Hepato Gastroenterol
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Hepato Gastroenterol · Jan 2001
Practical guidelines for the preservation of the pancreaticoduodenal arteries during duodenum-preserving resection of the head of the pancreas: clinical experience and a study using resected specimens from pancreaticoduodenectomy.
The purpose of this study was to create a practical guideline for vascular preservation during duodenum-preserving resection of the head of the pancreas. ⋯ To safely perform duodenum-preserving resection of the head of the pancreas, preservation of the whole posterior pancreaticoduodenal artery and anterior inferior pancreaticoduodenal artery is recommended because they can be safely dissected from the pancreas, and the posterior pancreaticoduodenal artery provides the major blood supply to the papilla and distal bile duct. However, removal of a short segment of posterior pancreaticoduodenal artery does not preclude a good blood supply to the duodenum because of bidirectional blood flow.
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Hepato Gastroenterol · Jan 2001
Review Case ReportsGastric rupture after Heimlich maneuver and cardiopulmonary resuscitation.
Choking is a common emergency problem. The Heimlich maneuver is unquestionably effective in relieving airway obstruction. ⋯ Lay public, paramedics and the medical professionals should be educated with the correct technique of Heimlich maneuver and its potential complications. All patients receiving Heimlich maneuver should be examined by an experienced physician.
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The aim of this study was to assess the results of major liver resection in patients with advanced hepatocellular carcinoma in terms of safety and survival. ⋯ We conclude that an aggressive policy of major liver resection with vascular reconstruction was justifiable in patients with advanced fibrolamellar variant of hepatocellular carcinoma and in selected patients with noncirrhotic hepatocellular carcinoma, and of doubtful value in patients with cirrhosis.
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Hepato Gastroenterol · Jan 2001
The therapeutic strategies in performing emergency surgery for gastroduodenal ulcer perforation in 130 patients over 70 years of age.
Gastroduodenal ulcer is a very common illness in Japan. As the number of elderly persons in Japan increases the same as in Europe and America, the number of such patients requiring a gastroduodenal emergency operation has also increased. Regarding the complications of peptic ulcer, a perforation remains the most important fatal complication. The aim of this study is to investigate the operative risk factors and the long-term recurrence rates and to define the optimal surgical procedures in emergency situations in elderly patients. ⋯ In conclusion, in an emergency situation, elderly patients are in a highly unfavorable prognostic condition due to their advanced age, and comorbidity, which thus leads to poorer results, not only worldwide, but also in Japan. Based on our findings, in duodenal ulcer cases, a simple closure and vagotomy is recommended because of its low mortality and minimal stress, except for cases with a giant perforation measuring over 20 mm in diameter at the perforation hole or with severe duodenal stenosis. In stomach ulcer cases, a gastrectomy may be recommended because of its low recurrence rate.
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Hepato Gastroenterol · Jan 2001
Validation of MPI and PIA II in two different groups of patients with secondary peritonitis.
There are several scoring systems designed to predict mortality in patients with peritonitis, which need validation in different patient populations. Our aim was to evaluate Mannheim Peritonitis Index (MPI) and Peritonitis Index of Altona (PIA II) in patients with postoperative peritonitis and other causes of secondary peritonitis. ⋯ POSTOP group patients had higher MPI, lower PIA II and higher CPS values ending up with higher mortality. This may be because of the delay in diagnosis and treatment, resulting with higher organ failure rates. Generally the results of evaluations for MPI and PIA II are similar. When these two peritonitis scores are combined and used together in the form of CPS, all the parameters improve.