ABSTRACT
BACKGROUNDS:Bile reflux gastritis can occur when pylorus ablation is associated with bile stasis in the stomach. It can also occur with a gastrojejunostomy when bile is continuously poured into the gastric remnant after a vagotomy and an antrectomy. The diagnosis of bile reflux gastritis can be made only when the patient has bile gastritis documented on biopsy; the simple observation of a bile-stained mucosa in a gastric remnant is not sufficient to make the diagnosis of bile reflux gastritis. METHODS: Technetium-99m diisopropyl iminodiacetic acid (Tc-99m DISIDA) scintigraphy was used to study bile reflux into the gastric remnant in 31 patients with gastric operations. All patients had gastrofibroscopic biopsies in order to identify the bile reflux gastritis. RESULTS: Tc-99m DISIDA Scintigraphy identified bile reflux in 15 (83.2%) of 18 patients after a subtotal gastrectomy and a Billroth II gastrojejunostomy. Hewever, no bile reflux occured in either the 10 patients with a hemigastrectomy plus Billroth I gastoduodenostomy or the 3 patients with a truncal vagotomy plus pyloroplasty. Also, gastrofibroscopic biopsies identified bile reflux gastritis in only 3 patients (9.7%) with a subtotal gastrectomy plus Billroth II reconstruction. CONCLUSIONS: The patients who underwent a subtotal gastrectomy and Billroth II reconstruction showed higher bile reflux rates than did the patients who underwent a hemigastrectomy plus Billroth I reconstruction and a truncal vagotomy plus pyloroplasty (p<0.05). Also, only 9.7% of the postgastrectomy patients developed bile reflux gastritis.
Subject(s)
Humans , Bile Reflux , Bile , Biopsy , Diagnosis , Gastrectomy , Gastric Bypass , Gastric Stump , Gastritis , Gastroenterostomy , Mucous Membrane , Pylorus , Radionuclide Imaging , Reflex , Stomach , Vagotomy , Vagotomy, TruncalABSTRACT
BACKGROUND : Truncal vagotomy produces a reduction in bile flow, an increased gallbladder volume, a delay in gallbladdr emptying, decrease in resting pressure, and decreased contraction following stimulation with cholecystokinin. Retrospective studies have suggested that vagotomy can be responsible for a 4 to 6 fold increase in the 4% to 5% control rate of cholelithiasis noted in the Framingham study. The measurement of the gallbladder ejection fraction by using Tc-99m DISIDA scintigraphy is suitable for the study of the motor functions of the gallbaldder. A gallbladder ejection fraction of less than 35% is highly predictive of the presence of gallbladder disease and is a good indicator of a favorable outcome following a cholecystectomy. METHODS : Between January 1995 and December 1996, 24 patients (truncal vagotomy + pyloroplasty, 5; truncal vagotomy partial + gastrectomy + Billroth I, 4; truncal vagotomy + partial gastrectomy + Billroth II, 12; total gastrectomy, 3) and 18 healthy volunteers were investigated prospectively by Tc-99m DISIDA scintigraphy for the measurement of the gallbladder ejection fraction. RESULTS : In normal subjects, the mean value of the gallbladder ejection fraction was 70.8%, and in patients after a gastric operations, it was 66.0% (p>0.05). Three (25.0%) of the 12 patients with a truncal vagotomy, partial gastrectomy, and Billroth II gastrojejunostomy had gallbladder ejection fractions of less than 35% (p<0.05). CONCLUSIONS : There was no difference in the gallbladder ejection fractions between the control group and the patients after gastric operations, including a truncal vagotomy. However there was a significant difference between the patients with a truncal vagotomy, partial gastrectomy, and Billroth II anastomosis and those receiving other gastric operations.
Subject(s)
Humans , Bile , Cholecystectomy , Cholecystokinin , Cholelithiasis , Gallbladder Diseases , Gallbladder , Gallstones , Gastrectomy , Gastric Bypass , Gastroenterostomy , Healthy Volunteers , Prospective Studies , Radionuclide Imaging , Vagotomy , Vagotomy, TruncalABSTRACT
Two cases of Castleman's disease (Giant lymph node hyperplasia) are reported. The first case was a multicentric cervical giant lymph node hyperplasia. Excisional biopsy confirmed the diagnosis of Castleman's disease of the plasma-cell type. Despite repeated dissection of the cervical lymph nodes, complete removal of the lymph nodes was impossible, and the type was changed into mixed type, and regrowth of the tumor was noted. Prednisolone was of no benefit. The patient is now living with cervical masses in situ without general symptoms, 4 years after the initial diagnopsis. The second case was a solitary retroperitoneal giant lymph node hyperplasia, incidentally found. Complete excision was performed and biopsy confirmed the diagnosis of Castleman's disease of hyaline-vascular type. No recurrence was found at 2 years after the excision.
Subject(s)
Humans , Biopsy , Diagnosis , Castleman Disease , Lymph Nodes , Neck , Prednisolone , RecurrenceABSTRACT
Conventional hemorrhoidectomy is still the main stairway to the treatment of the third or the fourth degree hemorrhoids. Among the various methods of hemorrhoidectomy, open hemonhoidectomy is claimed to decrease postoperative pain and wound infection, but to have disadvantage of long period of wound healing. Semi-closed hemorrhoidectomy has the advantage of rapid wound healing without increased risk of wound infection, but more painful postoperative course than open hemorrhoidectomy is suggested. To assess this conventional concept, two hundreds of patients were randomly allocated to either an open hemorrhoidectomy(Group 4, Operated by modified Goligher method, n=100) or a semi-closed hemorrhoidectomy(Group B, Operated by modified Nesselrod method, n=100), and postoperative results were analyzed. In group 4, the average time for disappearance of wound edema was 4.9days, average time for disappearance of wound pain was 9.0days, average time for painless defecation was 14.1 days, average time for complete wound healing was 28.4days. The main complications were overgranulation, skin tag, anal discharge and pruritus. The overgranulation requires curettage, the skin tags were resected under local anesthesia. Anal discharge and pruritus were spontaneously disappeared after the healing of the wound. In group B, the average time for disappearance of wound edema was 6.1 days, average time for disappearance of wound pain was 6.3days, average time for painless defecation was 9.2days, average time for complete wound healing was 20.7days. The main complications were skin tags, more prevalent than group 4, requiring resection under local anesthesia. No infectious complications were noted in both groups. Consequently, the old concept that open hemorrhoidectomy has advantage of less painful postoperative course than semiclosed hemorrhoidectomy cannot be accepted. Semi-closed hemorrhoidectomy offers more rapid loss of pain and more rapid healing of the wound than open hemorrhoidectomy, without increased risk of infectious complications. In conclusion, semi-closed hemorrhoidectomy is superior method to open hemorrhoidectomy in third or fourth degree hemorrhoids.
Subject(s)
Humans , Anesthesia, Local , Curettage , Defecation , Edema , Hemorrhoidectomy , Hemorrhoids , Pain, Postoperative , Pruritus , Skin , Wound Healing , Wound Infection , Wounds and InjuriesABSTRACT
Infectious complications such as wound infection and intra-abdominal abscess are rarely fatal, but perplexing to both patients and surgeons, and still remain asserious problem after appendectomy in about 5% of the patients. To be helpful to reduce post-appendectomy complications, authors retrospectively analyzed 229 cases of appendectomy performed during the period of one year, from January 1 through December 31, 1995, to find out contributing factors to the post-appendectomy infectious complications such as wound infection or intra-abdominal abscess. The results were as follows. 1) Infectious complications are more common in patients with four or more days of symptom. 2) Infectious complications are more common in patients with complicated appendicitis such as gangrenous or perforated appendicitis. 3) Preoperative antibiotics are helpful to prevent infectious complications in cases of complicated appendicitis. 4) There is no difference in the incidence of infectious complications between the immediate operations and overnight delayed operations in patients who were admitted in the late evening or at night. 5) There is no difference in the incidence of infectious complications between operators: staff surgeons who exclusively operated on patients with complicated appendicitis and residents(with or without supervision of staff surgeons) who mostly operated on patients with simple appendicitis. This means technical superiority has its role in preventing infectious complications. Early diagnosis and operation before the gangrenous change or perforation are warranted. Preoperative antibiotics are effective in cases of complicated appendicitis, but not in cases of simple appendicitis. But the lack of objective criteria to decide complicated appendicitis before the operation remains problem, and prospective study to solve this problem is needed. Technical perfectness is required to protect the wound and to remove the appendix without contamination. Preventive measures are also important to prevent the infectious complications in cases of inevitably contaminated wounds or inta-abdominal spaces.
Subject(s)
Humans , Abdominal Abscess , Anti-Bacterial Agents , Appendectomy , Appendicitis , Appendix , Early Diagnosis , Incidence , Organization and Administration , Retrospective Studies , Wound Infection , Wounds and InjuriesABSTRACT
No abstract available.