A new instrument for hepatic resection

A new instrument for hepatic resection was designed and developed. Use of the hepatic comb during hepatic resection is described. It is very simple in shape, easy to handle and inexpensive. Using the instrument has made mandatory rapid hepatectomy in poor risk patients possible. The hemostatic effect of the procedure with this instrument is excellent, which is an important consideration in surgical treatment of the liver.     

A ten year experience with hepatic resection

The results of our experience have demonstrated that patients who undergo hepatic resection for primary or metastatic carcinomas have survival rates considerably higher than those reported in the literature for patients who do not undergo resection. Morbidity rates as well as survival rates among the patients we studied lie within the reported values of the major institutions. It is certainly clear that, within the past five years, metastatic disease to the liver from a primary carcinoma of the colon and rectum has become a treatable disease. We, therefore, advocate the aggressive approach to carcinoma of the liver and look forward to further advancement in the treatment of this disease.     

Quantitative computerized tomographic densitometry for the evaluation of osteoporosis risk in menopausal women

OBJECTIVES: The aim of the study was retrospective analysis of osteoporosis risk in menopausal women. DESIGN: Retrospective analysis of bone mineral density of 2733 women was performed between 1997 - 1999 year. MATERIAL AND METHODS: Retrospective analysis of bone mineral density of 2733 women aged 16 to > 68 by quantitative computer tomography densitometry of L2-L4 vertebrae. RESULTS: The most rapid bone mineral density loss concerns postmenopausal women aged 59 to 63. By 18.7% comparing to the group 54-58 years and 59-63. CONCLUSIONS: 82% women who undergo densitometry is in the group over 44 years old. Bone mineral density loss is depending on age and concerns postmenopausal women, mainly.     

Distal segment tubal pregnancy after segmental resection for an isthmic pregnancy. A case report

The second case occurred of pregnancy in the remaining distal segment of a fallopian tube after segmental resection for an isthmic pregnancy.     

Results of hepatic resection and transplantation for fibrolamellar carcinoma.

Fibrolamellar carcinoma (FLC) is a tumor of the liver that can be differentiated from common hepatocellular carcinoma (HCC). Despite the exceptional role of the clinicopathologic signs and symptoms, true appraisal of the prognosis of the tumor is not clear and remains a controversial issue. To determine the long term prognosis of FLC more precisely, a retrospective study of 20 consecutive patients was performed, with analysis of selected pathologic factors, particularly the TNM staging system. Curative tumor removal (R0) was achieved by partial hepatic resection in 14 patients and total hepatectomy with subsequent replacement of the liver in six patients, respectively. The estimated overall five year survival rate was 36.6 percent. There was an advantage of partial versus total hepatectomy, with median survival times of 44.5 versus 28.5 months. Statistically significant better survival rates at five years were observed in patients with solitary tumors and in instances of absent regional lymph node metastases. Although other factors analyzed did not show significant differences, there was a tendency indicating individual tumor stage was the most significant determinant for prognosis. For further discussion of an apparently more favorable outcome of patients with FLC as compared with common HCC, detailed specification of the tumor stages seems mandatory. From the present analysis, the fibrolamellar variant could not be confirmed to be an independent indicator of better patient survival. The treatment of choice remains radical operation. The goal can, at best, be achieved by a therapeutic concept including partial as well as total hepatectomy, depending on the stage of the tumor.     

Examination of patient selection and outcome for hepatic resection for metastatic disease

Hepatic resection for metastatic disease is now an accepted therapeutic option in a selected group of patients. A series of 56 patients undergoing hepatic resection at a single institution from 1974 to 1985 are presented. Resection was carried out in 27 women and 29 men who ranged in age from 23 to 87 years (a mean of 56 years). The site of primary disease was: colorectal in 41, adrenal gland in two and other sites in 13. Of the 56 hepatectomies, 21 were done for synchronous secondary disease discovered before or at operation for the primary disease. Metachronous lesions were found in 35 patients, from two months to 17 years (a mean of 34 months) after excision of the primary tumor. Estimated five year survival rates using the Kaplan-Meier method was 25 per cent in the patients with colorectal primaries and 35 per cent in the entire group. No difference was demonstrated between synchronous and metachronous resections. Patients with multiple hepatic lesions did much poorer than those with solitary tumors. Patients with metastatic tumor consisting of one large lesion with surrounding satellite nodule or nodules had an expected survival time resembling that for those with true solitary metastases and were included in that group. No difference in survival time was observed in patients with carcinoma of the colon and rectum who had involvement of regional nodes at the time of the primary resection, as compared with patients with negative nodes. Hepatic resection for a secondary malignant growth can be performed safely with a real chance for cure in selected instances. We continue to recommend an aggressive approach to hepatic metastases, especially those of a colorectal origin.     

妇科病案的计算机管理系统

目的为了更好地总结妇科各专业组（包括普通妇科、妇科肿瘤和妇科内分泌）在临床积累的丰富经验,及加强病案的系统管理。方法应用计算机对病案进行管理和分析。本系统以ＦｏｘｐｒｏｆｏｒＷｉｎｄｏｗｓ２．６为开发工具,全汉字人机对话,界面友好。结果本系统为病历式屏幕设计,全按键式操作,易学、易懂;特殊项目数据库专门设计,使录入过程更加直观,明了;输入数据具有检错、提示和字典提示功能,使录入便捷、准确;具有较强的统计功能,并可绘制曲线;具有进一步开发的能力,扩大应用范围,适应不同科室的需求。经临床实际应用,取得良好的效果。结论应用本系统可大大提高工作效率,总结临床经验,并使科研结果及时问世,提高临床的诊疗水平。     

Fertility and pain outcomes following laparoscopic segmental bowel resection for colorectal endometriosis: a review

Intestinal involvement in endometriosis is thought to occur in up to 12% of all endometriosis cases. While colorectal resection is being increasingly advocated as a feasible management option in patients with severe disease, there still remains significant resistance towards this surgery. This article aims to review the current literature to determine the pain and fertility outcomes following segmental bowel resection for colorectal endometriosis.     

Use of the CEEA stapler to avoid ultra-low segmental resection of a full-thickness rectal endometriotic nodule

A woman with a history of numerous surgical episodes for treatment of aggressive endometriosis experienced rectal symptoms. She was prepared for the possibility of laparotomy with or without colostomy to relieve her symptoms. After extensive laparoscopic dissection of the rectovaginal septum, a circular stapling device (Premium Plus CEEA; Autosuture, Melbourne, Victoria, Australia) was used to excise completely an anterior rectal lesion that otherwise would have resulted in ultra-low rectal resection and anastomosis. Morbidity associated with the latter procedure was avoided; the patient was discharged within 72 hours and experienced no early or late complications. Postoperative barium enema was obviated by rapid return to normal bowel habits and complete resolution of dyschezia and dyspareunia.     

Limited segmental anterior rectal resection for the treatment of rectovaginal endometriosis: pain and complications

The aim of this cohort study was to assess the long-term response, complications and quality of life in patients undergoing segmental anterior rectal resection for endometriosis. The subjects consisted of patients who have undergone a segmental anterior rectal resection for endometriosis in the setting of a tertiary referral unit for the management of severe endometriosis. The data were obtained by means of a case note review and patient questionnaire. The main outcome measures were surgical complications and overall subjective improvement. Dysmenorrhoea, dyspareunia, dyschezia and chronic daily pain were measured using a visual analogue scale. Twenty-one anterior resections were performed by laparotomy and 24 by laparoscopy. There was no complication in 64% of the cases, and 83% of patients felt that their pain had resolved completely or was greatly improved. The Mean Self-Rated Health Status was significantly lower in the study group than in the general population. Deeply infiltrating endometriosis was confirmed in 92% of rectal specimens. Based on these results, we conclude that segmental anterior rectal resection is a relatively safe procedure for very severe rectovaginal endometriosis and also a very effective treatment.     

Repeat hepatic resection for primary and metastatic carcinoma of the liver

During the last 15 years, 19 patients underwent repeated hepatic resections for malignant lesions of the liver. The first hepatic resection had been performed four to 40 months earlier for treatment of hepatocellular carcinoma (nine patients) or hepatic metastases (ten patients), eight of which were of colorectal origin. Repeat resection was an extensive hepatectomy in six, a segmentectomy in six and a local excision in seven. In one patient, three wedge resections and, finally, hepatic transplantation were subsequently performed after an initial extended right lobectomy. The operative mortality rate was 5.2 per cent. The three year actuarial survival rate was 64 per cent after the second resection.     

A computerized perinatal data system for a region

The development of regionalized systems for perinatal care requires a record system which will provide a flow of patient information to and from referring and center hospitals. It should also provide for the risk evaluation of patients being cared for within the region as well as for the quality and statistical evaluation. When the Arizona Perinatal Program was established in 1975 with funding by the Robert Wood Johnson Foundation, the decision was made to adopt and expand a perinatal data system under development at St. Joseph's Hospital in Phoenix. This data system is made up of two major components: (1) a paper record system in which the documents completed by physician or nurse serve both as the medical record and a computer-input document and (2) a computer capable of simultaneous communication with 17 different terminals, directly or by telephone lines. Programs to meet the goals of patient care, quality evaluation, and statistical assessment are described.