Small-bowel enteroscopy with the double-balloon method was developed to improve access to the small intestine. This study evaluated the usefulness of this method for the resection of small-intestinal Peutz-Jeghers pol...Small-bowel enteroscopy with the double-balloon method was developed to improve access to the small intestine. This study evaluated the usefulness of this method for the resection of small-intestinal Peutz-Jeghers polyps. Two patients with Peutz-Jeghers syndrome underwent nonsurgical doubleballoon enteroscopic resection of polyps throughout the small intestine. Multiple polyps in the jejunum were successfully resected via the oral route, as were the polyps in the ileum via the anal route. All 18 polyps (10-60 mm in size) were resected without subsequent bleeding or perforation. Histopathologically, 3 large polyps (>30 mm diameter) were hamartomas with adenomatous components. Double-balloon enteroscopy was safe and useful for the diagnosis and the treatment of Peutz-Jeghers polyps throughout the small intestine. Double-balloon enteroscopic polypectomy might preclude complications of Peutz-Jeghers syndrome, including intussusception, bleeding, and tumorogenesis, thereby obviating the need for multiple laparotomies.展开更多
Objective: To evaluate adhesion reformation after laparoscopic excision of endometriosis and adhesiolysis in women with chronic pelvic pain. Design: Prospective clinical trial. Setting: University hospital. Patient(s)...Objective: To evaluate adhesion reformation after laparoscopic excision of endometriosis and adhesiolysis in women with chronic pelvic pain. Design: Prospective clinical trial. Setting: University hospital. Patient(s): Thirty-eight women with endometriosis and chronic pelvic pain. Intervention(s): A primary and second-look laparoscopy with adhesiolysis and excision of endometriotic lesions with a neodymium-yttrium argon garnet surgical laser technologies (SLT) contact laser. Main Outcome Measure(s): Adhesion formation and character (thin, thin and thick, or thick). Location of adhesions at a first laparoscopy was compared with de novo or reformation of adhesions and the location of adhesions at a second surgery. Result(s): Adhesions or adhesions combined with endometriotic lesions were significantly more likely to reform at second surgery compared with sites having only an endometriosis lesion. Thick adhesions were associated with a significantly increased likelihood of an adhesion reforming, compared with thin adhesions or thin and thick adhesions. Lesions or adhesions involving the ovarywere more likely to be associated with adhesions at a subsequent surgery, compared with lesions in the adjacent ovarian fossa or fallopian tube. Conclusion(s): Most patients developed adhesions after radical surgical excision of endometriosis for pelvic pain. The high incidence of adhesion formation after surgery for endometriosis underscores the importance of optimizing surgical techniques to potentially reduce adhesion formation.展开更多
To determine whether the ovarian trauma consequent to the laparoscopic removal of a cyst could result in the development of a humoral immunity, antiovarian antibodies were assayed in serum samples obtained from 40 wom...To determine whether the ovarian trauma consequent to the laparoscopic removal of a cyst could result in the development of a humoral immunity, antiovarian antibodies were assayed in serum samples obtained from 40 women before and after cystectomy.展开更多
Thoracoscopy has an expanding role in the treatment of FD cysts (bronchogenic cysts and esophageal duplications). We examined this trend in our patients and reviewed our overall experience. All charts of children unde...Thoracoscopy has an expanding role in the treatment of FD cysts (bronchogenic cysts and esophageal duplications). We examined this trend in our patients and reviewed our overall experience. All charts of children undergoing surgery for foregut duplications (FDs) in 2 pediatric hospitals between 1992 and 2003 were retrospectively reviewed. Data gathered included age, weight, symptoms, diagnostic tests, operative technique, postoperative course, complications, and outcome. There were 39 children, with FD resected by thoracotomy in 21 patients, thoracoscopy in 11 patients (no conversions to open), cervical incision in 6 patients, and laparotomy in 1 patient for an FD near the gastroesophageal junction. Diagnosis was made by antenatal ultrasound in 7 cases. Four of these neonates had tachypnea or cough, and the rest were asymptomatic. Seventy-five percent of patients diagnosed postnatally presented with respiratory symptoms. Excision of isolated FD (without lung resection)was compared between those who had a thoracotomy (n = 16) vs thoracoscopy (n = 11). The age, weight, operating time, and anesthesia time were not different between the 2 groups. However, the thoracoscopy group had significantly fewer chest tube days (1.6 vs 3.3 days) and a shorter hospital stay (2.6 vs 6.6 days). Intraoperative complications consisted of tracheal injury in 3 patients (2 thoracotomy, 1 thoracoscopy)-and esophageal mucosal injury in 2 patients (both thoracotomy), which were all recognized and repaired. Foregut duplications may present in a variety of ways and locations. Thoracoscopy is advantageous for isolated intrathoracic FDs.展开更多
Background and aims:In studies with small numbers of cases,it has been shown that endoscopic resection of adenomas in ulcerative colitis represents adequate treatment.In a larger study cohort with more prolonged follo...Background and aims:In studies with small numbers of cases,it has been shown that endoscopic resection of adenomas in ulcerative colitis represents adequate treatment.In a larger study cohort with more prolonged follow up,we assessed the reliability of this finding.Methods:Between 1988 and 2002,148 consecutive patients,mainly from private gastroenterologists’ practices,with ulcerative colitis were diagnosed as having an adenoma.In 60 patients,histological diagnosis was established in biopsies and in 87 patients in polypectomy specimens;one patient underwent proctocolectomy following diagnosis.The outcome of these patients was analysed after a mean follow up period of 6.0(3.63) years.Results:Among 60 patients,surprisingly without endoscopic treatment,48.3% developed ulcerative colitis associated neoplasia in the same colon segment(23.3% low grade intraepithelial neoplasia;8.3% high grade intraepithelial neoplasia;16.7% carcinoma) .Among 87 patients undergoing polypectomy of the adenoma,follow up revealed colitis associated neoplasia in other segments of colon in 4.6% of cases.Conclusion:Development of adenocarcinomas in a total of 6.7% of the overall patient group,and in 2.3% of those undergoing polypectomy,indicates that biopsy based diagnosis of an adenoma in ulcerative colitis must be considered to mandate endoscopic resection of the lesion;40% of affected patients did not receive any form of endoscopic removal of the lesion.This shows that the most recent guidelines are not followed in a considerable number of patients with ulcerative colitis in private practice in Germany.Although polypectomy of the adenoma represents adequate therapy,further regular follow up examinations are nevertheless necessary.展开更多
文摘Small-bowel enteroscopy with the double-balloon method was developed to improve access to the small intestine. This study evaluated the usefulness of this method for the resection of small-intestinal Peutz-Jeghers polyps. Two patients with Peutz-Jeghers syndrome underwent nonsurgical doubleballoon enteroscopic resection of polyps throughout the small intestine. Multiple polyps in the jejunum were successfully resected via the oral route, as were the polyps in the ileum via the anal route. All 18 polyps (10-60 mm in size) were resected without subsequent bleeding or perforation. Histopathologically, 3 large polyps (>30 mm diameter) were hamartomas with adenomatous components. Double-balloon enteroscopy was safe and useful for the diagnosis and the treatment of Peutz-Jeghers polyps throughout the small intestine. Double-balloon enteroscopic polypectomy might preclude complications of Peutz-Jeghers syndrome, including intussusception, bleeding, and tumorogenesis, thereby obviating the need for multiple laparotomies.
文摘Objective: To evaluate adhesion reformation after laparoscopic excision of endometriosis and adhesiolysis in women with chronic pelvic pain. Design: Prospective clinical trial. Setting: University hospital. Patient(s): Thirty-eight women with endometriosis and chronic pelvic pain. Intervention(s): A primary and second-look laparoscopy with adhesiolysis and excision of endometriotic lesions with a neodymium-yttrium argon garnet surgical laser technologies (SLT) contact laser. Main Outcome Measure(s): Adhesion formation and character (thin, thin and thick, or thick). Location of adhesions at a first laparoscopy was compared with de novo or reformation of adhesions and the location of adhesions at a second surgery. Result(s): Adhesions or adhesions combined with endometriotic lesions were significantly more likely to reform at second surgery compared with sites having only an endometriosis lesion. Thick adhesions were associated with a significantly increased likelihood of an adhesion reforming, compared with thin adhesions or thin and thick adhesions. Lesions or adhesions involving the ovarywere more likely to be associated with adhesions at a subsequent surgery, compared with lesions in the adjacent ovarian fossa or fallopian tube. Conclusion(s): Most patients developed adhesions after radical surgical excision of endometriosis for pelvic pain. The high incidence of adhesion formation after surgery for endometriosis underscores the importance of optimizing surgical techniques to potentially reduce adhesion formation.
文摘To determine whether the ovarian trauma consequent to the laparoscopic removal of a cyst could result in the development of a humoral immunity, antiovarian antibodies were assayed in serum samples obtained from 40 women before and after cystectomy.
文摘Thoracoscopy has an expanding role in the treatment of FD cysts (bronchogenic cysts and esophageal duplications). We examined this trend in our patients and reviewed our overall experience. All charts of children undergoing surgery for foregut duplications (FDs) in 2 pediatric hospitals between 1992 and 2003 were retrospectively reviewed. Data gathered included age, weight, symptoms, diagnostic tests, operative technique, postoperative course, complications, and outcome. There were 39 children, with FD resected by thoracotomy in 21 patients, thoracoscopy in 11 patients (no conversions to open), cervical incision in 6 patients, and laparotomy in 1 patient for an FD near the gastroesophageal junction. Diagnosis was made by antenatal ultrasound in 7 cases. Four of these neonates had tachypnea or cough, and the rest were asymptomatic. Seventy-five percent of patients diagnosed postnatally presented with respiratory symptoms. Excision of isolated FD (without lung resection)was compared between those who had a thoracotomy (n = 16) vs thoracoscopy (n = 11). The age, weight, operating time, and anesthesia time were not different between the 2 groups. However, the thoracoscopy group had significantly fewer chest tube days (1.6 vs 3.3 days) and a shorter hospital stay (2.6 vs 6.6 days). Intraoperative complications consisted of tracheal injury in 3 patients (2 thoracotomy, 1 thoracoscopy)-and esophageal mucosal injury in 2 patients (both thoracotomy), which were all recognized and repaired. Foregut duplications may present in a variety of ways and locations. Thoracoscopy is advantageous for isolated intrathoracic FDs.
文摘Background and aims:In studies with small numbers of cases,it has been shown that endoscopic resection of adenomas in ulcerative colitis represents adequate treatment.In a larger study cohort with more prolonged follow up,we assessed the reliability of this finding.Methods:Between 1988 and 2002,148 consecutive patients,mainly from private gastroenterologists’ practices,with ulcerative colitis were diagnosed as having an adenoma.In 60 patients,histological diagnosis was established in biopsies and in 87 patients in polypectomy specimens;one patient underwent proctocolectomy following diagnosis.The outcome of these patients was analysed after a mean follow up period of 6.0(3.63) years.Results:Among 60 patients,surprisingly without endoscopic treatment,48.3% developed ulcerative colitis associated neoplasia in the same colon segment(23.3% low grade intraepithelial neoplasia;8.3% high grade intraepithelial neoplasia;16.7% carcinoma) .Among 87 patients undergoing polypectomy of the adenoma,follow up revealed colitis associated neoplasia in other segments of colon in 4.6% of cases.Conclusion:Development of adenocarcinomas in a total of 6.7% of the overall patient group,and in 2.3% of those undergoing polypectomy,indicates that biopsy based diagnosis of an adenoma in ulcerative colitis must be considered to mandate endoscopic resection of the lesion;40% of affected patients did not receive any form of endoscopic removal of the lesion.This shows that the most recent guidelines are not followed in a considerable number of patients with ulcerative colitis in private practice in Germany.Although polypectomy of the adenoma represents adequate therapy,further regular follow up examinations are nevertheless necessary.
