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  • 1
    Electronic Resource
    Electronic Resource
    The Tachykinin Neuroimmune Connection in Inflammatory Pain (1991)
    Oxford, UK : Blackwell Publishing Ltd
    Annals of the New York Academy of Sciences 632 (1991), S. 0 
    Details
    ISSN: 1749-6632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Natural Sciences in General
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1749-6632.1991.tb33116.x
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  • 2
    Electronic Resource
    Electronic Resource
    Circulatory and Anatomic Differences among Experimental Gastric Tubes as Esophageal Replacement (1997)
    Springer
    World journal of surgery 21 (1997), S. 992-997 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. In this experimental study we measured microcirculatory and anatomic differences among a newly developed technique of gastroplasty—fundus rotation gastroplasty (FRG)—and conventional (CG) and reversed (RG) gastric tubes as substitutes for the thoracic and cervical esophagus. After transhiatal esophageal resection, 36 large white pigs were randomly assigned to have an FRG, CG, or RG. Tube length, gastric volume, and compliance as well as blood flow in the tube and the remaining gastric reservoir (by laser Doppler flowmetry) were measured. The FRG tubes were 35.9 ± 3.1 cm long, RG 38.7 ± 3.3 cm, and CG 27.3 ± 2.1 cm ( p 〈 0.05). Gastric compliance was 20.8 ml in the FRG and 3.2 ml and 2.9 ml in the CG and RG, respectively ( p 〈 0.001). Blood flow was significantly higher in FRG tubes than in RG tubes or CG tubes, resulting in a lower anastomotic failure rate (2/12 FRG, 6/12 CG, 7/12 RG). Hence a rotation flap of the gastric fundus (FRG) yields a long, well perfused tube by maintaining the blood supply of the gastric lesser curvature. FRG appears to be a good alternative to CG or RG as a substitute for the thoracic and cervical esophagus.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002689900338
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  • 3
    Electronic Resource
    Electronic Resource
    Importance of the Duodenal Passage and Pouch Volume after Total Gastrectomy and Reconstruction with the Ulm Pouch: Prospective Randomized Clinical Study (1996)
    Springer
    World journal of surgery 20 (1996), S. 60-67 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The objective of this randomized study was to examine which reconstruction method and which pouch volume offer the best preconditions for a good quality of life and extensive physiologic regulation of gastrointestinal hormones after total gastrectomy. Up to now there is no general agreement with regard to the ideal reconstruction after total gastrectomy. The importance of the duodenal passage, the need for a pouch reconstruction, and the ideal pouch volume are matters of controversy. A total of 60 patients underwent the following reconstructions: Ulm pouch (pouch reconstruction with preservation of the duodenal passage), Hunt-Lawrence-Rodino pouch, or Roux-en-Y reconstruction without pouch. The clinical course, quality of life, and regulation of gastrointestinal hormones in correlation to reconstruction type and pouch volume were documented. Quality of life was assessed by means of a standardized specific questionnaire. Blood glucose, insulin, cholecystokinin, motilin, secretin, and pancreatic polypeptide were measured after stimulation by a standardized test meal. Six months after total gastrectomy those patients with an Ulm pouch were found to have a significantly better life quality ( p 〈 0.01), higher body weight, and better physiologic regulation of gastrointestinal hormones; moreover, they developed (in contrast to all other reconstruction types) no pathologic glucose tolerance. Our conclusion is that all patients with a postoperative life expectancy of at least 6 months (i.e., tumor stages UICC I and II) should undergo pouch reconstruction with preservation of the duodenal passage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002689900011
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  • 4
    Electronic Resource
    Electronic Resource
    Diagnosis and Staging of Pancreatic Cancer by Positron Emission Tomography (1999)
    Springer
    World journal of surgery 23 (1999), S. 882-887 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The detection of pancreatic cancer or the discrimination between pancreatic cancer and chronic pancreatitis remains an important diagnostic problem. Several imaging modalities are now used to diagnose pancreatic cancer, including transabdominal ultrasonography (US), contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography, and selective angiography. None of these six methods is perfect: Each has advantages and disadvantages, and their sensitivity and specificity are in a high range. In 1990 positron emission tomography (PET) was first applied to diagnose pancreatic cancer. This new diagnostic modality is based on functional changes in the pancreatic cancer cells caused by enhanced glucose metabolism. Increased glucose utilization is one of the characteristics of malignantly transformed cells, independent of their origin. The technical development of PET has allowed this new procedure to be used for clinical evaluation. Using 2-(18F)-fluoro-2-deoxy-d-glucose, PET can identify pancreatic cancer and differentiate pancreatic cancer from chronic pancreatitis with a sensitivity of 85% to 98% and a specificity of 53% to 93%. However, high sensitivity and high specificity are strongly dependent on the tumor stage. At present PET is still experimental and is available only in specialized centers. It may represent a new and noninvasive diagnostic procedure for the detection and the staging of pancreatic cancer. Further clinical studies, especially including patients with early tumor stages (small tumor size), are needed. This review discusses the possibilities and limits of PET and evaluates its importance in the future.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002689900593
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  • 5
    Electronic Resource
    Electronic Resource
    Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis with inflammatory mass in the head (1990)
    Springer
    World journal of surgery 14 (1990), S. 83-87 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé L'auteur rapporte une série de 141 pancréatectomies pour pancréatites chroniques pseudo-tumorales de la tête du pancréas. Les résultats de la pancréatectomie céphalique avec conservation du duodénum se basent sur une expérience de 16 ans. La mortalité opératoire précoce est de 0.7%; la mortalité tardive est de 5%. Soixant-dix-sept pour cent des opérés étaient exempts de douleur; 67% des patients avaient repris leurs activités professionnelles. Après un suivi postopératoire moyen de 3.6 ans, la glycorégulation restait inchangée chez 81.7%, était améliorée à long terme chez 8.3% et s'était aggravée chez 10.1%. Chez les malades souffrant d'une pancréatite chronique pseudo-tumorale de la tête du pancréas, la pancréatectomie céphalique avec conservation du duodénum se révèle une autre possibilité à côté de l'opération de Whipple. La technique chirurgicale de l'opération de Beger comporte 2 étapes: (1) la résection sub-totale de la tête avec conservation du duodénum; (2) l'interposition de la première anse jéjunale pour anastomoser la queue du pancréas d'une part et le reliquat céphalique d'autre part. Comparée à la duodénopancréatectomie classique selon Whipple, l'opération de Beger, mentionnée plus haut, a l'avantage de préserver l'intégrité de l'estomac, du passage duodénal, et des voies biliaires. Cette technique n'est évidemment indiquée que dans les formes chroniques pseudo-tumorales limitées à la tête du pancréas. Obtenant une amélioration des douleurs à long terme et une conservation de la fonction endocrinienne, la pancréatectomie céphalique avec conservation du duodénum représente une technique efficace avec une morbidité et une mortalité précoces et tardives basses.
    Abstract: Resumen En 141 pacientes con pancreatitis cronica y masa inflamatoria de la cabeza del páncreas se realizó resección de la cabeza del órgano con preservación del duodeno en un perfodo de 16 anos. La mortalidad operatoria fue 0.7% y la mortalidad tardía, 5%. El 77% de los pacientes resultó totalmente libre de dolor abdominal y el 67% retornó a su ocupación habitual. En un seguimiento de 3.6 años el metabolismo de la glucosa apareció inmodificado en el 81.7% de los pacientes, deteriorado en el 10.1%, y con mejoría sostenida en el 8.3%. En pacientes con pancreatitis crónica severa y masa inflamatoria en la cabeza del páncreas la resección de la cabeza con preservación del duodeno représenta una alternativa a la operación de Whipple. La técnica quirúrgica incluye dos aspectos principales: el primero, la resección subtotal de la cabeza pero conservando el duodeno; el segundo, la restitution del flujo secretorio exocrino proveniente del cuerpo y de la cola del páncreas mediante la interposition de la primera asa yeyunal. En contraste con la operación de Whipple, la resección de la cabeza del páncreas con preservación del duodeno en pacientes con pancreatitis crónica évita la resección gástrica, la duodenectomía, y la resección del colédoco. En relación al control del dolor a largo plazo y a la conservación de la función endocrina del páncreas, la resección de la cabeza con preservación del duodeno es un procedimiento altamente eficaz que se acompaña de reducida morbilidad precoz y tardía y baja mortalidad, en virtud de la limitada resección quirúrgica que implica. En pacientes con pancreatitis crónica severa y masa inflamatoria en la cabeza del páncreas la resección de la cabeza con preservación del duodeno représenta una alternativa a la operación de Whipple.
    Notes: Abstract In 141 patients with chronic pancreatitis and an inflammatory enlargement of the head of the pancreas, a duodenum-preserving resection of the head of the pancreas was performed within a 16-year period. The hospital mortality was 0.7%; the late mortality was 5%. Seventy-seven percent of the patients were completely free of abdominal pain; 67% returned to their former occupation. After a follow-up period of 3.6 years, glucose metabolism was unchanged in 81.7% of the patients, in 10.1% it deteriorated, and in 8.3% it improved permanently. In patients with severe chronic pancreatitis and an inflammatory mass in the head of the pancreas, a duodenum-preserving resection of the head of the pancreas is an alternative procedure to the Whipple operation. The surgical technique of the duodenum-preserving resection includes 2 major steps: first, subtotal resection of the head of the pancreas conserving the duodenum; second, restitution of the exocrine pancreatic secretory flow from the body and tail of the pancreas by using the first jejunal loop as an interposition. In comparison to the Whipple procedure, the duodenumpreserving resection of the head of the pancreas in chronic pancreatitis spares the patient a gastric resection, a duodenectomy, and a common bile duct resection. With respect to long-lasting pain relief and preservation of the endocrine function of the pancreas, duodenum-preserving resection of the head is a highly effective surgical procedure with a low early and late morbidity and mortality due to the limited surgical resection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01670550
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  • 6
    Electronic Resource
    Electronic Resource
    Necrosectomy and postoperative local lavage in patients with necrotizing pancreatitis: Results of a prospective clinical trial (1988)
    Springer
    World journal of surgery 12 (1988), S. 255-261 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Un essai prospectif d'une méthode de traitement chirurgical consistant en nécrosectomie associée au lavage de l'arrière cavité des épiploons et de la cavité nécrotique a concerné 74 malades présentant une pancréatite nécrotique. Malgrè le traitement intensif 58 d'entre eux ont accusé des complications telles que troubles pulmonaires (57%), rénaux (37%), choc (12%), et infection (26%). La valeur moyenne des signes de pronostic précoce fut de 4.5 points. A l'intervention 62% des opérés présentaient une nécrose pancréatique étendue, 69% des opérés une nécrose extra-pancréatique, 39% une surinfection du tissu pancréatique. Après l'exèrése de la nécrose le lavage fut pratiqué quotidiennement avec en moyenne 7 litres de liquide pendant une période de 25 jours. Chez 18 malades fut constaté une libération importante de trypsine immunoactive et chez 20 malades un taux élevé de phospholipase cA dans le liquide de lavage pendant 12/14 jours après l'intervention. La durée des soins intensifs fut en moyenne de 6.5 jours et celle de l'hospitalisation de 54 jours. Le taux de mortalité opératoire fut de 8.1%. On peut conclure de ces faits que la nécrosectomie limitée, associée au lavage local constitue un traitement adapté aux lésions et à la libération locale d'éléments biologiques pathologiques: bactérie, endotoxine, trypsine, et phospholipase A au cours de la pancréatite nécrotique.
    Abstract: Resumen Setenta y cuatro pacientes con pancreatitis necrotizante fueron incluídos en un ensayo clínico prospectivo aplicando un protocolo de manejo quirÚrgico que comprende necrosectomía y lavado peritoneal postoperatorio de la transcavidad de los epiplones y de la cavidad necrótica. Cincuenta y ocho pacientes exhibierion fallas orgánicas postoperatorias tales como disfunción pulmonar (57%), disfunción renal (37%), shock (12%), y sepsis (26%) a pesar de cuidado intensivo. El valor promedio de los signos précoces pronóstico (Ranson), con exclusión de la retención de líquido fue de 4.5 puntos. Los hallazgos intraoperatorios revelaron necrosis pancreática extensa en 62% de los pacientes, necrosis extrapancreática en 69%, y contaminación bacteriana del material necrótico en 39%. Realizada la necrosectomía se instauró lavado peritoneal postoperatorio por un período promedio de 25 días con 7 litros (promedio) de líquido por cada 24 horas. En cada uno de los 18 pacientes estudiados se demostró liberación considerable de tripsina inmunorreactiva, así como una elevada concentración de fosfolipasa A2 inmunorreactiva, en el líquido de lavado hasta el 12
    Notes: Abstract Seventy-four patients with necrotizing pancreatitis were included in a prospective clinical trial of a surgical management protocol comprising necrosectomy and postoperative local lavage of the lesser sac and of the necrosis cavity. Fifty-eight patients showed preoperative organ failures such as pulmonary dysfunctions (57%), renal dysfunctions (37%), shock (12%), and sepsis (26%) in spite of intensive care treatment. The median value of the early prognostic signs was 4.5 points. Intraoperatively, 62% of the patients revealed extensive intrapancreatic parenchymal necrosis, 69% had extrapancreatic necrosis, and 39% showed bacterial contamination of the necrotic material. Following the necrosectomy, postoperative local lavage was performed for an average period of 25 days with 7 liters (median) of lavage fluid per 24 hours. In each of 18 studied patients, a considerable release of immunoreactive trypsin was demonstrated and, in each of 20 studied patients, a high concentration of immunoreactive phospholipase A2 was demonstrated in the lavage fluid up to the 12th/14th postoperative day. The intensive care period averaged 6 1/2 days, the hospital stay averaged 54 days. The hospital mortality rate was 8.1%. It is concluded that restricted necrosectomy and postoperative local lavage treatment correspond in particular to the pathomorphologic conditions and to the local release of biologically active compounds such as bacteria, endotoxin, trypsin, and phospholipase A2 in patients with necrotizing pancreatitis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01658069
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  • 7
    Electronic Resource
    Electronic Resource
    Concomitant Analysis of the Epidermal Growth Factor Receptor Family in Esophageal Cancer: Overexpression of Epidermal Growth Factor Receptor mRNA but Not of c-erbB-2 and c-erbB-3 (1999)
    Springer
    World journal of surgery 23 (1999), S. 1010-1018 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The epidermal growth factor receptor family consists of four closely related transmembrane receptors: epidermal growth factor receptor (EGF-R), c-erbB-2, c-erbB-3, and c-erbB-4. Overexpression of each receptor may lead to cell transformation and contributes to tumor progression in various malignancies. Although these factors have been analyzed in many cancers separately, little is known about their concomitant expression in esophageal cancer. Based on the finding that EGF-R and c-erbB-2 form highly active transmembranous heterodimers that enhance cell growth and proliferation, we used Northern blot analysis and immunohistochemistry to analyze the concomitant expression of EGF-R, c-erbB-2, and c-erbB-3 in tissue samples obtained from 39 patients undergoing esophagectomy for esophageal cancer. Northern blot analysis revealed a fourfold increase (p 〈 0.01) in EGF-R mRNA levels in the esophageal cancer samples in comparison with normal tissue samples. The c-erbB-2 receptor was only 1.25-fold elevated in the esophageal cancers, which failed to be statistically significant (p= 0.31). In contrast, c-erbB-3 mRNA levels were 3.5-fold lower (p 〈 0.01) in the esophageal cancers than in the normal tissues. Immunohistochemical analysis showed weak EGF-R, c-erbB-2, and c-erbB-3 immunostaining in the normal esophageal tissue. In esophageal cancer samples, immunoreactivity for EGF-R, c-erbB-2, and c-erbB-3 was mainly located in the cancer cells. Strong EGF-R, c-erbB-2, and c-erbB-3 immunoreactivity was present in 59%, 64%, and 64% of the esophageal cancer samples, respectively. In consecutive tissue sections, identical cancer cell clusters often exhibited these three closely related receptors simultaneously. However, correlation of the immunohistochemical findings with the clinicopathologic patient parameters revealed that the presence of EGF-R, c-erbB-2, or c-erbB-3 had no influence on patient survival (p 〉 0.05). In addition, the simultaneous presence of these receptors did not influence survival. Our findings indicate that in esophageal cancer the presence of EGF-R, c-erbB-2, and c-erbB-3 alone or in combination seems to have no major influence on patient prognosis and does not alter tumor growth behavior significantly.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002689900616
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  • 8
    Electronic Resource
    Electronic Resource
    Intraarterial Adjuvant Chemotherapy after Pancreaticoduodenectomy for Pancreatic Cancer: Significant Reduction in Occurrence of Liver Metastasis (1999)
    Springer
    World journal of surgery 23 (1999), S. 946-949 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The clinical benefit of adjuvant chemotherapy in pancreatic cancer patients is still questionable. Phase II studies using radiochemotherapy based on 5-fluorouracil (5-FU) provided evidence of an increase in median survival times. Because palliative chemotherapy by celiac artery infusion (CAI) led to an increase in survival in pancreatic cancer, we treated 24 patients with adjuvant CAI following resection of the head of the pancreas for pancreatic cancer (21 patients with Union Internationale contre le Cancer (UICC) stage III, 2 with UICC stage II, 1 with UICC stage I). Catheters were placed angiographically into the celiac artery and remained there for 5 consecutive days. One cycle of chemotherapy consisted of mitoxantrone, 5-FU, folinic acid, and cisplatinum. This treatment was repeated five times at monthly intervals. CAI was well tolerated, and World Health Organization (WHO) grade III toxicities were observed in 8%; WHO grade IV was seen in none of the treatment cycles. Furthermore, we observed pain reduction in nearly all patients under CAI. Median survival times in patients who received CAI were 23 months for all patients, whereas in patients who did not receive adjuvant treatment the median survival was 10.5 months. With Kaplan-Meier regression analysis of the patients who were curatively resected (R0 resection) and received CAI, the overall 4-year survival was 54%, whereas in patients without CAI the 4-year survival was 9.5%. The occurrence of liver metastases in the CAI group went down to 17%. These results demonstrate that CAI is well tolerated, reduces the risk of liver metastasis, and increases the survival time of pancreatic cancer patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002689900604
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  • 9
    Electronic Resource
    Electronic Resource
    Early acute cellular rejection: no effect on late hepatic allograft function in man (1999)
    Springer
    Transplant international 12 (1999), S. 195-201 
    Details
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; acute rejection ; liver function tests ; Liver function tests ; acute rejection ; liver transplantation ; Acute rejection ; liver function tests ; liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Whereas early acute cellular rejection, even if successfully treated, seems to have an impact on late function and survival of kidney and heart transplants, little quantitative data are available on its effect(s) on liver transplants. Routine liver function tests, the functioning liver cell mass (galactose elimination capacity) and microsomal metabolic capacity (aminopyrine breath test) were determined prospectively in 37 consecutive patients 1 year after liver transplantation. Of these, 19 (7 females and 12 males, 32–69 years of age) had previously required treatment for at least one biopsy proven acute cellular rejection episode occuring a median 7 days after grafting, while 18 (6 females and 12 males, 30–67 years of age) had not. The functioning liver cell mass and microsomal metabolic capacity were both within normal limits for the majority of patients and did not differ significantly between patients with and without previous acute cellular rejection episodes. In contrast to other solid organ transplants, early acute cellular rejection episodes do not affect late function of liver allografts in man.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050210
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  • 10
    Electronic Resource
    Electronic Resource
    Results of surgical treatment of necrotizing pancreatitis (1985)
    Springer
    World journal of surgery 9 (1985), S. 972-978 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Deux cent cinq malades atteints de pancréatite nécrotique qui avait résisté au traitement médical ont été opérés. Au cours de l'intervention en fonction de l'étendue et du poids du tissu nécrotique furent découverts 126 cas de lésions étendues et 79 cas de lésions limitées. Chez 40.4% des 138 opérés chez qui fut recherchée une surinfection bactérienne, celle-ci fut constatée. Le but essentiel du traitement fut de pratiquer l'exérèse de la nécrose, la nécrosectomie étant complétée soit par la mise en place de deux drains permettant en postopératoire le lavage et le drainage de la cavité péritonéale et/ou celui de la cavité nécrotique, soit par la constitution d'une dérivation interne, soit encore par le drainage simple de la zone affectée. La mortalité globale s'est élevée à 24.4%. La mortalité la plus faible (6%) fut observée lorsque la nécrosectomie fut complétée par le lavage local continu. Chez les malades dont la nécrose répondait à 30% du pancréas le taux de la mortalité fut inférieur à 7.6%, il s'élèva à 24% lorsque la nécrose affectait la moitié du parenchyme pancréatique, il atteignit 51.0% en cas de nécrose presque totale ou totale de la glande (p〈0.0001). L'extension de la nécrose au-delà des limites de la loge pancréatique s'est accompagnée d'une augmentation significative du taux de la mortalité (p〈0.02). Celui-ci s'est élevé à 32.1% en cas de surinfection bactérienne alors qu'il n'a pas dépassé 9.8% (p〈0.01) lorsque la nécrose est restée stérile. En se référant aux résultats de leur étude les auteurs affirment que l'évolution de la nécrose pancréatique dépend de son importance initiale, de son extension au-delà de la loge pancréatique et de la surinfection de la nécrose. Ils affirment également que le traitement chirurgical adéquat de la nécrose accroÎt les chances de guérison des malades atteints de pancréatite nécrotique.
    Abstract: Resumen Tratamiento quirÚrgico fué realizado en 205 pacientes con pancreatitis necrosante, una vez que el manejo médico hubo fallado. Intraoperatoriamente, y en relación con el tamaño del área necrótica y con el peso del tejido necrótico removido, 79 pacientes exhibieron necrosis pancreática limitada y 126 pacientes exhibieron un extenso proceso necrosante. En el 40.4% de 138 pacientes con informes bacteriológicos se encontró contaminación bacteriana de la necrosis pancreática. El propósito principal del tratamiento quirÚrgico fue la remoción del tejido necrótico. Esto fue realizado mediante drenaje de doble vía y lavado peritoneal y/o local post-operatorio continuo, en un grupo menor de pacientes con drenaje interno de la cavidad necrótica y, en unos pocos pacientes, con drenaje solamente. La tasa global de mortalidad hospitalaria fue de 24.4%. La mortalidad minima fue lograda en los pacientes tratados con necrosectomía y lavado local postoperatorio (6.0%). En los pacientes con necrosis de alrededor de un 30% del páncreas la mortalidad fue menor (7.6%) que en los pacientes con un 50% de necrosis (24.0%) o con necrosis subtotal/total (51.0%) (p〈0.0001). El desarrollo de necrosis extrahepática resultó en un incremento significativo de la tasa de mortalidad (p〈0.02). En los pacientes con necrosis bacteriológicamente contaminada se halló una tasa de mortalidad de 32.1%, en tanto que en los pacientes con necrosis estéril la mortalidad se redujo a 9.8% (p〈0.01). Con base en los resultados de este estudio hemos llegado a la conclusión de que la evolución de la pancreatitis necrosante depende esencialmente de la extensión de la necrosis del páncreas, del desarrollo de la necrosis extrapancreática y del estado bacteriológico del area necrótica. Un manejo quirÚrgico adecuado da lugar a una mayor tasa de supervivencia en pacientes con pancreatitis necrosante.
    Notes: Abstract In 205 patients with necrotizing pancreatitis, surgery was carried out following failure of medical treatment. Intraoperatively, according to the size of the necrotic area and the weight of the surgically removed necrotic tissue, 79 patients showed a limited pancreatic necrosis, and 126 patients an extended necrotizing process. In 40.4% of 138 patients with bacteriological reports, a bacterial contamination of the pancreatic necrosis was found. The main objective of surgical management was the removal of the necrotic tissue. This was performed with 2-way drainage and postoperative continuous peritoneal and/or local lavage, in a smaller group of patients with inner drainage of the necrosis cavity, and in a few patients with drainage alone. The overall hospital mortality rate was 24.4%. The lowest mortality was achieved in patients treated with necrosectomy and postoperative continuous local lavage (6.0%). In patients with necrosis of approximately 30% of the pancreas, mortality was lower (7.6%) than in patients with a 50% necrosis (24.0%) or in patients with a subtotal/total necrosis (51.0%) (p〈0.0001). Formation of extrapancreatic necrosis resulted in a significantly increased mortality rate (p〈0.02). In patients with bacterially contaminated necrosis, a mortality rate of 32.1% was found, whereas in patients with a sterile necrosis, mortality was down to 9.8% (p〈0.01). Based on the results of this study, we conclude that the clinical course of necrotizing pancreatitis depends essentially on the extent of the necrosis in the pancreas itself, the development of extrapancreatic necrosis, and the bacteriological status of the necrotic area. Adequate surgical management leads to a considerably increased survival rate of patients with necrotizing pancreatitis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01655406
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