ISSN:0014-312X    

DOI:10.1159/000128516

出版商:S. Karger AG    

年代:1986

数据来源: Karger

ISSN:0014-312X    

DOI:10.1159/000128517

出版商:S. Karger AG    

年代:1986

数据来源: Karger

ISSN:0014-312X    

DOI:10.1159/000128518

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The most significant complications of hydatid cyst of the liver are rupture and suppuration with an incidence of 6–19%. Rupture into the biliary tract was the most frequent complication and comprised 170 out of 222 complicated hydatid cysts of the liver in the author’s series. These jaundiced patients were managed both by obliteration of the residual cavity and restoration of the patency of the biliary tract which was obstructed by daughter cysts of remnants of the laminated membrane. Rupture into the bronchi requires immediate treatment due to bronchopulmonary complications which might ensue. Rupture into blood vessels and into the free peritoneal cavity is accompanied by severe anaphylactic shock which does not readily respond to corticosteroids. The former complication is accompanied by a high mortality rate, while the postoperative mortality of patients experiencing anaphylactic shock amounts to 1

ISSN:0014-312X    

DOI:10.1159/000128519

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Attempts have been made over the last 20 years, without notable success, to improve the prognosis of hepatic tumours by interfering with the blood supply from the hepatic artery. We review the background and history of this technique and offer a hypothesis as toits mechanism via free radicals. The ways in which this modality of treatment could be improved to optimize damage to the tumour are outlined.

ISSN:0014-312X    

DOI:10.1159/000128520

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Gastric ulceration has been induced after stress, combining 24 h of fasting and 48 h of restraint in 9 groups of 20 rats with or without a pyloroplasty or a pylorojejunostomy combined with atropine and gastric infusion of NaHCO3 or taurocholic acid. After death or sacrifice at 48 h, ulcer index and blood in the jejunum were determined. Gastric mucosal blood flow was measured semi-continuously by a laser Doppler velocimeter. There were 45% deaths after 48 h of restraint alone, and 70% in the group combining pylorojejunostomy with taurocholic acid. Mortality was lower (p ≤ 0.01) with pylorojejunostomy alone and more significantly so (p ≤ 0.001) when associated with NaHCO3. There was no death when NaHCO3 and atropine were combined with restraint. The mucosal blood flow increased significantly during the first 12 h of restraint in the taurocholic acid group. Both groups with NaHCO3 had mucosal blood flows similar to the controls. Gastric acid and gastric emptying, mucosal ischemia and bile reflux are joint factors inducing gastric stress ulcer. The 100% survival and the low ulcer index after a treatment by atropine and gastric infusion of NaHCO3 suggest that these well-known drugs should be used more frequen

ISSN:0014-312X    

DOI:10.1159/000128521

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Intraoperative manometry was performed in 771 patients undergoing cholecystectomy with (n = 158) and without (n = 613) interventions on the common bile duct and papilla. The method measures the resting pressure (RP) and pressure increase (PI) after injection of 1 ml NaCl/s as well as the time (TR) used for return to the initial pressure, using a Statham transducer. All values are recorded and statistically processed by the two-tailed t test. All three manometric parameters (RP, PI and TR) were statistically different (p ≤ 0.0001) between patients with and without alterations of the bile duct and papilla respectively. There was also a clear difference (p = 0.0001) of the TR (which is an indirect measure of the bile flow) between patients with stenosis of papilla (n = 55) and those who showed calculi in the bile duct (n = 103). In a further study we could demonstrate that histopathological changes of the papilla (specimen was taken during transduodenal papilloplasty because of isolated papilla stenosis) led to a prolonged TR, whereas TR in patients with negative histology was decreased. The sensitivity and specifity of this manometric method was very high, 92.4 and 98.6% respectively. This method of manometry enables to obtain precise data about pressure and flow in the bile duct uninfluenced by subjective reading errors in a simple and reproducible way. In our opinion it should complete other intraoperative diagnostic methods during cholecystectomy, particularly as manometry was the only method which led to the correct final diagnosis in 2% of 771 patient

ISSN:0014-312X    

DOI:10.1159/000128522

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Shock wave therapy of kidney- and gallstones, i.e. extracorporeal shock wave lithotripsy (ESWL), is a new, noninvasive technique to destroy concrements in the kidney, the gallbladder and in the ductus choledochus. This method was developed by the Dornier Company, Friedrichshafen, FRG, and tested in animal experiments at the Institute for Surgical Research of the University of Munich. In the meantime, kidney lithotripsy has gained worldwide acceptance. More than 60,000 patients suffering from urolithiasis have been treated successfully, what made surgical removal of their kidney stones obsolete. Gallstone lithotripsy is, however, still at the very beginning of clinical trial. Lithotripsy of gallbladder stones will have to be applied in combination with urso- or chenodesoxycholic acid in order to obtain complete dissolution of the fragments. Potential hazards to living tissues are briefly mentioned. Since the lung is particularly susceptible, shock waves must enter the body at an angle which ensures that lung tissue is not affected.

ISSN:0014-312X    

DOI:10.1159/000128523

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Coronary sinus blood flow and resistance were studied before and after intravenous dipyridamole in 4 patients with transplanted heart and normal coronary arteriogram treated by cyclosporine-prednisolone. Results were compared to those of a normal group of 7 subjects. Left ventricular endomyocardial biopsies were performed in the heart transplanted group. Mean right atrial pressure, cardiac index and left ventricular function were normal in the transplanted heart group. Mean aortic pressure and systemic vascular resistances were significantly higher in the transplanted group than in normals (p < 0.01), but coronary resistance were similar. Dipyridamole-induced vasodilation resulted in an increased coronary sinus blood flow and a decreased coronary resistance in both groups, but these effects were reduced in 1 patient with a transplanted heart that evidenced an important perivascular fibrosis after a subacute rejection. In conclusion, this preliminary report of coronary blood flow in patients with transplanted heart indicates that the ability of coronary sinus blood flow to increase after dipyridamole is normal in the transplanted heart without allograft rejection. A major limitation in coronary vasodilation was observed in 1 patient with rejection antecedents and perivascular fibrosis, which could play a role in left ventricular function deterioration in some patients after heart transplantation.

ISSN:0014-312X    

DOI:10.1159/000128524

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The confluence of the biliary duct constitutes the most common location of the bile duct neoplasms. Resection of the tumor is the only procedure which has met with longterm survival rates (more than 5 years). An enhanced exposure of the tumor in surgical intervention contributes to increasing the number of resectable cases. The transhepatic approach through the principal incision offers the best possibility to explore the tumors of the proximal bile duct confluence, using this approach the resection rate is higher than that of other routes. The surgical management of confluence biliary duct carcinoma can be curative if the diagnosis is made in early stages of the disease and if at that time resection is possible.

ISSN:0014-312X    

DOI:10.1159/000128525

出版商:S. Karger AG    

年代:1986

数据来源: Karger