[Secondary sigmoido-rectal-anal invagination. Case report and review of the literature].
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Biomedical subjects
Publications and source records attributed to V Paolucci.
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There is no agreement about a conservative surgical strategy in the therapy of acute necrotizing pancreatitis yet. This report describes our experience with "open packing" laparostomy. This procedure is only performed when renal and pulmonary insufficiency is proceeding, despite optimal conservative treatment. Since 1986 15 patients were treated in this manner. Three compartments are established: an upper compartment (stomach, liver, spleen--covered by the omentum majus, which is dissected from the colon transversum); a lower compartment (small bowel--covered by the left colon) and the mid compartment that permanently opens the bursa omentalis and the left retrocolic space. Initially a careful necrosectomy is performed, followed by a tamponade. At the intensive care unit changing of the tamponade and lavage of the bursa omentalis was done every day. So far two patients have died pursuing this therapeutic regimen.
The treatment of patients with advanced carcinomas of esophagus and gastric cardia endoscopic palliation should restore the passage for normal oral uptake. We compared the results of two methods: endoscopic neodym-YAG-laser-therapy (group I: 24 patients) and endoscopic perturbation (group II: 56 patients). An initial recanalisation was achieved after 1-4 sessions in group I and after 1-2 sessions in group II. Recurrence of dysphagia caused in median 5 endoscopic interventions in group I and 2 in group II. We observed no complications in group I and 5 complications in group II. The median survival times were not significantly different. The results and the follow-up show no definite superiority of one of the two methods, the selection of treatment modality depends on the technical possibilities and the personal experience of the physicians.
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