The role of laparoscopy in emergency abdominal surgery

Abdominal emergencies can also be operated on through the laparoscopic approach: the approach can be diagnostic laparoscopy, surgery assisted by laparoscopy or laparotomy directed according to the findings of the laparoscopy. The general contraindications refer above all to the state of haemodynamic instability of the patient and to seriously ill patients (ASA IV). In the absence of any specific counter-indications for the specific laparoscopic procedure to be carried out, many abdominal diseases requiring emergency surgery can be performed with the laparoscopic approach. The most frequent indications are appendicitis, acute colecistitis, gastroduodenal perforation, occlusion of the small intestine, and some abdominal traumas. With a correct selection of patients and the appropriate experience of the surgeon, the results are excellent and better than open surgery (less infection of the wound, complications, hospital stay and postoperative pain). A detailed explanation is given of the basic aspects of the surgical technique in the most frequent procedures of emergency laparoscopy.     

The role of intraoperative angioplasty performed simultaneously with reconstructive vascular surgery

21 arterial lesions were dilated intraoperatively in conjunction with primary vascular reconstructive procedures. Of these, five involved the iliac vessels, fourteen the femoropopliteal segment, one the subclavian artery and one the common carotid artery. 19 intraoperative balloon dilatations were successful and two were unsuccessful. Only one catheter-related complication were noted, it was a perforation of the wall of the artery caused by guidewire. No deaths occurred as a result of the combined procedure. Attention is drawn to the advantage of the intraoperative balloon dilatation and the authors recommend it on adequate conditions and correct indication.     

Early abdominal complications of intestinal surgery: the radiologist's role in management

Abdominal complications of intestinal surgery are an important cause of postoperative morbidity and mortality. We define early complications as those occurring within the first 30 days after surgery. The radiological contribution towards prompt and accurate diagnosis of common complications is discussed and the radiologist's role in non-operative management is outlined.     

腹部超声对老年人前列腺疾患的诊断

目的探讨老年人前列腺疾患经腹超声检查的声像图特征及其临床意义。方法对220例老年前列腺疾患腹部超声检查的结果进行回顾性分析。结果超声检出单纯前列腺增生症162例,前列腺结石4例,前列腺囊肿2例,增生并结石34例,增生并囊肿10例,增生并结石和囊肿1例,前列腺癌6例,前列腺肉瘤1例。结论老年人前列腺疾患声像图表现具有显的特点,经腹超声与经直肠超声检查比较,经腹超声仍应作为临床首选的检查方法。     

腹部超声对老年人前列腺疾患的诊断

目的探讨老年人前列腺疾患经腹超声检查的声像图特征及其临床意义.方法对220例老年前列腺疾患腹部超声检查的结果进行回顾性分析.结果超声检出单纯前列腺增生症162例,前列腺结石4例,前列腺囊肿2例,增生并结石34例,增生并囊肿10例,增生并结石和囊肿1例,前列腺癌6例,前列腺肉瘤1例.结论老年人前列腺疾患声像图表现具有显著的特点,经腹超声与经直肠超声检查比较,经腹超声仍应作为临床首选的检查方法.     

Transvaginal ultrasonic studies

The authors report their results obtained by the use of a new sonographic technique, transvaginal sonography. Transvaginal sonograms were compared with conventional transabdominal scans in 40 patients. In 35 per cent of cases the quality of the transvaginal image was found to be superior compared to that of the transabdominal image. The authors summarize the indications of transvaginal sonography and its advantages in comparison with conventional method. They recommend this new technique for the examination of pelvis in women in any ultrasound laboratories.     

The uses and abuses of drains in abdominal surgery

Controversy surrounds the indications for and effectiveness of the abdominal drain. There are a variety of factors which mitigate against formulating rigid guidelines for the indications of drains, but surgeons should understand the benefits and applications of drainage and the tissue responses to the constituent materials. Drains are not a substitute for meticulous surgical technique.     

New intraoperative diagnostic methods in parathyroid surgery: intraoperative measurement of parathyroid hormone

In thirty-seven patients undergoing parathyroidectomy from November 1999 to July 2000 with diagnosis of primary hyperparathyroidism the intraoperative intact parathyroid hormone level were studied. Preoperative samples of blood were taken from a peripheral vein before the beginning the operation. The second sample was taken 5 minutes after removal of parathyroid adenoma. The plasma intact parathyroid hormone concentration was measured by quick IRMA method. The preoperative high PTH levels reduced after excision of adenoma to the mean 18%. 33 patients had normal PTH levels after 5 minutes of removing. The total measuring time of quick PTH assay was about 30 minutes. The QPTH assay was a quantitative adjunct for the surgeon to ensure a successful parathyroidectomy. When the intraoperative QPTH level is not reduced to 50%, then the exploration should be continued and the probability of reoperation is decreased. They propose the application of the routine intraoperative measurement of QPTH level in all parathyroidectomy.     

老年人腹主动脉瘤的超声诊断评价

目的探讨超声检查在老年人腹主动脉瘤检查诊断中的价值和意义.方法对23例老年人腹主动脉瘤患者超声检查结果进行回顾性分析.结果老年人腹主动脉瘤的声像图表现在其形态结构与血流动力学改变方面均具有显著的特点,它为临床疾病的诊断提供了科学的依据.结论超声检查对老年人腹主动脉瘤的诊断具有肯定的价值,与X线血管造影、CT、MRI、DSA检查比较,超声检查简便经济、安全无损、重复性好、应列为临床首选.     

老年人腹主动脉瘤的超声诊断评价

目的 探讨超声检查在老年人腹主动脉瘤检查诊断中的价值和意义。方法 对23例老年人腹主动脉瘤患超声检查结果进行同顾性分析。结果 老年人腹主动脉瘤的声像图表现在其形态结构与血流动力学改变方面均具有显的特点,它为临床疾病的诊断提供了科学的依据。结论 超声检查对老年人腹主动脉瘤的诊断具有肯定的价值,与X线血管造影、CT、MRI、DSA检查比较,超声检查简便经济、安全无损、重复性好、应列为临床首选。     

The role of autotransfusion in vascular surgery

Use of autotransfusion has recently come into the limelight of clinical practice especially because of the AIDS-risk and financial considerations. Authors have analysed data of 20 patients with peripheral arterial disease at whom hemodilution were carried out before the operation with the aim of using autotransfusion. Attention is called to the importance of autotransfusion and its applicability in the practice of other sorts of surgery.     

The role of probiotics in gastrointestinal surgery

PURPOSE OF REVIEW: Postoperative complications in gastrointestinal elective surgery have been described as low. In certain circumstances, however, such as those including high-risk patients, the incidence is higher. In such situations, bacteremia and infectious complications may be caused by translocation of either gastrointestinal bacteria or its toxins as the result of bacterial overgrowth, loss of intestinal epithelial integrity, or immunologic compromising of the host. Attempts should be made to reduce the impact of these factors. Probiotics, which confer to the host health benefits similar to those offered by a balanced indigenous microbiota, are thought to act through a variety of mechanisms including the competition with potential pathogens for nutrients or enterocyte adhesion sites, degradation of toxins, production of antimicrobial factors, and local and systemic immunomodulation. RECENT FINDINGS: Recent studies have shown that probiotics play a role in decreasing postoperative complications in patients undergoing major gastrointestinal operations. SUMMARY: Considering the mechanisms of action of probiotics in the gastrointestinal tract, mainly in the intestine, evidence strongly suggests that the use of these microorganisms might positively affect the complication rate in patients undergoing surgery on the gastrointestinal tract.     

The role of probiotics in gastrointestinal surgery

The intestinal microbiota, which is a complex and dynamic population of different bacterial species, represents an important contribution to the health of the host. This microbiota plays a key role by promoting the integrity of the epithelial barrier and the development of mucosal immunity. However, under some stressful situations, such as after gastrointestinal surgery, infectious complications may originate from the intestinal microbiota of the patient. This phenomenon is known as the gut origin of sepsis hypothesis. However, the supply of probiotics has beneficial effects under similar conditions despite some controversial results. Therefore, it is important to carefully assess the efficacy of probiotics in the prevention and treatment of complications in surgical patients and to evaluate the safety of its use. This review provides an overview of the proposed mechanisms of probiotic action and the significant progress in this field, mainly concerning gastrointestinal surgery.