogen concentrations whilst 13 samples showed potentially combustible methane levels ( > 5%). Fifteen of 35 patients (43%) had potentially or actually explosive gas mixtures: 12 of 19 (63%) patients with an unsatisfactory bowel preparation compared with 3 of 16 (19%) with a satisfactory preparation (p < 0.01). The risk of explosive colonic gas is determined largely by the quality of bowel preparation. Picolax alone does not eliminate the risk of explosion during colonoscopic polypectomy or surgical diathermy at laparotomy or laparoscopy if the bowel is opened.

ISSN:0253-4886    

DOI:10.1159/000172133

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

The possible beneficial effect of reduced glutathione infusion on acute reflux pancreatitis was investigated in five groups of rats (8 each). In groups A, A’ and B, B’ acute pancreatitis was induced by means of a closed duodenal loop; group C was sham operated. In groups B and B’ reduced glutathione was infused at a flow rate of 0.2 ml/h (1,600 mg/kg/24 h) starting 2 h before the induction of pancreatitis and continuing for the subsequent 12 h. Groups A and A’ received equal volumes of saline solution. A, B and C rats were sacrificed 24 h after the induction of pancreatitis: serum amylase, AST, ALP and lipid peroxides together with pancreatic and liver histology were determined. A’ and B’ rats were observed for up to 15 days to evaluate survival. Serum amylase and liver function tests were higher in saline treated than in sham operated rats; while glutathione treated rats had lower values than saline treated, the differences were not significant. Lipid peroxides were not found to be significantly different among the three groups. Both groups with acute pancreatitis had pancreatic histological scores higher than sham-operated rats, with no significant difference between saline and glutathione-treated rat. Histological liver inflammation was a little more pronounced in acute pancreatitis rats, especially when they received only saline. It may be concluded that reduced glutathione infusion does not exert a substantial beneficial effect in the rat with acute reflux pancreatitis, probably due to the minor role played by oxygen-derived free radicals in the pathogenesis of this experimental model. Reduced glutathione has a protective effect on the liver; it is probably through this action that reduced glutathione seems to have some positive, although not substantial, effects in acute reflux pancreatitis induced by closed duodenal loop

ISSN:0253-4886    

DOI:10.1159/000172134

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

The presence of neuroendocrine cells (NEC) in the anorectum is well documented. However, the density of the endocrine cells in different regions of the anal canal has not been determined. Our aim was to determine the distribution of NECs in different regions of anal canal epithelium. We have studied the anal canal epithelium in 14 blocks in 7 specimens from patients undergoing abdominoperineal resection. Sections were stained with haematoxylin and eosin and also by the argyrophil technique. NECs were counted in the epithelium and glandular crypts in every 2 mm of visual field at an image magnification of 125. The anal transition zone (ATZ) was only present in 3 of 7 specimens studied. None of the 14 blocks exhibited NECs in the squamous-lined anal canal. However, melanocytes could be identified in this region. ATZ, when present, contained a relatively small number of NECs. The density of NECs showed a gradual increase from the squamocolumnar junction upwards for approximately 10 mm. The ATZ is absent in about 50-60% of the subjects. Also, NECs are only present in the columnar-lined anal canal. This may be important in operations on the anorectum as only the columnar-lined anal canal is likely to be affected by peptidergic modulation.

ISSN:0253-4886    

DOI:10.1159/000172135

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Anorectal physiology after sphincter-saving operations (stapled low anterior resection, manual low anterior resection, coloanal anastomosis) was evaluated by means of clinical data and manometric study. Our findings suggest that anorectal function is excellent after low anterior resection. Some mechanisms of sphincter continence are well preserved even after complete excision of the rectum.

ISSN:0253-4886    

DOI:10.1159/000172136

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

In a group of 22 patients with idiopathic fecal incontinence treated by postanal repair (PAR), functional results were determined with a postoperative interval of 3 and 34 ± 9 months. Incontinence was reduced in 10 patients, and 12 regained normal continence. In all patients, continent or not, pre- and postoperative studies (3 months after PAR) showed no modification of maximum resting pressure and of anal canal length while in continent patients, maximal voluntary contraction values were higher without being significant. Comparison of preoperative and 3-month postoperative defecographic X-rays showed no modification of either anorectal angle values, or of perineal descent. Isolated repair of striated sphincteric muscles, without internal sphincter repair, could result in the absence of resting pressure variation, and explain the lack of incontinence correction in 10 of our patients

ISSN:0253-4886    

DOI:10.1159/000172137

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Volvulus of the stomach is rare. We report a patient with chronic gastric volvulus that was diagnosed endoscopially, confirmed radiologically and treated operatively with derotation and fixation of the stomach by gastrostomy.

ISSN:0253-4886    

DOI:10.1159/000172138

出版商:S. Karger AG    

年代:1993

数据来源: Karger