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41.
Laparoscopic Cholecystectomy for Acute Cholecystitis: Prospective Trial 总被引:23,自引:0,他引:23
Samuel Eldar Edmond Sabo Ernest Nash Jack Abrahamson Ibrahim Matter 《World journal of surgery》1997,21(5):540-545
p
< 0.00001) and for hydrops (28.5%) and empyema of the gallbladder
(28.5%) (
p
= 0.004). The difference in conversion
between the group with acute necrotizing (gangrenous) cholecystitis and
the two groups with hydrops and empyema of the gallbladder was not
statistically significant (
p
= 0.07). The complication
rates of acute cholecystitis, hydrops, empyema of the gallbladder, and
gangrenous cholecystitis were 9.0%, 9.5%, 14.0%, and 20.0%,
respectively (
p
= NS). Patients with an operative
delay of 96 hours or less from the onset of acute cholecystitis had a
conversion rate of 23%, whereas a delay of more than 96 hours was
associated with a conversion rate of 47% (
p
= 0.022).
The complication rate was 8.5% in the laparoscopic group and 27% in
the converted group (
p
= 0.013). Patients over 65
years of age, with a history of biliary disease, a nonpalpable
gallbladder, WBC count over 13,000/cc, and acute gangrenous
cholecystitis were independently associated with a high LC conversion
rate; male patients, finding large bile stones, serum bilirubin over
0.8 mg/dl, and WBC count over 13,000/cc were independently associated
with a high complication rate following laparoscopic surgery with or
without conversion. Generally, LC can be performed safely for acute
cholecystitis, with acceptably low conversion and complication rates.
Different forms of cholecystitis carry various conversion and
complication rates in selected cases. LC for acute cholecystitis should
be performed within 96 hours of the onset of disease. Predictors of
conversion and complications may be helpful when planning the
laparoscopic approach to acute cholecystitis. 相似文献
42.
Charles M Chapron MD Fabrice Pierre MD Sylvie Lacroix MD Denis Querleu MD Jacques Lansac MD Jean-Bernard Dubuisson MD 《Journal of the American College of Surgeons》1997,185(5):461-465
Background:This study was undertaken to report our experience with major vascular injuries in gynecologic laparoscopy in order to specify the circumstances under which they occurred, the means of diagnosis, the risk factors, and the means for prevention.Study Design:Retrospective case review study.Results:Seventeen patients with 21 major vascular injuries were identified. The average age of the patients was 33.8 ± 11.6 years, and the mean body index mass was 21.6 ± 3.08 kg/m2. Three of four of the accidents occurred during the set-up phase of laparoscopy (13 cases; 76.5%), and in 4 cases (23.5%) the accident occurred during the laparoscopic surgery procedure. Eleven (84.6%) of the complications occurring during the set-up phase were secondary to insertion of the umbilical trocar and 2 (15.4%) to insertion of the needle used to create the pneumoperitoneum (P-needle). Half (6 cases; 54.5%) of the major vascular injuries secondary to insertion of the umbilical trocar were observed when reusable trocars were used. In every case, the diagnosis was made during the operation. Two patients died, and two others presented a serious complication (phlebitis; acute ischemia requiring reoperation).Conclusions:Major vascular injuries are rare but serious complications of laparoscopic surgery. Prevention of these accidents relies on the surgeon’s experience and scrupulous respect of the safety rules. In the vast majority of cases, it is necessary to convert to laparotomy immediately, calling in a vascular surgeon. 相似文献
43.
44.
45.
Clinical relevance of the host responses of periodontitis 总被引:1,自引:0,他引:1
46.
The use of the urological resectoscope in the treatment of rectal tumours has been described in detail. We report the use of the purpose built transanal resectoscope in the treatment of 34 patients. Fourteen patients had villous adenomas and all but one were relieved of symptoms. Of 20 patients with rectal carcinoma, three presented with acute intestinal obstruction and three had rectal stump recurrences. Palliation was excellent in patients with general symptoms, but the results were disappointing for rectal stump recurrences. Transanal resection (TAR) is a novel form of treatment for patients with rectal obstruction. Two patients in this study had their obstruction successfully relieved by transanal resection alone. This allowed formal bowel preparation and full pre-operative assessment. We feel that this technique is under-used and that the results of treatment justify more widespread acceptance of the procedure. 相似文献
47.
Radioiodinated tracers for the evaluation of dopamine receptors in the neonatal rat brain after hypoxic-ischemic injury 总被引:1,自引:0,他引:1
Amal Zouakia Sylvie Chalon Hank F. Kung Anne-Marie Dognon Elie Saliba Jean-Claude Besnard Denis Guilloteau 《European journal of nuclear medicine and molecular imaging》1994,21(6):488-492
In order to evaluate in vivo single-photon emission tomography (SPET) method of assessing cerebral function after hypoxic-ischemic injury in human neonates, we studied D1 and D2 dopamine receptors in a rat model. Seven-day-old rats underwent permanent unilateral common carotid ligation followed by exposure to 8% O2. Two weeks later, in brains with no visible loss of hemispheric volume, striatal dopaminergic receptors were studied, with [125I]TISCH and [1251]IBZM for the D1 and D2 dopamine receptors, respectively. Using [125I]TISCH, we observed no modifications of D1 receptors, but in contrast, ex vivo and in vitro autoradiographic experiments showed a 40% decrease in the striatal binding of [125I]IBZM on both the ipsilateral and the contralateral side to the carotid ligation. These alterations were detected with IBZM, a D2 dopamine receptor ligand usable for SPET imaging. Therefore, exploration of D2 receptors by SPET in human neonates suffering from perinatal hypoxia-ischemia may be valuable for the diagnosis and follow-up of cerebral function damages.
Correspondence to: D. Guilloteau 相似文献
48.
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