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At least 1,567 records · Page 87Linked to original sources
PubMed1997

Displaced metallic biliary stents: technique and rationale for interventional radiologic retrieval.

OBJECTIVE: We investigated the spontaneous course and the possibility of transhepatic removal of displaced biliary stents. MATERIALS AND METHODS: Displaced biliary stents were observed in 11 patients (13-75 years old) between October 1988 and August 1996. Stent types included the Palmaz stent (n = 3), Wallstent (n = 3), and the Strecker stent (n = 5). Reasons for stent displacement included primary misplacement (n = 4), dislocation due to transhepatic endoscopy with biopsy (n = 2), dislocation resulting from a recanalization maneuver in stent occlusion (n = 3), and unknown causes (n = 2). In three cases, the stent was displaced into the proximal bile duct system. Seven patients had primary malignancy. RESULTS: Eight of 11 displaced biliary stents were removed transhepatically. Extraction was performed using either a wire loop (n = 4) or forceps (n = 4). No complications occurred. In the remaining three patients, whose stents were displaced into the intestine, no invasive action was taken. In one of these patients, a Palmaz stent was passed spontaneously after 1 week. In the second of these patients, a 6 cm Wallstent remained innocuously at a position in the right lower abdomen, and the patient died as a result of malignancy. In the third patient, who had a 10-cm Wallstent, an abscess developed in the stent region 4 months after displacement and resulted in formation of an ileocutaneous fistula. CONCLUSION: Transhepatic extraction of displaced biliary stents is technically possible, even in the case of rigid stents such as the Palmaz stent. Because of the risk of intestinal perforation, displaced stents should be removed.

Adolescent↗
PubMedDate not supplied

[Clinical analysis of congenital abdominal wall defects--omphalocele and gastroschisis].

INTRODUCTION: This is a retrospective analysis of therapeutic approaches and treatment outcomes of congenital abdominal wall defects (omphalocele and gastroschisis) in a five year period. The aim of this study was to identify factors which can affect the prognosis of future therapeutic procedures. MATERIAL AND METHODS: We evaluated 13 children, 7 with omphalocele (2 female/5 male; mean birth weight of 2862 g; mean gestational age of 37 weeks), and 6 patients with gastroschisis (2 female/4 male; mean birth weight of 2640 g; mean gestational age of 36/2 weeks). All patients were treated at the Clinic of Pediatric Surgery from 1999 to 2003. RESULTS: In this study, thirteen cases of congenital abdominal wall defects (omphalocele and gastroschisis) were retrospectively investigated. All patients underwent prenatal ultrasound. Omphalocele was prenatally detected in 42.8% of fetuses, and gastroschisis in 16.7%. Coexisting anomalies were present in 57.1% of patients with omphalocele and in 16.7% of newborns with gastroschisis. Three patients with omphalocele were treated operatively, and four only conservatively. The abdominal wall of patients with gastroschisis was primarily closed in three patients. Two patients required a staged abdominal wall closure. One patient with gastroschisis and intestinal atresia underwent primary closure after partial intestinal resection and enterostomy. Based on these responses, a management protocol (algorithm) was recommended. The most common postoperative complication, in 7 cases of omphalocele, was mechanical ileus (n = 1), whereas among patients with gastroschisis the commonest were mechanical ileus (n = 1) and intestinal perforation (n = 1). The mortality of patients with omphalocele was 52% and with gastroschisis 66.7%. CONCLUSION: A strategy designed to optimize antenatal and neonatal factors is expected to increase the survival rate of patients with abdominal wall defects.

Abnormalities, Multiple↗
PubMedDate not supplied

Epidemiology of typhoid fever in Mauritius.

BACKGROUND: The epidemiology of typhoid fever in Mauritius was studied to determine whether there was any need for tourists visiting Mauritius to be vaccinated against the disease, and where Mauritians with typhoid fever had been infected. Data on antibiotic susceptibility of Salmonella typhi isolates from Mauritius were also analyzed. METHODS: Since 1997 every time S. typhi is isolated from blood cultures at our laboratory, an epidemiologic inquiry is conducted to determine the likely origin of the infection and the outcome of treatment, and the information collected is recorded. Results of antibiotic susceptibility testing are also noted. Data recorded on cases between 1997 and 2004 were reviewed and analyzed. RESULTS: S. typhi was isolated on 25 occasions during the 8-year period. The infection was likely to have been acquired in Mauritius in only 6 cases (24%). Another 6 cases (24%) occurred in expatriate workers from the Indian subcontinent. Of the 13 Mauritians (52%) who probably acquired the infection abroad, 11 had a history of recent travel to India. Thirteen of 14 S. typhi isolates from cases acquired in India were resistant to nalidixic acid. Of the 6 cases acquired in Mauritius, 4 occurred in children under 12 years and 1 was caused by a multiply resistant strain. Twenty-two patients made an uneventful recovery. One death was indirectly caused by typhoid fever, and there was 1 case each of intestinal perforation and relapse. CONCLUSIONS: In Mauritius typhoid fever is mainly an imported disease, but indigenous cases of the illness occur rarely and sporadically. Travelers to Mauritius need not be vaccinated against typhoid fever as the risk of acquiring the disease in the country is negligible. Mauritians traveling to India must be made aware of the risk of typhoid fever and of preventive measures. Ceftriaxone should be used as the initial first-line treatment of infection acquired in India.

Adolescent↗
PubMedDate not supplied

Pneumatosis cystoides intestinalis with abdominal free air in a 2-year-old girl after allogeneic bone marrow transplantation.

A 2-year-old girl with acute lymphoblastic leukemia (ALL) showing a t(4;11)(q21;q23) karyotype underwent allogeneic bone marrow transplantation (BMT) with the conditioning regimen of L-PAM (70 mg/m2/d for 3 days), busulfan (140 mg/m2/d for 2 days), and total body irradiation (12 Gy). On day 57, the patient developed pneumatosis cystoides intestinalis (PCI) when she received cyclosporin A and corticosteroids for graft-versus-host disease (GVHD). Because of the presence of massive abdominal free air and the suspicion of peritonitis, she underwent surgical intervention, which, however, revealed neither intestinal perforation nor peritoneal infection. She recovered from PCI in 10 days with nasogastric suction, fasting, and systemic broad-spectrum antibiotics. PCI with massive abdominal free air after BMT should be manageable by conservative therapy alone.

Abdomen, Acute↗
PubMed1985

Antibiotic treatment of infectious peritonitis in chronic peritoneal dialysis.

Antibiotic treatment of infectious peritonitis was evaluated in 97 primary episodes registered among 66 patients treated with chronic intermittent peritoneal dialysis over a 3-year period. 87% of the cases could be treated with antibiotics of low toxicity. The chance of continuing peritoneal dialysis after treatment of peritonitis was better among out-patients than among hospitalized patients. The overall continuance rate was 90%. Relapse of the primary infection occurred in 10% of the cases and was associated with a treatment duration shorter than 2 weeks. Superinfection occurred in 5% of the cases. In 15% the dialysis catheters had to be replaced, due primarily to problems of dialysis technique. Death during active peritonitis occurred in 4% of the cases and was associated with severe underlying diseases or complications, such as intestinal perforation and intraperitoneal abscess formation. Side effects attributable to antibiotic treatment occurred in 13% of the cases, the most common side effect being self-limiting diarrhoea.

Adult↗
PubMed1999

[Efficacy and safety of endoscopic papillary balloon dilation for removal of common bile duct stones in the elderly].

From May 1996 through August 1998, endoscopic papillary balloon dilation (EPBD) was performed to remove common bile duct stones in 17 elderly patients, aged 75 to 87 (average 81.9), including 7 with juxtapapillary diverticulum. The balloon-tipped biliary catheter for EPBD was inflated at a pressure of 10 atm, for 2 minutes, and the maximum diameter of the inflated balloon reached 8 or 10 mm. After one or two ERCP sessions using EPBD alone, the bile duct stones were removed in 16 (94.1%) of 17 patients, and endoscopic mechanical lithotripsy was required in 6 (35.3%) patients. Another patient required additional sphincterotomy for removal of the stone. Massive bleeding or intestinal perforation, which can be major complications of EPBD, did not occur, and while the minor complication of transient abdominal pain was observed in 3 patients but there was no case of pancreatitis. The clearance rates of stones and complication rates in our EPBD procedure were similar to other reports and to those of our data in younger patients, aged under 75. EPBD was a safe and effective technique for the extraction of the common bile duct stones in elderly patients.

Aged↗
PubMed2000

Ultrasound examination of gastrointestinal tract diseases.

With recent technical advances, increasing use of sonography in the initial evaluation of patients with abdominal disease may allow the detection of unexpected tumor within the abdominal cavity. Easiness of sonographic detection of bowel pathology, purposely or unexpectedly, warrants the inclusion of bowel loops during ultrasound examination when a patient complains of symptoms indicating diseases of the bowel. In patients complaining of acute abdominal symptoms or nonspecific gastrointestinal symptoms and showing signs such as abdominal pain, diarrhea, hematochezia, change of bowel habit, or bowel obstruction, sonography may reveal the primary causes and may play a definitive role in making a diagnosis. On ultrasonography, abnormal lesions may appear as fungating mass with eccentrically located bowel lumen (pseudokidney sign) or symmetrical or asymmetrical, encircling thickening of the colonic wall (target sign). In patients with mass or wall thickening detected on ultrasonography, additional work-up such as barium study, CT or endoscopy would be occasionally necessary for making a specific diagnosis.

Abdomen, Acute↗
PubMed2004

[Head and neck reconstruction using laparoscopically harvested omentum].

Since the need for laparotomy in harvesting the omentum is the most significant drawback, the omentum has not been the tissue of choice for reconstructive surgery. To compensate for this drawback, we started laparoscopic harvesting of the omentum and clarified the advantages and disadvantages of this procedure. Ten patients underwent laparoscopic harvesting of the omentum by abdominal surgeons, followed by reconstruction of head and neck defects. Surgery was conducted in 5 cases of defect reconstructions for parotid gland tumor surgery and 5 of oropharyngeal defect after cancer surgery. The average harvesting time was 107 minutes (55-140 minutes) and used the omentum and different amounts and length of the vascular pedicle. Although the omentum was successfully transplanted in 9 of 10 cases, 2 cases showed partial peripheral necrosis and 1 total necrosis. With the advantage of laparoscopic harvesting of the omentum, we could obtain appropriate omental size for the defect size. Especially after total parotidecomy, the omentum was useful to fill in the defect, reducing the patients' worries about postoperative deformity. In one case, the omentum was used to treat Frey syndrome, successfully relieving the symptoms. In oropharyngeal reconstruction, the omentum is used to fill dead space and prevented postoperative infection. Although mild abdominal pain was observed a few days after surgery, no major abdominal complications such as intestinal perforation or ileus occurred in the 8 to 39 months following laparoscopic harvest of the omentum. Since the omentum is pliable and easily fills a complicated defect, the omentum is considered satisfactory for reconstructing defects of the lateral face after parotid tumor surgery and small defects after oropharyngeal tumor surgery.

Aged↗
PubMed2004

Small bowel injuries in penetrating abdominal trauma during war: ten-year follow-up findings.

BACKGROUND: Injuries of the small intestine are common in penetrating abdominal trauma. This article presents 10-year follow-up results for 23 patients with penetrating small bowel injuries who were treated in Nova Gradiska City Hospital during the 1991-1992 war in Croatia. The early hospital mortality rate was 13% (three deaths), and good results were found for 16 (84%) of 19 patients after 10 years. METHODS: The hospital charts of 23 patients who sustained small bowel injuries during an 8-month period were reviewed. Of 20 patients who survived, 19 came for an examination and interview 10 years after injury. The following criteria were used: existence of an abdominal wall defect or hernia, bowel passage problems, and reoperations attributable to the small bowel injury. RESULTS: Early results revealed adhesive peritonitis and ileus for three patients demanding early reoperation (13%) and a hospital mortality rate of 13% (three deaths, mainly attributable to multiple injuries). Ten years after injury, 16 patients had no problems, whereas 3 reported occasional abdominal pain. CONCLUSION: Penetrating abdominal injuries in war demand urgent diagnostic procedures and, in almost all cases, urgent laparotomy. In cases with no evidence of abdominal penetration and cases involving multiple injuries, an aggressive approach reduces the risk of missing small bowel injuries. Use of established principles for surgical management of small bowel injuries yields good results and low incidences of late complications and difficulties.

Abdominal Injuries↗
PubMed1976

[Insight into Crohn's disease].

After noting that Cohn's disease has a long history behind it, the authors show a real increase in the frequency of the disease, apparently more marked in the Anglo-Saxon countries than in France. The etiopathogenesis of the disease is completely unknown. It seems that subjects suffering from Crohn's disease present an exacerbated xenic reaction. There are strong arguments in favour of a genetic contribution. The association with ankylosing spondylarthritis and thus the HLA system is particularly interesting. Following a breif review of the clinical signs and of the complications of the disease, the authors emphasize the diagnostic value of a scoring system. The evolution is very variable: quiescence which does not mean cure, progressive and continuous aggravation, alternation of outbreaks and remissions. Symptomatic, medical therapy is certainly effective but is efficacy is limited. Medical therapy aimed at the etiopathogenic factors is without foundation. Surgical intervention, sometimes immediately beneficial, is accompanied by a 50% frequency of recurrences in a ten-year period. Crohn's disease, fatal in 5% of cases, sometimes handicapping severely the development of the individual, is worthy of further rheumatological study.

Consanguinity↗
PubMedDate not supplied

Percutaneous and endoscopic management of bile leak following endoscopic stone retrieval--a case report.

Endoscopic sphincterotomy with stone removal is the method of choice for the treatment of choledocholithiasis. The main complications of this procedure are bleeding, pancreatitis, intestinal perforation and cholangitis. Herein, we report on a case of bile peritonitis in a patient who underwent sphincterotomy and stone retrieval. The literature regarding the etiology and management of bile peritonitis is also reviewed.

Aged↗
PubMed1999

Meconium peritonitis.

Meconium peritonitis is an unusual and often fatal form of neonatal peritonitis characterized by intraperitoneal calcification, numerous fibrosis with or without pseudocyst formation due to antenatal extravasation of meconium. This report is a retrospective study of 32 pediatric patients who were treated at the Surgical Department of the Children's Hospital from 1987 to 1996. The purposes of this study emphasize clinical manifestations, radiological findings, operative procedures and results of treatment. Twenty seven were neonates and five were older infants. The most common clinical presentation was abdominal distension at birth. The abdominal X-rays showed abnormal calcification and mass lesion in the peritoneal cavity in 71.9 and 46.9 per cent respectively. Only one patient was not treated surgically because he had no evidence of gut obstruction and inflammation. Thirty-one patients were operated on. At laparotomy, all of them had numerous inflammatory adhesion bands and matted bowel loops. Giant pseudocysts and intestinal perforations were noted in 64.5 and 54.8 per cent respectively. The obvious causes of meconium peritonitis were ileal atresia in 4, jejunal atresia in 3 and appendiceal perforation in 1. In the other 23 patients, no apparent cause of perforation was noted. Only lysis of the adhesion with or without drainage was done in 9 patients and one of these died. Partial resection of pseudocysts and exteriorization of the perforated bowel were done in 10 patients and 2 of these babies died. Primary anastomosis after resection of the perforated bowel was done in 12 patients and 5 of these cases died. The overall survival rate was 75 per cent. Our data from this study suggested that partial resection of the pseudocyst and temporary enterostomy should be done in cases with bowel perforation and severe meconium contamination. Early diagnosis, proper operative procedure and meticulous postoperative care offer the best opportunity for survival of patients with meconium peritonitis.

Female↗