Abstract:
:Between September 1984 and August 1991, 265 whole pancreaticoduodenal transplants were done at our institution, with bladder drainage of exocrine secretions through a duodenocystostomy. Seventeen patients subsequently underwent conversion from bladder to enteric drainage at 2 to 64 months after transplant. Eight conversion procedures were done to correct chronic intractable metabolic acidosis due to bicarbonate loss from the allograft: seven to alleviate severe dysuria, presumed secondary to the action of graft enzymes on uroepithelium; one to prevent recurrent allograft pancreatitis, presumed secondary to back pressure from the bladder; and one because of graft duodenectomy for severe cytomegalovirus duodenitis with perforation. None were done to correct technical complications from the initial transplant operation. The conversions were done by dividing the graft duodenocystostomy, then re-establishing drainage through a graft duodenal-recipient jejunal anastomosis. A simple loop of recipient jejunum was used for the duodenojejunostomy in 15 cases, and a Roux limb in two. One of those two cases had a previously created Roux limb that was available for use. The other was in the patient who underwent graft duodenectomy and subsequent mucosa-to-mucosa anastomosis of the pancreatic duct to a newly created Roux limb of jejunum. All patients experienced relief of their symptoms after operation. Two patients had surgical complications (12%), an enterotomy in one case, which was closed operatively, and an enterocutaneous fistula in the other case, which healed spontaneously with bowel rest and parenteral nutrition. The drawback to conversion is loss of urine amylase as a marker for rejection, particularly in recipients of solitary pancreas grafts (n = 5). In recipients of simultaneous pancreas-kidney (SPK) allografts (n = 12), the kidney can still be used to monitor for rejection (two with follow-up < 1 year, 10 with follow-up > 1 year). None of our solitary pancreas recipients, however, have lost graft function (follow-up, 10 to 36 months). The only pancreas allograft loss was in an SPK recipient who also rejected the kidney 6 months after conversion. She received a second SPK transplant with enteric drainage, and is insulin independent and normoglycemic 10 months after retransplantation. Patients converted for metabolic acidosis tended to have impaired renal function (mean creatinine, 2.14 +/- 0.98 mg/dL at time of conversion) due to chronic rejection, progression of native kidney diabetic nephropathy, or cyclosporine toxicity, and possibly could not compensate for bicarbonate loss from the pancreas allograft.(ABSTRACT TRUNCATED AT 400 WORDS)
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Stephanian E,Gruessner RW,Brayman KL,Gores P,Dunn DL,Najarian JS,Sutherland DEdoi
10.1097/00000658-199212000-00008subject
Has Abstractpub_date
1992-12-01 00:00:00pages
663-72issue
6eissn
0003-4932issn
1528-1140journal_volume
216pub_type
杂志文章abstract:OBJECTIVE:The objective of this study was to identify the utility of "keyhole" thoracotomy approaches to single vessel coronary artery bypass surgery. SUMMARY BACKGROUND DATA:Although minimally invasive surgery is efficacious in a wide variety of surgical disciplines, it has been slow to emerge in cardiac surgery. Amo...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199610000-00004
更新日期:1996-10-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to compare silicone-banded sleeve gastrectomy (BSG) to nonbanded sleeve gastrectomy (SG) regarding weight loss, obesity-related comorbidities, and complications. SUMMARY BACKGROUND DATA:As a primary bariatric procedure, SG leads to excellent weight loss, yet weight regain is a relev...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000004174
更新日期:2020-11-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to determine whether remote ischemic preconditioning (RIPC) protects aged liver against ischemia reperfusion (IR). SUMMARY OF BACKGROUND DATA:The demands for liver surgery in an aging population are growing. Clamping of vessels to prevent blood loss is integral to liver surgery, bu...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001765
更新日期:2016-11-01 00:00:00
abstract:OBJECTIVE:To identify factors that predict fourth- and fifth-year surgical resident satisfaction of attending teaching quality. SUMMARY BACKGROUND DATA:With the training of surgical residents undergoing major changes, a key issue facing surgical educators is whether high-quality surgeons can still be produced. Innovat...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000150257.04889.70
更新日期:2005-02-01 00:00:00
abstract::Six patients with surgically treated Menetrier's disease are presented. Diffuse or focal cystic hyperplasia of mucous secreting epithelium of the fundus with antral sparing characterized the stomachs in all of these cases. In most instances the disorder was found during evaluation of non-specific complaints of pain, n...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197704000-00015
更新日期:1977-04-01 00:00:00
abstract:OBJECTIVE:To review the workload, type and frequency of recurrence, long-term quality of life (QOL), and late oncologic outcomes with endoscopic therapy. BACKGROUND:The short-term oncologic efficacy of endoscopic resection (ER) and ablation for patients with high-grade dysplasia (HGD) or intramucosal adenocarcinoma (I...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003038
更新日期:2020-04-01 00:00:00
abstract:OBJECTIVE:To examine the clinicopathologic features and clonal relationship of multifocal intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. BACKGROUND:Intraductal papillary mucinous neoplasms are increasingly diagnosed cystic precursor lesions of pancreatic cancer. Intraductal papillary mucinous neopla...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182378a18
更新日期:2012-02-01 00:00:00
abstract::As a result of this retrospective analysis of hemorrhage from a porta-systemic venous shunt occurring within the small intestine, we believe that the early diagnosis of the syndrome is strongly suggested by the presence of varices in unusual locations demonstrated by the venous phase of mesenteric arteriography. In al...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197601000-00005
更新日期:1976-01-01 00:00:00
abstract::In our series of 101 patients with small bowel bypass for morbid obesity, nine developed biliary calculi postoperatively during a mean follow-up of 29.6 months. The development of gallstones depends in part on biliary cholesterol saturation and on the zeta potential of bile. In eight consecutive patients, the lithogen...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197801000-00011
更新日期:1978-01-01 00:00:00
abstract:OBJECTIVE:Results of the first prospective randomized clinical trial comparing partial and total portacaval shunt for variceal hemorrhage are reported. SUMMARY BACKGROUND DATA:Total portacaval shunts produce subnormal portal pressures, completely diverting hepatic portal flow. Partial shunts maintain higher pressures ...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-199404000-00005
更新日期:1994-04-01 00:00:00
abstract::Pulmonary microembolism of microaggregates associated with massive blood transfusion may be a cause of post-traumatic pulmonary embolism. The purpose of this study was to investigate in the dog the influence on certain physiologic parameters of transfusion of blood containing platelet: white blood cell: fibrin (PWF) a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197501000-00012
更新日期:1975-01-01 00:00:00
abstract::The effects of two levels of protein intake on protein metabolism in six severely burned adult patients were studied (means of 70% BSA burned). A crossover experimental design enabled the authors to study each patient at the end of two three-day dietary regimens. All diets were isocaloric and provided approximately 25...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198302000-00007
更新日期:1983-02-01 00:00:00
abstract::Among hypertensive and diabetic patients undergoing elective noncardiac surgery, preoperative status and intraoperative changes in mean arterial pressure (MAP) were evaluated as predictors of postoperative ischemic complications. Of 254 patients evaluated before operation and monitored during operation, 30 (12%) had p...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198911000-00012
更新日期:1989-11-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of surgical simulation compared with other methods of surgical training. SUMMARY BACKGROUND DATA:Surgical simulation (with or without computers) is attractive because it avoids the use of patients for skills practice and provides relevant technical training for trainees before t...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/01.sla.0000200839.93965.26
更新日期:2006-03-01 00:00:00
abstract::1016 Women were placed on estrogen support following hysterectomy and have been followed for a total of 14,318 patient/years. Support was principally conjugated estrogen with the customary dose 1.5 mg/day. The follow-up studies in this group of women shows a marked drop in deaths from all causes over those which might...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197705000-00010
更新日期:1977-05-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine the association between gabapentinoids on the day of surgery and adverse postoperative outcomes in patients undergoing colorectal surgery in the United States. BACKGROUND:Gabapentinoids, gabapentin and pregabalin, are recommended in multimodal analgesia protocols for ac...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003317
更新日期:2019-12-01 00:00:00
abstract:OBJECTIVE:To characterize the injuries to children by acts against civilian populations (AACP). SUMMARY BACKGROUND DATA:Only 2 articles have focused on the spectrum and severity of injuries to children by AACP. METHODS:A retrospective case study of children 0 to 18 years old who were entered into the Israel National ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000157233.18787.cd
更新日期:2005-04-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to evaluate the accuracy of abdominal ultrasonography (US) for screening and grading pediatric splenic injury. SUMMARY BACKGROUND DATA:The use of abdominal US has increased rapidly as a method of evaluating organ damage after blunt abdominal trauma. Despite US's increasing use, ...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/00000658-199704000-00010
更新日期:1997-04-01 00:00:00
abstract::Metabolic and hormonal studies were performed in 6 infants during the first 3 months of life while receiving 3 different types of parenteral nutrition: 1) 20% glucose and a nitrogen source (Dudrick's method) 2) 12% glucose, a nitrogen source and soybean fat emulsion (Intralipid method) and 3) 12% glucose, a nitrogen s...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-197507000-00012
更新日期:1975-07-01 00:00:00
abstract:OBJECTIVES:To determine the influence of patient depression (and anxiety) on postoperative outcome and surgeons' consideration of it. BACKGROUND:Patients' mental state influences the course of nonpsychiatric diseases. Evidence in the surgical setting comes mainly from cardiac-surgery patients and no predictive-model o...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000001448
更新日期:2015-11-01 00:00:00
abstract:OBJECTIVE:Resident duty hour restrictions were implemented in 2002-2003. This study examines changes in resident surgical experience since these restrictions were put into place. METHOD:Operative log data for 3 specialties were examined: general surgery, urology, and plastic surgery. The academic year immediately prec...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181e62299
更新日期:2010-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of debriefing and feedback on intraoperative nontechnical performance as an instructional strategy in surgical training. BACKGROUND:Regulatory authorities for accreditation in North America have included nontechnical skills such as communication and teamwork in the competencies ...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/SLA.0000000000001297
更新日期:2016-05-01 00:00:00
abstract:OBJECTIVE:To characterize factors predictive of improved survival following gastrectomy with additional organ resection for the treatment of gastric cancer. SUMMARY BACKGROUND DATA:Recent large series have reported significant survival disadvantages to patients who have undergone gastrectomy with splenectomy or pancre...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200208000-00003
更新日期:2002-08-01 00:00:00
abstract::A review of the experience with 66 patients on chronic hemodialysis who underwent 67 major surgical procedures is presented. There were 58 general surgical procedures, and nine major cardiovascular procedures including four emergency cardiac valve replacements. The preoperative, intraoperative and postoperative manage...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197406000-00008
更新日期:1974-06-01 00:00:00
abstract:OBJECTIVE:This multicenter study sought to evaluate the accuracy of the American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) surgical risk calculator for predicting outcomes after pancreatoduodenectomy (PD) and to determine whether incorporating other factors improves its predictive ...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000001796
更新日期:2017-05-01 00:00:00
abstract::The etiology of hepatic insufficiency associated with the multiple systems organ failure (MSOF) syndrome is unclear. The authors have investigated the possibility that a macrophage/Kupffer cell mediated modulation of hepatocyte function may play a role in this phenomenon. Isolated rat hepatocytes were cultured, and th...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:
更新日期:1985-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the effect of selective intramesenteric artery vasodilator infusion on intestinal viability in a rat model of acute segmental mesenteric vascular occlusion. SUMMARY BACKGROUND DATA:Although intramesenteric arterial vasodilator infusion may be an effective treatment for nonocclusive mesenteric isc...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200107000-00016
更新日期:2001-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the epidemiology of Clostridium difficile colitis (CDC) in a subset of patients admitted specifically to a surgical service. SUMMARY BACKGROUND DATA:CDC is an increasingly prevalent nosocomial infection that can prolong hospitalization and adversely affect patient outcome. Although this disease h...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199802000-00021
更新日期:1998-02-01 00:00:00
abstract:OBJECTIVE:To examine the expression of the transcription factor nuclear factor kappa B (NF-kappaB) in Barrett's epithelium and adenocarcinoma and the impact of NF-kappaB expression on tumor stage and response to neoadjuvant chemotherapy and radiation therapy. SUMMARY BACKGROUND DATA:Progression of Barrett's esophagus ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000118751.95179.c6
更新日期:2004-04-01 00:00:00
abstract:BACKGROUND:Patients frequently voice concerns regarding wait times for cancer treatment; however, little is known about the length of wait times from diagnosis to surgery in the United States. Our objectives were (1) to assess changes in wait times over the past decade and (2) to identify patient, tumor, and hospital f...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318211cc0f
更新日期:2011-04-01 00:00:00