摘要:

Traditionally, proctocolectomy and Brooke ileostomy has been offered to patients with chronic ulcerative colitis requiring an operation for therapeutic or prophylactic indications. The functional results of this approach were good but the patients were incontinent. Our hypothesis has been that by facilitating control of enteric content, the quality of life after proctocolectomy would be enhanced. Ideally, an operation which provides such control should not only excise all diseased and potentially diseased bowel, but should preserve the anal continence mechanism. The aim of this report is to detail how a new sphincter-sparing operation, ileal pouch-anal anastomosis, may fulfill these ideal criteria, while the more traditional continence-preserving approach of ileorectal anastomosis may not. Finally, the current and future role of ileorectal anastomosis is assessed in light of the recent introduction of ileal pouch-anal anastomosis.

ISSN:0253-4886    

DOI:10.1159/000171758

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Terbutaline, a beta-adrenergic agonist, administered subcutaneously inhibits pancreatic exocrine secretion. We studied the effects of intravenous terbutaline and propranolol on cholecystokinin-stimulated pancreatic secretion in conscious dogs. Terbutaline inhibited pancreatic juice volume, bicarbonate concentration, bicarbonate output and protein output, but had no effect on protein concentration. Propranolol blocked this inhibition and had no effect on the response to cholecystokinin. These observations suggest that (1) terbutaline inhibits pancreatic secretion by a beta-adrenergic mechanism and (2) the primary effect of terbutaline on canine exocrine pancreas is inhibition of water and bicarbonate secretion.

ISSN:0253-4886    

DOI:10.1159/000171759

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

This postmortem study examined the hypothesis that degenerative lesions of the hepatic and cystic arteries contribute to acute and chronic gallbladder disease. In 201 unselected adult autopsies, atherosclerosis of the hepatic artery was found in 7.8%, and intimal fibrosis of the cystic artery in 12.4%. These incidences correlated with that of systemic atherosclerosis (p 0.05): it seems unlikely that hepatico-cystic vascular degeneration contributes to chronic gallbladder disease.

ISSN:0253-4886    

DOI:10.1159/000171760

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Patients receiving abdominal or pelvic radiotherapy are at increased risk of developing colorectal carcinoma. In the presence of colonic carcinomas, there is a change in colonic mucus from normal sulphomucin to sialomucin. This also occurs during experimental carcinogenesis and is associated with the dysplastic changes of chronic ulcerative colitis. Twenty-six patients with radiation colitis were compared with 20 controls. All patients had received radiation for genito-urinary malignancy. There were 22 women and 4 men (median age 55 years). Biopsies were taken from 20 resected specimens, 5 sigmoidoscopic biopsies and 1 colonoscopic procedure. The specimens were examined by conventional and histochemical techniques for the presence of sialomucin. Neither sialomucin nor dysplasia were demonstrated in the control group. In the radiation group, there was no evidence of sialomucin in 8 cases, a mixed pattern in 9 cases and a positive reaction in 9. Dysplasia was seen in 2 of 8 patients with no sialomucin, 4 of 9 with a mixed pattern and 7 of the 9 showing a positive reaction. Four patients with recurrent squamous cell carcinomas for which the colon had been excised showed no evidence of sialomucin or dysplasia. Sialomucin and dysplasia appear in the radiation-damaged colon significantly more often than in controls (p < 0.001). The likelihood of dysplasia being present increased in proportion to the histochemical mucin abnormalities.

ISSN:0253-4886    

DOI:10.1159/000171761

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Among 428 patients who had undergone absolute curative resection of gastric cancer, 57 died of cancer recurrence. One hundred and seventeen patients who had survived longer than 5 years were used as controls. In the recurrence group, the primary lesion was larger and the lymph node metastasis more common as compared with the surviving controls. Prognostic serosal invasion was positive in 74% of the recurrence group and negative in 85% of the surviving controls. The most frequent mode of recurrence was hematogenous metastasis in negative prognostic serosal invasion (75%) and peritoneal disseminated metastasis in positive prognostic serosal invasion (52%).

ISSN:0253-4886    

DOI:10.1159/000171762

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Earlier reports have indicated increases in gastrin cell (G cell) mass in many disease states including hyperparathyroidism. This correlation has not been confirmed experimentally, nor has the influence of hypercalcemia separate from that of elevated parathormone been discerned. Sprague-Dawley rats (n = 16) were divided into experimental and control groups. The controls received biweekly intraperitoneal injections of 0.2 ml of propylene glycol and ethanol. Experimental rats received biweekly injections of cholecalciferol (125 µg/ml) in the above carrier and were then divided into 2 groups, group A with 5 weeks and group B with 8 weeks of treatment. Weekly blood was drawn for serum calcium (AA) and serum gastrin (RIA). At sacrifice, serum for parathormone assay (RIA) was drawn and the antral mucosa was stripped and digested. Total mucosa cells were counted and pelleted. Pellets were fixed and sectioned. Straining for G cells was performed using a double-antibody immunofiuorescence technique. Significant hypercalcemia was achieved by vitamin D treatment: mean serum calcium was 13.2 ± 1.2 and 13.5 ± 5.0 versus 10.7 ± 0.6 ml/dl in the controls (p < 0.05). Serum gastrin decreased from a mean value in controls of 98 ± 24 to 34 ± 10 pg/ml (both in group A and group B) (p < 0.05). The total number of antral G cells also decreased: controls 18.24 X 104 ± 10.97 × 104 to 5.22 × 104 ± 2.25 ± 104 in group A and 3.15 × 104 ± 1.38 × 104 in group B (p < 0.05). In this model, hypercalcemia resulted in a significant decrease in G cells as well as in a decrease in serum gastrin, despite a noticeable increase in gastric mucosal thickness. Hypercalcemia may not be a mechanism for G cell hyperplasia, but may be a direct or indir

ISSN:0253-4886    

DOI:10.1159/000171763

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Blood glucose concentrations were measured two times in the same 7 patients who had undergone total gastrectomy 0, 20, 50, 80 and 120 min after two glucose meals (50 g of glucose and 100 ml of water), which on a double-blind basis contained 5 g of guar gum and 5 g of wheat flour in random order. The mean blood glucose concentration was significantly (p < 0.01–0.001) lower 20, 80 and 120 min after the meal containing guar gum than after the meal containing wheat flour. All patients except two (one 50 min and the other 80 and 120 min postprandially) had lower blood glucose concentrations after the meals containing guar gum than after the meals containing wheat flour. Three of four patients who used 5 g guar gum three times daily in their meals felt it benefical in preventing dumping-like symptoms. One got disturbing meteorism. It was concluded that guar gum decreased glucose absorption and prevented postprandial hyperglycemia in these total gastrectomy patients. Guar gum may facilitate the planning of diets for such patient

ISSN:0253-4886    

DOI:10.1159/000171764

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Biliary tract disease and diabetes mellitus are considered to be ominously associated with high mortality and morbidity. The present report deals with 1,500 consecutive biliary procedures and compares the data of 189 diabetic patients (DP) with that of 1,311 nondiabetics (NDP). A wide data base was considered in both categories studied, and all data were computer-analyzed. The most significant results were as follows: (1) in the DP Group there was a higher incidence of patients above 60; (2) a larger percentage of DP were operated upon under emergency conditions (35 vs. 23%, p = 0.01; acute cholecystitis, septic cholangitis). (3) There was a higher rate of DP with septic bile (61 vs. 27%, p = 0.001) and a higher incidence of septic complications (usually wound infection) in the diabetic patients; (4) the mortality rate of DP was not significantly higher in elective cases; however, there was a significant difference in mortality in acute cases (3.1 vs. 1.1 %, p = 0.05). The main conclusions are: (1) A very low mortality rate (2.1 %) was achieved in diabetic patients undergoing surgery for acute cholecystitis and cholangitis, and it seems that the policy of early and definitive surgery adopted has contributed to the good results. (2) There is no significant difference between diabetic and nondiabetic patients with regard to elective surgery for cholelithiasis. (3) This study supports the view that cholelithiasis and its complications are very common in diabetic patients above the age of 50. Sonographic screening for gallstones in such populations seems useful. An epidemiological study of biliary complications in diabetics is being conducted at present by the authors.

ISSN:0253-4886    

DOI:10.1159/000171765

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

To determine the optimal length of bowel resection in the treatment of Crohn’s disease, we evaluated the influence of involvement of resection margins on the recurrence rate. This study involves 87 patients who underwent surgery for Crohn’s disease. Among the 91 surgical procedures performed, histology showed involvement of resection margins in 18 cases. Recurrent disease occurred in 33.3% of patients with involved resection margins as opposed to 27.4% of patients with disease-free margins. The difference between these two groups is not significant (χ2 = 0.249). As a result of this data and according to other reports, we conclude that limited resection in the surgical treatment of Crohn’s disease is jus

ISSN:0253-4886    

DOI:10.1159/000171766

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

A 46-year-old woman with an end-to-end hepaticojejunostomy after bile duct injury is presented. As a result of recurrent cholangitis due to a stricture of the anastomosis, she developed a left lobe liver abscess which perforated into the pericardium causing acute pyogenic pericarditis. Treatment by antibiotics, repeated puncture evacuations and even pericardectomy and drainage were unsuccessful until biliary reconstruction and drainage of the abscess were carried out. Until now, 2.5 years after operation, the patient has remained symptom-free.

ISSN:0253-4886    

DOI:10.1159/000171767

出版商:S. Karger AG    

年代:1987

数据来源: Karger