Hepato Gastroenterol
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Hepato Gastroenterol · Jul 2002
Comparative StudyNew insight for management of blunt splenic trauma: significant differences between young and elderly.
Although highly successful in children and young patients, the non-operative management of blunt splenic injury in the elderly has yet to be clearly studied. The purpose of this study was to determine whether or not a relationship exists among the mechanism of injury, the grade of splenic injury, the associated injuries, and whether patterns of injury differ between the young group (younger than 60 years old) and the elderly group (60 years and older than 60 years). ⋯ The final selection of splenic management decision was individualized for each patient and based on multiple variables. For persistent hemodynamic instability or unresolved concerns for other individual pathologic conditions, aggressive management is recommended. In the absence of these two important conditions, the variables that predicted a need for operative intervention include an Injury Severity Score above 20 in younger and elderly patients; an American Association for the Surgery of Trauma splenic grade above III in elderly; a large hemoperitoneum on an initial computed tomography scan; the presence of active extravasation on an initial computed tomography scan; and high-energy mechanisms. In conclusion, selecting the optimal non-operative management of blunt splenic injury in elderly patients remains difficult. An aggressive initial operation is thus recommended because the specific fragility of the spleen and the decreased physiologic reserve in elderly patients is difficult to estimate, especially at small hospitals where performing emergency splenic angiography and treating embolisms is difficult.
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Hepato Gastroenterol · Jul 2002
Comparative StudyComparison of urine trypsinogen-2 test strip with serum lipase in the diagnosis of acute pancreatitis.
The accuracy of a new rapid urinary trypsinogen-2 test strip (actim Pancreatitis) was compared with that of serum lipase for detection of acute pancreatitis in patients with acute abdominal pain. ⋯ Acute pancreatitis can be excluded with a higher probability with the actim Pancreatitis strip than with serum lipase determination, and therefore appears to be more suitable for screening of acute pancreatitis. With its high specificity with a cut-off > 3x the upper reference limit, serum lipase is suitable as a confirmatory test for pancreatitis when a positive dipstick result is obtained.
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Hepato Gastroenterol · Jul 2002
Risk factors influencing pancreatic leakage and the mortality after pancreaticoduodenectomy in a medium-volume hospital.
This study was designed to evaluate risk factors influencing pancreatic leakage and pancreatic leakage-related mortality in a medium-volume hospital. ⋯ In a medium-volume hospital, reconstruction after pancreaticoduodenectomy should be performed with careful attention to pancreas and anastomosis sites. In the patients with normal/mild fibrosing pancreas, duct-to-mucosa anastomosis without suturing the pancreas parenchyma may be a useful technique for reconstruction.
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Hepato Gastroenterol · Jul 2002
Surgical treatment of pulmonary recurrence after hepatectomy for colorectal liver metastases.
Although pulmonary recurrence is frequent among the extrahepatic recurrences after hepatectomy, the efficacy of surgical treatment for pulmonary recurrence after hepatectomy has not been confirmed. Surgical resection of pulmonary recurrence after hepatectomy for colorectal metastases was reviewed retrospectively to evaluate the survival benefit. ⋯ Pulmonary metastasectomy after hepatectomy for metastases from colorectal cancer is a safe treatment, and might offer prolonged survival for highly selected patients.
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Hepato Gastroenterol · Jul 2002
Enhanced inflammatory cytokine production at ischemia/reperfusion in human liver resection.
Clinical implications of acute reactant cytokine responses remain to be clarified in the setting of ischemia/reperfusion of human liver during liver resection and transplantation. ⋯ These observations suggest that overproduction of acute reactant cytokines (interleukin-6 from the portal system and interleukin-8 from the systemic circulation) in hepatic ischemia/reperfusion relates positively with postoperative hepatocyte injury in humans. We propose that hepatectomy done under a prolonged continuous inflow occlusion should be reconsidered when an enhanced generation of acute cytokines is anticipated, especially in case of a markedly high portal pressure during hepatic pedicle clamping.