Pathogenesis and clinics of gastric stump carcinoma (author's transl)

Statistics of postmortem examinations and retrospective long-term observations indicate a disposition of the resected stomach for the development of a primary carcinoma. The risk to develop a carcinoma after resection for peptic ulcer shows a two- to three-fold increase compared to gastric cancer mortality of the normal population. Because of the lack of typical symptoms for gastric stump cancer surgical treatment will occur late and the 5-years survival rate is only 1.38%. The cause of the increased cancer risk after gastric resection seems to be the atrophic gastritis in the gastric remnant which is found after a few years.     

Disappearance of blood from cerebrospinal fluid following subarachnoidal hemorrhage (preliminary note)

On the basis of cerebrospinal fluid investigations in 17 patients with subarachnoideal haemorrhage admitted to the hospital in the time period from Nov. 1 1973 to March 15 1975 the authors observed that the blood disappears from the fluid usually 8 days after the onset and they suggest that control lumbar tap and angiography should be performed at that time for possible referral of patients for surgical treatment. From the 8th day on there is no need of administration of drugs increasing blood clotting.     

Current trends in the therapy of bleeding duodenal ulcer

A distinction is drawn between two main groups of patients with continuous and massive haemorrhage respectively in bleeding duodenal ulcer, and the criteria upon which this distinction is based are described. The two main types of surgery proposed for the treatment of this complication of duodenal ulcer (vagotomy and gastric resection) are examined. The conclusion is drawn that vagotomy (truncular with drainage, or superselective with or without drainage) is to be preferred to gastric resection in the light of personal experience, and with particular reference to operative mortality and the recurrence of haemorrhage and ulcers.     

Aneurysm at the bifurcation of the internal carotid artery (author's transl)

The authors analyse 14 cases of aneurysm occurring at the point of bifurcation of the internal carotid artery into the middle and anterior cerebral arteries. Distinguishing features of this aneurysm are often its fairly large size and extensive implantation on the artery. Clinical symptoms are not specific but various neurological signs are frequent. The bifurcation of the carotid artery is not always readily visible; oblique views and angiotomography are often necessary. Owing to the usual severity of the natural evolution of this type of aneurysm (death in six out of eight cases), surgical treatment is advisable. Ligation of the carotid artery is disadvised because of the unpredictable nature of its results (further fatal haemorrhage in one out of three cases).     

Clinical picture of peptic ulceration diagnosed endoscopically

Clinical features and laboratory data are presented for 100 patients with benign gastric ulceration and 150 patients with duodenal ulceration confirmed endoscopically in a district general hospital unit. Abdominal pain was the commonest indication for endoscopy, but one third of examinations were performed for acute gastrointestinal haemorrhage. Although the patients were selected by referral for endoscopy their clinical presentation, age, and sex distribution were similar to those reported in previous general surveys. There were no clinical features which clearly distinguished gastric from duodenal ulceration. However, of those with gastric ulceration younger patients more often had distal ulcers and presented with pain, while elderly subjects tended to have high lesser curve involvement and presented with haemorrhage. Moreover, all females presenting with haemorrhage were aged over 50 years, while 6% of males bleeding from gastric ulceration and 40% of males bleeding from duodenal ulceration were under this age. Anaemia when present, except in two premenopausal females, indicated either a recent acute gastrointestinal haemorrhage or a coexistent second diagnosis.     

Five-year follow-up of a prospective randomised multi-centre trial of weekly chemotherapy (CAPOMEt) versus cyclical chemotherapy (CHOP-Mtx) in the treatment of aggressive non-Hodgkin''s lymphoma. Central Lymphoma Group

Benign tumors of the pancreatic head are normally treated by a partial duodenopancreatectomy. This operation has been developed for the treatment of malignant alterations in the pancreatic head and includes resection of the gastric bowel, duodenum and common bile duct. The aim of this study was to evaluate whether the less radical duodenum-preserving pancreatic head resection is a suitable surgical procedure in the treatment of benign pancreatic head tumors. From May 1982 to December 1996, seven patients underwent surgical treatment for benign pancreatic head tumors. Two patients suffered from gastrinoma of the pancreatic head, four exhibited a serous or mucinous cystadenoma, and one patient suffered from an intraductal papillary-mucinous tumor in this region. All patients were treated by duodenum-preserving pancreatic head resection. The operation was easily performed with little blood loss and a low rate of complications. None of the patients had to be reoperated upon due to postoperative surgical complications. After a follow-up period of a median 3 years, six of seven patients were had no recurrence of the disease and were symptom-free. One patient who had initially been operated on for gastrinoma still exhibited high gastrin values postoperatively. The endocrine and exocrine pancreatic function was not impaired in the early and late postoperative phase as compared to the preoperative assessment. From our results, it is concluded that duodenum-preserving pancreatic head resection is an adequately radical, yet organ-preserving procedure for the treatment of benign tumors of the pancreatic head without compromising endocrine and exocrine function.     

Transjugular intrahepatic portosystemic shunts (TIPS)

Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure recently introduced for the management of complications of portal hypertension. TIPS can be placed in the liver with relative ease by a skilled radiologist with a low risk of mortality. The major complications following the procedure are infection, especially in patients undergoing emergency TIPS, intra-abdominal haemorrhage from capsular punctures, and long-term problems related to encephalopathy and stenosis of the shunt. Encephalopathy is more of a problem in older patients with wide diameter shunts. Stenosis of the shunt is related to pseudo-intimal hyperplasia, probably related to transection of bile ductules during placement of the shunt. In view of the high rate of encephalopathy and stenosis following the shunt, a careful follow-up of all patients, including ultrasonographic and angiographic examination of the shunt, is mandatory. TIPS is used predominantly for the control of acute variceal haemorrhage, prevention of recurrent variceal bleeding, and refractory ascites when conventional treatment has failed. However, the role of TIPS in the management of complications of portal hypertension still awaits the outcome of clinical trials.     

Tension pneumothorax precluding laparoscopic repair of diaphragmatic hernia

BACKGROUND: Central Europe and the Czech Republic are specific in the prevalence of obesity which has increased by 10-40% during the last 10 years. METHODS: In the Czech republic there is 30 years of experience of a comprehensive approach to obesity treatment which includes: dietary treatment; exercise; behavioral modification; drug treatment; and bariatric surgery. Each of these approaches has its place in complex obesity management. Since 1983 bariatric surgery has been established in the Czech Republic for the treatment of morbid obesity. Vertical banded gastroplasty (VBG), gastric banding, laparoscopic nonadjustable and adjustable gastric bandings have been used over the years. Since 1993 laparoscopic gastric banding has been the only method used in our department. RESULTS: The comprehensive approach for obesity treatment in the Czech Republic has resulted in the development of obesity management and research centers, regional obesity units, obesity out-patients clinics and weight reduction clubs. The surgical treatment is a well-established part of this system and the long-term results of surgical treatment are acceptable both in terms of weight loss and complication rate. There has been no statistical difference in weight loss results following VBG and laparoscopic gastric banding, but there is a significant decrease in morbidity, and shorter hospital stay associated with laparoscopic gastric banding. CONCLUSIONS: The surgical approach in obesity treatment has an important place in the comprehensive care of obese patients. Laparoscopic gastric banding in the hands of an experienced surgeon is a method with low morbidity, short hospital stay and long-term weight loss results which are fully comparable with the results of other surgical approaches.     

Spontaneous rupture of the oesophagus (author's transl)

During the last 4 years three so-called spontaneous perforations of the oesophagus were treated, twice by surgical intervention 12 anys after the rupture. Two patients survived. The classical history of retching or vomiting and retrosternal splitting pain is indicative, wht medium, amidotrizoate sodium (Gastrografin), from the oesophagus. Prognosis depends decisively on the time of operation after the rupture. Direct suture of the rupture with plastic coverage of the defect by sewing on of the gastric fundus or by plication of the fundus have proved valuable.     

Experiences with acute moderate controlled hemodilution (author's transl)

The authors present an own method of hemodilution and experiences gained from 10 patients operated for chronic gastric or duodenal ulcer. The therapuetic results of the method show that it can be applied easely and safely in everyday surgical practice. In the patients treated with it no surgical and anaesthesiological complications could be observed during the operations as well as after them. The autors believe that the method of hemodilution for planned surgical operations will contribute to a more economical use of blood transfusions and to reduction in the occurrence of virus hepatitis.     

Massive hemorrhage from a gastric neuroma associated with a kidney neoplasm

A case of a gastric neuroma and kidney cancer were reported. The first symptoms of the disease was gastric haemorrhage. Urgent endoscopy showed submucous tumor of the gastric wall. The physical examination showed a presence of a tumor of the rib, proved to be secondary deposit from kidney carcinoma which had been found on abdominal ultrasound examination. Submucous excision of the followed by left nephrectomy was performed. At present an intensive x-ray therapy of rib tumor is continued because of patient's disagreement for rib resection.     

Urokinase in the management of vitreous hemorrhage

Urokinase is a plasminogen activator of human origin which breaks up the fibrin base of blood clots. When given as an intravitreal injection it produces hypopyon and glaucoma, both of which transient. In a series of 27 patients (34 eyes) with unresolved vitreous haemorrhage, this simple and relatively atraumatic treatment has produced marked objective improvement in 10, and greatly improved the life styles of a further 9. This series brings the total of reported cases to 93. When compared with recent American reports of surgical vitrectomy for vitreous haemorrhage, intravitreal urokinase appears to have a higher success rate, with a lower complication rate both in the short and long term. This study suggests that, despite the high cost of the purified enzyme, urokinase should be come the first line of attack in vitreous haemorrhage, vitrectomy being reserved for those patients who fail to respond.     

Ulcer surgery and anti-ulcer agents. Changes in surgical activities and sale of anti-ulcer agents in Nord-Tr?ndelag 1975-89

During recent decades the number of operations for peptic ulcer has decreased significantly. The incidence of operations for peptic ulcer or related complications during the period 1975-89 in persons older than 15 years was investigated in the Nord-Tr?ndelag region of Norway, with a population of approximately 100,000. The number of elective surgical procedures decreased by 72% from 1975 to 1989. The greatest reduction was found for duodenal ulcers. The incidence of acute operations decreased by 35%. The main reason was fewer surgical interventions in patients with haemorrhage, since the number of operations for perforation remained almost constant during the period of 15 years. The reduction in surgical treatment can be explained mainly by the introduction of new H2-antagonists in the seventies, leading to more successful pharmacological treatment of peptic ulcer.     

Serum lipids in patients with liver disease (author''s transl)

A long-term controlled therapeutic trial of gefarnate (600 mg daily) in the treatment of chronic gastric ulcer was carried out in 32 patients. Assessment was based on the clinical course and on repeated radiological and endoscopic examinations, which were performed after 3-months' treatment, at the end of the 1-year trial period, and towards the end of a follow-up period of approximately 2 1/2 to 3 1/2 years. In men with gastric ulcer, gefarnate proved to be highly effective, with 10 out of the 11 patients who received this treatment showing persistent healing of the ulcer compared with only 4 out of the 11 who were on dummy treatment. In the very small group of women it was not possible to show any difference between treatments. No adverse reactions to gefarnate occurred. These results suggest that gefarnate is a safe and effective treatment for chronic gastric ulcer.     

Penetration of cryotherapy in treatment after shoulder arthroscopy

The authors describe the case of a female patient affected with large symptomatic gastric leiomyoma, six centimeters in diameter, who presented to clinical observation referring gastric pain and melena. The first gastroscopy showed massive bleeding from a submucosal gastric lesion. The lesion was not endoscopically resectable and the injective endoscopic treatment of bleeding failed. The patient was surgically treated with laparotomic excision of the leiomyoma. She was back home in ten days. The authors describe this case to discuss the possibility to resect large gastric leiomyomas using endoscopic resection indeed surgical approach. They also enhance the validity of surgical treatment for its safety and radical approach to large lesions.     

Significance of 5'-deoxy-5-fluorouridine (5'-DFUR) administration before surgery for advanced gastric and colonic cancers--activity of pyrimidine nucleoside phosphorylase (PyNPase) and serum immunosuppressive acidic protein (IAP)

We administered preoperatively 5'-deoxy-5-fluorouridine (5'-DFUR) for treatment of advanced gastric and colonic cancers, and measured pyrimidine nucleoside phosphorylase (PyNPase) in the excised tumor sample and serum immunosuppressive acidic protein (serum IAP), which is an index of the immunity of host-bearing cancer, while studying its direct antitumor effect and improved immunity. Patients with 24 advanced gastric cancers and 36 colonic cancers were randomly divided into a preoperatively administered group and a non-administered group. In the preoperatively administered group, 5'-DFUR (1,200 mg/day) was orally administered on preoperative days 7 approximately 14. After collecting samples (about 0.5 g) from adjacent normal tissues with tumor within 30 minutes after extirpation of tumor and freezing those less than -20 degrees C, the PyNPase level was measured as soon as possible. Moreever, serum IAP levels at pre-administration in the administered group and on admission in the non-administered group were measured. Those in the administered group were measured again on the operative day. No decreasing tendency of PyNPase was generally found in cases with gastric colonic cancers, and no significant difference in stage-II was not either. However, a decreasing tendency in tumor activity was found by pre-administration. Moreover, there was significant improvement in the serum IAP level in cases with gastric and colonic cancers by pre-operative administration of 5'-DFUR. This tendency was also found in advanced colonic cancer with Dukes-C by Dukes's classification. In conclusion, it was suggested that the pre-operative administration of 5'-DFUR for treatment of advanced gastric and colonic cancers has a favorable influence for prognosis because the tumor region was retarded by the high PyNPase activity according to the severity of tumors and elevating tendency of the immune response in host.     

Surgical treatment of varices (author's transl)

Basically three possibilities are available for the treatment of the varicose symptom complex: 1. Varicosclerozation, 2. Surgery, 3. Compression. Dermatologists and internists understandably prefer varicosclerozation; surgeons, surgery. The best success, in my opinion, is achieved with all three possibilities of treatment are used in combination and adjusted individually to the vascular findings of each case. There is no effective varicosclerozation and no surgical treatment without subsequent compression. In no case, can treatment by medication be more than supportive for other effective measures. The goal of this article is to provide information regarding the present status of surgical treatment. Unavoidably, the indication for the other methods of treatment was also established.     

Lymph node metastasis in gastric cancer in the upper third of the stomach--surgical treatment on the basis of the anatomical distribution of positive node

BACKGROUND/AIMS: Little is known about the most appropriate surgical procedure for gastric cancer in the upper third of the stomach. The objective of this study was to determine the most appropriate surgical treatment for gastric cancer in the upper third of the stomach. METHODOLOGY: The clinicopathological characteristics of 115 node-positive gastric cancers in the upper third of the stomach were reviewed retrospectively and compared with those of 111 node-negative gastric cancers in the upper third of the stomach. RESULTS: Node-positive gastric cancers showed higher rates of peritoneal metastasis (p < 0.005), larger tumor sizes (p < 0.005), deeper tumor penetration (p < 0.005), higher rates of diffuse type in histology (p < 0.025), and more advanced histological stages (p < 0.005), than node-negative gastric cancers. Patients with node-positive gastric cancer demonstrated a poorer survival rate than those with node-negative gastric cancer (p < 0.005). Lymph node metastasis along the lower stomach was observed in cases of gastric cancer which had invaded beyond the muscularis propria of the stomach but not in those confined within the muscularis propria. No lymph node metastasis in the splenic hilum was found in association with gastric cancer when the depth was limited to the mucosa or the submucosa. CONCLUSION: The appropriate surgical procedures for the treatment of gastric cancer in the upper third of the stomach are as follows: a) proximal gastrectomy without splenectomy for gastric cancer when the depth is limited to the mucosa or the submucosa, b) proximal gastrectomy with splenectomy for gastric cancer when the depth of invasion extends to the muscularis propria, c) total gastrectomy with splenectomy for gastric cancer when the depth of invasion extends beyond the muscularis propria.     

Gastric motor dysfunction in diabetic patients: pathogenesis, clinical manifestations, diagnosis and treatment

Recent reports provide evidence, that the disordered gastric motoric function in diabetic patients depends on glycaemia and that it can influence metabolic control. The etiopathogenesis of disordered gastric motoric function is poorly understood and is mainly hypothetical. The diagnosis of this dysfunction is difficult. It is recommended to evaluate of gastric motility, especially by scintigraphy, manometry and electrogastrography. In the treatment, it is important to remember about the good metabolic control of diabetes and use the gastrokinetic drugs in the combination or alternating therapy. In especially severe cases, surgical therapy is indicated. Lack of effective method of gastric motoric dysfunction treatment in diabetic patients suggest the necessity of further studies on new drugs, which would normalise the motoric abnormality and eliminate the symptoms.     

Immediate results of surgical treatment of gastric stump cancer

An immediate result of surgical treatment of gastric stump cancer in 68 patients is presented. The resectability rate was 23.5%. Lethality after radical operations was 18.7%, after symptomatic operations and exploratory laparotomy-9.6%. Gastric resection was performed, using the method developed in the clinic with wrapping the anastomosis, or gastric stump by a loop of the afferent intestine. In development of gastric stump cancer, local spreading of a tumor is not a reason to discard performance of radical operation.