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  • 1
    Electronic Resource
    Electronic Resource
    Immunohistochemical study of alpha, mu and pi class glutathione S transferase expression in malignant melanoma (1997)
    Oxford, UK : Blackwell Publishing Ltd
    British journal of dermatology 136 (1997), S. 0 
    Details
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Human pi, mu and alpha class glutathione S transferases (GST) have been localized immunohistologically in normal skin, naevi and melanoma. Pi GSTs were found principally in the stratum basalis and, to a lesser extent, in the superficial layers. Normal melanocytes showed strong nuclear and cytoplasmatic staining. Distribution of GST mu in the epidermis showed that only the stratum basale, where melanocytes are located, stained well but with weak nuclear staining. Normal melanocytes were also well stained. The alpha GSTs were relatively abundant in the upper strata and to a lesser extent, in the basal layers. The absence of nuclear staining gives these cells a target appearance. Normal melanocytes showed strong cytoplasmatic staining. The pi GSTs seem to be most persistently and strongly expressed in malignant melanoma (MM), but mu GSTs are also found, whereas the alpha GSTs were only occasionally present. The finding of the GST mu in the melanocytes of the basal layer raises new questions regarding the role of GST mu in these cells because of the inherent risk of MM in individuals with a congenital deficiency of this isoenzyme. The role of GSTs in the resistance of cells to chemotherapy is also discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2133.1997.d01-1197.x
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  • 2
    Electronic Resource
    Electronic Resource
    Endorectal ultrasonography in the follow-up of rectal cancer Is it a better way of to detect early local recurrence? (1997)
    Springer
    International journal of colorectal disease 12 (1997), S. 78-81 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé. Après un traitement chirurgical curatif d'un cancer du rectum, divers protocoles sont utilisés dans le but de détecter le plus précocément possible une récidive. Le but de cette étude est de comparer les résultats obtenus par l'échographie endo-rectale (EUS) avec ceux obtenus par d'autres méthodes. Entre 1988 et 1995, 140 patients ont subi une résection curative d'un cancer du rectum. Les lésions pathologiques et échographiques ont étéévaluées sur la base de la classification TNM. Chez 21 patients, une récidive locale a été diagnostiquée: 5 de ces 21 correspondaient à une stade T 3 – 4, N 0 et 16 à un stade de T 2 – 4, N 1. Les 21 patients présentaient des évidences de récidive locale à l'échographie; 14 à l'examen digital, 16 à la colonoscopie, 18 au CT-Scan et 13 présentaient une élévation du taux d'antigène carcinoembryonnaire. Chez 12 patients asymptomatiques, l'échographie était positive à 12 reprises, le toucher rectal à 5 reprises, le CT-Scan chez 9, la colonoscopie chez 8, et un taux élevé de CEA chez 4. Une re-résection a été possible chez 15 patients 6 fois dans un but curatif et 9 fois dans un but palliatif. Ces constatations suggèrent que l'échographie endo-anale est plus précise dans la détection précoce des récidives locales en comparaison aux autres techniques d'évaluation. En raison du nombre limité de patients inclus dans cette étude, cet examen nécessite une évaluation plus extensive.
    Notes: Abstract. After curative surgery for rectal cancer, diverse protocols are used in order to detect early possible local recurrence. Our objective was to compare the results obtained by the endorectal ultrasonography (EUS) with other means of assessment. From 1988 to 1995, 140 patients have undergone curative surgery for rectal cancer. The pathological and sonographic lesions were evaluated according to the TNM classification. In 21 patients a local recurrence was diagnosed: 5 of those 21 were corresponding to T 3 – 4, N 0 and 16 to T 2 – 4, N 1 stage. All 21 showed evidence of local recurrence by EUS examination, 14 by digital rectal examination, 16 by colonoscopy, 18 by computed tomography, and the carcinoembryonic antigen level was high in 13 cases. In 12 patient who were asymptomatic EUS was positive in 12, digital rectal examination in 5, computer tomography in 9, colonoscopy in 8, and the CEA was increased in 4. Re-resection was possible in 15 cases, 6 with curative approach and 9 palliative. These findings suggest that EUS in care accurate in the early detection of local recurrence compared to other means of assessment review of the. The limited number of patients studies. Main form of assessment required further evaluation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003840050085
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  • 3
    Electronic Resource
    Electronic Resource
    Prospective evaluation of a minimally invasive approach for treatment of bile-duct calculi in the high-risk patient (1997)
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 632 -635 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Bile duct stones — Laparoscopic cholecystectomy — Endoscopic sphincterotomy — High-risk patient — Elderly
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The best approach to bile duct stones in high-risk patients is controversial. We showed in a randomized trial that open surgery had a morbi-mortality similar to that of endoscopic sphincterotomy alone (ES) and less late biliary complications. The aim of this study was to evaluate a minimally invasive approach to duct stones in high-risk patients compared with open surgery or ES alone. Methods: Sixty high-risk patients (mean age 80 years) suspected of duct stones were treated by ES + laparoscopic cholecystectomy (LC). High-risk factors were: age 〉 70 years, Goldman cardiac index 〉 13, chronic pulmonary disease, liver cirrhosis, neurologic deficit, and severe obesity. Results: ERCP success was 87%. Duct stones were found in 75%. LC succeeded in 92%. Post-LC stay was 4 days. Overall morbidity was 19% and mortality was 3%. Recurrent symptoms (mean follow-up: 9 months) was 3.6%. When compared with open surgery or ES alone, ES + LC had a similar morbi-mortality, but shorter postop stay (p 〈 0.001). Late symptoms appeared in 20% after ES alone vs 4% after open surgery or ES plus LC (p 〈 0.04). Conclusions: Combined ES + LC is an effective alternative to open surgery or ES alone for treatment of duct stones in high-risk patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900409
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  • 4
    Electronic Resource
    Electronic Resource
    Mirizzi's syndrome (1997)
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 842 -845 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Bile duct stones — Laparoscopy — Cholecystocholedochal fistula
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Mirizzi's syndrome (MS) is an unusual cause of obstructive jaundice. It can mimic bile duct cancer, and the role of laparoscopic surgery is not well defined. The aim of this paper is to report five cases and describe the pitfalls encountered in its diagnosis and treatment with a laparoscopic approach. Methods: From January 1992 to January 1996, five cases of MS out of 560 patients with gallstones prospectively treated and recorded were found (0.9%). Results: There were two men and three women, (mean age: 54 years [30–93]). In one case diagnosis of bile duct carcinoma was established but surgery revealed MS. Four cases were approached by laparoscopy, but all of them were converted: in two, due to a distorted anatomy, in a third due in the difficulty of visualizing the distal end of the bile duct, and in the last case due to the impossibility of retrieving the stones. All were treated with a cholecochorrhaphy over a T tube, except one, in which a hepaticojejunostomy was performed. Morbidity and mortality were nil, and they remain asymptomatic after a mean follow-up of 19 months (3–36). Conclusions: MS constitutes an important laparoscopic challenge, both to clearance of duct stones and to the proper reconstruction of the biliary duct. A prudent policy is to perform a dissection trial and convert if local conditions are not clear for an experienced laparoscopic surgeon.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900467
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  • 5
    Electronic Resource
    Electronic Resource
    The spilled stone (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 768-773 
    Details
    ISSN: 1432-2218
    Keywords: Spilled stone ; Laparoscopic cholecystectomy ; Symptomatic cholelithiasis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The application of laparoscopic techniques in digestive surgery to areas in which there was no previous experience has favored the appearance of new complications and clinical situations that were not observed during the open era. Initial opinion considered that stones left in the abdominal cavity were harmless, and a few clinical and experimental studies supported this opinion. But cumulative reports of cases suggest a potential danger. From 1991 to date, 49 cases of complications related to stones left in the abdominal cavity have been reported with severe complications that required an open surgical procedure. Stone spillage has not always been considered an indication of conversion of laparoscopic cholecystectomy but is now accepted as a source of infrequent but severe complications that may require a reintervention for treatment. Therefore it is recommended that efforts should be made to retrieve all spilled stones; the surgical procedure should be prolonged until this is achieved, in order to reduce one source of unpredictable morbidity. Open retrieval should be considered in selected cases if a large number or large stones are lost.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00190079
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  • 6
    Electronic Resource
    Electronic Resource
    Endoscopically-assisted laparoscopic partial gastric resection for treatment of a large benign gastric adenoma (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 344-346 
    Details
    ISSN: 1432-2218
    Keywords: Gastric adenoma ; Laparoscopic gastrectomy ; Flexible endoscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Gastric adenomas are benign tumors that are treated by fiberendoscopic removal, but large tumors need a surgical approach for resection. Laparoscopic approach fails to localize the exact placement of the lesion due to lack of sensitivity and fiberoptic control is advisable. We present a case of a large gastric adenoma that was resected by laparoscopy assisted with flexible gastric peroperative endoscopy because the lesion could not be palpated. A lateral gastric resection including the adenoma and wide margins was performed with an endostapler under fiberoptic control. Minimally invasive ancillary techniques enhance the efficacy of laparoscopic surgical procedures, especially in situations in which the lack of tactile feeling limits this approach.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00187388
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  • 7
    Electronic Resource
    Electronic Resource
    Laparoscopic surgery for splenic disorders (1998)
    Springer
    Surgical endoscopy and other interventional techniques 12 (1998), S. 66-72 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Splenic disorder — Open splenectomy — Laparoscopic splenectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Laparoscopic splenectomy (LS) has recently been gaining acceptance as an alternative to open splenectomy. However, several aspects, such as learning curve, residual splenic function, and management of large spleens, remain controversial. In this paper we present the analysis of technical details and immediate and late outcome of a consecutive series of 64 cases of splenic disorders approached by laparoscopy. Between Feb-1993 and April-1997, 64 patients with a wide range of splenic disorders were treated by laparoscopy, and prospectively recorded. Age, body mass index, operative time, number of trocars, perioperative transfusion, spleen weight, conversion rate, mode of spleen retrieval (bag or accessory incision), postoperative analgesia, stay and morbidity were analyzed. Late failures after LS were reevaluated with 99mTc-heat-damaged red blood cells scintigraphy and CT. LS was performed in 61 patients, and two cases with splenic cyst and one splenic artery aneurysm received a laparoscopic partial cystectomy and aneurysmectomy. LS was performed through an anterior approach in 12 patients and laterally in 49. Conversion rate was 6.5%. Accessory spleens were found in 7 patients (7/61, 11.5%). Morbidity was 16%. There was no correlation between the weight of the spleen, platelet count or obesity with operative time. A lateral approach was associated with a decrease in operative time (p 〈 0.002), postoperative stay (p 〈 0.001), transfusion (p 〈 0.04) and number of trocars (p 〈 0.001). Operative time was significantly longer in large spleens (〉1000 gr) (p 〈 0.001). However, there were no differences in transfusion rate, stay, morbidity or conversion rate. After a follow up of 12 m, 10 patients revealed a low platelet count. Scintigraphy showed residual splenic tissue in 3 (ITP). A wide range of splenic disorders can be treated by laparoscopy, including enlarged spleens. This technique should be continually audited, but initial results reflect the approach's safety and advantages provided that great technical care is taken and an exhaustive search for accessory spleens is conducted.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900597
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  • 8
    Electronic Resource
    Electronic Resource
    How, when, and why bile duct injury occurs (1998)
    Springer
    Surgical endoscopy and other interventional techniques 12 (1998), S. 322-326 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Gallstones — Open cholecystectomy — Laparoscopic cholecystectomy — Bile duct injury
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Bile duct injury (BDI) is a severe complication of laparoscopic cholecystectomy (LC). There is general agreement about the increase of this complication after LC vs open cholecystectomy (OC), but comparative studies are scarce. The aim of this paper has been to compare the incidence and clinical features of BDI after LC vs open procedures. Materials and methods: 3,051 OC, performed from June 1977 to December 1988 were retrospectively analyzed and compared with 1,630 LCs performed from June 91 to August 96, for which data were prospectively recorded. Age, sex, type of BDI, performance of intraoperative cholangiography (IOC), underlying biliary pathology, morbidity, mortality, and late morbidity were all analyzed. Results: BDI incidence was higher in group II (LC) (N: 16, 0.95%) than in group I, (OC, N: 19, 0.6%). BDI incidence was also higher in the group of patients in which it was necessary to convert to an open procedure (3/109, 2.7%, p 〈 0.05). BDIs were more frequently diagnosed intraoperatively in group I (OC, 18/19) than in group II (LC, 12/16). In both groups, BDI was more prevalent in cases operated by staff surgeons than residents, mainly in complicated gallbladder patients, with a bile duct of less than 7-mm diameter. Morbidity, postoperative stay, mortality, and late morbidity were similar after a BDI in both types of approach. Conclusion: (1) BDI increases with LC. (2) BDI after LC carries a similar postoperative morbidity and mortality to those after OC. (3) Incidence of BDI in converted cases increases significantly and this constitutes a high-risk group.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900662
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  • 9
    Electronic Resource
    Electronic Resource
    Conservative laparoscopic treatment of a posttraumatic splenic cyst (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 71-72 
    Details
    ISSN: 1432-2218
    Keywords: Splenic cyst ; Posttraumatic splenic cyst ; Conservative treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Laparoscopy has recently been demonstrated to be a useful alternative to open surgery for the surgical treatment of spleen disorders, and it can also facilitate a conservative approach for treatment of selected spleen lesions. We present the laparoscopic spleen-preserving treatment of a post-traumatic spleen cyst. A 28-year-old female presented a mass in the left hypochondrium immediately after an uneventful pregnancy. CT revealed a splenic cyst of 10×8 cm. Laparoscopic exploration showed a cyst located in the lower pole of the spleen. All the cyst wall not covered by spleen tissue (70%) was excised, and the fragment of cyst wall was recovered through a bag. The patient recovered uneventfully and was discharged 72 hours later. The laparoscopic approach should be considered for evaluation and treatment of selected benign cystic lesions of liver, retroperitoneum or spleen origin.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00187891
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  • 10
    Electronic Resource
    Electronic Resource
    Unsuspected carcinoma of the gallbladder (1994)
    Springer
    Surgical endoscopy and other interventional techniques 8 (1994), S. 211-213 
    Details
    ISSN: 1432-2218
    Keywords: Unsuspected carcinoma ; Gallbladder ; Laparoscopic dilemma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Laparoscopic cholecystectomy is the treatment of choice for gallstones. A formal contraindication is gallbladder cancer. However, in a great number of cases, this is a previously unsuspected intraoperative finding, and sometimes its first appearance is in acute cholecystitis. We present the case of 67-year-old woman, which presented an unsuspected carcinoma of the gallbladder that developed abdominal wall implants at the umbilical and left hypocondrium site. The success of LC favors the observation of cases similar to that described in this article. Surgeons who operate using laparoscopic techniques should bear this possibility in mind and practice an extemporaneous biopsy at the slightest suspicion of malignancy, and, if it is confirmed, the operation should be continued as an open one.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00591833
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