Hepato Gastroenterol
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Hepato Gastroenterol · Sep 2002
Review Case ReportsTreatment of superior mesenteric artery embolism with a fibrinolytic agent: case report and literature review.
Successful treatment of superior mesenteric artery embolism depends on an aggressive approach in patients at risk for mesenteric ischemia. This approach favors an early diagnosis and permits the reestablishment of arterial flow within an appropriate time, with prevention of vasospasm and control of organic insufficiencies. We report here a case of superior mesenteric artery embolism in which arterial flow was reestablished by selective intra-arterial infusion of streptokinase. ⋯ This procedure could be an alternative to embolectomy in selected patients, i.e., patients with an early diagnosis, no evidence of intestinal necrosis and with partial occlusion and/or occlusion of secondary branches of the superior mesenteric artery. Frequent arteriographies and intensive care are necessary in this approach. The patient should be continuously monitored because of the possibility of treatment failure and the need for embolectomy.
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Hepato Gastroenterol · Sep 2002
New therapeutic strategy of open pelvic fracture associated with rectal injury in 43 patients over 60 years of age.
A diversion of the fecal stream is generally regarded as an integral component of minimizing both the infectious morbidity and mortality associated with an open pelvic fracture. However, the efficacy of the fecal diversion in elderly has yet to be clearly elucidated. We performed a formal retrospective comparison between the elderly patients who underwent diversion and those who did not. ⋯ Diversion should not be regarded as an absolutely safe intervention for open pelvic fracture associated with rectal injury. However, if a failure of the primary repair or resection with anastomosis once occurs, then the patient's condition could change suddenly or worsen. Elderly patients especially have a poor physiological reserve, and thus a failure to perform a primary repair or resection with anastomosis can quickly lead to patient mortality. There may be some bias when selecting fecal diversion or not based on each surgeon's subjective judgment. In our cases, diversions tended to be done in severe cases. If surgeons encounter a pelvic fracture with severe rectal injury, then aggressive fecal diversion may thus be the procedure of choice in emergency elderly cases.
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Hepato Gastroenterol · Sep 2002
Interferon treatment for patients with chronic hepatitis C infected with high viral load of genotype 2 virus.
Interferon treatment is more effective in patients with chronic hepatitis C infected with genotype 2a virus than those with genotype 1b virus. We analyzed patients with chronic hepatitis C treated by interferon in our clinics to develop a more effective regimen of interferon treatment for patients with genotype 2 virus infection. ⋯ These findings suggest that the initial sufficient dose of interferon administration is effective to eradicate serum HCV-RNA in patients with a high viral load of genotype 2a virus in chronic hepatitis C.
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Hepato Gastroenterol · Sep 2002
Respiratory function after esophagectomy for patients with esophageal cancer.
Postoperative respiratory hypofunction sometime ruins quality of life of patients with esophageal cancer. From 1993, we introduced transhiatal esophagectomy without thoracotomy as a less invasive surgery to prevent postoperative respiratory complications for patients who have relatively early stage of esophageal cancer and have preoperative respiratory complication, or who are older in age. In this study, postoperative long-term evaluation of respiratory functions of patients with esophageal cancer who underwent esophagectomy was performed. ⋯ In patients treated with transthoracic esophagectomy, postoperative respiratory hypofunctions continued over 6 months after surgery. However, postoperative respiratory complications may not be related with the long-term postoperative respiratory hypofunction in patients with esophageal cancer.