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I fattori prognostici nel trattamento dei secondarismi epatici da neoplasia del colon retto
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HYPERALIMENTATION OF JAUNDICED PATIENTS DURING PERCUTANEOUS TRANS-HEPATIC BILIARY DRAINAGE - REPLY
No full textLaparoscopic cholecystectomy using methyl tert-butyl ether: preliminary results
No full textWe evaluated the usefulness of methyl tert-butyl ether in gallbladder extraction during laparoscopic cholecystectomy when large stones are present. Five patients with symptomatic gallbladder stones larger than 30 mm underwent laparoscopic cholecystectomy according to the standard procedure. Extraction of the gallbladder without enlarging the 10-mm orifice was not possible because of the large stones. We infused MTBE in the gallbladder through a 9-French polyethylene catheter passed into its neck already pulled out of the umbilical port. The solvent was injected, aspirated after 10 to 15 s, and then immediately reinjected. This procedure continued until the stones softened and it became possible to crush and to remove them easily with a forceps or aspirator. The mean duration of the entire procedure was 7.7 +/- 1.57 min. Methyl tert-butyl ether infusion should be considered during laparoscopic cholecystectomy because it is a cheap and fast method to allow gallbladder extraction when large stones are present
HYPERALIMENTATION OF JAUNDICED PATIENTS ON PERCUTANEOUS TRANS-HEPATIC BILIARY DRAINAGE
No full textAlthough percutaneous transhepatic biliary drainage (PTBD) restores hepatic and renal function in patients with obstructive jaundice, it is not certain whether it reduces the rate of complications and death after biliopancreatic surgery. We studied the possibility that the operative risks of jaundiced patients are related to malnutrition and the usefulness of hyperalimentation with PTBD to reduce the incidence of complications. Sixty-four patients with obstructive jaundice and serum bilirubin > 200 μmol/l were randomized into two treatment groups (n = 32) with PTBD or PTBD + hyperalimentation. Four patients were withdrawn from the latter group, two for metastatic cancer and two for complications of PTBD. Before starting hyperalimentation, the incidence of malnutrition was assessed by biochemical, immunological and anthropometric tests: malnutrition was found in 70 per cent of the patients. All the patients had good recovery of hepatic function but patients treated with PTBD alone still had high mortality (12.5 per cent) and morbidity (46.8 per cent) after biliopancreatic surgery. When hyperalimentation was provided to patients on PTBD for a period of 20 days before the operation, the incidence of complications fell to 17.8 per cent and mortality to 3.5 per cent. These results suggest that the combined use of PTBD and hyperalimentation, improving both hepatic function tests and the nutritional status of jaundiced patients, can reduce the rate of complications after biliary and pancreatic surgery
The effects of 9-hydroxy-19,20-bis-norprostanoic acid on mucus, acid and gastrin secretion in duodenal ulcer patients
No full textThe effects of 9-hydroxy-19,20-bis norprostanoic acid (rosaprostol, IBI), a new prostaglandin analogue, on gastric secretion and gastrin release were studied in 15 patients with duodenal ulcer. In acute experiments, rosaprostol lowered pentagastrin-stimulated acid secretion by 27-36%, whereas after chronic administration there were no changes in acid secretion or gastrin release (fasting and oxo-stimulated) but N-acetylneuraminic acid (NANA)-glycoproteins increased significantly. Our results indicate that the antisecretory and mucopoietic activities of 9-hydroxy-19,20-bis-norprostanoic acid are the basis of its healing effect in duodenal ulcer patients
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