Determining the predisposition to post-vagotomy peristaltic disorders in surgical treatment of peptic ulcer hemorrhage

Analysis of the results of organ-preserving operations in 246 patients with ulcerous gastroduodenal hemorrhages revealed a predisposition to motor-evacuation disorders of gastric performance, which plays an essential role in the individual choice of the operation in patients with ulcerous gastroduodenal hemorrhages. This makes it possible to reduce the number of postvagotomy complications linked with disturbed passage of food in the stomach and duodenum.     

复发性胃十二指肠溃疡再手术24例分析

为探讨消化性溃疡复发因素、临床特点和再手术方式，笔者回顾性分析了1985年1月～1999年8月再手术治疗的24例复发性消化溃疡患者的f临床资料。24例患者采用不同的手术方式。20例患者获得3～14年的随访，18例效果良好，2例溃疡复发。提示消化性溃疡术后复发与多因素有关，初次手术方式不当是主要因素。再次手术应采取个体化治疗方案。     

Cytomegalovirus as a cause of cecal ulcer with massive hemorrhage in a renal transplant recipient

Although cytomegalovirus disease following renal transplantation occurs frequently, ulcerative lesions of the gastrointestinal tract are not common. This report describes a patient with a single large cecal ulcer, with cytomegalovirus inclusion bodies located in the ulcer bed. The patient presented with massive rectal bleeding necessitating a right hemicolectomy. No other manifestations of systemic cytomegalovirus disease were present in this patient.     

腹腔镜缝合修补消化性溃疡穿孔29例报告

目的:探讨腹腔镜缝合修补消化性溃疡的临床应用价值。方法:回顾分析2002~2007年我院应用腹腔镜缝合修补消化性溃疡穿孔29例患者的临床资料。结果:29例患者中胃窦部前壁穿孔9例,胃体部小弯侧穿孔7例,十二指肠球部前壁穿孔11例,2例病检诊断为癌性溃疡穿孔中转开腹。穿孔直径≤5mm 22例,>5mm 7例。27例手术成功,无术后并发症发生。手术时间和住院时间短,均痊愈出院,随访6~42个月,无复发。结论:腹腔镜缝合修补消化性溃疡治疗消化性溃疡穿孔安全可靠,是一种较理想的手术方法,术后继续正规内科治疗,效果满意。     

Traumatic pediatric bile duct injury: nonoperative intervention as an alternative to surgical intervention

Background

Nonoperative management of blunt pediatric liver injuries has become the standard of care in the absence of hemodynamic instability. However, associated bile duct injuries remain as difficult challenges. Few case reports have demonstrated the benefits of conservative approaches, but others have found better outcomes with surgical intervention. In this study, we report on our experience with interventional endoscopic and radiologic management of 5 pediatric patients with bile duct injuries who underwent unsuccessful surgical interventions.

Methods

We conducted a retrospective review of medical records of all pediatric patients who were admitted with major blunt liver trauma and bile duct injuries over a period of 5 years.

Results

There were 5 patients (4 boys and 1 girl) whose ages range from 3 to 11 years in this study. All patients had major liver laceration and bilomas. Two had intrahepatic and 3 had extra hepatic bile duct injuries (2 right hepatic ducts and 1 junction of cystic duct with common bile duct). All of them underwent previous laparotomies, once in 2 patients, twice in 2 patients, and thrice in 1 patient. All 5 patients were eventually treated successfully with interventional endoscopic and radiologic techniques. Three underwent endoscopic retrograde cholangiopancreatography stenting with percutaneous drainage. Two patients were managed with percutaneous drainage alone. The follow-up is up to 2.5 years with normal liver function test and bile duct ultrasound.

Conclusion

With the current advancement in endoscopic retrograde cholangiopancreatography and intervention radiology techniques, we believe that interventional endoscopic and radiologic management of bile duct injuries caused by blunt trauma in children is successful and efficacious even after multiple laparotomies.     

Hypothermic circulatory arrest as a surgical adjunct: a 5-year experience with 60 adult patients.

As a surgical adjunct, the technique of hypothermic circulatory arrest (HCA) is well established in pediatric cardiac surgery but is used less frequently in adults. This study was undertaken to review the application, utility, and safety of HCA in adult surgery at a single institution. Between January 1985 and October 1990, 60 adult patients (greater than 18 years old) underwent surgical procedures that included HCA. There were 30 men and 30 women; mean patient age was 56.4 years (range, 20 to 81 years). Operative procedures were thoracic aortic aneurysm repair (35 patients, 58%), resection of intraabdominal malignancy (15 patients, 25%), coronary artery bypass (4 patients, 7%), and other miscellaneous procedures (6 patients, 10%). Eighty-two percent of the procedures were elective, whereas 18% were emergencies. Mean circulatory arrest time was 28.5 minutes (range, 2 to 64 minutes). Operative mortality was 15%; by multivariate analysis, risk factors for death included prolonged cardiopulmonary bypass time (p less than 0.05), higher post-HCA rectal temperature (p less than 0.05), and intraoperative hypotension (p less than 0.001). Patient age, sex, emergency status, duration of HCA, and perfusion variables on cardiopulmonary bypass did not predict operative mortality. The incidence of perioperative neurologic injury was 15%. The only risk factor for neurologic injury was intraoperative hypotension (p less than 0.05). One- and 3-year actuarial survival for patients undergoing operation on the heart or great vessels was 75.9% and 70%, respectively, whereas patients with intraabdominal malignancy had 75% and 23.4% 1- and 3-year survival.(ABSTRACT TRUNCATED AT 250 WORDS)     

改良腹腔镜手术治疗消化性溃疡急性穿孔：附23例报告

为探讨腹腔镜治疗消化性溃疡急性穿孔的临床价值。笔者采用腹腔镜微小三戳孔丝线缝扎法以及腔镜下冲洗、放置腹腔引流管治疗23例消化性溃疡急性穿孔患者。结果示，22例用三孔法完成，1例于右中下腹另行0.5 cm戳孔作为助手操作孔协助分离粘连后完成手术。无中转开腹病例。提示：腹腔镜治疗消化性溃疡急性穿孔具有缝扎可靠、创伤轻微、冲洗彻底、引流通畅、腹腔干扰少、恢复快等优点，可替代传统开腹穿孔修补术。     

Perforated peptic ulcer in the Hunter region: a review of 174 cases.

A review of 174 consecutive patients admitted with a diagnosis of perforated peptic ulcer to eight Hunter Region hospitals during 1979-86 is presented. Among the female admissions, the proportion of patients greater than 70 years of age was twice that in males. One-third of all perforations were in females who accounted for two-thirds of all perforated gastric ulcers. Multivariate analysis revealed that perforations located in the stomach and older age were both significant independent variables adversely affecting outcome following surgery. In contrast, shock at presentation and delay in operating were not statistically significant independent risk factors.     

Endoscopic electrocoagulation: an alternative to operative therapy in bleeding peptic ulcer disease

Twelve patients with severely bleeding peptic ulcers (six duodenal, five gastric, and one esophageal) who were considered to be at high operative risk were treated instead by endoscopic electrocoagulation of the bleeding point. Arrest of the bleeding was permanent in ten, one bled again two days later, and one patient died of nonulcer disease one day later. Although this method to control bleeding from peptic ulceration is new, it seems to offer promise especially when treating desperately ill people.     

The use of Vicryl Collagen® as a dura substitute: A clinical review of 78 surgical cases

Summary We performed a retrospective review of 78 consecutive neurosurgical procedures using Vicryl Collagen^?, a resorbable mesh of polyglactin 910 coated with bovine collagen, for dural substitution. The complications we encountered were infrequent and mostly minor (5 cases of subcutaneous CSF collections, 2 cases of aseptic meningitis, 1 superficial wound infection), and not unusual for the surgical procedures studied. One patient, however, had a major infection, starting in the superficial tissues, and extending toward the brain. In this patient, the resorption of the dural substitute appeared to be the cause for the intracranial extension of the infection. Three patients were reoperated on for recurrent tumour after a longer interval. We found minimal adhesions and good fibrous incorporation of the Vicryl Collagen^? into the surrounding normal dura. We conclude that Vicryl Collagen^? is a valuable alternative to the patient’s own fibrous tissues when dural substitution is necessary.     

Open surgery for pontine hemorrhage: experience in 3 cases]

Experience in three pontine hemorrhage cases which were treated by open surgery is recorded here. They were operated on by trans-fourth ventricular, subtemporal transtentorial on retromastoid suboccipital approaches. The neurological symptom improved noticeably in one case who was operated on through the retromastoid suboccipital approach seven days after the onset. The pontine hemorrhage can even be cured with open surgery which is performed in the early stage and through the operative approach.     

Operative management of trigeminal neuromas: an analysis of a surgical experience with 55 cases

Background

The trigeminal schwannoma is the second most common intracranial schwannoma. Their proximity to the critical skull base neural and vascular structures increases the complexity of surgical treatment. The aim of this study was to better understand the surgical approaches and the prognosis, as well as to assess the optimum therapeutic schedule.

Methods

This was a retrospective study of 55 patients with trigeminal schwannomas who visited our department between Jan 2007 and Jan 2012. We analyzed the clinical and radiological presentation, tumor characteristics, surgical approaches, the prognosis.

Results

The patients were 30 women and 25 men of mean age 36 years (range, 6–66 years) who received postoperative neurological and neuroradiological follow-up. The tumor was located in the middle fossa (type A) in 13 cases, in the posterior fossa (type B) in ten cases, in the middle and posterior fossae (type C) in 21 cases, and in the branches of the trigeminal nerve (type D) in 11 cases. The most common symptom was facial hypesthesia or numbness in 36 patients (65 %) . Total and nearly total tumor resection was achieved in 51 cases (93 %). Three patients (5 %) had worsening of preexisting deficits and there was no perioperative mortality. With an average follow-up period of 35 months, facial hypesthesia persisted in 26 patients (72 %),and improved in ten patients (28 %). Facial pain was relieved in 11 patients (100 %). There has been a recurrence in one case (2 %) and all patients resumed independent and social reintegration.

Conclusion

This study demonstrates radical surgery with excellent neurological outcomes is the primary treatment of trigeminal schwannomas. Appropriate selection of surgical approach according to tumor types is highly important and necessary. The preoperative facial pain could be relieved, hypesthesia frequently remains or could even be worsened after surgery.