RESUMEN

STUDY QUESTION: In non-male factor infertile couples, are there any differences in the developmental outcomes between children born through ICSI and conventional IVF (cIVF)? SUMMARY ANSWER: In this preliminary study, ICSI and cIVF seem to have a comparable effect on developmental outcomes after 12 months in children born to non-male factor infertile couples. WHAT IS KNOWN ALREADY: ICSI, an invasive technique, has raised concerns about potential developmental abnormalities in children. Limited data are available regarding the developmental outcomes of ICSI-conceived infants born to non-male factor infertile couples. STUDY DESIGN, SIZE, DURATION: This prospective cohort study involved a follow-up of all children aged 12 months or older who were born from pregnancies resulting from either ICSI or cIVF as part of a previous randomized controlled trial (RCT) (NCT03428919). PARTICIPANTS/MATERIALS, SETTING, METHODS: In the original RCT, 1064 women were randomly assigned to the ICSI or cIVF groups (532 women for each group). Follow-up was conducted with 155 couples (195 children) in the ICSI group and 141 couples (185 children) in the cIVF group. The Vietnamese version of the Ages & Stages Third Edition Questionnaires (ASQ-3) and the Development Red Flags questionnaires were completed by the participants. A total of 141 (90.1%) women (177 children) in the ICSI group and 113 (80.1%) women (145 children) in the cIVF group returned fully completed questionnaires. The primary outcomes were the developmental outcomes based on responses to the ASQ-3 and the Red Flags questionnaire. MAIN RESULTS AND THE ROLE OF CHANCE: The mean age of children at follow-up was 19.5 ± 5.0 months in the ICSI group and 19.3 ± 5.5 months in the cIVF group. The mean height and weight of children in both groups were similar. The overall proportion of children with any abnormal ASQ-3 score did not differ significantly between the ICSI and cIVF groups (16.9% vs 13.1%, P = 0.34). The proportion of children with Red Flag signs was also comparable between the two groups (6.2% vs 9.2%, P = 0.36, ICSI vs cIVF, respectively). LIMITATIONS, REASONS FOR CAUTION: Despite a reasonably high follow-up response rate, there is a potential risk of sampling bias, and overall, the number of children with developmental abnormalities was very small. The study relied solely on questionnaires as screening tools, rather than incorporating additional behavioral observations or physical developmental tests; this may have affected the statistical power and the significance of between-group comparisons. WIDER IMPLICATIONS OF THE FINDINGS: The current findings contribute to the existing evidence and support the comparative safety of ICSI and cIVF regarding early childhood development. However, more extensive and prolonged follow-up data for these children are needed to draw definitive conclusions. STUDY FUNDING/COMPETING INTEREST(S): No external funding was received for this study, and no authors reported conflicting interests. TRIAL REGISTRATION NUMBER: NCT04866524 (clinicaltrials.gov).

RESUMEN

INTRODUCTION: Preterm birth is the most common cause of neonatal morbidity and mortality. Women with twin pregnancies and a short cervical length are at high risk for preterm birth. Vaginal progesterone and cervical pessary have been proposed as potential strategies to reduce preterm birth in this high-risk population. Therefore, we aimed to compare the effectiveness of cervical pessary and vaginal progesterone in improving developmental outcomes of children born to women with twin pregnancies and mid-trimester short cervical length. MATERIAL AND METHODS: This was a follow-up study (NCT04295187) of all children at 24 months of age, born from women treated with cervical pessary or progesterone to prevent preterm birth in a randomized controlled trial (NCT02623881). We used a validated Vietnamese version of Ages & Stages Third Edition Questionnaires (ASQ-3) and a red flag questionnaire. In surviving children, we compared the mean ASQ-3 scores, abnormal ASQ-3 scores, the number of children with any abnormal ASQ-3 scores and red flag signs between the two groups. We reported the composite outcome of perinatal death or survival with any abnormal ASQ-3 score in offspring. These outcomes were also calculated in a subgroup of women with a cervical length ≤28 mm (<25th percentile). RESULTS: In the original randomized controlled trial, we randomized 300 women to pessary or progesterone. After counting the number of perinatal deaths and lost to follow-up, 82.8% parents in the pessary group and 82.5% parents in progesterone group returned the questionnaire. The mean ASQ-3 scores of the five skills and red flag signs did not differ significantly between the two groups. However, the percentage of children having abnormal ASQ-3 scores in fine motor skills was significantly lower in the progesterone group (6.1% vs 1.3%, P = 0.01). There were no significant differences in the composite outcome of perinatal death or survival with any abnormal ASQ-3 score in unselected women and in those with cervical length ≤28 mm. CONCLUSIONS: Cervical pessary and vaginal progesterone may have comparable effects on developmental outcomes in children at ≥24 months of age, born to women with twin pregnancies and short cervical length. However, this finding could be likely due to a lack of study power.

Asunto(s)

Muerte Perinatal , Nacimiento Prematuro , Embarazo , Recién Nacido , Femenino , Niño , Humanos , Progesterona , Embarazo Gemelar , Estudios de Seguimiento , Nacimiento Prematuro/prevención & control , Pesarios , Cuello del Útero , Administración Intravaginal

RESUMEN

Preserving primary teeth is crucial for maintaining the maxillary growth, aesthetics, mastication, and speech and for preventing from abnormal habits. Given the peculiar anatomy of the primary tooth, caries grow faster and more frequently to the pulp. In pediatric dentistry, new methods and enhanced material have been recently released on the market and broadened the field of treatments. In this paper, we review the pulp diseases affecting children and focus on the current root canal therapies that favour the physiological primary tooth loss.

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Conserver les dents de lait est essentiel pour assurer la croissance des maxillaires, l'esthétique, la mastication et la phonation ainsi que pour prévenir l'apparition de dysfonctions. Vu les particularités anatomiques des dents de lait, la carie progresse toujours plus rapidement et plus fréquemment jusqu'à la pulpe. L'avènement de nouvelles techniques et de nouveaux matériaux en dentisterie pédiatrique a élargi nos possibilités thérapeutiques. De même, l'interdiction d'utilisation de certains produits a conduit le pédodontiste à devoir trouver des alternatives de traitement. Le but de cet article est de faire le point sur les pathologies pulpaires chez l'enfant et sur les thérapeutiques endocanalaires actuelles.

Asunto(s)

Enfermedades de la Pulpa Dental/terapia , Diente Primario/patología , Niño , Pulpa Dental/patología , Enfermedades de la Pulpa Dental/patología , Enfermedades de la Pulpa Dental/cirugía , Humanos

RESUMEN

UV-visible absorption spectroelectrochemistry elucidated the different redox behaviours of Fe(III)- and Co(III)-mimochrome VI artificial enzymes, adsorbed on mesoporous conductive films of ITO. The reduction of the ferric complex was rapid and reversible, while the cobaltic complex exhibited irreversible processes probably related to multiple coordination states.

Asunto(s)

Cobalto/química , Enzimas Inmovilizadas/química , Hierro/química , Compuestos de Estaño/química , Secuencia de Aminoácidos , Electroquímica , Electrodos , Modelos Moleculares , Oxidación-Reducción , Porosidad , Conformación Proteica , Espectrofotometría Ultravioleta

RESUMEN

There is a growing body of literature examining the utility of behavioral treatment in primary progressive aphasia (PPA). There are, however, no studies exploring treatment approaches to improve speech production in individuals with apraxia of speech (AOS) associated with the nonfluent variant of PPA. The purpose of this study was to examine a novel approach to treatment of AOS in nonfluent PPA. We implemented a treatment method using structured oral reading as a tool for improving production of multisyllabic words in an individual with mild AOS and nonfluent variant PPA. Our participant showed a reduction in speech errors during reading of novel text that was maintained at one year post-treatment. Generalization of improved speech production was observed on repetition of words and sentences and the participant showed stability of speech production over time in connected speech. Results suggest that oral reading treatment is an efficient and effective means of addressing multisyllabic word production in AOS associated with nonfluent PPA, with lasting and generalized treatment effects.

Asunto(s)

Apraxias/terapia , Afasia Progresiva Primaria no Fluente/terapia , Logopedia/psicología , Anciano , Apraxias/complicaciones , Femenino , Humanos , Pruebas del Lenguaje/estadística & datos numéricos , Afasia Progresiva Primaria no Fluente/complicaciones , Autoinforme , Logopedia/métodos

RESUMEN

The TP53 mutation profile in chronic lymphocytic leukemia (CLL) and the correlation of TP53 mutations with allele status or associated molecular genetics are currently unknown. We performed a large mutation analysis of TP53 at four centers and characterized the pattern of TP53 mutations in CLL. We report on 268 mutations in 254 patients with CLL. Missense mutations appeared in 74% of cases compared with deletions and insertions (20%), nonsense (4%) and splice site (2%) mutations. The majority (243 of 268) of mutations were located in the DNA-binding domain. Transitions were found in 131 of 268 mutations, with only 41 occurring at methylated CpG sites (15%), suggesting that transitions at CpGs are uncommon. The codons most frequently mutated were at positions 175, 179, 248 and 273; in addition, we detected a common 2-nt deletion in the codon 209. Most mutations (199 of 259) were accompanied by deletion of the other allele (17p-). Interestingly, trisomy 12 (without 17p-) was only found in one of 60 cases with TP53 mutation (without 17p-) compared with 60 of 16 in the cohort without mutation (P=0.006). The mutational profile was not different in the cohorts with and without previous therapy, suggesting that the mechanism underlying the development of mutations may be similar, independent of treatment.

Asunto(s)

Genes p53 , Leucemia Linfocítica Crónica de Células B/genética , Mutación , Cromatografía Líquida de Alta Presión , Islas de CpG , Humanos

RESUMEN

The incidence of clinically significant anastomotic leaks after upper gastrointestinal surgery is approximately 4 % - 20 %, and the associated mortality can be as high as 80 %. Depending on the clinical presentation, the treatment options are surgery, conservative treatment with external drainage, or endoscopic treatment. This report presents 39 cases of clinically apparent anastomotic leaks or fistulas after surgery for upper gastrointestinal cancers that were treated by endoscopy with insertion of fibrin glue alone (n = 24) or with a combination of Vicryl plug and fibrin glue (n = 15). Thirteen of the 15 patients who underwent Vicryl/fibrin treatments showed complete healing of the anastomotic leak or fistula after one to four sessions. Long-term follow-up results are presented. Postoperative upper gastrointestinal fistulas or anastomotic leaks can be managed successfully with low morbidity by means of endoscopic insertion of Vicryl mesh with fibrin glue, thereby avoiding repeated major surgery and its associated risks.

Asunto(s)

Fístula del Sistema Digestivo/terapia , Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Adhesivo de Tejido de Fibrina/uso terapéutico , Gastrectomía/efectos adversos , Mallas Quirúrgicas , Algoritmos , Anastomosis Quirúrgica/efectos adversos , Fístula del Sistema Digestivo/etiología , Estudios de Seguimiento , Fístula Gástrica/etiología , Fístula Gástrica/terapia , Humanos , Fístula Intestinal/etiología , Fístula Intestinal/terapia , Poliglactina 910 , Complicaciones Posoperatorias , Cicatrización de Heridas

RESUMEN

Eosinophilic oesophagitis (EO), primarily a gastro-enterological disease, should be known to the surgeon and endoscopist as a differential diagnosis of dysphagia. We present a chronic and recurrent case of EO. As frequently seen, macroscopic findings are indicative of the causal illness. The diagnosis is finally made by the histological findings of a macroscopically inconspicuous mucosa of the esophagus, which is found in 10% of cases with EO. Random biopsies are necessary for the diagnosis. A short overview of therapy and course and a review of the literature are given.

Asunto(s)

Trastornos de Deglución/patología , Esofagitis Eosinofílica/patología , Adulto , Biopsia , Trastornos de Deglución/etiología , Diagnóstico Diferencial , Diagnóstico por Imagen , Esofagitis Eosinofílica/diagnóstico , Estenosis Esofágica/diagnóstico , Estenosis Esofágica/patología , Esofagoscopía , Esófago/patología , Humanos , Masculino

Asunto(s)

Remoción de Dispositivos/métodos , Migración de Cuerpo Extraño/terapia , Gastroscopía , Gastrostomía/efectos adversos , Gastrostomía/métodos , Humanos , Reoperación , Estómago

RESUMEN

Acute appendicitis is one of the most common acute surgical conditions of the abdomen. Nevertheless, the indications for appendectomy are associated with a high preoperative rate of false diagnoses. Although the rate of unnecessary appendectomies is comparatively high (20-30%) it is considered acceptable because the rate of perforated appendices is 7-30%. With good availability and lack of radiation exposure, ultrasound is the slice imaging modality of first choice. The sensitivity of ultrasonic detection of appendicitis lies between 55 and 98% and the specificity between 78 and 100%. Computed tomography (CT) has a significantly higher sensitivity for detecting acute appendicitis compared to ultrasound both in infancy and adulthood but the specificity shows no significant differences. CT is, therefore, the imaging modality of choice in cases of relevant differential diagnosis that cannot be visualized adequately or inconclusively by sonography especially in obese and critically ill patients. Comparison of ultrasound and magnet resonance imaging (MRI) revealed a significant advantage for MRI regarding accuracy, sensitivity and negative predictive value. In contrast, specificity and positive predictive value showed no significant differences. Currently MRI is only an alternative imaging modality to ultrasound in cases of undetermined and inconclusive ultrasonic findings especially in childhood and pregnancy. The value of ultrasound in the diagnosis of acute appendicitis is increasing and, particularly in the hands of experienced investigators, is an important imaging modality which delivers important and decision-making findings. Nevertheless, the final decision for appendectomy depends on the findings of the physical examination.

Asunto(s)

Apendicitis/diagnóstico , Apendicitis/cirugía , Ultrasonografía , Adulto , Apendicectomía , Apéndice/patología , Niño , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Imagen por Resonancia Magnética , Embarazo , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X

Asunto(s)

Adenocarcinoma/cirugía , Colostomía/métodos , Endoscopía del Sistema Digestivo , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Derivación Gástrica/métodos , Reflujo Gastroesofágico/cirugía , Gastrostomía/métodos , Yeyunostomía/métodos , Complicaciones Posoperatorias/cirugía , Terapia Recuperativa/métodos , Anastomosis Quirúrgica , Femenino , Adhesivo de Tejido de Fibrina/uso terapéutico , Humanos , Reoperación , Stents , Fístula Traqueoesofágica/cirugía

RESUMEN

In the early period following surgery, it is very important to reveal any complications. In this article the role of ultrasound in recognizing postoperative complications is demonstrated. Ultrasound findings in typical complications of abdominal surgery such as bleeding, abscess formation, acute cholecystitis, pancreatitis, and postoperative ileus are described. The diagnosis of postoperative bleeding, acute cholecystitis, and ileus is very reliable by ultrasound (sensitivity and specificity >95%). Ultrasonography is inferior to computed tomography in detecting pancreatitis and abscess formation. The guiding of interventions by ultrasound offers additional therapeutic options.

Asunto(s)

Sistemas de Atención de Punto , Complicaciones Posoperatorias/diagnóstico por imagen , Ultrasonografía Intervencional , Absceso Abdominal/diagnóstico por imagen , Absceso Abdominal/cirugía , Enfermedad Aguda , Colecistitis/diagnóstico por imagen , Colecistitis/cirugía , Humanos , Ileus/diagnóstico por imagen , Ileus/cirugía , Laparoscopía , Pancreatitis/diagnóstico por imagen , Pancreatitis/cirugía , Complicaciones Posoperatorias/cirugía , Hemorragia Posoperatoria/diagnóstico por imagen , Hemorragia Posoperatoria/cirugía , Sensibilidad y Especificidad

RESUMEN

Isolated edematous swelling of Bauhin's valve is a rare finding in cases of non-specific abdominal complaints in the lower right abdominal quadrant. The differential diagnosis includes entities such as tumours, chronic gastrointestinal inflammation and ileocoecal intussusception as well as specific infections, all of which require individual therapy. Based on two current cases and a review of the literature, aetiology, clinical picture and diagnostic findings of isolated edema of the ileocoecal valve are described. The typical ultrasound findings are presented. Due to its potential of excluding other diseases, modern ultrasound offers promising results in the case of isolated edematous swelling of Bauhin's valve.

Asunto(s)

Enterocolitis Neutropénica/diagnóstico por imagen , Válvula Ileocecal/diagnóstico por imagen , Adulto , Edema/etiología , Enterocolitis Neutropénica/patología , Enterocolitis Neutropénica/cirugía , Femenino , Humanos , Válvula Ileocecal/patología , Masculino , Ultrasonografía

RESUMEN

We present Raman spectra and Raman images of the methylene blue molecule adsorbed as a single layer on gold nanoparticles regularly arranged in periodic arrays. Spectra and images are recorded in the same spatial and spectral regions using an excitation under total internal reflection. Images of the Raman scattering appear as spots of circular shape located at the particle positions with size defined by the diffraction limit. It appears that all excited particles contribute equally to the Raman signal if the Gaussian intensity distribution of the laser beam is taken into account. These results demonstrate that Raman scattering can be a useful technique to study plasmon properties.

Asunto(s)

Oro/química , Ensayo de Materiales/métodos , Nanotubos/química , Nanotubos/ultraestructura , Espectrometría Raman/métodos , Resonancia por Plasmón de Superficie/métodos , Oro/análisis , Oro Coloide/análisis , Oro Coloide/química , Nanotecnología/métodos , Nanotubos/análisis , Tamaño de la Partícula

RESUMEN

PURPOSE: To evaluate the combined use of extended field-of-view sonography and tissue harmonic imaging (THI) for assessment of the abdominal wall. MATERIALS AND METHODS: In 32 patients (25 patients without and 7 patients with abdominal wall pathologies) extended field-of-view sonography of the abdominal wall was performed with and without THI using a 7.5 MHz ultrasound transducer. Images with a scan length of 60 cm were acquired above and below the arcuate line. The images were independently assessed by two observers regarding visibility of the anatomic structures and delineation of pathological changes using a 4-point grading scale. Furthermore, the influence of the extent of the subcutaneous fat on the image quality was assessed. For statistical analysis, kappa coefficients, Fisher"s exact test and a repeated measurement analysis of variance (ANOVA) were applied. RESULTS: In all patients, delineation of the abdominal wall was possible with diagnostic image quality. Abdominal wall pathologies were concurrently diagnosed for extended field-of-view sonography with and without utilization of THI. Image quality was rated better with THI when compared to extended field-of-view B-Mode sonography. In comparison to extended field-of-view B-Mode sonography, the agreement between both readers regarding image quality was markedly improved using extended field-of-view sonography in combination with THI. With increasing thickness of the subcutaneous fat layer, image quality was rated significantly better using THI than B-Mode ultrasound. CONCLUSION: Combined use of extended field-of-view sonography and THI improves image quality and documentation of ultrasound examinations. Especially in obese patients, the use of THI is advantageous. Therefore, abdominal wall ultrasound gains additional value in the preoperative planning.

Asunto(s)

Pared Abdominal/diagnóstico por imagen , Ultrasonografía/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Interpretación Estadística de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Programas Informáticos , Tomografía Computarizada por Rayos X

RESUMEN

Lithographically designed two-dimensional arrays consisting of gold nanoparticles deposited on a smooth gold film are used as substrate to examine the SERS effect of the trans-1,2-bis (4-pyridyl) ethylene molecule. These arrays display two plasmon bands instead of the single one observed for the same arrays of particles but deposited on indium tin oxide coated glass. Laser excitation within the short wavelength band does not bring about any SERS spectrum, while excitation within the long wavelength band yields SERS spectra with a gain per molecule rising up to 10(8). The simultaneous investigation of extinction and Raman spectra of arrays exhibiting various topography parameters enables us to suggest an interpretation for both the occurrence of the two plasmon resonances and for the high Raman enhancement. We suggest to assign the short wavelength band to a plasmon wave propagating at the gold glass interface and the long wavelength one to an air/gold surface plasmon mode modified by particle-particle interaction.

RESUMEN

BACKGROUND: The incidence of clinically relevant anastomotic leaks after upper gastrointestinal surgery is approximately 4% to 20%, and the associated mortality is up to 80%. Depending on the clinical presentation, the treatment options include surgery, conservative treatment with or without external drainage or endoscopic treatment. METHODS: This report presents nine cases of anastomotic leaks or fistulae after surgery for upper gastrointestinal cancers that were treated by insertion of a Vicryl plug and sealing with fibrin glue. Under sedation, all nine patients underwent endoscopic lavage of the cavity at the site of anastomotic leakage. The entrance to the cavity then was filled with Vicryl mesh and sealed off with fibrin glue. After the procedure, the patients underwent endoscopy and a water-soluble contrast study for assessment of the result. RESULTS: Seven of the nine patients had complete healing of the anastomotic leak or fistula after one to two endoscopic treatments. In one case, the treatment failed immediately because of a large and direct tracheoesophageal fistula. Another patient experienced recurrent intrathoracic abscesses after initial technical success. CONCLUSIONS: Postoperative upper gastrointestinal fistulas or anastomotic leaks can be managed successfully with little morbidity by means of endoscopic insertion of Vicryl mesh with fibrin glue, thereby avoiding repetitive major surgery and its associated risks.

Asunto(s)

Fístula Cutánea/cirugía , Endoscopía del Sistema Digestivo , Fístula Esofágica/cirugía , Adhesivo de Tejido de Fibrina/uso terapéutico , Fístula Gástrica/cirugía , Poliglactina 910 , Complicaciones Posoperatorias/cirugía , Mallas Quirúrgicas , Adhesivos Tisulares/uso terapéutico , Adulto , Anciano , Anastomosis Quirúrgica , Fístula Bronquial/etiología , Fístula Bronquial/cirugía , Carcinoma/cirugía , Fístula Cutánea/etiología , Fístula Esofágica/etiología , Neoplasias Esofágicas/cirugía , Esofagectomía , Gastrectomía , Fístula Gástrica/etiología , Gastroenterostomía , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Neoplasias Gástricas/cirugía , Fístula Traqueoesofágica/etiología , Resultado del Tratamiento

RESUMEN

Interventional techniques in treatment of complicated diverticulitis gain more and more importance. In particular abscesses and bleeding are treated successfully. In case of diverticular abscess (Hinchey classification stage I and II) percutaneous drainages are placed sonographically or CT guided. Interventional drainage offers the possibility of elective one-stage surgical treatment of diverticulitis with significant reduce of mortality and morbidity rates. Diverticular bleeding is usually diagnosed and treated endoscopically. Only if endoscopy is not able to manage bleeding, angiography or nuclear scan is demanded. In case of stenosis endoscopic treatment has not jet gained clinical relevance.

Asunto(s)

Absceso/cirugía , Diverticulitis del Colon/cirugía , Urgencias Médicas , Hemorragia Gastrointestinal/cirugía , Obstrucción Intestinal/cirugía , Enfermedades del Sigmoide/cirugía , Absceso/diagnóstico , Colonoscopía , Diagnóstico por Imagen , Diverticulitis del Colon/diagnóstico , Drenaje , Hemorragia Gastrointestinal/etiología , Humanos , Obstrucción Intestinal/diagnóstico , Enfermedades del Sigmoide/diagnóstico

RESUMEN

Surface enhanced Raman scattering (SERS) was used to study phospholipid monolayers transferred by the Langmuir-Blodgett (LB) technique to SERS active substrates. These substrates, which were constituted of gold colloidal nanoparticles bound to polysilane films grafted onto glass plates, showed a uniform and homogeneous layer with strong interacting particles as revealed from UV-visible extinction spectra and atomic force microscopy images. Laser excitation at 632.8 nm within the red part of the localized surface plasmon resonance leads to intense and reproducible SERS spectra of trans-1,2-bis(4-pyridyl)ethylene (BPE). From SERS measurements at different pHs it was possible to determine the apparent pK(a) of BPE adsorbed on gold-coated silanized substrates in the absence and presence of one LB monomolecular layer of phospholipids. These SERS titrations allowed the estimation of the pH at the metal-LB film interface.

Asunto(s)

Oro/química , Espectrometría Raman/métodos , Concentración de Iones de Hidrógeno , Rayos Láser , Microscopía de Fuerza Atómica , Nanotecnología , Fosfolípidos/química , Dispersión de Radiación , Silicio/química , Propiedades de Superficie , Rayos Ultravioleta

RESUMEN

UNLABELLED: BACKGROUNDS AND STUDY AIMS: At the time of diagnosis most patients with pancreatic cancer are still irresectable for cure. The aim of this study was to evaluate surgical palliation, in particular against the background of endoscopic stent placement. PATIENTS AND METHODS: This retrospective study analyses the therapeutic results in 107 patients with an irresectable pancreatic carcinoma operated on between 1990 and 1998. RESULTS: 104 patients showed primary therapeutic success with adequate bile drainage. In 97 % a simultaneous gastrojejunostomy was performed. The overall complication rate was 24 % and the hospital mortality 3.7 %. Median survival after surgical treatment was 201 days. CONCLUSIONS: Because of a decrease in perioperative morbidity and mortality, surgical palliation of irresectable pancreatic carcinoma still remains an effective therapy, especially for patients expected to survive 6 months or more. The surgical procedure offers the better chance for long-term palliation of obstructive jaundice and duodenal obstruction compared to the endoscopic approach. However, to consider both, the surgical and the endoscopic treatment, complementing each other, seems to be important to guarantee optimal palliation for the individual patient.

Asunto(s)

Adenocarcinoma/cirugía , Desviación Biliopancreática , Neoplasias Pancreáticas/cirugía , Adenocarcinoma/mortalidad , Adulto , Anciano , Drenaje , Endoscopía , Femenino , Gastroenterostomía , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Neoplasias Pancreáticas/mortalidad , Estudios Retrospectivos , Factores de Tiempo