摘要:

Of patients with gastric carcinoma, ± 1 % of cases will occur in patients who have undergone a prior gastrectomy for benign peptic ulcer disease. The interval between the original operation and the development of gastric malignancy is at least two decades. This possibility must constantly be kept in mind in the follow-up of postgastrectomy patients. It should be included in the differential diagnosis of the so-called postgastrectomy syndromes, particularly when long-standing symptomatology undergoes a subtle change. The majority of these malignancies are advanced at the time of diagnosis, with a mean survival of less than a year

ISSN:0253-4886    

DOI:10.1159/000171874

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

In a prospective study we analyzed the recurrence rates in 505 patients with a chronic duodenal, intrapyloric or prepyloric ulcer. In the period from 1973 to 1982 the 5-year recurrence rate in 392 patients after proximal gastric vagatomy was 10% for the intrapyloric and 14.5 % for the duodenal ulcer, whereas patients with a prepyloric ulcer had a recurrence rate of 29%. Since 1982 our therapy of choice for the prepyloric ulcer has therefore been antrectomy and selective gastric vagotomy. The recurrence rate in 19 patients with a prepyloric ulcer treated by this procedure was now 0%. Furthermore we analyzed and discussed acid and gastrin secretion in this group of patients in relation to the different ulcer localizations.

ISSN:0253-4886    

DOI:10.1159/000171875

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Physiopathological mechanism of respiratory distress syndrome associated with acute pancreatitis remains unclear. We observed a case of drowning-like hypoxemia due to a pancreaticobronchial fistula; this patient, with a necrotizing isthmic pancreatitis, had only two Ranson’s criteria, and showed a clearly isolated mechanical reason for respiratory failure. Then, the retrospective study of 40 patients having an objective surgical recognition of necrotizing pancreatitis (NP) was performed. Twelve patients received ventilatory support. The prevalence of isolated sepsis-related respiratory failure was 9 out of 12 cases (75%). Two patients had a secondary infection of necrosis also associated with a pancreaticobronchial fistula, and in 1 case this isolated mechanism of respiratory distress was obvious. Such a prevalence of 25% of fistula-related respiratory failure has never been observed before. The onset of severe hypoxemia in the course of NP appears to be a sensitive and pathognomonic sign of evolving complication of pancreatitis, leading to endoscopic retrograde pancreatography, and to prompt surgery. In the opposite way than that suggested by the enzymatic hypothesis, we were not able to show any reason for applying mechanical ventilation to patients suffering from pancreatitis, in the absence of intraabdominal sepsis, and/or pancreaticobronchial fistul

ISSN:0253-4886    

DOI:10.1159/000171876

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

We have studied the liver histologies of 106 severely obese patients and the effects of jejunoileal bypass 2–5 years later in 12 of them when a second operation was needed for conditions not influencing liver function. Liver specimens of severely obese patients showed fatty infiltration (95%), inflammatory infiltration (72%), and hepatic fibrosis (50%). Ultramicroscopic analysis of liver biopsy samples from patients who had jejunoileal bypasses showed significant worsening of the fatty infiltration and hepatic fibrosis, whereas inflammatory infiltration was not changed. There were many new collagen fibrils. The smooth endoplasmic reticulum was hypertrophic and dilated. The mitochondria showed some signs of matrix degeneration. There were many lipofucsin granules and vacuoles containing dense osmophilic bodies. Our data suggest that liver histology should be evaluated in patients selected for jejunoileal bypas

ISSN:0253-4886    

DOI:10.1159/000171877

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Peritoneal lavage was performed in 66 patients with gastric carcinoma to assess the amount of free tumor cells. 12/66 patients (18 %) proved to have free cancer cells. The intestinal type of carcinoma showed more frequently free tumor cells (8/12). There was no correlation between free cancer cells and the number of invaded lymph nodes. Patients with curative surgery but free cancer cells belong to the risk groups for early recurrences. Whether surgery on its own causes an increase in free tumor cells needs to be studied as well as the potential benefit of adjuvant chemotherapy in these patients.

ISSN:0253-4886    

DOI:10.1159/000171878

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

An analysis of prospectively collected data was made on 490 patients with carcinoma of the esophagus seen between July 1982 and December 1986 to determine the incidence of synchronous liver metastases and the outcome of these patients. Twenty-seven patients (5.5%) had liver metastases detected by clinical examination, ultrasound scanning or at laparotomy. Fourteen patients had palliative resection of the tumor, 2 had a bypass, 7 had a laparotomy only and 4 were moribund. The median survival of resected patients was 4.5 months (range: 2–42 months) and for those with exploration alone it was 2.0 months (range: 0.5–7 months). The 2 patients who had a bypass lived 6 and 7 months, respectively. Patients undergoing exploration only had, in addition to liver metastases, unresectable primary tumors with peritoneal seedlings which precluded even a bypass. No statistically significant difference in survival can be demonstrated between this group of patients with liver metastases and those without liver involvement undergoing similar palliative treatment. We conclude that when relief of dysphagia is the primary goal of treatment, liver metastasis per se should not deter attempts at performing the most effective palliative procedure possi

ISSN:0253-4886    

DOI:10.1159/000171879

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

The aim of the present study was to determine the differences in gastric acidity between duodenal ulcer patients with and without recurrent ulceration after elective proximal gastric vagotomy (PGV). The pre- and postoperative results of 24-hour intragastric pH monitoring of 10 patients with ulcer relapse were compared to the data from a control group of 42 patients without recurrence. Patients with ulcer recurrence had a significantly (p < 0.05) lower median pH and a significantly (p < 0.05) higher median percentage of pH recordings of ≤ 2 during the postoperative sleep phase than patients without ulcer relapse. High nocturnal acidity seems to be a predisposing factor for the recurrence of ulcers after PGV. A risk group for ulcer recurrence after PGV is defined by a postoperative median pH of ≤ 2.0 and a median percentage of pH readings of ≤ 2 of more than 70% during the sleep phase. The sensitivity and specificity of postoperative intragastric pH monitoring for identification of this at-risk group was 80 and 91 %, respect

ISSN:0253-4886    

DOI:10.1159/000171880

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

The incidence of gallstones in patients who had undergone radical gastrectomy for cure of gastric cancer was 4–8 times higher than in the general population. At least two factors seem to be involved in this high incidence: one is complete vagotomy which is inevitable in gastrectomy with lymph node dissection, and the other perioperative hepatic dysfunction. One fourth of these patients with gallstones required cholecystectomy with or without T-tube drainage. The high incidence of gallstones and a rather difficult cholecystectomy we experienced forced us to perform prophylactic cholecystectomy in these gastric cancer patients diagnosed with: cirrhosis or hepatitis; hemophilia or other hematologic disorders, and the cancer lesion involving the aborad part of the stomac

ISSN:0253-4886    

DOI:10.1159/000171881

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

We describe a case in which esophageal carcinoma invaded a coexisting leiomyoma. A 45-year-old Japanese man had complained of slight dysphagia and showed an abnormal shadow on the chest X ray film 10 years ago. Endoscopic examination revealed an irregular large ulcer located over a protuberant white mass in the middle of the esophagus. Subtotal esophagectomy, including lymph node dissection, was performed. The resected tumor was of resilient consistency and 10 × 6 × 4 cm in size. Microscopically, the submucosal tumor was consistent with leiomyoma. The mucosal lesion over the leiomyoma was a poorly differentiated squamous-cell carcinoma, which invaded the leiomyoma. The patient died 527 days after operation. A literature review was made of reports on 8 such cases in which esophageal carcinoma was overlying a leiomyoma. It was suggested that the protruding of the leiomyoma into the esophageal lumen might induce the mucosal carcinoma by chronic irritatio

ISSN:0253-4886    

DOI:10.1159/000171882

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Non-neoplastic congenital true cysts of the pancreas in adults are rare. We present our experience with 6 cases: 3 clinical and 3 autopsy cases. The clinical cases were collected from over 300,000 surgical-pathology specimens, and the autopsy cases from over 11,000 necropsies. The patients presented with pain, duodenal obstruction and a pancreatic mass at laparotomy. One of the clinical cases represents what we believe to be the second reported case of congenital multiple true pancreatic cysts in an adult, and the first to be radiologically documented. Optimal surgical management includes operative pancreatography and resection.

ISSN:0253-4886    

DOI:10.1159/000171883

出版商:S. Karger AG    

年代:1989

数据来源: Karger