Hepato Gastroenterol
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Primary sclerosing cholangitis is an uncommon chronic hepatobiliary disorder, and the definitive surgical treatment for symptomatic primary sclerosing cholangitis is liver transplantation. Although some cases with primary sclerosing cholangitis treated with hepaticojejunostomy or partial hepatectomy have been reported, the indications for these procedures and their long-term results have not been well defined or studied. We present three patients with segmental primary sclerosing cholangitis, and discuss the indication of surgical treatment for primary sclerosing cholangitis excluding liver transplantation. ⋯ All patients were treated hepaticojejunostomy and achieved long-term survival. Although liver transplantation is the treatment of choice for primary sclerosing cholangitis, in cases of segmental primary sclerosing cholangitis, local resection of the involved structures may be curative. Resection of a discrete lesion may provide many years of survival with a good quality of life, in some cases obviating the need for liver transplantation.
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Hepato Gastroenterol · May 2004
Randomized Controlled Trial Comparative Study Clinical TrialStress ulcer prophylaxis in critically ill patients: a randomized controlled trial.
Critically ill patients especially who require mechanical ventilation or have coagulopathy are at increased risk for stress-related gastrointestinal hemorrhage. There are conflicting data on the efficacy and complication rates of various prophylactic regimens. ⋯ We could not show that omeprazole, famotidine, or sucralfate prophylaxis can affect already very low incidence of clinically important stress-related bleeding in high-risk surgical intensive care unit patients. Furthermore, our data suggested that especially gastric pH increasing medication could increase the risk for nosocomial pneumonia. Routine prophylaxis for stress-related bleeding even in high-risk patients seems not to be justified.
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Hepato Gastroenterol · May 2004
Review Case ReportsMucosa-associated lymphoid tissue lymphoma of the duodenum: report of a case resistant to Helicobacter pylori eradication.
We present a case of mucosa-associated lymphoid tissue (MALT) lymphoma of the duodenum treated with surgical resection. A 64-year-old woman underwent upper gastrointestinal endoscopy because of melena. Examinations revealed an ulcer-forming lesion at the second portion of the duodenum that was diagnosed histologically as low-grade MALT lymphoma. ⋯ Duodenal MALT lymphoma is a rare entity. Only 17 cases have been reported in the English literature. We summarized the characteristics of the disease and tried to figure out differences in comparison with those in the stomach, including the involvement of the Helicobacter pylori infection.
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Hepato Gastroenterol · May 2004
Clinical TrialPhase II study of combination doxorubicin, interferon-alpha, and high-dose tamoxifen treatment for advanced hepatocellular carcinoma.
Our previous studies showed that high-dose tamoxifen may improve the therapeutic efficacy of doxorubicin (HTD regimen) in hepatocellular carcinoma. Interferon-alpha, either as a single-agent treatment or as a biochemical modulator, has also been reported to be effective in the treatment of hepatocellular carcinoma. In this study, we sought to clarify if the addition of Interferon-alpha2b to HTD regimen could further improve the control of advanced hepatocellular carcinoma. ⋯ Combination of interferon-alpha2b, high-dose tamoxifen, and doxorubicin is an effective treatment for advanced hepatocellular carcinoma. However, the data does not support that addition of interferon-alpha2b is superior to HTD regimen alone.
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Hepato Gastroenterol · May 2004
Pancreas-sparing duodenectomy in duodenal pathology: indications and results.
Pancreas sparing-duodenectomy is an organ-preserving surgical procedure suitable for patients with premalignant or early malignant lesions of the duodenum. The surgical technique is challenging due to the close anatomical relationship between the pancreas and the duodenum. ⋯ Pancreas-sparing duodenectomy is a challenging surgical technique and requires excellent knowledge of the anatomy. Intraoperative fresh-frozen section is mandatory to exclude malignant disease. If performed for appropriate indications, pancreas sparing-duodenectomy offers the potential to preserve the anatomical gastrointestinal passage and the integrity of the pancreas.