Early derivation operation can restore the pancreas histology and function in chronic obstructive pancreatitis in the cat.

Background/aims: Obstruction of the main pancreatic duct leads to progressive obstructive and atrophying pancreatitis in the cat. The question remains whether "early" derivative procedures can halt the destructive process or not?

Methodology: Twelve cats submitted to total obstruction of the main pancreatic duct developed chronic obstructive pancreatitis as documented by histopathology. After 5 weeks, five animals underwent a caudal pancreaticojejunostomy, the others served as controls.

Outcome after 'curative' surgery for carcinoma of the lower third of the rectum.

Background: Controversy exists about the optimal surgical resection for lower third rectal carcinoma. The aim of this retrospective study was to analyse whether the type of surgery is a significant predictor of outcome after curative surgery alone.

Methods: Eighty-two consecutive patients underwent abdominoperineal rectum excision (APRE, 41 patients) or sphincter-saving operation (SSO, 41 patients) for adenocarcinoma at 3.

Clinical and manometric effects of combined external beam irradiation and brachytherapy for anal cancer.

This study evaluates anorectal function after combined tele- and brachytherapy for anal cancer using manometric measurements and a standardized questionnaire. Eight patients received 44 +/- 3 Gy external beam radiation followed by 20 +/- 4 Gy interstitial brachytherapy with iridium-192. Patients were examined 43 months (range 25-83) after therapy.

Surgery for gastric remnant carcinoma following Billroth II gastrectomy.

Between January 1983 and December 1995, 31 patients with gastric remnant carcinoma were operated on 6-45 years after a Billroth II resection for peptic ulcer disease. Total gastrectomy with Roux-en-Y reconstruction was performed in all cases. In 16 patients (52%) extended resection with removal of one or more adjacent organs was necessary for oncological reasons.

Delayed remote abscess formation after spillage of infected gallstone during laparoscopic cholecystectomy: CT and US findings.

We report on a patient who presented an abdominal wall abscess two years after percutaneous cholecystectomy. The diagnosis of wall abscess caused by migrating gallstones could be made sonographically, whereas thin-section spiral CT failed to show the cause of the abscess: a non-calcified gallstone.

Diagnostic accuracy of ultrasonography and surgical decision-making in patients referred for suspicion of appendicitis.

Two groups of patients referred for suspicion of acute appendicitis were compared to evaluate the accuracy of preoperative ultrasonography (US) and surgical decision-making. In one retrospective study, US was performed by trainees using a 3.5 MHz probe (219 patients).

Controlled trial of metronidazole treatment for prevention of Crohn's recurrence after ileal resection.

Background/aims: New lesions recur within weeks to months after ileal resection and ileocolonic anastomosis for Crohn's ileitis. A double-blind controlled trial was performed using metronidazole to prevent recurrence after ileal resection.

Methods: Sixty patients who underwent curative ileal resection and primary anastomosis were included within 1 week after surgery.

Radical versus local surgical treatment for rectum carcinoma. A variety of options?

Local excision has to be classified as either indeterminate or non curative from a surgical oncological point of view. It seems to be an acceptable procedure for well differentiated, exophytic/polypoid pT1 lesions of less than 3 cm in diameter, providing the resection margins are tumour-free. For all other lesions radical surgery is to be preferred, unless the patient is unfit for major surgery or refuses an eventual permanent colostomy.

Manometric evaluation of incontinent patients.

The relationship between symptoms and manometric data was studied in incontinent patients. Conventional anal manometry, the rectal saline infusion test and the balloon-retaining test were performed in 27 control subjects (M:8, F:19; mean age: 47 yr) and in 40 incontinent patients (M:5, F:35; mean age: 49 yr). The correlation coefficient between the clinical degree of continence/incontinence and the maximum anal basal tone, squeeze pressure and the pressure increment during squeeze was -0.

Three cases of non-tumoural tight stenosis of the bifurcation of the hilar bile ducts.

Stenosis of the bifurcation of the hepatic bile duct is usually caused by malignant lesion. We report on three different causes of benign stenosis of the hepatic confluence with a similar radiological pattern on direct cholangiography. The first case is considered a spontaneous neuroma, the second a periductal abscess, and the third case a postoperative stricture Bismuth type 4.

Clinical value of whole-body positron emission tomography with [18F]fluorodeoxyglucose in recurrent colorectal cancer.

To assess the clinical value of whole-body positron emission tomography (PET) with [18F]fluorodeoxyglucose (FDG) in recurrent colorectal cancer, 35 patients were studied: 15 had resectable liver metastases, one a resectable lung metastasis, eight resectable pelvic recurrence, eight a presacral mass with equivocal findings on imaging, and three increasing serum levels of carcinoembryonic antigen (CEA) without clinical or radiological signs of recurrent disease. PET affected management decisions in seven of 16 patients with metastatic disease. In one of eight patients with pelvic recurrence demonstrated by computed tomography (CT), PET detected unknown pulmonary metastases.

Interleukin-6 and coagulation-fibrinolysis fluctuations after laparoscopic and conventional cholecystectomy.

This study assesses quantitatively the fluctuations of interleukin-6 (IL-6) and coagulation-fibrinolysis proteins in patients undergoing elective laparoscopic (n = 14) and conventional (n = 10) cholecystectomy. The patients in both groups were comparable in age and sex. Serum levels of interleukin-6, and plasma levels of fibrinogen, von Willebrand factor-antigen, tissue-type plasminogen activator-antigen, and plasminogen activator inhibitor-1 were determined for up to 48 h postoperatively.

Imaging of polypoid endoluminal growing bile duct tumors.

We reviewed the radiological documents and protocols of 196 cases of bile duct tumors examined over a period of 12 years: 20 of them (10.2%) presented with a polypoid endoluminal growth. The aim of this study was to provide a better knowledge about the radiological features of this less frequent kind of tumor.

Restorative proctocolectomy in elective and emergency cases of ulcerative colitis.

A consecutive series of restorative proctocolectomy for ulcerative colitis was reviewed to determine whether an emergency restorative proctocolectomy procedure leads to a higher morbidity, more especially anastomotic leakage. Severity of illness and nature of surgery were divided in two categories: (1) no acute disease and elective surgery (18 patients), (2) acute disease requiring emergency surgery either immediately or within one week of admission (12 patients). Morbidity after elective surgery was 27% and after emergency surgery 66% (P < 0.

The trigger for rectal filling sensation.

In order to evaluate whether rectal volume, weight or pressure is the main trigger for rectal sensation, their respective values were determined at each of the rectal filling sensation thresholds (first, constant, urge, maximum) in 12 adult control subjects. The rectal balloon was filled at 60 ml/min in sitting position using water (twice), air and mercury consecutively. Pressure values were corrected for the elastic properties of the balloon, while the volume of inflated air was recalculated taking into account the prevalent rectal pressure and temperature.

Duodenal leiomyosarcoma.

We present a case of duodenal leiomyosarcoma studied with computerized tomographic (CT) and magnetic resonance (MR) images. Some differential diagnostic remarks are mentioned. The topographic abilities of MR to determine the exact origin of the tumor are stressed.

Paraprosthetic fistula after aortobifemoral prosthetic reconstruction: treatment by autogenous saphenous venous replacement. A case report.

Paraprosthetic fistula is a rare but dramatic complication of aortofemoral prosthetic reconstruction. Conventional treatment consisting of removal of the prosthesis and extra-anatomical revascularization results in a high morbidity and mortality rate. The authors present a patient with a paraprosthetic fistula, who was successfully treated by excision of the graft and "in situ" replacement by autogenous saphenous vein.

Repeated hepatic ischemia in combination with chemotherapy for liver carcinoid metastases.

Both hepatic ischemia and chemotherapy are effective in the treatment of carcinoid liver metastases, but their effectiveness is often limited, partial and transient. It has been shown that, during intermittent occlusion of the hepatic artery with a surgically implanted occluder, no revascularisation from collaterals occurs. We studied the feasibility, the side-effects, the response to tumour measurements and hormonal excretions of a combined treatment of repeated hepatic ischemia and 5-Fluorouracil and Streptozotocin-administration in carcinoid liver metastases.

Valvular colonic sphincter substitutes. An experimental study in dogs.

Three types of colonic sphincter substitutes were placed at an abdominal colostomy in dogs. Simple valve construction (8) was based on orthograde intussusception of the colon over 3.5 cm.

Inflammatory fibroid polyp of the ileum.

We report a patient who presented with recurrent right upper quadrant colics after a previous cholecystectomy. Radiological examination revealed the presence of a polypoid mass in the ileum caused by an anatomo-pathologically proven inflammatory fibroid polyp (IFP) in the ileum. Clinical and pathological aspects related to this rare benign lesion are discussed.

The internal anal sphincter can not close the anal canal completely.

We determined the maximum closing capability of the internal anal sphincter muscle ring in vitro and in vivo. The internal sphincter, 4 to 6 mm thick, cannot close the anal canal hermetically, not even during maximal contraction. The blood-filled anal cushions have to fill up an intrasphincteric gap of at least 7 to 8 mm in diameter.

Acute colonic pseudo-obstruction.

We present two cases of acute colonic pseudo-obstruction, one complicated with perforation. Orthopedic surgery was the pathogenetic factor in both cases. Recovery was successful in both patients after appropriate treatment.