Hepato Gastroenterol
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Hepato Gastroenterol · Jul 2007
Case ReportsPreservation of segment 4 inferior by distal middle hepatic vein reconstruction combined with extended right hepatectomy after portal vein embolization in a patient with a huge initially unresectable HCC.
An extended hepatectomy combined with preoperative portal venous embolization can offer curative resection in patients with initially unresectable hepatocellular carcinoma. However, hypertrophy of the future remnant liver is occasionally unsatisfactory after portal venous embolization in some patients to remove the initially unresectable tumor. In these patients, hepatic venous reconstruction to preserve hepatic parenchyma may contribute to the possibility of resection. ⋯ His postoperative course was almost uneventful. Postoperative abdominal computed tomography showed the satisfactorily preserved Segment 4 inferior. Distal hepatic venous reconstruction combined with an extended hepatectomy may further offer a chance of a curative resection for patients in whom enough hypertrophy of the future remnant liver is not obtained after portal venous embolization.
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Hepato Gastroenterol · Jun 2007
Clinical TrialLaparoscopic appendectomies: results of a monocentric prospective and non-randomized study.
Appendicitis is one of the most frequent causes of abdominal pain in western countries. It occurs in 6 to 7% of the United States population. Despite laboratory and imagery tests, 15 to 40% appendices removed by laparotomy appear to be normal at histological examination. Thus, others pathologies beside appendicitis may be found in patients with right lower quadrant pain. This had led some to advocate laparoscopy for patients suspected to have acute appendicitis. The aim of this study is to determine the contribution of laparoscopy in patients with right lower quadrant pain and the implications of removing a macroscopic normal appendix. Rates of all pathologies and normal appendices were found at laparoscopy. Morbidity, mortality rates and length of hospital stay linked to laparoscopic appendectomy. ⋯ Laparoscopy is a reliable technique, safe and reproducible. It is an effective and relatively atraumatic tool to investigate abdominal cavity. This allows an accurate decision-making, which is especially advantageous in young women who have a high rate of non-appendicular pathologies. Laparoscopy also reduces the rate of unnecessary abdominal exploration while realizing a correct diagnosis of others possible pathologies. We therefore advocate laparoscopy in patients with abdominal right-lower-quadrant pain, especially women.
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Hepato Gastroenterol · Jun 2007
An infrequent cause of upper gastrointestinal tract bleeding: "Dieulafoy's lesion".
Dieulafoy's lesions are uncommon sources of upper gastrointestinal tract bleeding. Endoscopists must be aware of these lesions when evaluating patients with upper gastrointestinal tract bleeding. ⋯ Endoscopic methods should be the first choice in treating bleeding Dieulafoy's lesions. Both EIT and EBL are successful methods for achieving initial hemostasis. However, EIT therapy has a higher re-bleeding rate. EBL is a safe and effective method for the treatment of bleeding Dieulafoy's lesions.
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Hepato Gastroenterol · Mar 2007
Randomized Controlled TrialCan procalcitonin help us in timing of re-intervention in septic patients after multiple trauma or major surgery?
In surgical sepsis, the rapid identification of source of infection at an early stage after surgery or serious trauma is crucial for favorable outcome. The discrimination between local and generalized infection is critical for correct treatment. ⋯ We observed a clear tendency to decrease extent of multiple organ dysfunction syndrome in patients, in which therapeutic decision was made earlier using procalcitonin as an additional marker separating local infection from generalized one.
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Hepato Gastroenterol · Mar 2007
Lesser-sac lavage for intraoperative detection of blunt pancreatic duct injury.
Blunt pancreatic duct injury is difficult to differentiate, especially during surgery. In terms of demonstration of pancreatic duct injury, endoscopic retrograde pancreatography (ERP) is the gold standard imaging study, however, availability can be problematic. Therefore, we have designed a method utilizing lesser-sac lavage to differentiate pancreatic duct injury. ⋯ Using lesser-sac lavage for measurement of LAA and LA L constitutes a rapid, non-invasive and effective method for detection of pancreatic duct injury, especially transection of the main duct. LAA appears to be a better indicator for differentiation of minor (superficial laceration or side branch) or major (MPD) pancreatic injury at the first time point (15 minutes post lavage) compared to LAL. By contrast, LAL appears to be a better indicator with respect to differentiation of the injured pancreas from the normal organ at this time point.