European Journal of Surgery最新文献

{"title":"Chronic idiopathic anal pain","authors":"John Christiansen","doi":"10.1080/110241598750004724","DOIUrl":"10.1080/110241598750004724","url":null,"abstract":"PURPOSE: This study was undertaken to analyze whether intra-anal ultrasound examination, anorectal physiologic evaluation, and histopathologic examination in patients with chronic idiopathic anal pain presented any common features and whether the results of different treatment modalities correlated with these findings. METHODS: Eighteen patients who met the criteria for chronic idiopathic anal pain were studied. All had an intra-anal ultrasound examination and a complete anorectal physiologic evaluation. In a selected group of patients, ultrasound-guided biopsy samples were taken from pathological areas in the internal and external sphincter. Treatment consisted of analgesics only in four patients, 0.2 percent nitroglycerin ointment in four, and ultrasound injection of botulin (botulinum toxin, Botox®) into the intersphincteric space in nine. Two patients, including one who was previously treated with botulin, ultimately had a colostomy. RESULTS: Four patients were managed satisfactorily on analgesic treatment under the guidance of the hospital's pain clinic. Nitroglycerin ointment resulted in temporary pain relief in one of four patients. Injection of botulin resulted in a permanent improvement in four patients, a temporary improvement in one patient, and no effect in four patients. Two patients had a colostomy, resulting in complete pain relief. The effect or lack of effect of nitroglycerin ointment and botulin was not related to changes in anal pressure. CONCLUSION: Chronic idiopathic anal pain is a condition of unknown origin for which no proven therapy exists. As in other syndromes based on muscular dystonia, some patients may benefit from injection of botulin.","PeriodicalId":100508,"journal":{"name":"European Journal of Surgery","volume":"164 2","pages":"83-88"},"PeriodicalIF":0.0,"publicationDate":"2003-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/110241598750004724","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20459729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An insidious case of streptococcal soft tissue infection","authors":"Steven E. Buijk, Karan J. Kanhai, Jan T. Weststrate, Hajo A. Bruining","doi":"10.1080/110241598750004841","DOIUrl":"10.1080/110241598750004841","url":null,"abstract":"","PeriodicalId":100508,"journal":{"name":"European Journal of Surgery","volume":"164 2","pages":"153-155"},"PeriodicalIF":0.0,"publicationDate":"2003-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/110241598750004841","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20460236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidelines for the correct conduct of clinical research in surgery","authors":"Alan V. Pollock","doi":"10.1080/110241598750004454","DOIUrl":"10.1080/110241598750004454","url":null,"abstract":"<p>Clinical research may be either epidemiological or experimental. Epidemiological (observational) research includes cross-sectional, case-control, and cohort studies and draws attention to associations, which may or may not denote cause and effect. Experimental research may be explanatory, the purpose of which is to advance our knowledge of physiological or pathological events; or it may be pragmatic, the purpose of which is to influence our treatment of patients. All these types of clinical research have their own rules, but underlying the detailed rules are the universal ones of telling the truth and doing no harm. Copyright © 1998 Taylor and Francis Ltd.</p>","PeriodicalId":100508,"journal":{"name":"European Journal of Surgery","volume":"164 4","pages":"243-249"},"PeriodicalIF":0.0,"publicationDate":"2003-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/110241598750004454","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20559749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An “all comers” policy for ruptured abdominal aortic aneurysms: how can results be improved?","authors":"Mary C. Barry,&nbsp;Paul E. Burke,&nbsp;Stephen Sheehan,&nbsp;Austin Leahy,&nbsp;Patrick J. Broe,&nbsp;David J. Bouchier-Hayes","doi":"10.1080/110241598750004481","DOIUrl":"10.1080/110241598750004481","url":null,"abstract":"<div>\u0000 \u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective:</h3>\u0000 \u0000 <p>To review our experience of a non-selective policy for the treatment of ruptured abdominal aortic aneurysm to see if the policy was justified, and to identify any preoperative risk factors that adversely influenced outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design:</h3>\u0000 \u0000 <p>Retrospective study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting:</h3>\u0000 \u0000 <p>Teaching hospital, Republic of Ireland.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects:</h3>\u0000 \u0000 <p>258 patients admitted with abdominal aortic aneurysms between January 1982 and December 1993.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions:</h3>\u0000 \u0000 <p>Definitive surgical treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures:</h3>\u0000 \u0000 <p>Morbidity, mortality, and risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results:</h3>\u0000 \u0000 <p>In-hospital mortality for all patients was 43% (110/258). Overall, women did worse than men (28/44, 64%, died, compared with 96/214, 45%, <i>p</i> = 0.03). The mortality among patients over the age of 80 (23/45, 51%) was not significantly different from that among younger patients (97/202, 48%). Blood pressure, platelet count, and haemoglobin concentration were all significantly lower preoperatively among those who died (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions:</h3>\u0000 \u0000 <p>Age alone cannot be used to justify witholding definitive surgical treatment. Treatment should be aimed towards reversing haematological and haemodynamic abnormalities preoperatively to try to improve outcome. Copyright © 1998 Taylor and Francis Ltd.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100508,"journal":{"name":"European Journal of Surgery","volume":"164 4","pages":"263-270"},"PeriodicalIF":0.0,"publicationDate":"2003-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/110241598750004481","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20559752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is pyloric function preserved in pylorus-preserving pancreaticoduodenectomy?","authors":"Luigi G. Lupo,&nbsp;Oronzo C. Pannarale,&nbsp;Donato F. Altomare,&nbsp;Lucrezia Caputi,&nbsp;Laura Dell'Erba,&nbsp;Pasquale Ricci,&nbsp;Vincenzo Memeo","doi":"10.1080/110241598750004788","DOIUrl":"10.1080/110241598750004788","url":null,"abstract":"<div>\u0000 \u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective:</h3>\u0000 \u0000 <p>To assess the function of the pylorus after pylorus-preserving pancreaticoduodenectomy (PPPD) done for periampullary or pancreatic cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design:</h3>\u0000 \u0000 <p>Prospective, observational controlled clinical study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting:</h3>\u0000 \u0000 <p>Teaching hospital, Italy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects:</h3>\u0000 \u0000 <p>17 patients who had undergone PPPD, and 15 healthy control subjects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Investigations:</h3>\u0000 \u0000 <p>Endoscopy to check for gastritis and marginal ulcers and 24 h-pH monitoring and ^99mTc HIDA scintigraphy to detect jejunogastric reflux. Scintigraphy was also used to evaluate gastric and jejunal transit after a solid meal labelled with ^99mTc colloid sulphur.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures:</h3>\u0000 \u0000 <p>Signs of delayed gastric emptying, jejunogastric reflux and gastric outlet obstruction in the short and long term.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results:</h3>\u0000 \u0000 <p>In the early postoperative period only 1 patient had delayed gastric emptying. In the long term, two patients had symptoms of dyspepsia and 8/11 showed alkaline reflux with persistent gastric pH more than 4 for more than 12 hours; 3 had histological signs of gastritis. There was no difference in gastric emptying compared with controls, but three patients had prolonged emptying time (T1/2 more than 85 minutes). Endoscopy findings correlated with pH monitoring results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions:</h3>\u0000 \u0000 <p>After PPPD, most patients have abnormal pyloric function, but it is clinically evident in only a small proportion. Copyright © 1998 Taylor and Francis Ltd.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100508,"journal":{"name":"European Journal of Surgery","volume":"164 2","pages":"127-132"},"PeriodicalIF":0.0,"publicationDate":"2003-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/110241598750004788","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20460230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subcutaneous splenosis: report of a case diagnosed 36 years after splenectomy","authors":"Clark J. Zeebregts,&nbsp;Christiaan De Bruyne,&nbsp;Hans R. J. Elbers,&nbsp;Wim J. Morshuis","doi":"10.1080/110241598750004823","DOIUrl":"10.1080/110241598750004823","url":null,"abstract":"","PeriodicalId":100508,"journal":{"name":"European Journal of Surgery","volume":"164 2","pages":"149-150"},"PeriodicalIF":0.0,"publicationDate":"2003-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/110241598750004823","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20460234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The surgeon as a risk factor for complications of midline incisions","authors":"Leif A. Israelsson","doi":"10.1080/110241598750004382","DOIUrl":"10.1080/110241598750004382","url":null,"abstract":"<div>\u0000 \u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective:</h3>\u0000 \u0000 <p>To compare among surgeons the risk-adjusted rates of wound infection and incisional hernia after midline incisions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design:</h3>\u0000 \u0000 <p>Prospective clinical study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting:</h3>\u0000 \u0000 <p>County hospital, Sweden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects:</h3>\u0000 \u0000 <p>1013 patients who underwent midline laparotomy between August 1989 and June 1993.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions:</h3>\u0000 \u0000 <p>Wounds were sutured by a continuous technique and details of patients and operations were recorded. The suture technique was monitored by the suture length:wound length ratio.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures:</h3>\u0000 \u0000 <p>Postoperative wound infection, and incidence of incisional hernia at 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results:</h3>\u0000 \u0000 <p>The details of patients and operations varied significantly among surgeons. Senior surgeons sutured with a lower suture length:wound length ratio than juniors (mean (SD) 4·1 (1·4) compared with 5·3 (2·1), <i>p</i> &lt; 0·01). The individual rates of wound infection varied from 0 to 27% (mean 10%) and that of incisional hernia from 5% to 26% (mean 15%). After correction for patient selection three surgeons had significantly higher rates of wound infection and one significantly lower than the others, two surgeons had significantly higher rates of incisional hernia and two significantly lower. Only one surgeon differed significantly in the rate of incisional herniation after also adjusting for the suture technique. The length of surgical experience did not affect the rate of wound complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion:</h3>\u0000 \u0000 <p>The suture technique, monitored by the SL:WL ratio, is the most important factor for variability in the incidence of incisional hernia among surgeons in continuously sutured midline incisions. The suture technique may also help to explain the variability in rates of wound infection. Copyright © 1998 Taylor and Francis Ltd.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100508,"journal":{"name":"European Journal of Surgery","volume":"164 5","pages":"353-359"},"PeriodicalIF":0.0,"publicationDate":"2003-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/110241598750004382","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20585061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of bile duct stones: lithotripsy by laser, electrohydraulic, and ultrasonic techniques","authors":"Per Jonas Blind,&nbsp;Mats Lundmark","doi":"10.1080/110241598750004201","DOIUrl":"10.1080/110241598750004201","url":null,"abstract":"","PeriodicalId":100508,"journal":{"name":"European Journal of Surgery","volume":"164 6","pages":"403-409"},"PeriodicalIF":0.0,"publicationDate":"2003-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/110241598750004201","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20613209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two cases of arteriovenous malformation of the intestine treated by laparoscopic surgery","authors":"C. Vara-Thorbeck,&nbsp;R. Toscano,&nbsp;V. Requena,&nbsp;M. Salvi,&nbsp;A. Martin-Palanca,&nbsp;V. Muñoz","doi":"10.1080/110241598750005958","DOIUrl":"10.1080/110241598750005958","url":null,"abstract":"INTRODUCTIONWhen conventional diagnostic tests fail to show thecause of gastrointestinal haemorrhage we must bear inmind the possibility of arteriovenous fistulas.Since 1960 when Margolis et al. (11) showed inangiographic studies that arteriovenous fistulas exist, anumber of authors have described angiomatous lesionsthat may be confused with arteriovenous ones (2, 9).Consequently, there is a need to describe how todifferentiate arteriovenous fistulas from intestinalhaemangiomas. Haemangiomas are generally macro-scopic lesions that can easily be seen and some casesare detected by barium studies; they are palpablemasses found often in the stomach, small intestine, andrectum. Arteriovenous fistulas, on the other hand, aremicroscopic lesions generally found in the right colonthat cannot be detected by palpation or by conventionaldiagnostic methods.When Meyer et al. (12) reviewed published reportsand documented 22 of their own cases in 1981, theyfound only 218 cases that involved arteriographicstudies.Our two cases, post-operatively confirmed to bearteriovenous fistulas, serve to indicate not only theeffectiveness of laparoscopy to explore and treat thisdifficult condition, but also the complications that mayoccur even with minimally invasive surgery in elderlypatients with arteriovenous fistulas and several life-threatening diseases.CASE 1A 25-year-old woman was admitted with a history ofintermittent rectal bleeding for several years with noother gastrointestinal symptoms. Her haemodynamicstate was stable, but her mucosa was pale. At digitalrectal exploration the finger was covered with redblood. Haematological analysis showed that she had anormocytic, normochromic anaemia. Endoscopy of theupper gastrointestinal tract, intestinal transit study, andcolonoscopy were within normal limits. Mesentericarteriography showed that the terminal branches of theileocaelic artery were tortuous and abnormally wide(Fig. 1). We decided to treat her laparoscopically.A Verres needle was introduced into the umbilicalregion under general anaesthesia, to induce pneumo-peritoneum. Three ports were used: a 10 mm one in theumbilicus, another 10 mm one in the left subcostal areain the midclavicular line, and a 5 mm one in the leftiliac fossa. We introduced the optic through theumbilical trocar to explore the entire intestine and theabdominal cavity and noted that the segment of ileumthat had looked abnormal on the arteriogram wasthickened. We exteriorised this loop through a McBur-ney’s incision, resected the diseased segment, anasto-mosed the two ends of healthy intestine extracorpore-","PeriodicalId":100508,"journal":{"name":"European Journal of Surgery","volume":"164 7","pages":"553-556"},"PeriodicalIF":0.0,"publicationDate":"2003-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/110241598750005958","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20613424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gerard M. Doherty, Dirk S. Baumann, Lawrence L. Creswell, John A. Goss, Terry C. Lairmore (Editors). The Washington manual of surgery. Little, Brown and Company. Boston, Massachusetts, 1996. (632 pages). ISBN 0-316-92446-6","authors":"Gudrun Lindmark","doi":"10.1080/110241598750005002","DOIUrl":"10.1080/110241598750005002","url":null,"abstract":"","PeriodicalId":100508,"journal":{"name":"European Journal of Surgery","volume":"164 1","pages":"77"},"PeriodicalIF":0.0,"publicationDate":"2003-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/110241598750005002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77239221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}