Surgery annual最新文献

{"title":"Techniques for endoscopic obliteration of esophageal varices.","authors":"G Van Stiegmann","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Endoscopic treatment is widely accepted for both initial and subsequent definitive therapy in patients with hemorrhage from esophageal varices. Endoscopic sclerotherapy, once performed with rigid endoscopes in anesthetized patients, is now performed with flexible endoscopes in awake patients, who frequently return home immediately after the procedure. Such treatment does not confer a survival advantage in the early period after variceal hemorrhage, but serial treatment does result in a lower risk of recurrent hemorrhage and probably prolongs life. Primary treatment by endoscopic sclerotherapy appears to be equal or more effective than primary shunt therapy, even with a sclerotherapy failure rate of from 10 to 30 percent. In spite of such results, the incidence of rebleeding and treatment-related complications and the mortality among sclerotherapy-treated patients remain high. Newer forms of endoscopic treatment such as polymer injection and mechanical ligation have emerged in attempts to better the results obtained with sclerotherapy. Refinement of the technique for conventional sclerotherapy and the potential for increased effectiveness of the new techniques may yet result in improved and safer endoscopic therapy for bleeding esophageal varices.</p>","PeriodicalId":76570,"journal":{"name":"Surgery annual","volume":"23 Pt 1 ","pages":"175-202"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13154449","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":"Update on the status of fetal surgery.","authors":"M T Longaker,&nbsp;N S Adzick,&nbsp;M R Harrison","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76570,"journal":{"name":"Surgery annual","volume":"23 Pt 2 ","pages":"53-68"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13018278","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":"Application of laser energy in urologic surgery.","authors":"J A Smith","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76570,"journal":{"name":"Surgery annual","volume":"23 Pt 2 ","pages":"81-97"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13018280","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":"Gallstone lithotripsy.","authors":"B D Schirmer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>ESWL, in its present state of technology, is unlikely to displace endoscopy as the treatment of first choice for common duct stones present after cholecystectomy, since endoscopic sphincterotomy is necessary to enhance passage of stones from the ductal system. However, when endoscopy fails, ESWL may prove a useful adjunctive treatment for both choledocholithiasis and intrahepatic stones. ESWL for gallstones is currently an evolving treatment option for patients with symptomatic gallstones. On the basis of data presented, its efficacy for fragmenting stones seems established, as does its safety using current guidelines. There is a high rate of success in patients with one or several small cholesterol gallstones. Although definitive proof has yet to be established, it is widely believed that the use of adjuvant bile salt therapy is essential for improving the clearance and dissolution of fragments resulting from ESWL. ESWL for gallstones, of all the nonsurgical treatments, seems to have the greatest advantage as an alternative to surgical intervention since it is the least invasive and can be performed in the ambulatory setting. In comparing ESWL to cholecystectomy, it holds the potential major advantages of being an outpatient treatment, keeping time off from work to a minimum, and being extremely well tolerated by and much less painful for a patient. Its major disadvantages at this time include its applicability to only a small segment of the patients with gallstones. Like all other nonsurgical treatments, it is also not a definitive treatment of gallstones, recurrent stone formation rates possibly being as high as 50 percent or more within 5 years of treatment. In today's scheme of health care delivery, the use of ESWL may ultimately depend on the willingness of the public or health care system to bear the additional costs of multiple treatments of gallstones during a person's lifetime as opposed to one definitive operation with its associated discomforts and temporary disability. The emergence of ESWL for treating gallstones has resulted in a not unexpected criticism, though probably a healthy criticism from the surgical community in general. However, as emphasized in a recent editorial, we surgeons owe it to our patients to be prepared to offer the best suitable treatment for their condition. ESWL in its present state may be that treatment for only a few patients with gallstones, but advancing technology could increase its applicability. Surgeons should therefore continue to lead by knowing how to use lithotripsy to treat cholelithiasis.</p>","PeriodicalId":76570,"journal":{"name":"Surgery annual","volume":"23 Pt 1 ","pages":"91-114"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13154454","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":"Intestinal ischemia.","authors":"U H Haglund,&nbsp;P O Park","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76570,"journal":{"name":"Surgery annual","volume":"23 Pt 2 ","pages":"173-86"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13018276","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":"Overview of surgery: 1991.","authors":"J A Collins","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76570,"journal":{"name":"Surgery annual","volume":"23 Pt 1 ","pages":"1-29"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13154446","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":"Pathogenesis of hepatic steatosis during total parenteral nutrition.","authors":"M S Nussbaum,&nbsp;J E Fischer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The hepatic toxicity of TPN that is seen clinically appears to be multifactorial in origin. Most patients develop a combination of hepatic steatosis with evidence of cholestasis and abnormalities in liver function. The model that we have studied is one of pure hepatic steatosis since, on repeated study, these rats do not develop any liver function abnormalities. It is unclear whether this is related to the fact that these are short-term experiments, that rat livers respond differently from humans, or that rats do not have gallbladders. It has not been possible to carry these experiments out beyond 3 weeks since the rats develop bacterial colonization of the central lines as well as evidence of line sepsis. thus confounding the issue of hepatic toxicity being due to the TPN or to sepsis. One hypothesis is that hepatic steatosis is an early marker of liver toxicity and that prevention or reversal of hepatic steatosis may protect the liver from further abnormality. Insulin and glucagon seem to play a critical role in the development of TPN-associated hepatic steatosis. Specifically, an elevated portal venous insulin-glucagon molar ratio appears to be the primary stimulus and any treatment that lowers this ratio should diminish hepatic steatosis. The use of glucagon as a treatment modality is new. We have found no evident side effects of low dose glucagon in rats when it is added to the TPN solution. Glutamine has received much attention recently as a nutritional pharmacological agent in ameliorating some of the intestinal complications of parenteral nutrition and is well tolerated when administered appropriately. Intravenous lipid administration is an important nonprotein calorie source, especially when a high dextrose base cannot be used, and plays a role as well in preventing the development of hepatic steatosis. Thus, it is suggested that the clinical treatment of hepatic steatosis during TPN can be safely performed using any one, or a combination, of these modalities and without having to discontinue the TPN infusions. Since we observed no deterioration of liver function in rats receiving TPN for up to 2 weeks, we cannot completely relate these findings and recommendations to the hepatic dysfunction seen clinically with the use of TPN. Additional study will be required before this can be conclusively determined.</p>","PeriodicalId":76570,"journal":{"name":"Surgery annual","volume":"23 Pt 2 ","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13067828","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":"Hereditary colon cancer syndromes.","authors":"R J Fitzgibbons,&nbsp;H T Lynch,&nbsp;G M Salerno","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76570,"journal":{"name":"Surgery annual","volume":"23 Pt 2 ","pages":"111-32"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13018273","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":"Fecal diversion for Crohn disease of the colon.","authors":"M C Winslet,&nbsp;M R Keighley","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76570,"journal":{"name":"Surgery annual","volume":"23 Pt 2 ","pages":"99-110"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13018281","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 current status of the management of civilian injuries to the colon.","authors":"L W Baker,&nbsp;S R Thomson","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76570,"journal":{"name":"Surgery annual","volume":"23 Pt 1 ","pages":"203-23"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13154450","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}