Hepato Gastroenterol
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Hepato Gastroenterol · Mar 2008
Strong association between frequency of intermittent inflow occlusion and transient increase in serum liver enzymes after hepatic resection.
Although significantly higher serum levels of liver transaminases are commonly observed after hepatic resection, the factors responsible for the increase and the association between the increase and the postoperative course remain unclear. ⋯ The frequency of intermittent inflow occlusion is the only factor that affects the postoperative enzyme elevation.
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Hepato Gastroenterol · Jan 2008
Comparative StudyDuodenogastroesophageal reflux: results of medical treatment and antireflux surgery.
Recent studies have shown that reflux of the duodenal content to the esophagus plays an important role in esophageal mucosal damage. The aim of the study is to compare the duodenogastroesophageal (DGER) reflux with the severity of reflux esophagitis and evaluate its response to either medical and/or antireflux surgery. ⋯ DGER in acid medium is more injurious to the esophagus than DGER in alkaline pH. The severity of esophageal injury does not correlate with the severity of acid or bile reflux but has a direct correlation with impaired distal esophageal motility. Medical treatment gives satisfactory control of symptoms and healing of esophageal lesion in 70% of DGER. The response to medical treatment does not depend on the severity of esophageal injury but depends on the severity of bile and acid reflux. Nissen fundoplication in refractory patients, either open or laparoscopic, was effective in control of heartburn in 95% of patients contrary to 50% in mixed symptoms.
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Hepato Gastroenterol · Dec 2007
Case ReportsThe successfully curative treatment of advanced gastric adenocarcinoma with multiple liver metastases and paraaortic lymph node metastases by salvage operation following the biweekly paclitaxel and S-1 combination chemotherapy: a case report.
We report the case of 67-year-old man who was given a diagnosis of advanced gastric adenocarcinoma. Complete response of multiple liver and paraaortic lymph node metastases occurred in this patient after combination chemotherapy with systemic injection of paclitaxel and oral administration of novel dihydropyrimidine- dehydrogenase- inhibitory fluoropyrimidine (S-1). Following 7 courses of the biweekly paclitaxel and S-1 combination chemotherapy, the patient underwent total gastrectomy with D3 extended lymph node dissection. ⋯ The patient is fine and has not shown any recurrence at other sites 37 months after surgery. Salvage surgery following paclitaxel and S-1 chemotherapy may be feasible for patients with advanced gastric cancer and complete regression of distant metastases. Biweekly paclitaxel and S-1 combination chemotherapy has been used safely and its administration may be continued for a long time in an outpatient clinic setting for the treatment of advanced gastric cancer.
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Hepato Gastroenterol · Dec 2007
Hepaticojejunostomy in the treatment of iatrogenic biliary lesions following laparoscopic cholecystectomy. A retrospective study on 51 cases.
Laparoscopic cholecystectomy is characterized by a higher incidence of iatrogenic biliary lesions. The Authors evaluate the role of hepaticojejunostomy in the treatment of iatrogenic biliary lesions following laparoscopic cholecystectomy in 51 patients observed in the Campania region, Italy from 1991 to 2003. ⋯ Laparoscopic cholecystectomy causes a higher incidence of iatrogenic biliary lesions. Hepaticojejunostomy gives better long-term results and lower morbidity compared to T-Tube plasty. Management of septic complications in patients with iatrogenic biliary lesions represents the first therapeutic step.
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Hepato Gastroenterol · Dec 2007
Laparoscopic cholecystectomy in acute cholecystitis: a proposal of safe and effective technique.
Laparoscopic cholecystectomy is slowly taking its place also in an emergency setting, regardless of its initial unfortunate course when iatrogenic lesions during surgery, complications and conversion rate make the laparoscopic approach in acute cholecystitis a hazard. With the development of laparoscopic technique, the laparoscopic cholecystectomy for acute cholecystitis becomes a reality, but its role in emergency is not yet defined. From December 1998 to December 2005, 133 consecutive laparoscopic cholecystectomies for acute cholecystitis were performed in our institution by the same surgeon. ⋯ The latter analysis is reported. Laparoscopic cholecystectomy, when performed with an adequate technique and as early as possible represents a safe procedure to treat acute cholecystitis in an emergency setting. The technique described, considering the results, lack of iatrogenic lesions and acceptable operating time, represents a standardized surgical strategy to approach acute cholecystitis (AC) in a safe, effective and reproducible manner.