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  • 1
    ISSN: 1436-2813
    Keywords: major hepatectomy ; multiple regression analysis ; portal pressure ; aging ; liver cirrhosis ; chronic hepatitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The regenerative capacity of the liver was assessed using a volumetric method on computed tomography in 21 adults: 16 underwent a standard right hepatic lobectomy for hepatocellular carcinoma, there were hepatic metastases in 3 others, and 2 suffered from other diseases. The patients' ages ranged from 33 to 68 years with a mean age of 57.0 years. The regeneration rate was expressed as the rate of the volume increase of the remnant left lobe compared with the preoperative volume of the left lobe. A univariate regression analysis showed that the portal pressure had a highly inverse correlation with the regeneration rate of the liver (r = −0.4753,P = 0.0397), while a multiple regression analysis demonstrated the correlation between the portal pressure, age, and the regeneration rate (multipler = 0.5640). The regeneration rate of the normal liver (97.6 ± 53.5%) was significantly higher than that of the chronic hepatitic (43.0 ± 40.7%), and also tended to be higher than that of the cirrhotic liver (51.5 ± 13.2%). However, there were no differences between chronic hepatitic and cirrhotic livers. The portal pressure before hepatectomy of the normal liver (149 ± 19 mmH2O) was significantly lower than those of chronic hepatitic (188 ± 38 mmH2O) and cirrhotic (245 ±78 mmH2O) livers. We thus conclude that the regenerative capacity of the liver following a right hepatic lobectomy could be estimated on the basis of both portal pressure and age. The regenerative capacity was also influenced by underlying liver diseases.
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Surgery today 24 (1994), S. 1034-1034 
    ISSN: 1436-2813
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Surgery today 27 (1997), S. 1-2 
    ISSN: 1436-2813
    Keywords: risk to surgeons ; HIV ; AIDS
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Clinical & experimental metastasis 10 (1992), S. 337-344 
    ISSN: 1573-7276
    Keywords: DNA content ; hepatocellular carcinoma ; pulmonary metastasis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: To better comprehend the differences in deoxyribonucleic acid (DNA) content between a primary hepatocellular carcinoma (HCC) and pulmonary metastatic nodules, tissue specimens taken at autopsy of 25 patients who had not received any drugs to treat the malignancy were examined using microspectrophotometry. The DNA distribution patterns were classified into Types I–III, and low (Types I and II) or high (Type III) ploidies, according to DNA distribution. Changes in the DNA content from high to low ploidies, namely DNA ploidy reduction from the primary lesion to pulmonary metastatic lesions, was evident in 9 of the 25 patients (36%), and changes from low to high were noted in 2 of the 25 patients (8%). The remaining 14 (56%) showed no evidence of changes in the DNA ploidy pattern. Reduction of DNA ploidy seen in HCC and its metastatic lesions in the lung may be one of the aspects of clonal evolution or selection mechanisms during the progression of tumor growth and metastasis.
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  • 5
    ISSN: 1573-8280
    Keywords: surgical adjuvant therapy ; adoptive immunotherapy ; interleukin 2 ; lymphokine-activated killer cells
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We designed a unique regimen of adoptive immunotherapy with lymphokine-activated killer (LAK) cells and recombinant interleukin 2 (rIL-2) for application with surgical adjuvant therapy of cancer. The regimen features the prolonged (6 consecutive days) s.c. administration of low-dose rIL-2 and the transfer ofex vivo generated LAK cells from regional lymph node lymphocytes, obtained at the time of surgical operation. According to this regimen, 5 patients with primary lung cancer received immunotherapy about 2 weeks after surgery (pulmonary lobectomy). Clinical toxicities included fever(5/5), fatigue(5/5), slight(〈 5%) weight gain(5/5), increase of pleural effusion at the lobectomy site(2/5), and edema formation(1/5). All toxicities reversed within 4 days after the completion of therapy. Rebound lymphocytosis after therapy ranged from 2.4 to 5.5-fold (mean, 4.3-fold) over the baseline. Peripheral blood lymphocytes obtained during this lymphocytosis exhibitedin vitro LAK activity in 4 of 5 patients. Thus, the regimen is considered to be well-tolerable and immunologically active in regard to the postoperative state of the patients.
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  • 6
    ISSN: 1573-8280
    Keywords: concomitant malignant pleurisy ; interleukin-2 ; intrapleural IL-2 ; postoperative adjuvant therapy ; resectable lung cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Thirteen patients with resectable lung cancer and concomitant malignant pleurisy which could not be detected by preoperative chest roentogenograms were treated with surgical resection of the primary lesions and postoperative intrapleural instillations of interleukin-2 (IL-2). All of the patients demonstrated disappearance of cancer cells from pleural effusion after the IL-2 therapy. Four of the 13 patients survived over 5 years and 2 of them are in disease free state at this moment (January 31, 1993). The first recurrent sites were distant organs in 8 of 11 patients with recurrence and lymph nodes in 3 of them. No pleural recurrence was observed. These results indicate that the postoperative intrapleural IL-2 therapy may be one of hopeful adjuvant therapies in patients with resectable lung cancer and concomitant malignant pleurisy, although distant metastasis and lymph node recurrence could not be suppressed completely.
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  • 7
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Les résultats du traitement du cancer gastrique chez 54 patients âgés de 80 ans ou plus, opérés entre 1967 à 1989 ont été analysés. La durée moyenne de la période d'observation postopératoire était de 24 jours. Dans la plupart des cas, les examens préopératoires avaient montré des anomalies pulmonaires, rénales ou cardiaques. Le taux de morbidité globale postopératoire, due essentiellement à des complications pulmonaires, était de 40.7%. Chez les deux patients ayant une insuffisance pluriviscérale, l'un est décédé d'un infarctus du myocarde le lendemain de l'intervention, l'autre d'une pneumopathie au 12è jour post-opératoire. Dans la période postopératoire immédiate, un certain nombre de ces patients âgés a nécessité des soins intensifs. Le taux de morbidité était corrélé avec le caractère total de la gastrectomie, la durée de l'opération (〉3 heures) et une perte sanguine peropératoire de plus de 300 ml (p〈0.05). Après analyse multifactorielle, le type de chirurgie s'est avéré être le facteur indépendant majeur de la survenue des complications postopératoires. La plupart des tumeurs (92.6%) pouvaient être enlevées par les techniques conventionelles et une intervention à visée curative était réalisée chez 36 patients (66.7%). Vingt-quatre patients sont décédés en rapport avec l'évolution de leur maladie. Le taux de survie actuarielle à 5 ans était de 23.8%. Après ajustement en fonction de l'âge et du sexe, ce taux est passé à 36.9%. La probabilité de survie à long terme pour les patients à un stade précoce (T1-2, N0-1) était statistiquement meilleure que pour ceux dont la maladie était avancée (T3-4, N2, ou M1). Même pour un patient de 80 ans ou plus, une chirurgie gastrique large pour cancer peut être envisagée dans certaines conditions bien précises.
    Abstract: Resumen Informamos en este artículo el resultado del tratamiento quirúrgico de cáncer gástrico en 54 pacientes mayores de 80 años, en el período 1967 a 1989. El período de seguimiento postoperatorio fue de 24 días en promedio. En la mayoría de los casos los exámenes preoperatorios demostraron alteraciones pulmonares, renales o cardiacas. La tasa de morbilidad postoperatoria fue 40.7% y la causa mas frecuente fue la complicación pulmonar. De dos pacientes con múltiples alteraciones orgánicas, uno murió un día después de la operación como consecuencia de infarto miocárdico y uno murió de neumonía 12 días después de la operación. Se requiere cuidado intensivo en el período postoperatorio temprano. La incrementada morbilidad apareció relacionada con resecciones amplias, tales como gastrectomía total, con operaciones más de 3 horas de duración y con pérdida intraoperatoria de sangre superior a 300 ml (p〈0.05). En el análisis de variables, el tipo de cirugía apareció como un factor independiente mayor relacionado con complicaciones postoperatorias. La mayoría de los tumores (92.6%) pudo ser resecado mediante procedimientos estándar de resección y la operación curativa fue posible en 36 pacientes (66.7%). Se presentaron 24 muertos debidas a progresión del cáncer. La tasa cruda global de sobrevida a 5 años fue 23.8%, y de 36.9% al efectuar la correctión para sexo y edad. La probabilidad de sobrevida a largo plazo de pacientes con enfermedad en estadios tempranos (Tl-2, No-1) resultó estradísticamente superior que la de los pacientes con enfermedad avanzada (T3-4, N2, M1). Por lo tanto, aun en pacientes en la octava década de la vida, se puede considerar cirugía gástrica en pacientes cuidadosamente seleccionados.
    Notes: Abstract We report here the outcome of surgical treatment for gastric cancer in 54 patients over 80 years of age presenting from 1967 to 1989. The mean observation interval of the postoperative period was 24 days. In most cases, preoperative examinations revealed pulmonary, renal or cardiac disturbances. The postoperative morbidity rate was 40.7%, most commonly as a result of pulmonary complications. In the 2 patients with multiple organ disturbances, 1 died 1 day after operation following myocardial infarction and the other died of pneumonia 12 days postoperatively. Intensive care treatments were needed in the early postoperative period. The increased morbidity rate proved to be related to wide resectional procedures such as total gastrectomy, operative time in excess of 3 hours, and intraoperative blood loss 〉300 ml (p〈0.05). When adjustment for confounding variables was made in the multivariate discriminant analysis, the type of surgery proved to be a major independent risk factor related to postoperative complications. The majority of tumors (92.6%) could be removed by standard resectional procedures and curative operation was feasible for 36 (66.7%) patients. There were 24 deaths due to progression of the cancer. The crude overall 5-year actuarial survival rate was 23.8%, while the rate was 36.9% when correction was made for sex and age. The probability of long-term survival for patients in a relatively early stage of disease (T1-2, N0-1) was statistically better than for those with a more advanced disease (T3-4, N2, M1). Thus, even for patients in the 8th decade of life, gastric surgery can be considered, for carefully selected patients.
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  • 8
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Pour étudier l'influence des différentes techniques de reconstruction après résection pour cancer de l'esophage sur la qualité de vie postopératoire, on a interviewé 50 patients opérés et indemnes de récidive. Parmi ceux-ci, 9 avaient eu une reconstruction en position présternale (group 1), 24 par une voie rétrosternale (groupe 2) alors que 17 avaient eu une anastomose intrathoracique (groupe 3). Des difficultés d'alimentation ont été observées chez respectivement 22; 41.6 et 5.% des patients dans les groupes 1, 2 et 3. Un syndrome de dumping a été observé chez respectivement 11.1, 12.5 et 11.8%. Un pyrosis n'a été noté que dans deux cas du groupe 3. Une perte de poids supérieure à un Kg a été observée chez respectivement 33.3, 41.7 et 41.2% des patients. Il n'y avait aucune différence postopératoire en ce qui concerne les tests de performance ou les tests de laboratoire. En conclusion, bien que la voie intrathoracique soit la meilleure en ce qui concerne l'alimentation, il n'y avait aucune différence quant à la qualité de vie pour les trois techniques.La qualité de vie s'est amélioré progrèssivement chez tous les patients quelle que soit la technique employée s'il n'avait pas de récidive.
    Abstract: Resumen Con el propósito de determinar la influencia sobre la calidad de vida de los procedimientos operatorios de reconstrucción luego de la resección de un cancer esofágico, se realizaron entrevistas para valorar los factores tanto subjetivos como objetivos relativos a la calidad de la vida en 50 pacientes libres de enfermedad recurrente. En este grupo de 50 pacientes se practicó reconstrucción por la vía anterotorácica en 9 (Grupo I), por la ruta retroesternal en 24 (Grupo II) y se practicó anastomosis intratorácica en 17 (Grupo III). Se demostró alteración en el paso de los alimentos en 22.0%, 41.6% y 5.9% en los Grupos I, II y III, repectivamente; se evidenciaron sítomas de “dumping” en 11.1%, 12.5% y 11.8% en cada grupo. Sólo se encontró pirosís en dos casos en el Grupo III. Pérdida de peso mayor de 1.0 kg frente al peso preoperatorio fue obsevada en 33.3%, 41.7% y 41.2%, respectivamente. No hubo diferencia en cuanto a la actividad física postoperatoria ni en los hallazgos de laboratorio entre los grupos. Por lo tanto, aunque la anastomosís intratorácica es más favorable en cuanto al buen paso de los alimentos, no se evidencian diferencias significativas en los demás factores pertinentes a calidad de vida entre las diferentes rutas de reconstrucción, y la calidad de la vida mejoró paulatinamente en todos los grupos con el paso del tiempo en estos pacientes libres de recurrencia postoperatoria de su cáncer esofágico.
    Notes: Abstract To investigate the influence of the operative procedures of reconstruction after resection of esophageal cancer on the postoperative quality of life, an interview was conducted and subjective and objective factors related to the quality of life were evaluated in 50 patients without a recurrence of esophageal cancer. Among the 50 cases, reconstruction by the antethoracal route was performed in 9 (group I) and by the retrosternal route in 24 (group II). Intrathoracic anastomosis was done in 17 (group III). A postoperative disturbance of the food passage was seen 22.0, 41.6, and 5.9% in groups I, II, and III, respectively. Dumping symptom was evident 11.1, 12.5, and 11.8%, respectively. Heartburn was seen only in two cases, in group III. A body weight loss of more than 1.0 kg from preoperative weight was seen in 33.3, 41.7, and 41.2% of groups I, II, and III, respectively. There was no difference in the postoperative performance status or laboratory data among the groups. Thus, although intrathoracic anastomosis was favorable for postoperative food passage, there was no significant difference in any other factors in the quality of life among the routes of reconstruction, and the quality of life gradually improved in patients of all groups as postoperative time passed in the cases without postoperative recurrence of esophageal cancer.
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  • 9
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Vingt-deux patients cirrhotiques ayant un carcinome hépatocellulaire associé à des varices esophagiennes ont eu une résection hépatique aggressive associée à une dévascularisation et/ou à une sclérothérapie endoscopique périopératoire (groupe A). Les résultats ont été comparés à ceux de 37 patients cirrhotiques sans varices oesophagiennes qui ont eu une résection hépatique pour un carcinome 〈 2 cm pendant la même période (groupe B). Ont été étudiés les données cliniques, paracliniques préopératoires, l'aspect anatomopathologique, la survie globale et la survie sans maladie. La durée de l'opération, la quantité de sang perdu et le poids du foie réséqué ne différaient pas, alors que la taille de la tumeur dans le groupe A (2.7±1.6 cm, moyenne±ET) était significativement plus importante que dans le groupe B (1.5±0.3 cm). La fonction hépatique préopératoire était plus perturbée dans le groupe A par rapport au groupe B exception faite pour le temps de prothrombine. En dépit de ces inconvénients, les taux de survie sans maladie à 1, 3 et 5 ans des groupes A étaient respectivement de 72% et 94%, 48% et 54%, et 38% et 45% par rapport au groupe B, repsectivement. Les taux de survie globale étaient respectivement de 91% et 97%, 79% et 79% et 54% et 67%, sans différence significative, dans les groups A et B. Aucun malade dans le groupe A n'a saigné après traitement. Sur ces données, la résection hépatique aggressive associée à une dévasculatisation simultanée ou une sclérothérapie endoscopique périopératoire est le traitement de choix pour un carcinome hépatocellulaire associé à des varices oesophagiennes.
    Abstract: Resumen Veintidós pacientes con carcinoma hepatocelular (CHC) y várices esofágicas concomitantes fueron sometidos a resección hepática acompañada de devascularización y/o escleroterapia endoscópica perioperatoria (grupo A). Con el propósito de evaluar esta modalidad de tratamiento, se estudiaron también 37 pacientes cirróticos sin varices esofágicas que fueron sometidos a resección hepática por CHC pequeño, de 2 cm o menos, en la misma época (grupo B), comparando datos preoperatorios, hallazgos anatomopatológicos, tasas de evolución libre de enfermedad y tasas de sobrevida. El tiempo operatorio, la magnitud de la pérdida de sangre y el peso del hígado resecado no mostraron diferencias entre los dos grupos; sin embargo, el tamaño del tumor en el grupo A (2.7±1.6 cm) fue significativamente mayor que en el grupo B (1.5±0.3 cm). La alteración de la función hepática en el grupo A apareció más pronunciada que en el grupo B, excepto por el tiempo de protrombina. A pesar de estas ventajas, las tasas de evolución a uno, tres y cinco años en los dos grupos fueron 91% vs 97%, 79% vs 79% y 54% vs 67% (grupo A vs grupo B) respectivamente, cifras que no representan diferencia significativa. Además, no se encontró sangrado varicoso en el grupo A después del tratamiento. Con base en taies hallazgos, se plantea que el tratamiento de elección en los pacientes con CHC y várices esofágicas concomitantes es la resección agresiva combinada con devascularización simultánea y/o escleroterapia endoscópica perioperatoria.
    Notes: Abstract Twenty-two cirrhotic patients with hepatocellular carcinoma (HCC) and concomitant esophageal varices underwent aggressive hepatic resection accompanied by simultaneous devascularization, perioperative endoscopic injection sclerotherapy, or both (group A). To evaluate this treatment, 37 cirrhotic patients without esophageal varices who underwent hepatic resection for small HCC (2 cm or less) during the same period (group B) were studied to compare clinical data, preoperative laboratory data, pathologic findings, disease-free rates, and survival rates. The operative time, blood loss, and resected liver weight did not differ between the two groups; however, the tumor size of group A (2.7±1.6 cm, mean±SD) was significantly larger than that of group B (1.5±0.3 cm). The preoperative liver function of group A was also more severe than that of group B except for prothrombin time. Despite these disadvantages, the 1-, 3-, and 5-year disease-free rates of the two groups were 72% versus 94%, 48% versus 54%, and 38% versus 45%, respectively, and the 1-, 3-, and 5-year survival rates were 91% versus 97%, 79% versus 79%, and 54% versus 67% (group A versus group B), respectively, which showed no significant differences. Furthermore, there was no variceal bleeding in group A after treatment. Based on the above findings, for treatment of HCC and concomitant esophageal varices, aggressive hepatic resection accompanied by simultaneous devascularization, perioperative endoscopic injection sclerotherapy, or both is the preferred form of treatment.
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  • 10
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé L'incidence de la positivité d'anticorps du virus de l'hépatite C (HCV) n'est pas connue avec précision. L'objectif de cette étude a été de déterminer la prévalence de l'infection HCV parmi les patients en chirurgie et d'identifier les patients à risque. On a dosé les anticorps HCV chez 789 patients en chirurgie entre Avril 1991 et Mars 1992. Parmi ceux-ci, 129 (16.3%) ont été positifs, un taux bien plus élevé que dans la population Japonaise générale. Les maladies hépatobiliaires et l'hypertension portale ont été associées à un taux de positivité plus élevée que les autres maladies (94/206, 45.6% vs 35/583, 6%; p〈0.0001). La positivité HCV a été retrouvée chez 54.1% (119/220) des patients en chirurgie avec des facteurs de risque connus, contrastant avec 1.9% (10/569) des patients sans ces mêmes risques. Nous concluons que les patients venant à la chirurgie ont a fort risque d'infection HCV et que le personnel médical doit en être averti.
    Abstract: Resumen Se desconoce la incidencia de seropositividad del anticuerpo al virus de la hepatitis C (HCV). El propósito del presente estudio fue clarificar la prevalencia de infección por HCV en los pacientes quirúrgicos y de identificar aquellos de alto riesgo. Entre abril de 1991 y marzo de 1992 se practicaron pruebas de anticuerpo antiHCV en 789 pacientes quirúrgicos. De éstos, 129 (16.3%) presentaron prueba positiva, lo cual es una tasa de positividad bastante más alta que la observada en la población japonesa general. Las enfermedades hepatobiliares y la hipertensión portal aparecieron asociadas con una mayor tasa de positividad que otras entidades (94/206, 45.6% vs. 35/583, 6%; p〈0.0001). Los pacientes mayores de 50 años exhibieron tasa de positividad más elevada que los más jóvenes (118/578, 20.4% vs. 11/211, 5.3%; p〈0.0001). La tasa de positividad HCV ascendió hasta 54.1% (119/220) entre los pacientes quirúrgicos con riesgos conocidos de hepatitis, en contraste con sólo 1.9% (10/569) en aquellos carentes de tales factores de riesgo. Nuestra conclusión es que los pacientes quirúrgicos exhiben una alta incidencia de infección HCV, a lo cual los profesionales de la salud deben prestar especial atención a fin de evitar contagio.
    Notes: Abstract The incidence of hepatitis C virus (HCV) antibody positivity is unknown. The purpose of this study was to clarify the prevalence of HCV infection among surgical patients and to identify high risk surgical patients. HCV antibody tests were performed in 789 surgical patients between April 1991 and March 1992. Of these patients, 129 (16.3%) tested positive, which was much higher than the positivity of the ordinary Japanese. Hepatobiliary diseases and portal hypertension were associated with a higher positivity than other disease categories (94 of 206, 45.6% versus 35 of 583, 6%; p〈0.0001). Patients above 50 years of age had a higher positivity than their younger counterparts (118 of 578, 20.4% versus 11 of 211, 5.3%; p〈0.0001). The HCV positivity was as high as 54.1% (119 of 220) among surgical patients with known risk factors for hepatitis, in contrast to only 1.9% (10 of 569) among those without such risk factors. We conclude that surgical patients have a high incidence of HCV infection, for whom medical professionals should pay special attention to avoid disease transmission.
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