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  • 11
    Electronic Resource
    Electronic Resource
    The prediction of portal pressure: A multivariate analysis of clinical data and intraoperative portal pressure (1994)
    Springer
    Surgery today 24 (1994), S. 309-312 
    Details
    ISSN: 1436-2813
    Keywords: portal pressure ; hepatic resection ; platelet count ; indocyanine green retention rate ; prothrombin time index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Portal pressures were estimated non-invasively in 100 patients who underwent hepatic resection and completely fulfilled the 21 variables evaluated. Ten variables were selected from among all those in the univariate analysis, and a stepwise discriminant analysis revealed four independent significant variables, namely: The indocyanine green dye retention test at 15 min (ICGR15); the prothrombin time index; the platelet count; and the globulin fraction. An equation to estimate the portal pressure was made using the coefficients in the analysis, the reliability of which was confirmed (r=0.70484,P=0.0001). The univariate analysis revealed ten significant variables to discriminate portal hypertension, defined as a portal pressure of over 200 mmH2O. A multiple logistic regression analysis of these variables revealed two independent variables, being ICGR15 and the platelet count. Thus, we consider that our equation for estimating portal pressure is potentially useful, and that the platelet count and ICGR15 are the most significant parameters in discriminating between the presence or absence of portal hypertension. Moreover, a platelet count of less than 120×103/mm3 and an ICGR15 value of more than 15% correlated well with portal hypertension.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02348558
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  • 12
    Electronic Resource
    Electronic Resource
    A clinical analysis of multiple organ failure following elective surgery (1994)
    Springer
    Surgery today 24 (1994), S. 333-336 
    Details
    ISSN: 1436-2813
    Keywords: multiple organ failure ; elective operation ; liver cirrhosis ; esophageal carcinoma ; aortic aneurysm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A retrospective analysis was made of 58 patients who unexpectedly developed multiple organ failure (MOF) following elective surgery, and the results were compared with those of 168 control patients who did not develop MOF. In 33 patients with liver cirrhosis, MOF was related to poor liver function, a low albumin level, excessive blood loss, many transfusions, and a high incidence of hypotension. MOF, rather than liver failure alone, was featured by postoperative bleeding and infection. In 15 patients with esophageal carcinoma, MOF was correlated with many transfusions, anastomotic leakage, and postoperative infection. In 10 patients who underwent surgery for an aortic aneurysm, poor renal function and extended anesthesia time were associated with MOF. These results indicate that to prevent MOF following elective surgery, it is important to: (1) Select patients for liver surgery according to their liver function, and minimize the risk of bleeding and infection, (2) avoid too many blood transfusions, and minimize the risk of leakage and infection in esophageal surgery, and (3) select patients for aortic surgery based on renal function and reduce the anesthesia time as much as possible.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02348563
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  • 13
    Electronic Resource
    Electronic Resource
    The clinical characteristics of patients with synchronous squamous cell carcinoma of the esopohagus and hepatocellular carcinoma (1994)
    Springer
    Surgery today 24 (1994), S. 803-808 
    Details
    ISSN: 1436-2813
    Keywords: synchronous double cancer ; esophageal cancer ; hepatocellular carcinoma ; etiology ; prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract An ongoing analysis of 762 patients with esophageal cancer revealed 4 (0.52%) male patients with synchronous hepatocellular carcinoma (HCC). A long history of habitual alcohol intake and heavy cigarette smoking was recognized in all four patients and, therefore, the possibility of these two factors being independent risk factors for this double cancer was suggested. Palliative treatment was undertaken since either one or both cancers were too far advanced, or because liver function was poor even in those patients with resectable cancers. The prognosis correlated more closely to the TNM stage of esophageal cancer rather than the HCC and the causes of death were related to the esophageal cancer in all four patients. These findings suggest that, in patients with this combination of double cancer, the state of the esophageal cancer may be a more reliable prognostic factor than that of the HCC and thus, the curability of esophageal cancer is of primary importance.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01636310
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  • 14
    Electronic Resource
    Electronic Resource
    Open and closed suction drainage after hepatic resection (1993)
    Springer
    Surgery today 23 (1993), S. 871-874 
    Details
    ISSN: 1436-2813
    Keywords: hepatic resection ; intraperitoneal septic complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A retrospective study was conducted to compare open conduit drains with closed suction drains, with regard to the occurrence of intraperitoneal septic complications after hepatectomy (IPSCH). The subjects comprised 50 consecutive Japanese patients who underwent hepatic resection followed by the insertion of a closed suction drain and the control group comprised 50 patients in whom a simple conduit drain had been placed following liver surgery. There were no significant differences between the two groups in sex, age, underlying liver disease, or the type of hepatectomy performed; nor was there a significant difference in the incidence of IPSCH, the simple conduit drain group versus the closed suction drain group being (10% versus 8%, respectively). However, bile leakage was highly related to IPSCH, the incidence being 60% and 100% in the simple conduit drain and closed suction drain groups, respectively. Thus, to prevent IPSCH, the treatment of bile leakage is a much more important factor than the type of drain used.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00311364
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  • 15
    Electronic Resource
    Electronic Resource
    The significance of methicillin-resistant Staphylococcus Aureus infection in general surgery: A multivariate analysis of risk factors and preventive approaches (1993)
    Springer
    Surgery today 23 (1993), S. 880-884 
    Details
    ISSN: 1436-2813
    Keywords: MRSA ; Staphyloccus aureus ; risk factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To investigate the characteristics, risk factors, and prevention of methicillin-resistant Staphylococcus aureus (MRSA), a total of 3,627 patients were studied. Among these, 1,336 patients with various infections were used in a risk factor analysis of MRSA to determine the relationship between the use of antibiotics and the incidence of MRSA. Only 3.0% of infections were attributed to MRSA, the esophagus and colorectal region being highly involved, as anastomotic or pelvic abscesses, while the lung had a lower incidence. Almost half the patients with MRSA infections (47.6%) had concomitant infections. A univariate analysis revealed the following significant factors: The coexistence of gastrointestinal or metastatic malignancy, sepsis, tracheostomy, and the prior use of antibiotics such as the β-lactam compounds or aminoglycosides. A multivariate analysis showed that gastrointestinal malignancy, sepsis, and the prior use of aminoglycosides, tetracycline, macrolides, and carbapenems were independently significant factors. To promote the education of doctors and nurses, regular in-service meetings on MRSA were held in the ward. Moreover, preventive approaches such as patient isolation, strategically placed hand washing equipment, and the use of disposable gloves and contaminated waste bags, have been initiated, and the incidence of MRSA has decreased significantly since then. Thus, to control MRSA, the following steps should be taken: (1) constant and careful surveillance, (2) regular risk factor analyses, (3) the optimal administration of antibiotics, and (4) the education of all hospital staff.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00311366
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  • 16
    Electronic Resource
    Electronic Resource
    Occurrence of intraperitoneal septic complications after hepatic resections between 1985 and 1990 (1995)
    Springer
    Surgery today 25 (1995), S. 49-54 
    Details
    ISSN: 1436-2813
    Keywords: intraperitoneal sepsis ; hepatic resection ; bile leakage ; blood transfusion ; gut-origin sepsis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In this study, the risk factors related to intraperitoneal septic complications occurring after hepatectomy (IPSCH) as well as the effect of various perioperative variables on the outcome of IPSCH between 1985 and 1990 were analyzed. Twenty-one of 211 patients (10.0%) developed IPSCH. The findings in the patients with IPSCH were compared with those in 190 patients without IPSCH. The significant variables associated with the development of IPSCH included a high incidence of accompanying chronic renal failure (14.3% vs 2.1%), a larger blood loss during surgery (2,130 vs 1,340 ml) as well as a greater amount of intraoperative blood replacement (1,130 vs 570 ml), and a greater weight of the resected liver (367 vs 233g). IPSCH occurred in 10 of 12 patients who had postoperative bile leakage. Eighteen patients (85.7%) with IPSCH were discharged from the hospital after non-operative management; however, the hospital death rate (14.3% vs 1.1%) was significantly higher in patients with IPSCH. This review suggests that the incidence of IPSCH has not decreased recently. Thus, to prevent IPSCH, at least following bile leakage, it is necessary to perform a careful division of the liver parenchyma followed by a bile leakage test, and when this complication occurs unexpectedly in patients who have a good functional reserve of the remnant liver, IPSCH can be effectively drained percutaneously under ultrasound guidance.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00309385
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  • 17
    Electronic Resource
    Electronic Resource
    Hepatitis C virus replication is associated with expression of transforming growth factor-α and insulin-like growth factor-II in cirrhotic livers (1996)
    Springer
    Digestive diseases and sciences 41 (1996), S. 208-215 
    Details
    ISSN: 1573-2568
    Keywords: hepatitis C virus ; transforming growth factor-ga ; transforming growth factor-β1 ; insulin-like growth factor-II
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The molecular role of hepatitis C virus (HCV) in liver disease has yet to be clarified. In this study, we analyzed the relationship of HCV replication with mRNA expression of growth factors and mutation of tumor suppressor gene, ie, transforming growth factor-β1 (TGF-β1), which promotes cirrhotic changes; TGF-α, insulin-like growth factor-II (IGF-II), which are both related to hepatocyte transformation; and tumor suppressor genep53, which is associated with HCC progression. A semiquantitative RNA polymerase chain reaction (RNA-PCR) was used to analyze genetic expression in 31 cirrhotic liver specimens from patients with HCV. In order to detect HCV replication, the minus-strand RNA of HCV, which serves as a template for the synthesis of genomic plus-strand RNA, was examined. The expression of the growth factors was semiquantified by RNA-PCR, and the mutation ofp53 was detected using PCR-single-strand conformation polymorphism. According to the semiquantitative analysis, HCV replication was not associated with the expression of TGF-β1 but was significantly so with the overexpression of TGF-α (r=0.74) and IGF-II (r=0.65) in the HCV-positive cirrhotic livers. No mutation ofp53 was recognized in any of the samples. Our investigation thus suggested that the replication of HCV might mediate the coexpression of TGF-α and IGF-II and act as a possible initiating factor for hepatocarcinogenesis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02208606
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    Paper (German National Licenses)
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