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  • 1
    Electronic Resource
    Electronic Resource
    The role of topically applied dexamethasone in preventing peritoneal adhesions: Experimental and clinical studies (1977)
    Springer
    World journal of surgery 1 (1977), S. 389-393 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé La formation d'adhérences intrapéritonéales a été étudiée dans deux groupes de rats dont la séreuse iléale avait été lésée par du nitrate d'argent. L'application locale d'une solution de dexaméthasone a été comparée à un groupe témoin traité par simple irrigation au sérum physiologique. La fréquence et la gravité des adhérences sont, une et quatre semaines aprés l'opération, nettement moindres (p〈0.01) chez les rats traités à la dexaméthasone que chez les témoins. On observe de plus, chez les témoins, des sténoses intestinales par adhérences, qui sont totalement absentes chez les rats traités à la dexaméthasone. Pour prévenir l'apparition des adhérences, les temps les plus efficaces pour l'administration de la dexaméthasone sont en cours de laparotomie avec réinjection une semaine plus tard. L'application locale de dexaméthasone a été essayée en clinique, au cours de laparotomies pour obstruction récidivante par adhérences chez 34 malades: 9 % ont présenté de nouvelles récidives au cours des 1–6 années suivantes. Chez 13 malades traités uniquement par irrigation au sérum physiologique, la fréquence des récidives a été de 30 %. Chez 5 malades, la dexaméthasone a été administrée par voie intrapériton éale pendant la laparotomie et aux ler et 2ème jours postopératoires: aucun n'a présenté de récidive.
    Notes: Abstract In an experimental study, the serosa of the ileum of rats was injured with silver nitrate, and the effect of topical application of a dexamethasone solution on subsequent formation of intraperitoneal adhesions was compared to the effect of saline irrigation (controls). There was a highly significant difference (p〈0.01) in the incidence and grade of adhesions observed 1 and 4 weeks postoperatively between the control and dexamethasone-treated rats. Furthermore, adhesive intestinal strictures were observed in the control rats, but not in the animals that received dexamethasone. Administration of dexamethasone at the time of laparotomy and again 1 week postoperatively was most effective in preventing adhesions. In a clinical trial, topical application of dexamethasone at the time of laparotomy for recurrent adhesive intestinal obstruction in 34 patients was associated with a 9% incidence of further recurrence of adhesive obstruction over a 1–6 year follow-up period, compared to a 31% incidence of recurrent obstruction in 13 similar patients who received only saline irrigation. Intraperitoneal administration of dexamethasone at the time of laparotomy and for the first 2 days postoperatively in 5 patients was followed by no recurrence of obstruction.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01556870
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  • 2
    Electronic Resource
    Electronic Resource
    Experience with routine postoperative choledochoscopy via the T-tube sinus tract (1978)
    Springer
    World journal of surgery 2 (1978), S. 379-384 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé En 40 mois, entre Avril 1974 et en Juillet 1977, 566 cholédocoscopies postopératoires ont été faites chez 186 malades à l'Hôpital de l'Université de Teikyo. Dans cette série sont compris 56 malades avec calculs résiduels du cholédoque et 23 avec calculs intrahépatiques. La cholédocoscopie a permis d'enlever les calculs dans 52 et 20 de ces cas. Dans certains cas, l'endoscopie a mis en évidence des calculs insoupçonnés, non révélés par la cholangiographie faite par le drain de Kehr. Notre expérience montre que cette technique est réellement utile pour le diagnostic et le traitement de la lithiase biliaire: nous conseillons donc son emploi, en combinaison avec la cholangiographie. Dans cette série, tous les échecs et complications de la méthode ont été dus à une malposition du drain de Kehr à l'opération. Pour éviter ces ennuis, il faut placer dans le cholédoque, à angle droit, un drain de Kehr calibre 18 Fr. ou même mieux 20 Fr., de façon à éviter les sinuosités de parcours et à obtenir un trajet suffisamment large pour permettre la cholédocoscopie postopératoire.
    Notes: Abstract In the 40-month period from April, 1974 to July, 1977, postoperative choledochoscopy was performed 566 times in 186 patients at Teikyo University Hospital. Included in this series were 56 patients with retained common bile duct stones and 23 patients with intrahepatic stones; the stones were removed by postoperative choledochoscopy in 52 and 20 of these patients, respectively. In some patients, unsuspected stones were detected endoscopically after a completion T-tube cholangiogram was reported as negative for stones. Our experience to date indicates that this technique is of substantial diagnostic and therapeutic value in the management of biliary calculi. Therefore, routine use of postoperative choledochoscopy as an adjunct to T-tube cholangiography is strongly advocated. Failure of attempts to remove retained stones endoscopically and complications in this series were all attributable to inadequate insertion of the T-tube into the common bile duct at the time of operation. To overcome this problem, a T-tube of at least No. 18 Fr. caliber, and preferably of No. 20 Fr. caliber, should be inserted at operation into the common bile duct at a right angle, so as to avoid a tortuous sinus tract and produce a tract of sufficient caliber to permit postoperative choledochoscopy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01561526
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  • 3
    Electronic Resource
    Electronic Resource
    Serum bone Gla protein as an indicator of parathyroidectomy in patients with secondary hyperparathyroidism (1990)
    Springer
    World journal of surgery 14 (1990), S. 431-435 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé La protéine BGP (bone Gla protein) est une protéine dépendante de la vitamine K, marqueur de renouvellement osseux. Pour savoir si la BGP était un indicateur utile de parathyroïdectomie chez les patients ayant une hyperparathyroïdie secondaire (HP II), nous avons mesuré les niveaux sériques de BGP. Trente-sept patients ayant une HP II suivis un an au moins après leur parathyroïdectomie ont été étudiés. Tous les patients ont eu une parathyroïdectomie totale avec réimplantation. Nous avons également mesuré la BGP chez 46 patients hémodialysés chroniques depuis au moins 3 ans comme témoins. Le taux sérique de BGP (normal: 〈6.5 ng/ml) étaient très augmentés chez 37 patients parathyroïdectomisés, leurs valeurs allant de 4.2 ng/ml à 645 ng/ml, la moyenne étant 278.8±159.8 ng/ml (moyenne±écart type) comparée à 65.0±85.2 ng/ml chez les 46 témoins (p〈0.001). Les patients ayant une BGP élevée se plaignaient de douleurs osseuses et articulaires sévères. La BGP sérique des patients ayant eu une parathyroïdectomie était en corrélation significative avec les phosphatases alcalines sériques et la mPTH (p〈0.001 pour les deux). Le poids total des tumeurs parathyroïdes réséquées était de 2,152±1,368 mg, le poids tumoral extrême allant de 200 à 5,600 mg. Le taux de BGP était en corrélation significative avec le poids tumoral (r=0.656,p〈0.001). Les 2 patients qui avaient des niveaux BGP au-dessous de 10 ng/ml avaient des poids tumoraux de seulement 470 mg et 240 mg, respectivement, et leur Symptomatologie douloureuse n'a pas changé en postopératoire, même si leur taux de mPTH a augmenté.Ces résultats suggèrent que le mesure de BGP est une méthode sensible pour détecter le renouvellement osseux augmenté et est une méthode utile dans l'indication d'une parathyroïdectomie pour HP II.
    Abstract: Resumen La proteína Gla ósea (PGO) es una proteína vitamina K-dependiente que es marcador del recambio óseo. Con el objeto de determinar si la PGO sérica es un indicador útil del resultado de la paratiroidectomía en pacientes con hiperparatiroidismo secundario, procedimos a medir los niveles séricos de PGO. Treinta y siete pacientes con hiperparatiroidismo seguidos por más de un año fueron estudiados; todos los pacientes fueron sometidos a paratiroidectomía y autotrasplante de glándula paratiroides. Cuarenta y seis pacientes tratados con hemodiálisis crónica por más de 3 años fueron utilizados como controles. Los niveles séricos de PGO (normal: 〈6.5 ng/ml) aparecieron marcadamente elevados en 37 de los pacientes sometidos a paratiroidectomía, con un rango de 4.2 ng/ml a 645 ng/ml y un valor promedio de 278.8±159.8 ng/ml, versus 65.0±85.2 ng/ml en los 64 pacientes control (p〈0.001). Los pacientes con niveles altos de PGO sufrían de severos dolores óseos y articulares. Los niveles séricos de PGO en los pacientes sometidos a paratiroidectomía aparecieron significativamente correlacionados con los niveles de fosfatasa alcalina sérica y de mPTH (p〈0.001 para ambos). El peso total de los tumores paratiroideos resecados fue 2,152±1,368 mg, con un rango de 200 mg a 5,600 mg. Se observó una correlación altamente significativa entre el nivel de PGO y el peso del tumor (r=0.656,p〈0.001). Los 2 pacientes que exhibieron niveles de PGO inferiores a 10 ng/ml tuvieron tumores con pesos de sólo 470 mg y 240 mg, respectivamente, y no mejoraron de su dolor en el postoperatorio, aunque sus niveles de mPTH ascendieron. Estos resultados sugieren que las determinaciones de PGO representan un método sensible para detectar recambio óseo incrementado y que es de posible utilidad como indicador de paratiroidectomía en pacientes con hiperparatiroidismo secundario.
    Notes: Abstract Bone Gla protein (BGP) is a vitamin K-dependent protein which is a marker of bone turnover. To determine whether serum BGP is a useful indicator for parathyroidectomy in patients with secondary hyperparathyroidism, we measured serum BGP levels. Thirty-seven patients with secondary hyperparathyroidism who were followed up for more than 1 year after parathyroidectomy were studied. All patients underwent total parathyroidectomy and autotransplantation. Controls were 46 patients who were treated by chronic hemodialysis for more than 3 years. Serum BGP levels (normal: 〈6.5 ng/ml) were markedly increased in 37 patients with parathyroidectomy, ranging from 4.2 ng/ml to 645 ng/ml, with a mean value of 278.8±159.8 ng/ml (mean±standard deviation) versus 65.0±85.2 ng/ml in the 46 controls (p〈0.001). Patients with a high BGP level had severe bone and joint pain. Serum BGP in patients with parathyroidectomy was significantly correlated with serum alkaline phosphatase and mPTH (p〈0.001 for both). The total weight of resected parathyroid tumors was 2,152±1,368 mg, and tumor weights ranged from 200 mg to 5,600 mg. There was a highly significant correlation between BGP level and tumor weight (r=0.656,p〈0.001). The 2 patients who showed BGP levels below 10 ng/ml had tumor weights of only 470 mg and 240 mg, respectively, and revealed no improvement of pain postoperatively, although their mPTH levels were increased. These results suggested that BGP measurement is a sensitive method for detecting increased bone turnover and is possibly useful as an indicator for parathyroidectomy in patients with secondary hyperparathyroidism.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01658548
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  • 4
    Electronic Resource
    Electronic Resource
    The importance of postoperative choledochoscopy for management of retained biliarytract stones (1980)
    Springer
    Surgery today 10 (1980), S. 302-309 
    Details
    ISSN: 1436-2813
    Keywords: Cholelithiasis ; Common bile duct calculi ; Cholangiography ; Choledochoscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract From 1974-8, 808 postoperative choledochoscopy procedures, conducted by insertion of choledochofiberscope into the biliary tract through the sinus tract after the T-tube had been removed, were carried out in 292 patients at Teikyo University Hospital, Tokyo, Japan. In this series, 104 with retained biliary tract stones were encountered, and complete removal of stones was successfully carried out in 101, using postoperative choledochoscopy. Any failures of removal of retained biliary tract stones were attributed to improper insertion of the T-tube. The T-tube, of at least 18 French calibers should be inserted into the common bile duct at a right angle so as to obviate a tortuous sinus tract. The follow-up study in cases of complete extraction of the retained biliary tract stones showed that this approach is most effective. Recurrent stone with a silk nidus was found in one patient in whom postoperative choledochoscopy had been performed one year previously. Reoperation was carried out in this particular case. All other patients have remained asymptomatic. Finally, we advise routine use of postoperative choledochoscopy as an adjunct to the T-tube cholangiography, in order to prevent the possibility of retained biliary tract stones.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02468792
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  • 5
    Electronic Resource
    Electronic Resource
    Nationwide investigations of intestinal obstruction in Japan (1990)
    Springer
    Surgery today 20 (1990), S. 660-664 
    Details
    ISSN: 1436-2813
    Keywords: intestinal obstruction ; nationwide survey
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Two nationwide questionnaire surveys of intestinal obstruction in Japan were undertaken, covering two two-year periods, from January, 1975 to December, 1976 and from January, 1985 to December, 1986, respectively. The findings of a comparative review of these two surveys indicated that although the overall mortality of intestinal obstruction had not changed between 1975/76 and 1985/86, being 6.8 per cent and 6.5 per cent, respectively, simple adhesive obstruction had decreased from 3.2 per cent in 1975/76 to 2.0 per cent in 1985/86. The main cause of adhesion was laparotomy and in cases of both simple adhesive obstruction and strangulated adhesive obstruction, the rate of adhesion secondary to laparotomy of the upper gastrointestinal tract and colon and rectum had increased between 1975/76 and 1985/86. Obstructions caused by neoplasms had increased from 8.2 per cent in 1975/76 to 10.0 per cent in 1985/86, while those caused by adhesions had incresed further still, from 42.5 per cent in 1975/76 to 60.8 per cent in 1985/86. Among the latter group, nonoperatively treated cases had increased, which may be accounted for by the fact that facilities which adopt non-operative treatment using intestinal decompression as the first choice for simple adhesive obstruction cases have increased. In both surveys, the mortality of cases receiving nonoperative treatment was lower than that of operative cases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02471029
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  • 6
    Electronic Resource
    Electronic Resource
    Immunohistochemical study of medullary thyroid carcinoma: Relationship of clinical features to prognostic factors in 36 patients (1988)
    Springer
    World journal of surgery 12 (1988), S. 572-578 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Cette étude a été élaborée pour identifier 11 antigènes différents, y compris la calcitonine (CT), la peptide codée par le gène calcitonine (PCGC), la peptide de stimulation de la gastrine (PSG), et ACE dans les tumeurs de 36 patients ayant un cancer médullaire de la thyroïde (CMT) avec la technique de coloration immunopéroxidase. La clinique des patients ayant un CMT a été comparée aux données immunohistochimiques pour établir des facteurs influençant le pronostic. Les CMT contenaient de nombreuse substances chimiques chez la plupart des patients. La CT et ACE étaient positifs chez tous les patients. La PCGC et la PSG se coloraient positivement chez 96.6 et 82.9% des patients à CMT, respectivement, suggérant que la PCGC et la PSG sont des marqueurs tumoraux potentiels pour le CMT. Dans les cellules tumorales, CT, PSGC., et PSG ont été souvent identifiées dans les mêmes cellules. En général on a trouvé plus d'antigènes chez les patients à CMT familiaux que chez les patients à CMT sporadiques. Chez les 2 patients inopérables chez qui l'évolution était extrêmement agressive, ces tumeurs étaient histologiquement indifférenciéés et la coloration pour ces hormones, pauvres, suggèrant une perte des caractères spécifiques neurendocrines de la tumeur. Chez ces 2 patients, la distribution de CT et d'ACE était inversement proportionnelle l'une par rapport à l'autre: la quantité de CT était réduite dans les cellules alors que la coloration pour l'ACE était homogène. Les résultats de cette étude suggèrent que la PCGC et la PSG, comme le sont déjà la CT et l'ACE, sont peut-être des marqueurs tumoraux pour le CMT. Il est possible que la CT et l'ACE puissent être utilisés pour différencier les patients à haut degré de malignité.
    Abstract: Resumen Este estudio fue diseñado con el fín de identificar 11 antígenos diferentes, incluyendo calcitonina (CT), péptido calcitonina gen-relacionada (PCGR), péptido liberador de gastrina (PLG), y antígeno carcinoembriónico (ACE), en los tumores de 36 pacientes con carcinoma medular de tiroides (CMT) utilizando técnicas de coloración con inmunoperoxidasa. Además, se compararon las características clínicas del CMT con los hallazgos inmunohistoqufmicos para definir factores que tengan influencia sobre el pronóstico. Se encontró que el CMT contiene una variedad de productos en muchos de los pacientes y que la CT y el ACE fueron positivos en la totalidad de los pacientes. El PCGR y PLG mostraron coloración positiva en 96.6% y 82.9% de los pacientes, respectivamente, lo cual sugiere que el PCGR y el PLG son noveles marcadores tumorales del CMT. En las células tumorales comparadas en secciones adyacentes apareadas, las 3 hormonas, CT, PCGR, y PLG fueron frecuentemente demostrados en células idénticas. Los pacientes con enfermedad de tipo familiar exhibieron mayor número de sustancias múltiples que los pacientes con enfermedad esporádica. En los 2 pacientes inoperables con progresión tumoral de extrema agresividad, los tumores mostraron indiferenciación en la histología y pobre coloración para las hormonas péptidos, lo cual sugiere que se habían perdido sus cualidades específicas como tumores neuroendocrinos. Estos 2 pacientes, en particular, revelaron una relación inversa entre la distribución de CT y de ACE, tal que pequeñas cantidades de CT estaban presentes en células que exhibían coloración homogénica para ACE. Este estudio sugiere que el PCGR y el PLG, además de la CT y el ACE, pueden ser potenciales marcadores tumorales para CMT. La CT y el ACE pueden ser posibles marcadores para diferenciar los pacientes con severo grado de malignidad de aquellos con malignidad ordinaria.
    Notes: Abstract This study was designed to identify 11 different antigens including calcitonin (CT), calcitonin gene-related peptide (CGRP), gastrin-releasing peptide (GRP), and carcinoembryonic antigen (CEA), in the tumors of 36 patients with medullary thyroid carcinoma (MTC) using immunoperoxidase staining techniques. In addition, clinical features of MTC patients were compared with the immunohistochemical findings to establish factors influencing prognosis. MTC was found to contain various products in many patients and CT and CEA were positive in all patients. CGRP and GRP showed positive staining in 96.6% and 82.9% of MTC patients, respectively, suggesting that CGRP and GRP are novel tumor markers for MTC. In tumor cells, CT, CGRP, and GRP were often revealed in identical cells. Familial patients showed more multiple substances than sporadic patients. In the 2 inoperable patients with extremely aggressive progression, tumors showed undifferentiated histology and poor staining for peptide hormones, suggesting that specific qualities such as neuroendocrine tumor had been lost. These 2 patients particularly revealed an inverse relationship between CT and CEA distribution such that small amounts of CT were present in cells which have homogenous staining for CEA. This study suggests that CGRP and GRP, in addition to CT and CEA, may be a histologically potential tumor marker for MTC. CT and CEA may be possible markers for differentiating patients with high malignancy from those with ordinary malignancy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01655455
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  • 7
    Electronic Resource
    Electronic Resource
    Efficacy of streptococcal preparation OK-432 for gastric cancer patients—comparison between intradermal and intramuscular injection (1984)
    Springer
    Surgery today 14 (1984), S. 191-197 
    Details
    ISSN: 1436-2813
    Keywords: immunotherapy ; OK-432 ; gastric cancer ; cancer therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Nonspecific immunotherapy with OK-432, penicillin and heat treated lyophilized powder of Su-strain of streptococcus pyogens A3, was evaluated in patients with recurrent or unresectable stomach cancer to assess the relative benefit of the preparation administered by different routes. Comparative studies were made of the variation in immunological parameters, the survival rate and the incidence of adverse reactions in two groups of patients with uniform background factors: 24 receiving the preparation intradermally and 18 receiving intramuscular doses of the preparation. In the former group, no serious adverse reaction occurred but more marked improvement was achieved in various immunological parameters examined. The survival rate was significantly higher (P=0.005) for patients receiving intradermal than those receiving intramuscular doses of the preparation. The results of the present study showed that the preparation is of greater value when it is administered intradermally than intramuscularly.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02469567
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  • 8
    Electronic Resource
    Electronic Resource
    Villous component as a marker for synchronous and metachronous colorectal adenomas (1992)
    Springer
    Diseases of the colon & rectum 35 (1992), S. 1148-1153 
    Details
    ISSN: 1530-0358
    Keywords: Villous tumor ; Villous component ; Synchronous adenoma ; Metachronous adenoma ; Colon ; Rectum
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To determine whether patients with colorectal adenomas containing a villous component (+vc group) have a higher incidence of synchronous or metachronous colorectal adenomas, 527 consecutive cases of completely removed colorectal adenoma were used. Synchronous adenomas were detected in 22.6 percent and 19.0 percent of the patients in the +vc and −vc groups, respectively. In the analysis of metachronous adenomas, 164 patients who had been followed for 1 to 11 years (mean, 3.31 years) were included. The cumulative adenoma-free rate according to Kaplan-Meier tended to be lower in the +vc group, the difference being statistically significant 1.0 to 1.2 years after treatment of the initial adenoma and the two curves being different based on the generalized Wilcoxon test. The numbers of newly detected adenomas annually were 1.76 and 0.86, and their annual incidences were 1.09 and 0.59 times, in the +vc and −vc groups, respectively. These results suggest the importance of the villous component as a predictor of metachronous colorectal adenomas.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02251966
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