[Ileocecal tuberculosis complicated by tuberculous cerebellar abscess. Diagnosis and evaluation of trial treatment].
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Biomedical subjects
Publications and source records attributed to L Engelholm.
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Endoscopic cystoenterostomy was performed in 33 patients with chronic pancreatitis. Endoscopic cystoduodenostomy (ECD) was done in 22 cases of symptomatic paraduodenal cysts and endoscopic cystogastrostomy (ECG) in 11 cases of retrogastric pseudocysts. The success rates were 96% for ECD and 100% for ECG. The relapse rate was 9% after ECD and 19% after ECG. No significant complications were observed after successful ECD and clinical relief of pain was achieved in 20 patients. ECD was an effective and definitive treatment for 19 of the 22 cases. Two complications of ECG were gastric hemorrhage and iatrogenic pseudocyst infection. In two ECG patients, percutaneous drainage was required. ECG alone was a definitive treatment for 8 of the 11 cases. When restricted to the precise morphological indication (paraintestinal cyst bulging into the duodenal or gastric lumen), ECD is the first choice for treatment of paraduodenal cysts, whereas ECG is an alternative procedure for the drainage of retrogastric pseudocysts, offering at least results as good as percutaneous drainage.
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Between 1978 and 1983, 32 patients underwent a proximal duodeno-pancreatectomy for malignant lesions of the ampullary region on head on the pancreas. Pre-operative diagnosis was made by endoscopic cholangio-pancreatography, echography, tomodensitometry and arteriography. 14 patients underwent a pre-operative endoscopic bile drainage procedure. The operative mortality was 6,2% and the morbidity 43%; the intensity of the icterus as well as the preoperative bile drainage procedure did not change these factors significantly. The pre-operative diagnostic procedures permitted a clear definition of the extent of the tumor and retrospective analysis demonstrated their prognostic significance with regard to long-term survival. 11 patients are still alive. The presence of histologically proven metastases reduce significantly the duration of survival. Surgical resection is the best treatment for malignant tumors of the ampullary region and the head of the pancreas without local or distant metastases.
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