No abstract available.
Humans ; Purpura, Thrombocytopenic, Idiopathic* ; Splenectomy*

No abstract available.
Catheters*

No abstract available.
Pancreas*

No abstract available.
Gastrectomy*

No abstract available.
Carcinoma, Hepatocellular/mortality/*surgery ; Hepatectomy ; Human ; Liver Neoplasms/mortality/*surgery ; Liver Transplantation ; Neoplasm Recurrence, Local ; Survival Rate

BACKGROUND: Pancreatoduodenectomy is a standard operation for benign and malignant lesions of the periampullary area. Even though the complication and the mortality rates have markedly decreased owing to recent developments in surgical techniques and postoperative care, the complication rates still remain high. Especially, pancreatic leakage is the main cause of death today in a pancreatoduodenectomy, so surgical techniques dealing with this problem have emerged as a major issue. The usual techniques used have been the duct ligation method, the duct occlusion method, a pancreatojejunostomy, and a pancreatogastrostomy. However, a recent trend has been to maintain pancreato-enteric continuity. Thus, the authors used a pancreatojejunostomy with the duct-to-mucosa method to decrease the complications. METHODS: The authors retrospectively reviewed the medical records of 56 patients who had undergone a pancreatoduodenectomy between January 1987 and July 1997 by one surgeon. RESULTS: The male-to-female ratio was 1.4:1 and the mean age was 55.5 years (ranging from 25 to 77). A Whipple's operation was done in 44 cases, and a pylorus-preserving pancreatoduodenectomy was done in 12 cases. All the cases used a pancreatojejunostomy with the duct-to-mucosa method. No pancreatic leakage was observed in any of the 56 cases. The immediate postoperative complication rate was 28.6%, and there was one (1.8%) postoperative mortality due to adult respiratory distress syndrome. Six patients complained of minimal exocrine functional abnormality, but only one patient, who had suffered severe chronic pancreatitis preoperatively, routinely now takes a pancreatic enzyme. However, even after long-term follow up, no endocrine insufficiency has been detected. CONCLUSIONS: Through our experience, a pancreatojejunostomy with the duct-to-mucosa method is a secure and reasonable method and can be used for all patients undergoing a pancreatoduodenectomy.
Cause of Death ; Follow-Up Studies ; Humans ; Ligation ; Medical Records ; Mortality ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy* ; Pancreatitis, Chronic ; Postoperative Care ; Postoperative Complications ; Respiratory Distress Syndrome, Adult ; Retrospective Studies

Insulin is well known to have a hepatotrophic effect, but exogenous insulin has a negative effect on liver regeneration because it decreases the level of endogenous insulin. Howerver intraportal exogenous insulin will have some differences. This study was set up to analyse the effect of portal insulin via intraperitoneal route on liver regeneration in rats which have a normal pancreas with or without liver cirrhosis after partial hepatectomy. Beforehand, insulin levels of the portal blood at the time intervals of 0, 30, 60, 120, and 240 minutes after intraperitoneal injection of insulin were measured and compared with those after subcutaneous injection. The results were: 1.5, 140.9, 58.6, 20.4, 14.3 g/ml in intraperitoneal group(n=14) and 1.5, 22.3, 27.1, 32.4, 29.1 g/ml in subcutaneous group(n=14). Intraperitoneally injected insulin was absorbed more rapidly than subcutaneously injected insulin. Thirty nine rats with normal liver were divided into 5 groups A(n=8): intraperitoneal saline, B(n=9): intraperitoneal insulin 2 IU/Kg, C(n=7): subcutaneuos insulin 2 IU/Kg, D(n=7): intraperitoneal insulin 5 IU/Kg, E(n=8): subcutaneous insulin 5 IU/Kg. They were all 2/3 partial hepatectomized and remnant livers were obtained after 24 hours after hepatectomy. Ninety minutes before sacrifice, 100 Ci,H3-thymidine was injected intraperitoneally and their C.P.M./ g of DNA was measured and compared with each other groups. The same procedures were done with another twenty seven rats with liver cirrhosis (A'(n=5), B'(n=6), C'(n=6), D'(n=5), E'(n=5)) which was induced by oral ingestion of CCl4 for 12 weeks. The results were: 38.29, 25.77, 14.37, 34.04, 23.83 C.P.M./ g in normal rat group and 23.76, 8.11, 10.89, 8.80, 12.22 C.P.M./ g. In normal rat, the C.P.M.'s of intraperitoneal groups were higher than those of subcutaneous group and the difference was statistically significant between A and C group (p<0.05). In cirrhotic group, there were not any significant differences between any two groups. It can be concluded that exogenous insulin has an inhibitory effect on liver regeneration. But intraperitoneal insulin exerts less inhibitory effect on liver regeneration than subcutaneous insulin because intraportal insulin is more potent in liver regeneration and has less negative feed back on endogenous insulin than systemic insulin.
Animals ; DNA ; Eating ; Hepatectomy ; Injections, Intraperitoneal ; Injections, Subcutaneous ; Insulin* ; Liver Cirrhosis ; Liver Regeneration* ; Liver* ; Pancreas ; Rats*

The European Association for the Study of the Liver (EASL) in 2001 and the American Association for Liver Diseases (AASLD) in 2005 followed the Barcelona - Clinic Liver Cancer (BCLC) staging classification and treatment schedule. Surgical resection can be offered for patients who have a single lesion if they are not cirrhotic or have cirrhosis and still have well-preserved liver function, normal bilirubin and hepatic vein pressure <10 mmHg (level II). But the Japanese Practice Guideline reported by the Japanese Society of Hepatology in 2007 recommended surgical resection for 2 or 3 tumors no more than 3 cm in diameter, even in cases with 4 or more lesions. The differences in practice guidelines between these two areas come from different cultural situations, especially in the availability of transplantation. Our results from hepatic resection in 834 patients with HCC from 1992 to 2004 at Seoul National University Hospital were as follows: 1) After surgical resection, the favorable prognostic group are patients with tumor size less than 10 cm in size without major vessel invasion. 2) Surgical resection is recommended in the favorable group of patients with oligonodular tumors. 3) Surgical resection is not indicated for patients with major vessel tumor invasion or portal hypertension. In the AASLD guidelines, liver transplantation is an effective option for patients with HCC, corresponding to the Milan criteria: solitary <5 cm or up to three nodules <3 cm (level II), and a living donor transplantation can be offered for HCC if the waiting time is long enough to allow tumor progression leading to exclusion from the waiting list (level II). Japanese Practice Guidelines restrict liver transplantation to patients under the age of 65. The role of salvage liver transplantation is still controversial. Early detection and the development of therapeutic agents for metastases by microvascular tumor invasion are important for increasing survival of HCC patients.
Appointments and Schedules ; Asian Continental Ancestry Group ; Bilirubin ; Carcinoma, Hepatocellular ; Fibrosis ; Gastroenterology ; Glycosaminoglycans ; Hepatic Veins ; Humans ; Hypertension, Portal ; Liver ; Liver Diseases ; Liver Neoplasms ; Liver Transplantation ; Living Donors ; Neoplasm Metastasis ; Transplants ; Waiting Lists

No abstract available.
Crohn Disease*

No abstract available.
Tuberculosis*