RESUMEN
Between July 1987 and December 1990, 13 patients with postoperative bile leakage were treated with endoscopic sphincterotomy and a naso-biliary drain. All the leaks healed in two weeks, except for one (intrahepatic) that needed two months to heal in association with percutaneous management. The non-surgical treatment of bile leakage is the preferred approach on account of the superior safety, efficacy and cost-effectiveness as compared with surgical repair, which is associated with significant morbidity, mortality and costs. The treatment of choice has to be endoscopic, which is much easier and safer than the transhepatic approach, especially in the non-dilated duct, while another advantage over radiology includes the possibility for rapid definitive treatment of distal obstruction (e.g. residual stones). A leak from an extrahepatic duct heals rapidly, while a leak from an intrahepatic duct takes longer to heal and sometimes needs associated percutaneous drainage. Finally, the authors propose treating an extrahepatic bile leak merely with naso-biliary drainage without cutting the papilla, and an intrahepatic bile leak with endoscopic sphincterotomy, nasobiliary drainage and a bilio-duodenal endoprosthesis.
Asunto(s)
Enfermedades de los Conductos Biliares/cirugía , Drenaje , Complicaciones Posoperatorias/cirugía , Esfinterotomía Endoscópica , Humanos , NarizRESUMEN
Seventy-two patients with tumor and ten with non-neoplastic colon disease were studied for the presence of estrogen receptors (ER) by three different methods. Only seven specimens (six primary adenocarcinomas and one recurrent cancer) had an ER concentration above 3 fm/mg of cytosolic protein, with no sex, age and tumor stage correlation. Our results suggest that the large bowel does not contain a cytosolic receptor for estradiol.
Asunto(s)
Adenocarcinoma/metabolismo , Enfermedades del Colon/metabolismo , Neoplasias Colorrectales/metabolismo , Receptores de Estrógenos/metabolismo , Anciano , Colon/metabolismo , Dextranos , Femenino , Humanos , Técnicas para Inmunoenzimas , Masculino , Persona de Mediana Edad , ProtaminasAsunto(s)
Pancreatitis/tratamiento farmacológico , Somatostatina/uso terapéutico , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Pruebas Enzimáticas Clínicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pancreatitis/diagnóstico , Somatostatina/administración & dosificación , Factores de TiempoAsunto(s)
Diagnóstico por Computador , Traumatismo Múltiple/cirugía , Terapia Asistida por Computador , Cuidados Críticos , Urgencias Médicas , Corazón/fisiología , Humanos , Pulmón/fisiología , Monitoreo Fisiológico , Traumatismo Múltiple/fisiopatología , Pronóstico , Pruebas de Función RespiratoriaRESUMEN
An assay of Kininase II activity in the serum of 92 jaundice patients revealed a significant difference between the group with viral hepatitis (268.48 +/- 70.93 U/ml), that with biliary obstructions (133.05 +/- 37.64 U/ml) and with cirrhosis (173.76 +/- 79.56 U/ml). The increase encountered in patients with medical jaundice correlates well with total bilirubinaemia but not with cytolysis enzymes. This suggests failed demolition of ACE by the hepatocyte during cellular stress.
Asunto(s)
Pruebas Enzimáticas Clínicas , Ictericia/diagnóstico , Peptidil-Dipeptidasa A/sangre , Adolescente , Adulto , Anciano , Bilirrubina/sangre , Colestasis/complicaciones , Colestasis/diagnóstico , Colestasis/etiología , Diagnóstico Diferencial , Femenino , Hepatitis Viral Humana/complicaciones , Hepatitis Viral Humana/diagnóstico , Humanos , Ictericia/etiología , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico , Pruebas de Función Hepática , Masculino , Persona de Mediana EdadRESUMEN
The report analyses the comparative efficacy of three different tumour markers (CEA, GICA and TPA) in providing indications for the postoperative monitoring of patients treated for cancer of the digestive tract. Assessment of effectiveness of chemotherapy produced different results according to the site of the tumour (stomach, colon or pancreas). In the case of cancers of the pancreatic head, the influence of jaundice on the markers was also evaluated, to discover which marker provided most information on the tumour investigated.
Asunto(s)
Antígenos de Neoplasias/análisis , Neoplasias Gastrointestinales/cirugía , Monitoreo Fisiológico , Neoplasias del Colon/cirugía , Humanos , Invasividad Neoplásica , Recurrencia Local de Neoplasia/diagnóstico , Cuidados Posoperatorios , Neoplasias Gástricas/cirugíaRESUMEN
Considerations of a physiopathological nature are expressed with regard to haemorrhagic multiple-injury patients in the light of the experience acquired in first-aid practice at the University of Turin department of emergency surgery. While treatment of the basic injury is the key to therapy, sufficient infusion management and careful monitoring of coagulation parameters before and during transfusion may be of fundamental importance in survival. By the same token, not all blood products available can be used indiscriminately. A treatment and monitoring protocol for the reinstatement of volaemia and corpuscle mass, and for the correction of coagulopathy due to loss, consumption and wash-out is proposed.
Asunto(s)
Transfusión Sanguínea , Hemorragia/etiología , Heridas y Lesiones/complicaciones , Transfusión de Eritrocitos , Fluidoterapia , Hemorragia/terapia , Humanos , Infusiones Parenterales , Sustitutos del Plasma/administración & dosificación , Transfusión de Plaquetas , Choque/terapia , Choque Hemorrágico/terapiaAsunto(s)
Análisis de los Gases de la Sangre , Cuidados Críticos , Gases/análisis , Pruebas de Función Respiratoria , Acidosis Respiratoria , Alcalosis Respiratoria , Dióxido de Carbono/análisis , Diagnóstico por Computador , Humanos , Concentración de Iones de Hidrógeno , Intubación Intratraqueal , Monitoreo Fisiológico , Consumo de Oxígeno , Cuidados Posoperatorios , Respiración Artificial , Espacio Muerto RespiratorioAsunto(s)
Computadores , Cuidados Críticos , Microcomputadores , Monitoreo Fisiológico/instrumentación , Dióxido de Carbono/metabolismo , Diagnóstico por Computador , Humanos , Concentración de Iones de Hidrógeno , Cuidados Intraoperatorios , Consumo de Oxígeno , Presión Parcial , Cuidados PosoperatoriosAsunto(s)
Colelitiasis/cirugía , Anciano , Colangiografía , Colecistectomía , Colelitiasis/diagnóstico , Endoscopía , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The large amount of data resulting from arterial and venous HGA's and analysis of expired gases carried out during the monitoring of critical surgical patients has been statistically reduced to only seven parameters. Personal Mini Computer software able to quantify or predict the necessity for mechanical ventilatory assistance in individual cases has been developed on the basis of the 7 parameters. The system, presently used only as a check, has been found very reliable. Two cases are reported in order to illustrate its use in intensive treatment.
Asunto(s)
Análisis Químico de la Sangre , Computadores , Cuidados Críticos , Monitoreo Fisiológico/instrumentación , Pruebas de Función Respiratoria , Programas Informáticos , Humanos , Procedimientos Quirúrgicos OperativosAsunto(s)
Pruebas de Coagulación Sanguínea , Puente Cardiopulmonar/efectos adversos , Activación de Complemento , Fibrinólisis , Cininas/metabolismo , Intercambio Plasmático/efectos adversos , Diálisis Renal/efectos adversos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Úlcera Péptica/etiología , Estrés Fisiológico/complicaciones , Adolescente , Adulto , Anciano , Cimetidina/uso terapéutico , Cuidados Críticos , Femenino , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Persona de Mediana Edad , Úlcera Péptica/complicaciones , Úlcera Péptica/tratamiento farmacológico , Úlcera Péptica/mortalidad , RiesgoRESUMEN
A group of 50 patients operated for carcinoma of the colon in June 1980-December 1981 with a follow-up period of min. 2 months-max. 15 months is presented. C.E.A. measurements were taken in all patients pre and post-operatively and then every 2 months in an attempt to establish its diagnostic and prognostic value. In immediate diagnostic and prognostic terms, pre-operative C.E.A. appears to be insignificant. However both pre-operative C.E.A. and C.E.A. at a distance of 6 months were found to be reliable for long term (max. 15 months) prognosis.
Asunto(s)
Adenocarcinoma/diagnóstico , Antígeno Carcinoembrionario/análisis , Neoplasias del Colon/diagnóstico , Adenocarcinoma/inmunología , Adulto , Anciano , Unión Competitiva , Neoplasias del Colon/inmunología , Femenino , Humanos , Radioisótopos de Yodo , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
Bayes theorem; multivariance analysis, and the discriminating function of Mahalanobis applied to sixteen laboratory examinations employed in the diagnosis of diseases of the extrahepatic bile ducts and pancreas gave the following results: 1) the weight of each test was first measured in general terms, and then with regard to different levels of differentiation, with a classification in decreasing order in each case; 2) little redundancy was noted, and few examinations were of relatively negligible importance; furthermore, combinations of several tests did not lead to positive results; 3) reclassification according to the formula of Bayes and by means of the discriminating function proved sound supports for clinical decision, since they provided 70% and 80% of exact classification respectively; 4) the importance of the minicomputer in the construction of experimental diagnostic models was substantiated.
Asunto(s)
Enfermedades de las Vías Biliares/diagnóstico , Computadores , Hepatopatías/diagnóstico , Minicomputadores , Enfermedades Pancreáticas/diagnóstico , Enfermedades de las Vías Biliares/cirugía , Diagnóstico por Computador/instrumentación , Diagnóstico por Computador/métodos , Humanos , Hepatopatías/cirugía , Enfermedades Pancreáticas/cirugíaAsunto(s)
Síndrome de Dificultad Respiratoria/etiología , Traumatismos Torácicos/complicaciones , Corticoesteroides/uso terapéutico , Antibacterianos/uso terapéutico , Dextranos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Respiración Artificial , Síndrome de Dificultad Respiratoria/terapia , Insuficiencia Respiratoria/etiologíaRESUMEN
Multivaried and trend analyses were applied to a set of 27 periodic haematochemical checks on 37 patients given surgery for biliopancreatic pathology. Preoperative and postoperative data were separately analysed. The software employed was specially designed for the purpose. The discriminating function was used in the preoperative period to establish the best moment for diagnosis, which turns out to be 5 days after admission to hospital. Variance and regression analyses were used for short term prognosis by calculating survival chances. In one case the prognosis turned out to be distinctly inaccurate.