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Biomedical subjects

L F Hollender

Publications and source records attributed to L F Hollender.

At least 55 records · Page 3Linked to original sources
PubMed1986

[Chronic pancreatitis--drainage or resection?].

In certain cases of chronic pancreatitis, the severity of the disease can lead to surgery. In the indication for operation 4 factors are determining: development of complications, severe intractable pain, cachexia of pancreatic origin, and the diminishing cases of suspicion of carcinoma. The surgical strategy depends mostly on the enlargement of the Wirsungian duct and on the topography of the lesions. Has the Wirsungian duct reacted at least 1 cm in diameter on 6-7 cm length, a latero-lateral isoperistaltic wirsungo-jejunostomie with Roux-en-Y loop seems to be a worthwhile procedure. Are the lesions located predominatly in the head of the pancreas with a narrowed Wirsungian duct, a subtotal duodenopancreatectomy is indicated. If the body and tail of the gland are mostly involved, a left pancreatectomy will be performed, combined with one of the different possibilities of a retrograde drainage of the remaining right pancreas. Follows a critical analysis of the 197 cases operated by the authors. After discussion of mortality and morbidity, late results are studied, patients being divided into 2 groups according to a follow-up of 5 years or less. 56% of the patients treated by subtotal duodenopancreatectomy demonstrated good results after 5 years. But only 43 % of patients with a wirsungo-jejunostomy and 38% of patients with left pancreatectomy belonged to this group. Finally, arguments in favour of a drainage procedure or resection are specified.

Adult↗
PubMed1985

[Current status of the treatment of perforated duodenal ulcer].

A European study involving 15 major centres shows that the surgical treatment of a perforated duodenal ulcer depends closely upon the underlying condition and the operative risk. The latter is determined on the basis of the age of the subject, the time since the perforation, and the chronicity of the ulcer as well as the possible concomitant existence of severe medical pathology. In the optimal situation, preference is given to suture of the perforation and supraselective vagotomy. When general conditions are poor, the tendency is for a more simple approach such as simple suture or even the Taylor Wangensteen method. Type B II gastric resection remains indicated where there is associated bleeding or in the presence of large non-suturable ulcers which cannot be dealth with by a Rives-type patch of epiploon.

Age Factors↗
PubMed1985

[Total duodenal diversion by fundo-jejunostomy with Roux-Y-loop in the treatment of severe postoperative recurrent reflux esophagitis].

Fundo-jejunostomy with a 60 cm long Roux-en-Y loop removes almost all symptoms in severe postoperative recurrent reflux esophagitis. We analysed 12 own cases and compared them with those published in literature. 90% of most satisfactory results were obtained. Nevertheless indication for fundo-jejunostomy must be discussed and limited to those cases, which do not respond to medical treatment.

Duodenum↗
PubMed1984

[Acute hemorrhagic necrotizing pancreatitis. Analysis of 58 patients].

The authors stress the therapeutic importance of peritoneal lavage for eliminating toxic substances from the abdominal cavity. In cases of a stenosing papilla or an impacted gallstone, endoscopic papillotomy and stone extraction are recommended. The indication for surgical interventions, like nekrosectomy or segmental resection of the pancreas, are discussed in detail. In case of diffuse recurrent peritonitis the technique of the "open abdomen" should be taken into consideration. The results of 44 resections and 14 necrosectomies are represented. The overall mortality rate comes up to 35 or 40% respectively.

Acute Disease↗
PubMed1983

[Value of blood lipase determination in pancreatic diseases. Comparison with blood amylase assay].

The comparative diagnostic value of plasma lipase and amylase levels was evaluated in 90 patients with various symptoms of pancreatic disease. Comparison with healthy subjects showed that the lipase assay was more sensitive than the amylase assay in patients with acute pancreatitis or post-traumatic pancreatic injury, but not in patients with chronic pancreatitis. On the other hand, acute pancreatitis can be detected earlier by measuring plasma amylase levels, owing to the rapid release of this enzyme. The relative importance of these two laboratory tests is discussed.

Amylases↗
PubMed1983

[Surgical treatment of acute necrotizing hemorrhagic pancreatitis. Analysis and prospective deductions on 58 cases].

Three degrees of severity could be recognized in 58 patients operated upon for severe acute hemorrhagic pancreatitis, based on results of intensive care, particularly anti-shock therapy, wide peritoneal lavage, and possible need for endoscopic relief of sphincter of Oddi obstruction due to a stone. The principal parameters evaluated were clinical and biological features and the course of the affection. As a result of these data, 44 pancreatic resections of variable extension and 14 excisions of necrotic tissues were performed. Results of these two types of operations, as well as the dominant causes of postoperative and secondary deaths, are analyzed in detail. The indications for surgery are discussed, together with the tactical methods to be applied as a function of the general condition and the detailed study of the pancreas and the state of the adjacent organs. Particular importance should be attached to the presence of respiratory insufficiency. The possible need for routine biliary external drainage is discussed, and the major role played by parenteral nutrition, which should be initiated as early as possible, is emphasized. These findings suggest that two fundamental principles should guide surgery of acute hemorrhagic pancreatitis: the need for surgery in selected cases, though over-aggressive operations should be avoided, and, more particularly, the concept, to be shared of the need for repeated operations, enabling avoidance of excessive procedures during initial surgery.

Acute Disease↗