Résumé
RESUMEN Introducción: El tratamiento de la úlcera péptica duodenal (UPD) ha cambiado radicalmente en el transcurso de los últimos 50 años debido a la efectividad del tratamiento médico. Sin embargo, la cirugía todavía tiene un importante papel en el tratamiento de la úlcera duodenal; y dentro de éste la vagotomía. Objetivo: Describir el origen y evolución de la vagotomía altamente selectiva (VAS), y su papel en el tratamiento quirúrgico de la UPD. Material y métodos: Se revisó la bibliografía publicada durante los últimos 50 años relacionada con la VAS en el tratamiento quirúrgico de la UPD. La fuente de los datos utilizados fue obtenida de Clinical Key, Pubmed, Google, Scopus y Scielo, desde 1970 hasta 2020. Desarrollo: La VAS se aplicó por primera vez en el humano en 1967 por Holle y Hart. Posteriormente, Johnston y Wilkinson y Amdrup y Jensen en 1970, informan sus resultados, conservando el píloro. La única debilidad que se le atribuye a la VAS es una alta tasa de recurrencia de la úlcera; sin embargo, su mortalidad y morbilidad son mínimas, por lo que es la intervención de elección para la úlcera duodenal intratable o complicada. Conclusiones: Debido a la disminución en la necesidad del tratamiento quirúrgico, pocos cirujanos están entrenados y experimentados en esta operación técnicamente difícil; lo que ha sido el principal factor para las altas tasas de recurrencia. Sin embargo, consideramos que la VAS tiene vigencia actual en manos de cirujanos entrenados y experimentados.
ABSTRACT Introduction: The treatment of duodenal peptic ulcer (DPU) has radically changed over the last 50 years due to success of medical treatment. However, surgery still has an important role in the treatment of duodenal ulcer; and with this, vagotomy. Objective: To describe the origin and evolution of highly selective vagotomy (HSV), as well as its role in the surgical treatment of DPU. Material and Methods: We reviewed the bibliography published during the last 50 years in relation to highly selective vagotomy (HSV). The data used were obtained from the search carried out in Clincal Key, Pumed, Google, Scopus and Scielo databases during the period 1970-2020. Development: Highly Selective Vagotomy was first performed in humans by Holle and Hart in 1967. Later, their results were informed by Johnston and Wilkinson and Amdrup and Jensen in 1970, preserving the pylorus. The only weakness attributed to HSV is a higher ulcer recurrence rate; however, mortality and morbidity are minimal, so it is the intervention of choice for intractable or complicated duodenal ulcers. Conclusions: Because of the decline in the need for surgical management, fewer surgeons are trained and and have enough experince to perform this technically challenging surgery, which has been the main factor associated with higher recurrence rates. However, we consider that HSV has a current relevance when it is performed by trained and experienced surgeons.
Sujets)
HumainsRésumé
A 48-year-old man with Buerger disease and intractable finger ulcers underwent successful transplantation of autologous peripheral blood-derived mononuclear cells pretreated with erythropoietin and blood donation to activate bone marrow function. Clinical symptoms on his finger ulcers improved significantly within 1 month after mononuclear cell transplantation, however, one of the intractable ulcers reappeared 2 months later. In total three transplantations were performed. Every cell transplantation revealed similar effectiveness 1 month later, and the interval of the subsequent disappearance of finger ulcers ranged from 3–6 months. There were no adverse effects based on this new therapy. These findings suggest that autologous peripheral mononuclear cell transplantation pretreated with erythropoietin and blood donation might be a non-invasive and safe alternatives for patients with Buerger disease and intractable finger ulcers.
Résumé
Primary gastric lymphorna represents one to 7% of all gastric cancer and is the most common type of extranodal lymphoma. In attempt to evaluate the endoscopic characteristics, we analysed clinical and endoscopic findings in 35 patients with primary gastric lymphoma between January 1980 and August 1994 at the Yonsei Medical Center. The results were as follows: 1) The mean age of patients was 47.1 years with male to female ratio of 1.5: l. 2) Gastroscopy was performed in all 35 patienits, which revealed polypoid lesion in one case(2.9%), ulcerative lesion in 15 cases(42.9%), ulcero-infiltrative lesion in 6 cases(17.1%) and diffuse infiltrative lesion in 2 cases(5.7%). Gastric lymphoma was suggested in 6 cases, advanced gastric cancer in 21 cases, early gastric cancer in 5 cases and benign gastric ulcer in 3 cases. Pathologic diagnosis of biopsy specimens were gastric lymphoma in 24 cases, adenocarcinoma in 5 cases and chronic superficial gastritis in one case. 3) The characteristics of the endoscopic findings in gastric lymphoma were intractable or recurrent ulcer in 10 cases, thickened and mounded ulcer margin in 9 cases, multiple ulcers in 9 cases, giant rugae in 7 cases and polypoid or depressed lesion with central ulceration in 4 cases. In conclusion, recognition of specific endoscopic findings such as intractable or recurrent ulcer, volcano-like ulcer, multiple ulcers, giant rugae and combined lesion, the possibility of a lymphoma should be considered and vigorous biopsy attempts should be carried out. Then if the first microscopic report does not suggest this diagnosis, a second investigation including jumbo biopsies, perhaps by diathermy, should be undertaken.