Hepato Gastroenterol
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Hepato Gastroenterol · Jan 2004
Case ReportsSevere lactic acidosis and thiamine deficiency during total parenteral nutrition--case report.
We encountered a case of total parenteral nutrition-associated lactic acidosis that did not respond to sodium bicarbonate or other conventional emergency treatments. He was characterized by minimal food intake before surgery, delayed gastric emptying after pylorus-preserving pancreatoduodenectomy due to pancreas head cancer and long-term total parenteral nutrition without food intake and vitamin supplements after surgery. ⋯ We emphasize the need to supplement total parenteral nutrition with thiamine-containing vitamins for the patients whose food intake does not meet nutritional requirements and to intravenously replenish using high-dose thiamine simultaneously with the manifestation of signs and symptoms of severe lactic acidosis with unknown cause. In conclusion, thiamine deficiency should be included in the differential diagnosis of lactic acidosis for the patients who received total parenteral nutrition without food intake and vitamin supplements.
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Hepato Gastroenterol · Jan 2004
Long-term results of central inferior (S4a+S5) hepatic subsegmentectomy and pancreatoduodenectomy combined with extended lymphadenectomy for gallbladder carcinoma with subserous or mild liver invasion (pT2-3) and nodal involvement: a preliminary report.
Gallbladder carcinoma, especially advanced cancer that has invaded the subserosal or deeper layers, has a poor prognosis. Recently, radical operations combining resection of the liver and pancreas with extended lymph node dissection have been introduced to improve the prognosis of advanced gallbladder carcinoma. We have introduced central inferior (Couinaud's subsegments 4a and 5; S4a+S5) hepatic subsegmentectomy and pancreatoduodenectomy combined with extended lymphadenectomy for gallbladder carcinoma demonstrating subserous or mild liver invasion (pathological tumor stage pT2-3) and nodal involvement. ⋯ S4a+S5 hepatic subsegmentectomy and pancreatoduodenectomy combined with extended lymphadenectomy improve the long-term survival of gallbladder carcinoma with pT2-3 and nodal involvement. The presence of pN2 disease is not a contraindication for surgery. Further study is necessary to evaluate the usefulness of this radical procedure, especially as a standard operation.
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We present the clinical features and outcome of 34 patients with hepatocellular carcinoma older than 70 years of age who underwent hepatic resection (elderly-HCC). Nowadays, hepatic surgeons unavoidably have to perform hepatic resection on elderly patients with hepatocellular carcinoma due to increasing life expectancy. However, the outcome of hepatic resection on elderly patients with hepatocellular carcinoma varies in each series, and the exact role of surgery in the management of hepatocellular carcinoma in the elderly remains to be clarified. ⋯ We present the clinical features and outcomes of 34 elderly patients with hepatocellular carcinoma who underwent hepatic resection. The results seem to indicate that hepatic resection is safe and feasible in the elderly with hepatocellular carcinoma with or without cirrhosis. The prognosis after hepatic resection is as comparable as that of the younger patients with hepatocellular carcinoma.
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Hepato Gastroenterol · Jan 2004
Spleen-preserving distal pancreatectomy for intraductal papillary-mucinous tumor (IPMT).
Recently, the significance of preserving the spleen has received a lot of attention. Since our first trial and success of spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein for chronic pancreatitis, this procedure has been more frequently performed and reported. In this study, we introduce the technique and indications for the procedure for intraductal papillary mucinous tumor of the pancreas. ⋯ Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein is easy and safe, and should be performed for some of the patients with intraductal papillary mucinous tumor of the pancreas.