摘要:

Peptic oesophageal stricture develops in approximately 10-15% of patients with inadequately treated reflux oesophagitis and poses a difficult clinical problem. The management of reflux oesophagitis has been revolutionised by improvements in medical management, endoscopic and balloon techniques of oesophageal dilatation. The major advance has been the development of inhibitors of gastric acid secretion: histamine receptor antagonists and H+ + K+ + ATPase inhibitors. Studies have recently shown that the H+ + K+ + ATPase inhibitor omeprazole is effective in the management of severe resistant reflux disease with peptic stricture formation, leading to a reduction in the number of oesophageal dilatations required by up to 60% of patients. The aim of this article is to review the current medical, endoscopic and surgical management of severe peptic oesophagitis with stricture formation.

ISSN:0257-2753    

DOI:10.1159/000171412

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

The effect of Chagas’ disease on the digestive tract is evaluated based on the experience acquired in the surgical management of 929 cases of megaesophagus: 807 in the nonadvanced state of the disease and 122 with dolichomegaesophagus. The 807 subjects with nonadvanced megaesophagus were submitted to wide esophagocardiomyectomy on the anterior esophagogastric junction combined with an antirefl·ux valvuloplasty procedure. There was no mortality. On the other hand, dolichomegaesophagus was always resected, with an esophagogastroplasty through the esophageal bed. The index of mortality of the series was 4.1% (5/122) and the main postoperative complications were pleural effusion (22.1 %) and fistula of the esophagogastric anastomosis (8.2%). Over the long term the patients adapted well to the operation and gained weight. For the treatment of the megacolon, an easier technique has been employed: resection of the dilated sigmoid colon and colorectal anastomosis just above the anorectal ring. In 30 patients, no leakages, infection or other major complications were seen. The patients, after 1 year of follow-up, had a normal bowel trans

ISSN:0257-2753    

DOI:10.1159/000171413

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Developments in therapeutic endoscopy over the last decade have made it possible to perform endoscopic hemostasis for bleeding peptic ulcers. This review traces the developments in this field in the Department of Surgery of the National University of Singapore. A recently conducted prospective randomized controlled trial using intralesional adrenaline and heater probe demonstrated that initial hemostasis could be achieved in 100% of patients with actively bleeding ulcers or stigmata of recent hemorrhage. The rebleed rate was 6.6% compared with 20.3% in a well-matched control group. The recent advent of laparoscopic vagotomy and laparoscopic Billroth II gastrectomy offers a low-morbidity surgical option to long-term medical treatment for the follow-up management of patients with bleeding ulcers.

ISSN:0257-2753    

DOI:10.1159/000171414

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Duodenal ulcer disease is a heterogenous condition characterized by episodes of recurrence and remission. Recurrences are often painful and may result in gross duodenal scarring and pyloric stenosis; bleeding and perforation can complicate the disease, requiring operative treatment and increasing mortality. Treatment should therefore maintain remission after ulcer healing, prevent possibly lethal complications, be safe and maintain efficacy over time. Maintenance treatment with H2 receptor antagonists reduces the rate of symptomatic relapse, but there is no evidence that it affects the complication rate. Tolerance develops in a subgroup of patients and seems to contribute to their poor response to long-term H2 antagonist therapy. It seems wise to prescribe maintenance treatment for 3 years following initial healing in patients with severe relapsing disease, or smokers with recurrent symptoms, and to continue it for life in selected individuals at increased risk of acute complications or of complication-related mortality.

ISSN:0257-2753    

DOI:10.1159/000171415

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Anal cancer is uncommon accounting for only 2% of anorectal cancers. The recognition of many similarities between cervical and anal cancer has stimulated research into the identification of a common aetiological agent. DNA from human papillomaviruses has consistently been found in both of these cancers and is thought to be an important factor in the development of both of these tumours. Simultaneously, epidemiological data from the west coast of America have indicated that the demography of anal cancer may be changing. Further studies in the USA and the UK have identified certain groups at high risk of developing anal cancer. These high-risk groups include ‘never married’ men and immunosuppressed patients both from iatrogenic immunosuppression in transplant patients and those infected with HIV. The potential increase in anal cancer cases, due to the ever increasing numbers of patients who have received transplants and the spiralling number of the population infected with HIV make it timely to review what is known of the aetiology, presentation and management of this can

ISSN:0257-2753    

DOI:10.1159/000171416

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

This review deals first with the methodology of anorectal manometry. The methods of recording anorectal pressures with perfused catheters, sleeve catheters, water- or air-filled balloon catheters and microtransducers are presented and discussed as well as the various polygraphs used in this investigation. In the second part, the routine anorectal manometry and the parameters to be studied in this investigation are described. Then, the additional manoeuvres which have been described in anorectal manometry are discussed. Finally, the major results obtained in recto-anal dysfunctions are described, that is manometric findings in constipation in adults and children, in incontinence and in the descending perineum syndrome. The usefulness of anorectal manometry in surgical and various conditions is also discussed.

ISSN:0257-2753    

DOI:10.1159/000171417

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Alcohol abuse is a major cause of liver disease. While ethanol itself has been shown to be hepatotoxic, its primary metabolite acetaldehyde has also been implicated in the pathogenesis of alcoholic liver disease. The majority of ethanol metabolism occurs in the liver and high concentrations of acetaldehyde accumulate during chronic ethanol abuse. Acetaldehyde has been shown to react with many proteins in vitro, forming stable covalent adducts. These modifications can act as neoantigens and may also alter biological function. Acetaldehyde-modified proteins have been detected in the livers of ethanolfed rats and human alcoholics. Circulating antibodies reactive with modified proteins have also been detected. A direct linkage between acetaldehyde-modified proteins, antibodies and liver damage has yet to be established, but current research should clarify the picture in the next few years.

ISSN:0257-2753    

DOI:10.1159/000171418

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Since the introduction of endoscopic retrograde cholangiopancreatography in the 1970s and of endoscopic sphincterotomy (EST) in 1974, endoscopic techniques for the diagnosis and therapy of biliary and pancreatic disorders have proliferated. Although some procedures have become part of routine practice, for example EST for postcholecystectomy bile duct stones and stent insertion for inoperable biliary strictures, the place of others is unclear at present and should be evaluated by prospective randomized clinical trials. The choice of either an endoscopic or a transhepatic approach for biliary disease is usually dictated by local expertise, but these should be regarded as complementary rather than competing techniques, and complex biliary problems should be managed jointly by the endoscopist, interventional radiologist and hepatobiliary surgeon.

ISSN:0257-2753    

DOI:10.1159/000171419

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Current knowledge of Escherichia coli strains responsible for bowel infections, including the more recently defined entero-haemorrhagic and entero-adherent types, is reviewed.

ISSN:0257-2753    

DOI:10.1159/000171420

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

The essential protective structure against the heavy enteric antigenic burden, the gut mucosa, prevents penetration of noxious agents, but allows a minimal exchange of large molecules and particles between the gut lumen and the ‘milieu intérieur’ of the body. M cells in the follicle-associated epithelium of the gut, ideal gateways for the presentation of enteric antigens to the cells of the gut-associated lymphoid tissue (GALT), are also weak links in the mucosal barrier, and may provide access for various microorganisms. The afferent limb of the GALT consists of distinct aggregates of lymphoid cells located in Peyer’s patches, the vermiform appendix and the solitary lymphatic follicles, and of the mesenteric lymph nodes. The efferent limb subsumes the diffusely scattered mucosal leukocytes, mainly lymphocytes and plasma cells. Intraepithelial and mucosal T lymphocytes are instrumental in launching local immune responses, producing lymphokines, and in the specific lysis of virally infected cells. Antigenic stimulation of the GALT results in local secretion of antibodies, or in suppression of systemic immunologic responses to ingested antigens (‘oral tolerance’). Poorly controlled mucosal immune responses result in organ-specific diseases. Extranodal lymphomas that mimic structures of the GALT may arise on a background of inflammatory or immunologic (autoimmune)

ISSN:0257-2753    

DOI:10.1159/000171421

出版商:S. Karger AG    

年代:1993

数据来源: Karger