Abstract:
BACKGROUND:The current opinion is that the reflux of jejunal juice over the whole length of a long Roux-en-Y jejunal loop is very uncommon. We aimed to challenge this concept by monitoring the presence of bile in the organ proximal to a 60-cm loop during a 24-hour period with use of the Bilitec device, an optoelectronic instrument capable of measuring absorbance of a beam of light, the wavelength of which is close to the absorbance peak of bilirubin. PATIENTS AND METHODS:Forty-one patients, 8 of whom had been cholecystectomized, were investigated after total gastrectomy (group I, n = 17), distal gastrectomy (group II, n = 7), or duodenal switch (group III, n = 17). The percentage of recording time absorbance >0. 25 (absorbance scale ranging from 0 to 1) was calculated in reference to data from healthy subjects. RESULTS:Bile was detected in 17 patients (41%), 5 belonging to group I, 2 to group II, and 10 to group III (P = 0.165). Bile exposure remained within the range of controls in 14 patients whereas it was above this range in 3 patients, 2 of whom had disabling heartburn and severe esophagitis. The percentage of time absorbance >0.25 did not significantly differ from one group to another (P = 0.257) or according to whether patients had been cholecystectomized or not (P = 0.439). However, unlike cholecystectomized patients, patients still having their gallbladder refluxed predominantly during postprandial periods. Lengthening of the loop from 60 cm to 110 cm in the 2 symptomatic patients with a pathologic bile reflux resulted in relief of heartburn and healing of esophagitis in both while bile reflux was abolished in 1 and dramatically reduced in the other. CONCLUSIONS:Bile refluxes over the whole length of 4 Roux-en-Y loops out of 10. In most patients, bile reflux remains within the range of healthy subjects, producing neither symptoms nor mucosal damage; and it occurs independently of the organ proximal to the loop, but its timing of occurrence is modified by cholecystectomy. Although only for exceptional indications, lengthening of an incompetent loop is effective in patients with excessive bile reflux and severe related symptoms and lesions.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Collard JM,Romagnoli Rdoi
10.1016/s0002-9610(00)00326-3subject
Has Abstractpub_date
2000-04-01 00:00:00pages
298-303issue
4eissn
0002-9610issn
1879-1883pii
S0002-9610(00)00326-3journal_volume
179pub_type
杂志文章abstract::A 2.5 kg thoracopagus (Siamese) twin and a 0.73 kg premature newborn developed systemic candidiasis and were treated with intravenous miconazole. The conjoined twin was in a state of severe metabolic acidosis, respiratory distress, jaundice, anuria, abdominal distension, and shock. The 0.73 kg premature infant was als...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(79)90349-0
更新日期:1979-11-01 00:00:00
abstract::Esophageal transection with the EEA stapler was performed in five patients with bleeding esophageal varices. Bleeding from varices has not recurred in surviving patients during follow-up of up to 27 months. One death occurred during the postoperative period. Esophageal transection with the EEA stapler is an effective ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(80)90125-7
更新日期:1980-12-01 00:00:00
abstract::The incidence of postoperative wound complications and early cancer recurrence was studied in 289 patients who had mastectomy alone and in 113 patients who underwent immediate reconstruction following mastectomy. Patients undergoing immediate reconstruction were younger and had less advanced disease than patients who ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80572-0
更新日期:1993-07-01 00:00:00
abstract::A small bore feeding tube may be readily introduced into the stomach by splinting it internally, before insertion, with a flexible arteriographic guide wire, which is removed when the tube is in place. Gentle placement of the tube is recommended. ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(80)90374-8
更新日期:1980-05-01 00:00:00
abstract:BACKGROUND:The current trend in breast cancer treatment is toward breast conservation and selective use of axillary lymph node dissection. Patient eligibility criteria for treatment without axillary dissection are evolving. METHODS:We retrospectively reviewed the tumor registry over a 10-year period at Naval Medical C...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/S0002-9610(96)00249-8
更新日期:1996-11-01 00:00:00
abstract:PURPOSE:To provide an algorithm for the management of hepatic cysts through an analysis of our series over 16 years. METHOD:We reviewed the surgical management and outcome of patients with hepatic cysts between 1984 and 2000 at a single institution. Data were collected by chart review, telephone interview, and follow-...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(01)00611-0
更新日期:2001-05-01 00:00:00
abstract:BACKGROUND:Alcohol use may alter mental status and vital signs in injured patients, leading to increased testing during emergency department (ED) evaluation. We hypothesized that alcohol use increases the hospital charges when caring for these injured patients. METHODS:The National Hospital Ambulatory Medical Care Sur...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2012.08.014
更新日期:2013-07-01 00:00:00
abstract:BACKGROUND:It was hypothesized that splenectomy following trauma results in hypercoagulability. METHODS:A prospective, nonrandomized, single-center study was performed to evaluate coagulation parameters in trauma patients with splenic injury. RESULTS:Patients with splenectomy (n = 30) and nonoperative management (n =...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2010.01.015
更新日期:2010-05-01 00:00:00
abstract::Splenectomy results in a lifelong risk of overwhelming infection in the adult as well as the child. This has prompted our current enthusiasm for splenic salvage in trauma patients. A number of alternatives to total splenectomy exist; however, the complications that result from splenic salvage must not exceed the risk ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(82)90556-6
更新日期:1982-12-01 00:00:00
abstract:BACKGROUND:The treatment of idiopathic anal ulcerations in AIDS patients is still evolving. These patients suffer with severe incapacitating anal pain. PATIENTS AND METHODS:Relief of pain was achieved with the use of intralesional steroid injections. Twenty-one patients from 1990 to 1993 presented with severe anal pai...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(97)00117-7
更新日期:1997-10-01 00:00:00
abstract:BACKGROUND:Previous reports of minimally invasive antireflux surgery for gastroesophageal reflux disease (GERD) have been small, short-term series utilizing only a laparoscopic approach. We conducted a retrospective review and report our 66-month experience with more than 1,000 laparoscopic and thoracoscopic antireflux...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(98)00034-8
更新日期:1998-04-01 00:00:00
abstract::Follicular carcinoma of the thyroid usually metastasizes through a hematogenous route to the bone, lung, and central nervous system. Metastasis to subcutaneous tissues and retro-orbital region is unusual. We report an unusual case of follicular thyroid carcinoma with metastasis to subcutaneous tissues in the right tem...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2009.07.048
更新日期:2010-06-01 00:00:00
abstract:BACKGROUND:Open and laparoscopic antireflux surgeries are standard for the treatment of gastroesophageal reflux disease (GERD). The in-hospital outcomes of laparoscopic and open antireflux procedures were analyzed and compared at US academic medical centers. METHODS:Using International Classification of Diseases, Nint...
journal_title:American journal of surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.amjsurg.2008.07.041
更新日期:2008-12-01 00:00:00
abstract:BACKGROUND:Chronic pain is a severe complication of mesh-based inguinal hernia repair. Its perceived risk varies widely in the literature. The current objectives are to review the incidence, severity, and consequences of chronic pain and its etiologies. DATA SOURCES:A multi-database systematic search was conducted for...
journal_title:American journal of surgery
pub_type: 杂志文章,评审
doi:10.1016/j.amjsurg.2007.02.012
更新日期:2007-09-01 00:00:00
abstract:OBJECTIVE:The purpose of our study is to further clarify the incidence of ductal carcinoma in situ (DCIS) patients that are upstaged upon final pathology and/or have metastatic disease in the axilla. METHODS:All patients were diagnosed with DCIS or DCIS with microinvasion (DCISm) on their diagnostic biopsy and receive...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2005.06.011
更新日期:2005-10-01 00:00:00
abstract:BACKGROUND:Port placement injuries are a potentially devastating complication of laparoscopic surgery. Ultrasound assessment for visceral slide has the ability to preoperatively determine adhesion-free areas. The utility of this technique has not been studied when performed by surgeons. METHODS:Surgeons without expert...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2014.12.020
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:Despite significant advantages to patients, less than 5% of all colorectal surgeries for cancer are performed laparoscopically. A minimally invasive colorectal cancer program was created in our Veterans' Affairs hospital with the intent of increasing access and improving quality of patient care while maintai...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2009.07.016
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND:Medical students often experience difficulty comprehending anatomic relationships of complex operations to which they are exposed during surgical clerkship. Pancreaticoduodenectomy, the Whipple procedure, is one such operation. Although video recordings are available to facilitate the learning of the Whipple...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0002-9610(98)00201-3
更新日期:1998-10-01 00:00:00
abstract::In a 2 year period, 60 consecutive feeding enterostomies were placed in malnourished patients. The major complication rate was 1.6 percent. Total complications were 8 percent. Thirty day mortality was 13 percent. Nearly all patients were given isosmotic nonelemental diets. The incidence of diarrhea was 2 percent with ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(85)80102-1
更新日期:1985-03-01 00:00:00
abstract:BACKGROUND:A critical outcome analysis of a large, single-institution experience provides a better frame of reference for an assessment of the role of laparoscopic colectomy for colorectal pathology. METHODS:Review of a prospectively gathered database was performed of a consecutive series of laparoscopic colectomy pat...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2005.10.039
更新日期:2006-03-01 00:00:00
abstract:BACKGROUND:During the reproductive years, women have a 4-fold higher prevalence of gallstones than men, making gallbladder disease a critically important topic in women's health. Among age-matched women and men hospitalized for cholecystitis, gender based differences in demographics, management, and economic and clinic...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2013.07.011
更新日期:2013-11-01 00:00:00
abstract::The following report illustrates a rare case of small bowel obstruction which occurred when a large phytobezoar, which had formed in a proximal jejunal diverticulum, dislodged and migrated distally. Obstruction and subsequent perforation resulted when the phytobezoar passed into the narrow terminal ileum and lodged ju...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2007.02.018
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Few data exist regarding surveillance for multiple primary melanoma (MPM) in elderly patients or whether the incidence and risk factors are the same as for younger patients. Thus, we studied the frequency and characteristics of MPM in the elderly melanoma patients. METHODS:From our prospective melanoma regi...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2015.05.023
更新日期:2016-01-01 00:00:00
abstract::Two courses of triple-agent chemotherapy were given to 47 patients with advanced head and neck cancer. All but one patient with a nasopharyngeal carcinoma had resectable stage III and IV squamous cell carcinoma. Eighty-eight percent of the patients responded to the chemotherapy with a 50 percent or greater decrease in...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(82)90417-2
更新日期:1982-10-01 00:00:00
abstract:INTRODUCTION:Medical students applying for general surgery residencies often require a letter of recommendation (LOR) from the Surgical Chair. However, LORs may reveal gender and ethnic bias. This study examines the presence of implicit bias in general surgery resident selection by evaluating chair LORs. METHODS:A ret...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2020.08.010
更新日期:2020-08-15 00:00:00
abstract:BACKGROUND:Administrative databases oversimplify the relationship of factors such as volume or training on surgical outcomes. METHODS:A prospective statewide surgeon-initiated database was queried to obtain incident cases of rectal cancer in Vermont from April 1999 to June 2001. Demographics, procedure performed, meth...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2007.01.029
更新日期:2007-10-01 00:00:00
abstract::Three hundred patients who underwent upper abdominal operations were studied. One hundred fifty patients were treated by insertion of a nasogastric tube, and 150 patients were treated without it. The incidence of postoperative pneumonia was 10 times higher in the patients treated with a nasogastric tube. Pneumonia was...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章
doi:10.1016/0002-9610(80)90395-5
更新日期:1980-06-01 00:00:00
abstract:BACKGROUND:Platelets are thought to participate in tumor metastasis. However, the relationship between platelet count and prognosis in pancreatic cancer remains unresolved. METHODS:A chart review of patients undergoing resection for pancreatic adenocarcinoma was undertaken. Demographic, perioperative, and outcome data...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2004.11.014
更新日期:2005-03-01 00:00:00
abstract:BACKGROUND:Hepatic portal venous gas is an unusual entity associated with a variety of abdominal catastrophes. There is usually a grave prognosis when hepatic portal venous gas is associated with ischemic bowel disease. We reported a 57-year-old man with hepatic portal venous gas associated with extensive infarction of...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2004.09.014
更新日期:2005-04-01 00:00:00
abstract::Thirteen published series concerning laparoscopic cholecystectomy performed in the United States were reviewed. The review was based on reports that included at least 100 patients. Three of the series are surveys of surgery chairpersons and multiple hospitals. The other 10 series are based on the experience of the inv...
journal_title:American journal of surgery
pub_type: 杂志文章,评审
doi:10.1016/s0002-9610(05)80939-0
更新日期:1993-04-01 00:00:00