Biomedical subjects

Juozas Pundzius

Publications and source records attributed to Juozas Pundzius.

17 recordsLinked to original sources

PubMed2006

Clinical and anatomical basis for the classification of the structural parts of liver.

Progress of diagnostic human's liver imaging (ultrasound, computerized tomography, magnetic nuclear resonance, etc.) stimulates development of modern liver surgery. Therefore, before and during the operation, surgeons and radiologists can determine the site and extent of liver damage, its relationship with blood vessels and ascertain which part of the liver should be resected. For this reason, physicians have to know anatomical and clinical peculiarities of the liver. Naming of the parts of this complex inner organ is still highly varied: parts, halves, lobes, divisions, sectors, segments, and subsegments. Our understanding and explanation of liver composition are still defined differently among anatomists, surgeons, and radiologists, thus not only confusing less experienced specialists, but also increasing probability of mistakes. Such lack of communication aggravates the design of an operation plan and its documentation, which frequently may even result in undesirable legal consequences. Unified terms among surgeons and radiologists are of importance not only in clinical settings of one country, but also on the international level (e.g. when comparing results of surgery). The smallest parts of the liver are defined using C. Couinaud's segmentation system, allowing for a precise identification of the site of liver damage, as well as to plan methods of segment resection that would protect the remaining hepatic tissue. The classification that best meets the needs of surgeons and radiologists was the one proposed by H. Bismuth. We suggest that this classification should also be used by our physicians who are engaged in diagnostics and treatment of hepatic diseases in their practice. We also discuss other classifications used worldwide (those proposed by J. Healey and P. Schroy, N. Goldsmith and R. Woodburne, C. Couinaud, and H. Bismuth) and present recommendations of global societies of anatomists and surgeons.

Bile Ducts, Intrahepatic↗

PubMed2006

[Multiple endocrine neoplasia type 2A].

Multiple endocrine neoplasia (MEN) type 2A, or Sipple syndrome, is a rare autosomal dominantly inherited syndrome, which is characterized as combination of medullary thyroid carcinoma, pheochromocytoma, primary hyperparathyroidism, sometimes with rarer inherited disorders like Hirschsprung disease and cutaneous lichen amyloidosis. Syndrome is caused by germinative mutations in c-ret protooncogene, which are typical for different MEN 2 syndromes. We report a clinical case of MEN 2A. A 43-year-old female patient was operated on for pheochromocytoma 7 years after diagnosis and treatment of spread medullary thyroid carcinoma. This is the most common combination of MEN 2A tumors. Diagnosis was based upon clinical data, tumors combinations and analysis of inherited endocrine pathology in first-line relatives. This syndrome has already been diagnosed in Lithuania, but in the last decade after determining the genetic basis of MEN 2 and applying modern genetic examinations in clinical praxis, the strategy of diagnostics and prophylaxis of this syndrome has changed and survival prognosis for patients with this syndrome has improved. Conception of pathogenesis and clinical features of MEN 2A syndrome, genetic selection of inheritors of this syndrome is one more step in early cancer diagnosis, which allows to use cancer prevention measures in time, to apply effective treatment and improve patients' prognosis. Reporting this clinical case of MEN 2A we aimed to pay attention of general practitioners to this rare, but in Lithuania diagnosed too, syndrome and its clinic, diagnostic, and treatment features.

Adrenal Gland Neoplasms↗

PubMed2006

Predicting development of infected necrosis in acute necrotizing pancreatitis.

The incidence of severe acute pancreatitis is about 30 cases per 100,000 inhabitants, and it carries an overall mortality rate of 10-15%. Infection of pancreatic necrosis occurs in 20-30% of patients with severe acute pancreatitis and triples the mortality rate. Therefore, early prediction and diagnosis of infection in necrotizing pancreatitis are extremely important. The aim of the studies included in this review was to investigate the potential of specific prognostic factors to predict the development of secondary pancreatic infection in severe acute pancreatitis. This is seen as an important tool allowing to perform a computed tomography- or ultrasound-guided fine needle aspiration for bacteriological sampling at the right moment, to confirm the diagnosis, and, finally, to select the subgroup of patients who would benefit from the antibiotic prophylaxis. Precise patients' selection could possibly result in more rational use of antibiotics in patients with acute necrotizing pancreatitis and reduction of multi-resistant bacteria. Recent studies show that C-reactive protein is an important prognostic marker of pancreatic necrosis with the highest sensitivity and negative prognostic value in this respect. Procalcitonin alone or in combination with interleukin-6 best identifies patients not at risk for infection. However, a review of the clinical studies suggests that we still do not have an optimal model, thus there is a need for new more reliable biochemical and/or clinical predictive systems.

APACHE↗

PubMed2005

Prognostic factors for short and long-term survival in patients selected for liver transplantation.

UNLABELLED: Indices for predicting of survival are essential tools for assessing prognosis and establishing priority for liver transplantation. Our aim was to investigate the survival and prognostic significance of Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) scale for short and long-term survival prognosis in waitlist of patients selected for liver transplantation. MATERIAL AND METHODS: The group of 236 patients with diagnosis of different chronic liver disease was investigated in period of 4.5 years. Persons with CTP scoring > or =10 were included into the waitlist for liver transplantation. Other inclusion criteria were based on CTP scoring > or =7 plus one or more liver cirrhosis complications. The cumulative and mean survivals were evaluated according to the Kaplan-Meier statistical analysis. The distribution and the survival data for the patients were based on biochemical variables. The clinical status of waitlist patients was evaluated by applying the CTP and MELD scales. The short and long-term survival prognosis was assessed. The odds ratios with 95% confidence interval univariate analysis were evaluated. RESULTS: During the period of 4.5 years 45 persons were selected for waitlist group. Mortality rate was 51.1%, average survival--17.9 months. The significant trends towards higher cumulative proportion of survival were observed for the patients with low serum bilirubin, creatinine and low blood urea. The highest mortality rate was in the group with CTP scores > or =12. The highest mortality and the shortest average of survival were in the group of cases with the highest scores. It was established the significant difference for short-term survival (less than 3 months) prognosis in MELD scale. CTP scores had no predictive influence for survival during 3 months. Also both scoring had high prognostic value for prediction of the long-term survival (more than 3 months). Deterioration of cumulative survival and overall survival were affected by increase of serum bilirubin, blood urea and creatinine. Increase of scores in CTP and MELD scale had the direct positive correlation with increased mortality. MELD scale has higher capability to predict short-term mortality risk in patients with end-stage liver disease. CTP and MELD scales have proven good prognostic capabilities both for short and long-term survival in patients with chronic liver disease.

Bilirubin↗

PubMed2005

[Multiple endocrine neoplasia syndromes. Type 2].

The second type of multiple endocrine neoplasia syndromes can be described as rare syndromes, heritable in autosomal dominant manner and linking medullary thyroid carcinoma to different tumors of endocrine organ system and endocrinopathies. This syndrome is divided into multiple endocrine neoplasia syndrome type 2A (MEN 2A), characterized with combination of medullary thyroid carcinoma, pheochromocytoma and primary hyperparathyroidism; type 2B (MEN 2B), characterized with combination of medullary thyroid carcinoma, pheochromocytoma, marfanoid habitus and ganglioneuromatosis, and familial medullary thyroid carcinoma syndrome, characterized with the only indication, which is hereditary medullary thyroid carcinoma. Though type 2 multiple endocrine neoplasia syndrome has been known since 1961, yet, the cause of the syndrome, which is germline mutations of c-ret protooncogene, was detected just a decade ago and syndrome pathogenesis with its characterized endocrine neoplasia carcinogenesis machinery were detected. Implementation of progressive genetic researches in clinical practice enabled precise diagnosis of multiple endocrine neoplasia syndrome and its subtypes not only for ill patients but also for healthy syndrome inheritors, e.g. relatives of the sick. Stated genotype link to phenotype helps to prognosticate possible combinations of endocrine neoplasia and endocrinopathies, and to choose purposeful patient observation. Genetic screening of the inheritors of multiple endocrine neoplasia type 2 syndrome enabled purposeful researches and observations of patients with a huge risk of uprising endocrine neoplasia, it also enabled application of effective prophylaxis methods, avoidance or early diagnostic of malignant tumors and life prognosis improvement for patients with malignant tumors while practicing well-timed treatment adaptation. This literature review contains the newest data on multiple endocrine neoplasia syndrome type 2 and its pathogenesis, diagnostics, patient observation, endocrine cancer prophylaxis and methods of treatment, which are characteristic for syndrome and which are being chosen according to biochemical endocrine neoplasia symptoms and genetic diagnosis.

Adolescent↗

PubMed2005

Etiology of bile infection and its association with postoperative complications following pancreatoduodenectomy.

UNLABELLED: Currently controversy exists whether bile infection following preoperative biliary drainage has an impact on postoperative complications and mortality rate. The objective of the study was to determine etiology of preoperative bile infection and to evaluate its influence on postoperative complications and mortality after pancreatoduodenectomy. METHODS: Data on 64 patients, undergoing pancreatoduodenectomy at Kaunas University of Medicine Hospital between 2002 and 2004 were collected prospectively. We evaluated etiology and the impact of bile infection on development of post-operative complications. Patients were divided into groups according to results of intraoperative bile culture. RESULTS: In 31 patients (48.4%) intraoperative bile cultures were negative, while in remaining 33 patients (51.6%) infected bile was documented. Both patient groups were homogenous according to demographic data, preoperative and intraoperative variables. Pancreaticoduodenectomy was performed in 21 patients after preoperative biliary drainage (endoscopic stenting, bilidigestive anastomosis or percutaneous bile drainage), others (n=43) had primary operation. Infected bile was found more often in patients who underwent biliary drainage (p<0.0001). Among 43 patients with primary pancreaticoduodenectomy 22 patients underwent endoscopic retrograde cholangiopancreatography without stenting, while remaining 21 had no preoperative endoscopic manipulation. Infected bile was present in 9 patients after endoscopic retrograde cholangiopancreatography (40.9%) and in 4 without preoperative endoscopy (19%). Enterococcus and Escherichia coli dominated in bile cultures of patients with primary pancreaticoduodenectomy, while multiple species (3 and more microorganisms) dominated following drainage procedures. Septic postoperative complications were identified in 26.6% of cases. Infected bile did not influence both overall and septic postoperative complications. Bacteria causing abdominal cavity and wound infections matched bile cultures in 7.7% of cases only. CONCLUSIONS: Our data show that infected bile is found more often after preoperative biliary drainage procedures. However, bile infection did not increase statistically significantly the number of postoperative septic complication.

Adult↗

PubMed2004

Increased postoperative peritoneal adhesion formation after the treatment of experimental peritonitis with chlorhexidine.

BACKGROUND AND AIMS: Chlorhexidine is known as a substance that produces adhesions. However, in an experimental model of peritoneal injury, lavage with chlorhexidine and saline solutions produced a similar number of adhesions. This study was designed to test the hypothesis that chlorhexidine gluconate 0.05% solution used for the treatment of peritonitis increases formation of postoperative peritoneal adhesions as compared to standard lavage with saline solution. MATERIAL AND METHODS: Forty Wistar rats were randomly allocated to gastric or faecal peritonitis groups. In each group rats were further randomly subdivided into saline or chlorhexidine peritoneal lavage groups. After 30 days the rats were killed and intraperitoneal adhesions were evaluated by adhesion score and grading. RESULTS: Adhesion scores were statistically significantly different between saline and chlorhexidine groups in both gastric and faecal peritonitis models. In the faecal peritonitis chlorhexidine group a 20% small bowel intussusception rate was observed, while there were no such complications in the other study groups. The conglomerate of organs formed by dense adhesions was present in 60% of cases when gastric peritonitis was lavaged by chlorhexidine and in only 10% when saline solution was used ( P<0.05). Neither chlorhexidine nor saline solutions have caused such dense adhesions in faecal peritonitis. CONCLUSION: Peritoneal lavage with chlorhexidine gluconate 0.05% solution in the treatment of experimental peritonitis results in increased adhesion formation.

Animals↗

PubMed2004

Results of treatment of primary liver cancer at Kaunas University of Medicine Hospital.

Though the results of treatment of primary liver cancer depend on many circumstances, the opportunity to perform a curative liver resection remains the main point in prognosis on survival. The aim of the study was to examine our first experience in the treatment of liver cancer. From 1996 to 2001 we observed 54 patients with liver cancer: 46 hepatocellular and 6 cholangiocellular carcinomas, 1 malignant carcinoid, and 1 carcinosarcoma. In presence of liver cirrhosis (21 patients, 38.8%) hepatic function was evaluated using Child Pugh classification. Lesions were multiple in 28 cases and single in 26 cases. Ten patients (18.5%) were radically resected, 12 patients (22.2%) were managed by laparotomy and biopsy, 2 by percutaneous ethanol injections, 1 by trans-ileocolic portal vein embolization + hepatic artery embolization. There were 7 deaths (28%) and 18 complications (72%) after the surgical treatment. The survival results of patients who underwent resection were better (median 240 days) compared with palliative treatment group (median 113.3 days); by Log-Rank test p=0.208. CONCLUSION. The use of liver resections in patients affected by single or monolateral liver cancer is effective and potentially radical treatment. Mortality and morbidity rate is high. Alternative therapies can be conveniently considered in case of multicentric Child B-C patients.

Adult↗

PubMed2004

[Multiple endocrine neoplasia syndroms. Type 1].

Multiple endocrine neoplasia (MEN) type 1 syndrome or Wermer syndrome is a classical malignant neoplasia syndrome, inherited in the autosomal dominant pattern, when hyperplastic and/or neoplastic injury develops synchronously or metachronously in the cells of the parathyroid gland, pancreas islets, hypophysis, and rarer in other neuroendocrine organs. The syndrome develops when germinative MEN 1--neoplasia suppression gene inactivation mutations occurs. More than 95 percent of patients have this MEN 1 gene mutation, when the penetration of mutation is almost 100 percent. An early stage of this syndrome is hyperfunction in organs, with the syndromes of hormone excess, later benign and/or malign neoplasia develops, this mostly determines the prognosis for the patient. The risk of this syndrome developing should be estimated for all the patients diagnosed with endocrine organ hyperplasia, which determines hyperfunction, or endocrine organs neoplasia. For patients with multiple endocrine neoplasia type 1 syndrome, endocrine neoplasia develops earlier than in sporadic cases; multifocality is typical for them. Multifocality of neoplasia, typical combinations of injuries and anamnesis of the family helps to diagnose the syndrome. Diagnosis is confirmed through genetical analysis, which is also important in determining the inheritors of mutations, potential patients. After genetically diagnosing multiple endocrine neoplasia type 1 syndrome, it is not enough to analyze and look after patients with malignant neoplasia, or to make early diagnosis on pre-neoplasic disease and neoplasia, or to apply means of prevention and start well-timed treatment, but also to diagnose this syndrome for the patient's relatives, and to determine their risk of getting cancer. This opens new possibilities in early diagnostics and prevention of malignant neoplasia. The main purpose of this literature review is to introduce medical-practitioners to the newest theories of type 1 multiple endocrine neoplasia syndrome pathogenesis, clinical peculiarities, methods of diagnostics and treatment.

Adult↗

PubMed2004

[Pancreaticojejunal anastomosis: the "Achilles heel" of pancreaticoduodenectomy].

This article reviews available data on factors influencing healing of pancreatic anastomosis following pancreaticoduodenectomy. Technical approaches of various techniques of pancreatic anastomosis including pancreaticogastrostomy are discussed and compared. Attention is paid to the other associated risk factors for pancreatic anastomotic leakage such as patient status, as well as morphologic and physiologic peculiarities of pancreatic remnant. The concept of pharmacological prevention of anastomotic leakage is discussed.

Age Factors↗

PubMed2004

Evaluating average expenditures per case in Kaunas University of Medicine Hospital.

The aim of the study was to evaluate average expenditures per case in Kaunas University of Medicine Hospital (KUMH). Case is defined as one treatment episode in particular inpatient department. Five cost groups have been used and defined in monetary terms in each clinical category (profile): labor costs; medication costs; laboratory, radiology and anesthesiology (for surgical clinics) services costs; running costs of medical equipment supply; other costs (including costs of patients' meal, laundry, transportation, communication, auxiliary services, heating, electricity, water, buildings maintenance and repair, etc.). Cases were analyzed using case mix dimensions: gender, age, absence or presence of surgical operation, patient separation status and inpatient service groups. During the study average expenditures per case were estimated: surgery--1161.10 Litas, therapy--1312.15 Litas, obstetrics and gynecology--685.82 Litas, newborn and child care--893.54 Litas and intensive care--1292.92 Litas. Relation between expenditures and case mix variables was measured using correlation analysis method. Using multiple regression analysis method, expenditures per case in each clinical category (profile), according case mix dimensions were predicted. Predicted expenses did not differ much from estimated cost per case.

Adolescent↗

PubMed2003

Results of treatment of extrahepatic cholangiocarcinoma at Kaunas University of Medicine Hospital.

Adenocarcinoma of the extrahepatic bile ducts is considered to be a rare cause of obstructive jaundice. Prognosis is poor and only radical surgery can prolong the life of such patients. The aim of study was to evaluate the outcome of treatment of patients having extrahepatic carcinoma of the bile ducts. Patients underwent treatment at Kaunas University of Medicine Hospital. A retrospective study was performed of 57 patients suffering from cancer of extrahepatic bile ducts in 1996-2001. Diagnosis was established by ultrasonography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography and computed tomography. Sixteen patients (25%) received symptomatic treatment. Thirty-three patients (61%), receiving palliative therapy, underwent a biliodigestive bypass (n=14), an intraoperative biliary stenting (n=10), an endoscopic biliary drainage (n=6), or percutaneous transhepatic biliary drainage (n=3). Eight patients (14%) underwent radical resections of bile ducts: five patients had resections of bile ducts with D2 lymphonodectomy, two patients had bile duct resections in combination with pancreatoduodenal resection and one patient had resection of the bile ducts in combination with right hepatectomy. Histological examinations of the resected specimens revealed a curative effect in seven out of eight cases. There were no deaths in the group of radically treated patients. In the group of patients receiving palliative therapy 8 patients died: four patients died because of cardiovascular complications, two patients died of hepatorenal syndromes, one patient died because of multiorgan failure and one died of peritonitis. Five patients died in the group receiving symptomatic treatment. Assessing remote results of treatment, median survival time of patients who underwent resection was 89 days. Survival results of patients who had curative resections were much better (ranging from 277 to 1084 days). Median survival time of patients, receiving palliative treatment, was 65 days and 29 days of group, receiving symptomatic treatment. Recent progress made in surgical techniques and in perioperative management of extrahepatic cholangiocarcinomas as well as modern diagnostic achievements has greatly contributed to the outcomes of radical surgery. The main aim of the treatment is to perform resection of the bile ducts cancer.

Aged↗

PubMed2003

[The impact of morphologic and physiologic peculiarities of the pancreas on pancreas-related complications following pancreatoduodenectomy].

BACKGROUND: The factors influencing failure of pancreaticojejunostomy following pancreatoduodenectomy are still ill-defined. Our previous study showed that age of patient, bilirubinemia or malignant nature of peripancreatic tumor had no impact on pancreas-related morbidity following pancreatoduodenectomy. The hypothesis is that it could be influenced by the level of pancreatic fibrosis, diameter of the main pancreatic duct, and exocrine pancreatic function. Aim of the study was to analyze the impact of morphologic and physiologic peculiarities of pancreatic remnant on development of pancreas-related morbidity after Whipple procedure. MATERIAL AND METHODS: We have analyzed retrospectively clinical data of 122 patients who have undergone pancreatoduodenectomy in the Department of Surgery of Kaunas University of Medicine Hospital during 1995-2001. Fibrosis of pancreatic parenchyma, diameter of main pancreatic duct, and preoperative exocrine function were evaluated. Pancreas-related morbidity was determined as either peripancreatic sepsis or pancreatic fistula. Fibrosis of pancreatic remnant was determined by computer-aided morphometric analysis. The exocrine pancreatic function was tested the day before surgery by Pancreatic Elastase-1 Stool test. RESULTS: One hundred twenty two patients have undergone pancreatoduodenectomy during 1995-2001. Pancreas-related morbidity was encountered in 27 (22.13%) cases, pancreatic fistula in 13 (10.65%) and peripancreatic sepsis in 14 (11.47%). Univariate analysis shows that diameter of main pancreatic duct and level of postoperative amylasemia were significantly different between the groups with and without pancreatic complications (p=0.001 and p=0.002, respectively) as well as there was significant difference of pancreatic exocrine function and fibrosis between the groups of patients who developed pancreas-related complications and who did not (p=0.003 and p=0.026, respectively). When logistic regression analysis was applied on those 4 variables, only one independent risk factor - exocrine pancreatic function at the cut-off of stool Elastase 100 micro g/g was revealed (odds ratio 21.6). The sensitivity of the Stool Elastase-1 test was 0.86, specificity 0.78, positive predictive value - 0.55 and negative predictive value - 0.95. CONCLUSIONS: The level of pancreatic fibrosis, diameter of the main pancreatic duct, and exocrine pancreatic function mainly influence pancreas-related morbidity following pancreatoduodenectomy. Exocrine pancreatic function measured by Stool Elastase-1 test is helpful for the detection of the group of patients with minimal risk for pancreas-related morbidity after pancreatoduodenectomy.

Data Interpretation, Statistical↗

PubMed2003

[Influence of preoperative biliary drainage and obstructive jaundice on the early outcome of pancreaticoduodenectomy].

OBJECTIVE: To assess the influence of jaundice and preoperative biliary drainage (PBD) on postoperative outcome following pancreaticoduodenectomy (PD). MATERIAL AND METHODS: Data of 122 patients who underwent PD for periampular tumors and pancreatic adenocarcinoma in Kaunas University of Medicine Hospital was analyzed. Patients were divided into groups: those who have not underwent PBD, but had preoperative bilirubin level <50 micromol/l (n=42), patients without PBD, but preoperative bilirubin exceeding 50 micromol/l (n=61) and patients who have undergone preoperative PBD (n=19). RESULTS: Overall morbidity following PD was 55.6%. There were 10.7% pancreatic fistulas, 13.1% septic complications (either intraabdominal sepsis or wound infection) and 9% of postoperative intraabdominal bleeding. Postoperative mortality was 9.8%. There was no statistically significant difference in either overall morbidity, pancreatic fistula rates, septic complications, bleeding or postoperative mortality between jaundiced and nonjaundiced patients. Preoperative bilirubinemia in patients without PBD and without postoperative complications did not significantly differ from those without PBD who developed complications. Overall morbidity, pancreatic fistula rate, septic complications, bleeding, postoperative mortality were similar in PBD and nonPBD groups as well as in stented and nonstented patients. CONCLUSIONS: As obstructive jaundice has no impact on postoperative results of PD. PBD or stenting of bile ducts should not be used routinely and is justified in cases when surgery with intent for cure has to be postponed.

Adenocarcinoma↗

PubMed2002

[A rare complication of chronic pancreatitis: pancreatic ascites].

Case report of successful treatment of pancreatic ascitis is presented. Pancreatic ascitis is a rare complication of chronic pancreatitis. A local inflammation of pancreas ducts-system is a cause of pancreatic duct stenosis, later--of pancreatic duct obstruction. That causes dilatation and rupture of pancreatic duct, then pancreatic juice comes to peritoneal cavity and there collects exudate, rich of protein. Diagnosis of pancreatic ascitis is possible after investigation of evacuated peritoneal fluid. Conservative treatment is insufficient in 40-60% cases. Operative technique must be chosen concerning pathology of pancreatic duct. Most important point in pancreatic ascitis treatment is to preserve pancreatic functions. Investigation and correct treatment are necessary conditions of successful treatment of pancreatic ascitis.

Adult↗

PubMed2002

[Results of the surgical treatment of periampullary cancer at the Kaunas Medical University Hospital].

During 1998-2000 (till October 1) 55 radical operations on the pancreas because of periampullary carcinoma were performed in Kaunas Medical University Hospital. There were 50 pancreatoduodenal resections (PDR) and 5 total pancreatectomies (PE). Age of patients ranged from 28 to 78 years, mean age was 61.9 years. Thirty six percent (36.4%) of patients were older than 70 years. Carcinoma of the head of the pancreas was diagnosed in 48 (87.3%) cases, common bile duct carcinoma in 3 (5.5%) cases, carcinoma of p. Vateri in 2 (3.6%) cases and carcinoma of duodenum in 2 (3.6%) cases. Twenty five (45.5%) patients were suffering from first or second stage cancer, 28 (50.9%)--from third stage. Stage IV was diagnosed for 2 (3.6%) patients, due to invasion to the portal, mesenteric or splenic veins. For those patients resection of portal, mesenteric or splenic veins was performed. Malignant invasion to the resection margin of the pancreas was found in 4 (7.3%) patients. Regional lymphadenectomies (D1) were performed in 23 cases and radical lymphadenectomies (D2) in 32 cases. There was no statistically significant difference in overall morbidity after the operations between those two groups. Hospital mortality in PDR group was 8% (4 pts.) and 20% (1pt.) in PE group. Actuarial survival was estimated based on data of February 1, 2001. Survival function was compared between patients who underwent radical (n = 50) and palliative (n = 43) operations. Median survival time after radical operations was 382 days, whereas after palliative operations--128 days. As postoperative morbidity is not influenced by the extent of lymphadenectomy, D2 dissection should be performed. The pancreatic resection during PDR should be performed through macroscopically normal pancreatic tissue. PE is recommended if the macroscopical invasion to distal part of the pancreas is present.

Adenocarcinoma↗

PubMedDate not supplied

Preoperative stratification of pancreas-related morbidity after the Whipple procedure.

Morbidity and mortality after pancreatoduodenectomy are greatly related to dehiscence of pancreatojejunostomy. We have analyzed risk factors of significance for and prediction of pancreas-related morbidity. We have retrospectively analyzed 122 patients. The relationship of fibrosis of pancreas, exocrine function, and diameter of pancreatic duct to pancreas-related morbidity was evaluated. Computer-aided morphometric analysis and the pancreatic elastase-1 stool test were used. Univariate analysis showed that the diameter of the main pancreatic duct and postoperative amylasemia were different in patients with and without pancreatic complications (P = 0.001 and P = 0.002, respectively). Pancreatic exocrine function was reduced and fibrosis was higher in patients without pancreatic complications (P = 0.003 and P = 0.026, respectively). Logistic regression analysis revealed exocrine pancreatic function as an independent risk factor. Pancreas-related morbidity is influenced by pancreatic fibrosis, diameter of pancreatic duct, and exocrine function. Preoperative evaluation of exocrine function allows detection of patients with minimal risk for pancreas-related morbidity.

Adult↗