Abstract:
OBJECTIVE:To analyze the impact of a conservative strategy of management in patients with necrotizing pancreatitis, reserving intervention for patients with documented infection or the late complications of organized necrosis. SUMMARY BACKGROUND DATA:The role of surgery in patients with sterile pancreatic necrosis remains controversial. Although a conservative approach is being increasingly used, few studies have evaluated this strategy when applied to the entire spectrum of patients with necrotizing pancreatitis. METHODS:The authors reviewed 1,110 consecutive patients with acute pancreatitis managed at Brigham and Women's Hospital between January 1, 1995, and January 1, 2000, focusing on those with pancreatic necrosis documented by contrast-enhanced computed tomography. Fine-needle aspiration, the presence of extraintestinal gas on computed tomography, or both were used to identify infection. RESULTS:There were 99 (9%) patients with necrotizing pancreatitis treated, with an overall death rate of 14%. In three patients with underlying medical problems, the decision was made initially not to intervene. Of the other 62 patients without documented infection, all but 3 were managed conservatively; this group's death rate was 11%. Of these seven deaths, all were related to multiorgan failure. Five patients in this group eventually required surgery for organized necrosis, with no deaths. Of the 34 patients with infected necrosis, 31 underwent surgery and 3 underwent percutaneous drainage. Only four (12%) of these patients died, all of multiorgan failure. Of the total 11 patients who died, few if any would have been candidates for earlier surgical intervention. CONCLUSIONS:These results suggest that conservative strategies can be applied successfully to manage most patients with necrotizing pancreatitis, although some will eventually require surgery for symptomatic organized necrosis. Few if any patients seem likely to benefit from a more aggressive strategy.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Ashley SW,Perez A,Pierce EA,Brooks DC,Moore FD Jr,Whang EE,Banks PA,Zinner MJdoi
10.1097/00000658-200110000-00016subject
Has Abstractpub_date
2001-10-01 00:00:00pages
572-9; discussion 579-80issue
4eissn
0003-4932issn
1528-1140journal_volume
234pub_type
杂志文章abstract::During a 29-month trial, 65 patients with acute gallstone pancreatitis were randomly selected for biliary tract explorations either within 73 hours of admission (36 patients) or at three months following remission with nonoperative measures (29 patients, with five others awaiting elective operation). The details of su...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198109000-00008
更新日期:1981-09-01 00:00:00
abstract::Three patients with Menetrier's disease and protein-losing gastropathy who were studied during a 12 year period have been presented. The characteristic findings which differentiate them from patients with hypertrophic hypersecretory gastropathy, including the Zollinger-Ellison syndrome, are: 1) hypertrophy of gastric ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197505000-00036
更新日期:1975-05-01 00:00:00
abstract::Stress ulcer has become an important clinical entity and its two major complications--bleeding and perforation--are among the most baffling problems, in terms of management, in clinical practice. Perforation, though the less common of the two, is perhaps the most formidable particularly when this occurs in a very sick...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197912000-00006
更新日期:1979-12-01 00:00:00
abstract::Seventy-seven patients with a primary complaint of persistent cough, wheezing, and/or recurrent pneumonia were evaluated for the presence of occult gastroesophageal reflux disease. Fifty-four patients (70%) had increased esophageal acid exposure on 24-hour pH monitoring of the distal esophagus. In 28% of these patient...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199003000-00005
更新日期:1990-03-01 00:00:00
abstract:OBJECTIVE:To assess ischemia and reperfusion (I/R) injury in a hemihepatectomy model in pigs after prolonged continuous or intermittent vascular inflow occlusion in the liver. SUMMARY BACKGROUND DATA:Massive intraoperative blood loss during liver resections can be prevented by temporary vascular inflow occlusion, cons...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199903000-00011
更新日期:1999-03-01 00:00:00
abstract:OBJECTIVE:To determine whether the antibacterial properties of cultured composite keratinocyte grafts can be enhanced by cytokines that stimulate the innate immune response. SUMMARY BACKGROUND DATA:Use of composite grafts of cultured keratinocytes has been limited because of their susceptibility to burn wound microorg...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200201000-00015
更新日期:2002-01-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to elucidate the significance and limitations of serum amylase levels in the diagnosis of blunt injury to the pancreas. SUMMARY BACKGROUND DATA:Several recently published reports of analyses of patients with blunt abdominal trauma have indicated that determination of the serum...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199707000-00010
更新日期:1997-07-01 00:00:00
abstract:OBJECTIVE:Comparison of minimal access retroperitoneal pancreatic necrosectomy (MARPN) versus open necrosectomy in the treatment of infected or nonresolving pancreatic necrosis. SUMMARY OF BACKGROUND DATA:Infected pancreatic necrosis may lead to progressive organ failure and death. Minimal access techniques have been ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181d96c53
更新日期:2010-05-01 00:00:00
abstract::Five days after thyroidectomy (Tx) or sham-Tx in young male Sprague-Dawley rats, sepsis was induced by cecal ligation and puncture (CLP). Control animals underwent laparotomy and manipulation of the cecum without ligation or puncture. Sixteen hours after CLP or laparotomy, protein synthesis and degradation were measur...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198707000-00003
更新日期:1987-07-01 00:00:00
abstract::One hundred and forty patients with an intractable ascites complicating a chronic liver disease received a peritoneovenous shunt (PVS) using the LeVeen valve. Operative mortality was ten per cent but was 25% in patients with severe liver failure. Intraoperative drainage of ascites sharply decreased postoperative compl...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198504000-00014
更新日期:1985-04-01 00:00:00
abstract::Although many factors may influence the choice of the operative incision, physiologic safety in terms of the degree of postoperative hypoxemia should be considered. No data currently exist to delineate in markedly obese patients the effect of the operative incision on the extent or duration of this hypoxemia. Fifty-f...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/00000658-197506000-00012
更新日期:1975-06-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to identify the survival of patients with locally advanced pancreatic cancer (LAPC) and assess the effect of surgical resection after neoadjuvant therapy on patient outcomes. BACKGROUND:An increasing number of LAPC patients who respond favorably to neoadjuvant therapy undergo surgica...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002753
更新日期:2019-08-01 00:00:00
abstract:SUMMARY BACKGROUND DATA:To analyze the effects of a treatment program of intraoperative electron beam radiation therapy (IOERT) and external beam radiation therapy and chemotherapy on the outcome of patients with unresectable or locally advanced pancreatic cancer. METHODS:From 1978 to 2001, 150 patients with unresecta...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000152016.40331.bb
更新日期:2005-02-01 00:00:00
abstract:BACKGROUND:The "surgical personality" is a mostly negative academic and cultural image of the surgeon as egotistical, paternalistic, and inflexible. Because of this image, surgeons have been viewed as resistant to change and some behaviors, vulnerability, for example, are viewed as "suspect" because they seemingly thre...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003707
更新日期:2019-12-02 00:00:00
abstract::The diagnosis of intra-abdominal abscess by radiographic means often relies on combining the results of several different imaging modalities. Computed tomography (CT) has been shown to be a safe, accurate and rapid diagnostic method of diagnosing these abscesses. Five patients with a variety of intra-abdominal abscess...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197901000-00006
更新日期:1979-01-01 00:00:00
abstract:OBJECTIVE:The aims of this study were to use a comprehensive whole-mount pathologic analysis to characterize microscopic patterns of residual disease, as well as circumferential and distal resection margins, in rectal cancer treated with preoperative CMT; and to identify clinicopathologic factors associated with residu...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000232540.82364.43
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:Many women who present with desmoid-type fibromatosis (DF) have had a recent pregnancy. Long-term data about disease behavior during and after pregnancy are lacking. OBJECTIVE:To investigate the possible relationship between DF and pregnancy. PATIENTS AND METHODS:A cohort of women with DF and pregnancy was...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000000224
更新日期:2014-05-01 00:00:00
abstract::Diminished poststenotic pressure and flow accompanied experimental application of multiple subcritical arterial stenoses in series. Effects of additional stenoses, causing equivalent constrictions, were cumulative in a nonlinear fashion. Seven-hundred-twenty measurements were performed using 10 cm ileofemoral canine a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197711000-00020
更新日期:1977-11-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine whether parastomal hernia (PSH) rate can be reduced by using synthetic mesh in the sublay position when constructing permanent end colostomy. The secondary aim was to investigate possible side-effects of the mesh. BACKGROUND:Prevention of PSH is important as it often ca...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0000000000002542
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:To review the methodology employed in surgical mortality studies to control for potential confounders. SUMMARY BACKGROUND DATA:Nationwide hospital data are increasingly used to investigate surgical outcomes. However, poor data granularity and coding inaccuracies may lead to flawed findings. METHODS:We condu...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/SLA.0000000000002119
更新日期:2017-06-01 00:00:00
abstract:OBJECTIVE:To assess the incidence of biliary complications after right lobe living-donor liver transplantation (LDLT) in patients undergoing duct-to-duct choledochocholedochostomy or Roux-en-Y choledochojejunostomy reconstruction. SUMMARY BACKGROUND DATA:Biliary tract complications remain one of the most serious morbi...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000206419.65678.2e
更新日期:2006-04-01 00:00:00
abstract::The factors contributing to the development of esophageal mucosal injury in gastroesophageal reflux disease (GERD) are unclear. The lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and the presence of excessive duodenogastric reflux (DGR) was evaluated in 205 consecutive patients with GERD and v...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199207000-00006
更新日期:1992-07-01 00:00:00
abstract::A prospective study was performed on 358 patients to examine the diagnosis, management, and natural history of fish bone ingestion. All patients admitted with the complaint had a thorough oral examination. Flexible endoscopy under local pharyngeal anesthesia would be performed on patients with negative findings. Of 11...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199004000-00012
更新日期:1990-04-01 00:00:00
abstract::The etiology and mechanisms by which severe trauma or sepsis induce hepatic failure are unknown. Previously we showed that Kupffer cells (KC), the fixed macrophages of the liver, induce a profound decrease in hepatocyte (HC) total-protein synthesis when exposed to endotoxin. Furthermore we demonstrated that endotoxin-...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199010000-00009
更新日期:1990-10-01 00:00:00
abstract:BACKGROUND:Postcholecystectomy complex bile duct injuries involving the hilar confluence, which are often associated with vascular injuries and liver atrophy, remain a considerable surgical challenge. The aim of this study is to report our experience of major hepatectomy with long-term outcome in these patients. METHO...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31817b65f2
更新日期:2008-07-01 00:00:00
abstract:OBJECTIVE:To review a single center's 10-year experience with liver transplantation (LTx) for the biliary atresia-polysplenia syndrome (BA-PS) and to define surgical and clinical guidelines for its management. SUMMARY BACKGROUND DATA:BA is the most common indication for pediatric liver transplantation (LTx) and is ass...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199804000-00022
更新日期:1998-04-01 00:00:00
abstract:OBJECTIVE:To evaluate the outcome of preoperative gemcitabine-based chemoradiation therapy (CRT) for borderline resectable pancreatic cancer (BRPC), focusing on the associations among the tumor-vascular relationship, surgical outcomes, and pattern of recurrence. SUMMARY BACKGROUND DATA:Among the various multimodal tre...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001547
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:The purpose of the present study was to determine the effect of insulin therapy on hepatic function, structure, and hepatic mRNA and protein cytokine expression during the hypermetabolic cascade post burn. SUMMARY BACKGROUND DATA:Liver function and morphology are crucial for survival of patients suffering fr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000133353.57674.cd
更新日期:2004-08-01 00:00:00
abstract::Studies were performed to further investigate an abnormality of the alternative complement pathway associated with burn injury. C3 conversion by inulin and cobra venom factor was measured in serial serum samples from 18 burned patients and in the sera from 25 normal controls. C3 conversion by both activating substance...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198108000-00018
更新日期:1981-08-01 00:00:00
abstract:OBJECTIVES:To assess survival after liver resection and transplantation in patients with hepatocellular carcinoma (HCC) beyond Milan criteria. BACKGROUND:The role of liver resection and transplantation remains controversial for patients with HCC beyond Milan criteria. Resection of advanced tumors and transplantation u...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001866
更新日期:2016-10-01 00:00:00