Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Jul 2009
Comparative StudyThe lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer.
Survival after surgery of pancreatic cancer is still poor, even after curative resection. Some prognostic factors like the status of the resection margin, lymph node (LN) status, or tumor grading have been identified. However, only few data have been published regarding the prognostic influence of the LN ratio (number of LN involved to number of examined LN). We, therefore, evaluated potential prognostic factors in 182 patients after resection of pancreatic cancer including assessment of LN ratio. ⋯ Not the lymph node involvement per se but especially the LN ratio is an independent prognostic factor after resection of pancreatic cancers. In our series, the LN ratio was even the strongest predictor of survival. The routine estimation of the LN ratio may be helpful not only for the individual prediction of prognosis but also for the indication of adjuvant therapy and herein related outcome and therapy studies.
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J. Gastrointest. Surg. · Jul 2009
Acute abdominal pain in patients with systemic lupus erythematosus.
Patients with Systemic Lupus Erythematosus (SLE) that present with acute abdominal pain (AAP) represent a challenge for the general surgeon. The purpose of this study was to identify the major causes of AAP among these patients and to define the role of disease activity scores and the APACHE II score in identifying patients with an increased perioperative risk. ⋯ This is one of the largest series of AAP and SLE. Most common causes of AAP were pancreatitis and intestinal ischemia. APACHE II score in patients with intestinal ischemia was higher than those with serositis; further studies are needed to examine whether this score may help to differentiate these etiologies when CT findings are inconclusive. APACHE II score was the most important factor associated with mortality. Furthermore, a prompt diagnosis and an appropriate surgical management are essential in order to improve patient outcome.
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J. Gastrointest. Surg. · Jul 2009
Case ReportsHigh jejunal perforation complicating tuberculous abdominal cocoon: a rare presentation in immune-competent male patient.
Tuberculosis (TB) peritonitis is a rare presentation of TB that is typically insidious, presenting with systemic symptoms and nonspecific abdominal pain. In the majority of the cases, this leads to bowel obstruction and rarely causes abdominal cocoon. The disease process predominantly affects the small bowel with a tendency to involve the terminal ileum, leading to perforation on rare occasions. ⋯ TB should be considered in all cases of atypical bowel perforations. Proximal jejunostomy and early use of anti-TB drugs can facilitate primary repair in aggressive TB infection with multiple bowel perforations.
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J. Gastrointest. Surg. · Jul 2009
Identification of patients at risk for development of tertiary peritonitis on a surgical intensive care unit.
Tertiary peritonitis (TP) is defined as a severe recurrent or persistent intra-abdominal infection after adequate surgical source control of secondary peritonitis (SP). The aim of this study was to analyze the characteristics of patients with SP who will further develop TP in order to define early diagnostic markers for TP. ⋯ The MPI at IO as well as CRP and SAPS II at the second postoperative day helps to identify patients at risk for tertiary peritonitis.