Hepato Gastroenterol
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Hepato Gastroenterol · Nov 2003
Comparative StudyInnovative chemotherapies for stage III colon cancer: a cost-effectiveness study.
The lower mortality rate associated with Oxaliplatin or Irinotecan added to Fluorouracil chemotherapy for stage III colon cancer should outweigh significantly higher costs of these therapies. While efficacy data currently are lacking, our aim was to generate cost-effectiveness data about a range of potential benefits to define the increase in mortality reduction required for the future acceptance of these new chemotherapies. ⋯ Even the most conservative scenario showed a discounted cost-effectiveness ratio of only 12,485 per life year gained, when compared to best supportive care and therefore met strict cost-effectiveness standards. Oxaliplatin chemotherapy should be accepted for all patients with stage III colon cancer if the required 20% increase in mortality reduction is achieved. Because of the high impact on cost-effectiveness each more expensive chemo-therapy schedule with higher overall dosage should first prove its superior clinical efficacy.
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Hepato Gastroenterol · Nov 2003
Prevalence of pulmonary hypertension in patients with hepatosplenic Mansonic schistosomiasis--prospective study.
Thirty-four patients with portal hypertension and previous history of esophageal varices hemorrhage due to hepatosplenic Mansonic schistosomiasis were prospectively studied. ⋯ In conclusion, pulmonary hypertension is a frequent complication in patients with portal hypertension due to hepatosplenic Mansonic schistosomiasis and, in 20.6% of the cases, it can be considered as moderate or severe. Our results suggest that shunt surgeries, which can aggravate pulmonary hypertension, should be employed very cautiously in the treatment of schistosomal portal hypertension.
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Hepato Gastroenterol · Nov 2003
Resection of localized recurrences after hepatectomy of colorectal cancer metastases.
Hepatectomy is generally considered the only mode of curative treatment available for patients with colorectal liver metastases, even though recurrence occurs in more than 60% of the patients. ⋯ In appropriately selected patients with colorectal cancer, surgical excision of localized recurrences after hepatectomy may be effective in prolonging survival.
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Hepato Gastroenterol · Nov 2003
Case ReportsDelayed massive arterial hemorrhage after pancreaticoduodenectomy for cancer. Management of a life-threatening complication.
Delayed massive arterial hemorrhage from the operating field occurs in 1-4% of cases after pancreaticoduodenectomy, with a mortality rate up to 50%. The purpose of this study was to define diagnostic and treatment methodologies to maximize survival. ⋯ Early diagnosis and management of pancreatic leak represents the only means to prevent a delayed massive arterial hemorrhage. Transarterial embolization or surgical ligation of the hepatic artery proximal to the celiac axis represents the procedure of choice to control the bleeding. Taking down the pancreatic anastomosis and oversewing the pancreatic stump is safe and effective. Extensive drainage of the operating field should always be associated to prevent multisystem organ failure.
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Hepato Gastroenterol · Nov 2003
Case ReportsSpleen-preserving distal pancreatectomy with preservation of the splenic artery and vein for intraductal papillary-mucinous tumor (IPMT): three interesting cases.
Preservation of the spleen at distal pancreatectomy has recently attracted considerable attention. Since our first trial and success with spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein for tumors of the pancreas and chronic pancreatitis, this procedure has been performed more frequently. Three patients with intraductal papillary-mucinous tumor underwent spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. ⋯ Severe complications were not found in any of the three cases and the postoperative course was uneventful. The patients have been followed as outpatients without any recurrence. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein is easy and safe, and should be performed for some patients with intraductal papillary mucinous tumor of the pancreas.