RESUMEN
BACKGROUND: Twenty to thirty per cent of patients with chronic pancreatitis develop inflammatory enlargement of the head of the pancreas. A safe procedure has been developed for duodenum-preserving pancreatic head resection; this report describes the preliminary results achieved. METHODS: Thirty patients, 27 men and three women of mean age 44 years, underwent surgical resection following the development of an inflammatory mass in the pancreatic head. All patients had weight loss and frequent abdominal pain. Jaundice was present in three and diabetes mellitus in ten patients. The diagnosis of chronic pancreatitis was made by a combination of endoscopic retrograde cholangiopancreatography, sonography and computed tomography. Pancreatic function was assessed by amylum tolerance test (ATT), oral glucose tolerance test and stool elastase measurement. The surgical procedure involved wide local resection of the inflammatory tumour in the pancreatic head, without division of the pancreas over the portal vein. Reconstruction involved drainage via a jejunal Roux-en-Y loop. In three icteric cases, prepapillary bile duct anastomosis was also performed using the same jejunal loop. RESULTS: There were no hospital deaths or major complications. After a median follow-up of 10 (range 6-14) months, all patients were symptom free. The mean increase in body-weight was 8.9 (range 4-20) kg. The ATT and stool elastase level demonstrated improved exocrine function but there was no change in endocrine function. CONCLUSION: This type of pancreatic head resection is a safe procedure that provides good short-term relief of symptoms associated with inflammatory changes in the head of the pancreas in chronic pancreatitis.
Asunto(s)
Páncreas/cirugía , Pancreatitis/cirugía , Adulto , Colangiopancreatografia Retrógrada Endoscópica/métodos , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pancreatitis/diagnóstico , Pancreatitis/etiología , Tomografía Computarizada por Rayos X/métodosRESUMEN
AIMS: Disturbance of the exocrine function can persist for several weeks following pancreatic surgery. Active proteases in the duodenal lumen may help to recover exocrine function, but the effect can depend on dosage. METHODS: A placebo-controlled trial of enteric-coated pancreatin (Kreon 25,000 U lipase [A] and Kreon 10,000 U lipase [B]; 3 x 1 caps/day) was performed for 2 weeks following pancreatic surgery (resection or drainage operation in each group). A total of 60 patients were randomized, 20 to A and B pancreatin groups each, and 20 to the placebo group. We tested exocrine function via faecal elastase determinations, amylum tolerance test (ATT) and checks on the symptoms of maldigestion. RESULTS: After medication for 10 days, in group A there was evidence of the beneficial effect of pancreatin suggested by 35% improvement in ATT, unchanged body weight and disappearance of maldigestion. In group B, positive influence of pancreatin was confirmed only in those patients who underwent drainage operation, with moderate improvement of the symptoms of maldigestion and an almost unchanged body weight. In the control group and in resected patients in group B, abnormal ATT and maldigestion remained, while average body weight decreased by 3.5 kg. In all groups, no significant change was noted in the elastase concentration. CONCLUSION: The results suggest that dose-dependent enteric-coated pancreatin treatment after pancreatic surgery may lead to rapid improvement in the exocrine pancreatic function, probably by reducing the cholecystokinin response to food stimulation. This is an important indication for enteric-coated pancreatin medication.
Asunto(s)
Páncreas/metabolismo , Páncreas/cirugía , Enfermedades Pancreáticas/metabolismo , Enfermedades Pancreáticas/cirugía , Pancreatina/administración & dosificación , Adulto , Peso Corporal , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Persona de Mediana Edad , Elastasa Pancreática/análisis , Periodo Posoperatorio , Resultado del TratamientoRESUMEN
Authors report 10 case of tension free inguinal hernia repair with PHS double mesh grafts, used for the first time in Hungary. The operative technique is described in details. The first results are promising. Patients had minimal postoperative pain and recovery time was small. On the base of the results, the procedure is suitable for day surgery.
Asunto(s)
Hernia Inguinal/cirugía , Mallas Quirúrgicas , Materiales Biocompatibles , Humanos , Estudios Prospectivos , Procedimientos Quirúrgicos Operativos/métodos , Resultado del TratamientoRESUMEN
Insulinomas are usually small, benign tumors of the pancreas, often found in obese patients, which require an incision that is out of all proportion to the size of the lesion. A laparoscopic technique for enucleation of a pancreatic insulinoma is described.
Asunto(s)
Insulinoma/cirugía , Laparoscopía/métodos , Neoplasias Pancreáticas/cirugía , Anciano , Femenino , Humanos , UltrasonidoRESUMEN
Authors report a case of a left side subclavian steal syndrome, caused by occlusion of the subclavian artery, combined with a high grade stenosis of the innominate artery. The rare combination of arteriosclerotic lesions of the supraaortic arteries have been treated by an aorto-bisubclavian bypass procedure performed from a median sternotomy. This is the first publication of this method in the Hungarian surgical literature.
Asunto(s)
Arteriopatías Oclusivas/cirugía , Tronco Braquiocefálico/cirugía , Síndrome del Robo de la Subclavia/cirugía , Angiografía , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriosclerosis/complicaciones , Arteriosclerosis/cirugía , Tronco Braquiocefálico/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Esternón/cirugía , Arteria Subclavia/diagnóstico por imagen , Arteria Subclavia/cirugía , Síndrome del Robo de la Subclavia/diagnóstico por imagenRESUMEN
A report on 40 patients is given, who had to undergo esophageal transection due to bleeding varices. 17 patients were operated as an emergency, 23 patients had a prophylactic treatment. Mortality was high with 58.82% and 21.7% respectively. The need of blood replacement was higher in the emergencies. The main cause of death was liver failure, the average time of survival 40 months. We conclude that esophageal transection is of some value in cases of acute bleeding, after failure of non-interventional treatment.
Asunto(s)
Várices Esofágicas y Gástricas/cirugía , Hemorragia Gastrointestinal/cirugía , Cirrosis Hepática/cirugía , Adulto , Anciano , Causas de Muerte , Várices Esofágicas y Gástricas/clasificación , Várices Esofágicas y Gástricas/mortalidad , Femenino , Hemorragia Gastrointestinal/clasificación , Hemorragia Gastrointestinal/mortalidad , Humanos , Hipertensión Portal/clasificación , Hipertensión Portal/mortalidad , Hipertensión Portal/cirugía , Cirrosis Hepática/clasificación , Cirrosis Hepática/mortalidad , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Tasa de SupervivenciaRESUMEN
In the last ten years 62 patients were operated on by the authors because of liver echinococcosis. Each of the infections caused by echinococcus granulosus. In the course of the examination ultrasonography, abdominal X-ray, Casoni test and ELISA were used. Angiography and ERCP were applied only to answer special questions. The echinococcus cysts were removed in 15 cases by atypical liver resection, in 42 cases by pericystectomy and in 5 cases by partial cystectomy using the Pringle's manoeuvre in all of them. Operative mortality was 3.22%. Jaundice was observed in three cases, fever in five cases, wound infection in two cases. Reoperations had to be performed in two cases. All of the patients were treated postoperatively with mebendasol (Vermox). Recurrence of the infection could not be observed.
Asunto(s)
Equinococosis Hepática/cirugía , Adulto , Equinococosis Hepática/diagnóstico por imagen , Equinococosis Hepática/enzimología , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Ictericia/etiología , Masculino , Mebendazol/uso terapéutico , Persona de Mediana Edad , Cuidados Posoperatorios , Radiografía , Infección de la Herida Quirúrgica/tratamiento farmacológico , UltrasonografíaRESUMEN
The authors evaluate the results of extensive lymph node dissection for gastric cancer at 50 patients. It has been found that the lymph node dissection did not increase the risk of operation. The mortality rate was 2%. The average number of removed and histologically examined lymph nodes was 26. The extensive lymph node dissection and the accurate histology provided opportunity for precise staging. Their first evaluation of survival showed an encouraging improvement of prognosis regard to that of patients survival treated by traditional surgical method. Besides it they reviewed the classification of Japanese Research Society for Gastric Cancer for the lymph drainage of the stomach and the surgical technique of the lymph node dissection.