Abstract:
:Emergency portacaval shunt for variceal bleeding is associated with a high operative mortality, particularly if used as a last resort. Because of this, a strong case has been made against emergency shunt. This report describes an experience with emergency portacaval shunt for the treatment of variceal bleeding when used systematically after hemodynamic stabilization and control of the bleeding episode with balloon tamponade, if necessary, in patients with mild or moderate liver disease. The population studied comprised 62 consecutive patients who rebled from varices while participating in a controlled trial of propranolol for the prevention of rebleeding. Of the 62 patients, nine died of massive hemorrhage and 53 survived the hemorrhage. Of the 53 survivors, 11 had severe liver disease and were not considered for shunt surgery. Of the remaining 42 patients with mild or moderate liver disease, 36 had emergency central portacaval shunt. The interval between endoscopic diagnosis of variceal bleeding and surgery averaged 19 +/- 3 hours (mean +/- SE). The operative mortality rate, defined as in-hospital mortality, was 19%. One- and 2-year survival rates were 78% and 71%, respectively. The incidence of postoperative hepatic encephalopathy was 36%; all patients responded favorably to protein restriction and lactulose. Thus, under specific conditions, emergency portacaval shunt results in an acceptable long-term survival rate. In patients with mild or moderate liver disease, emergency portacaval shunt should be considered when other forms of treatment for the prevention of variceal rebleeding have failed.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Villeneuve JP,Pomier-Layrargues G,Duguay L,Lapointe R,Tanguay S,Marleau D,Willems B,Huet PM,Infante-Rivard C,Lavoie Pdoi
10.1097/00000658-198707000-00007subject
Has Abstractpub_date
1987-07-01 00:00:00pages
48-52issue
1eissn
0003-4932issn
1528-1140journal_volume
206pub_type
杂志文章abstract:OBJECTIVE:The authors determined the molecular mechanisms for the failure of transforming growth factor-beta (TGF-beta) to inhibit the growth of SW1116 and SW48 colon cancer cell lines. BACKGROUND:Transforming growth factor-beta is a bifunctional regulator of cell growth that typically stimulates proliferation of mese...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199506000-00015
更新日期:1995-06-01 00:00:00
abstract:OBJECTIVE:Research evaluating fatigue-induced skills decline has focused on acute sleep deprivation rather than the effects of circadian desynchronization associated with multiple shifts. As a result, the number of consecutive night shifts that residents can safely be on duty without detrimental effects to their techni...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181661a99
更新日期:2008-03-01 00:00:00
abstract:OBJECTIVE:This study determined how scar formation develops in a non-human primate model of fetal skin repair. SUMMARY BACKGROUND DATA:A transition from healing scarlessly to healing with scar formation characterizes skin repair in rat and sheep fetuses. New knowledge of the regulatory processes occurring in the fetal...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199304000-00011
更新日期:1993-04-01 00:00:00
abstract:OBJECTIVE:The authors addressed whether a repeat hepatic operation is warranted in patients with recurrent isolated hepatic metastases. Are the results as good after second operation as after first hepatic operation? SUMMARY BACKGROUND DATA:Five-year survival after initial hepatic operation for colorectal metastases i...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199606000-00015
更新日期:1996-06-01 00:00:00
abstract::Successful long-term limb salvage using cephalic vein bypass grafts was attained in 70 limbs of 67 patients over the past 11 years. The saphenous vein was absent in 76% and inadequate in 24% of the cases. Revascularization for limb salvage was carried out in 83%. Ninety per cent of the grafts were extended to the infr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198412000-00019
更新日期:1984-12-01 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:OBJECTIVE:To assess whether elective colon and rectal surgery can be safely performed without preoperative mechanical bowel preparation. SUMMARY BACKGROUND DATA:Mechanical bowel preparation is routinely done before colon and rectal surgery, aimed at reducing the risk of postoperative infectious complications. However,...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/01.SLA.0000055222.90581.59
更新日期:2003-03-01 00:00:00
abstract:OBJECTIVE:To determine whether glutamine (GLN)-supplemented parenteral nutrition (PN) improves clinical outcomes in surgical intensive care unit (SICU) patients. SUMMARY BACKGROUND DATA:GLN requirements may increase with critical illness. GLN-supplemented PN may improve clinical outcomes in SICU patients. METHODS:A p...
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.0000000000001487
更新日期:2016-04-01 00:00:00
abstract::The late results of brachial thrombectomy following cardiac catheterization were evaluated in 20 patients. All patients had a radial pulse present and no symptoms or signs of ischemia of the hand at the time of discharge from the hospital. Late evaluation of these 20 patients revealed 8 in whom the long-term results w...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197604000-00019
更新日期:1976-04-01 00:00:00
abstract::Although the clinical results of Brooke ileostomy are good, patients are permanently incontinent of stool and gas. Alternative operations designed to restore enteric continence, such as ileal pouch-anal anastomosis, must not only be as safe and effective as Brooke ileostomy, but should provide an improved quality of l...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198905000-00015
更新日期:1989-05-01 00:00:00
abstract:OBJECTIVE:To determine whether bariatric surgery is associated with a lower risk of cancer. BACKGROUND:Obesity is strongly associated with many types of cancer. Few studies have examined the relationship between bariatric surgery and cancer risk. METHODS:We conducted a retrospective cohort study of patients undergoin...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000002525
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVE:These studies were designed to elucidate the mechanism by which signals delivered by anti-CD2 monoclonal antibody (MoAb) interfere with activational signals delivered by anti-CD3 MoAb and induce long-term graft survival and tolerance. SUMMARY BACKGROUND DATA:Anti-CD2 or anti-CD3 MoAb can prolong allograft su...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199310000-00009
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVE:To compare the modified Rossetti fundoplication with the classic Nissen. SUMMARY BACKGROUND DATA:The traditional surgical treatment of gastroesophageal reflux in children has been the classic Nissen fundoplication, defined by liver mobilization, crural repair, takedown of short gastric vessels, and floppy wr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199906000-00003
更新日期:1999-06-01 00:00:00
abstract:OBJECTIVE:To assess the authors' hypothesis that with modern techniques, the current risks of repair for both complete and partial atrioventricular canal (AVC) are equal. SUMMARY BACKGROUND DATA:Repair of complete AVC in infancy has traditionally carried a substantial mortality. In contrast, partial AVC has been consi...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200210000-00014
更新日期:2002-10-01 00:00:00
abstract:OBJECTIVE:To analyze the challenges encountered during surgical quality improvement interventions, and explain the relative success of different intervention strategies. SUMMARY BACKGROUND DATA:Understanding why and how interventions work is vital for developing improvement science. The S3 Program of studies tested wh...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001583
更新日期:2016-12-01 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:OBJECTIVE:We hypothesized that training to expert-derived levels of speed and motion will lead to improved learning and will translate to better operating room (OR) performance of novices than training to goals of speed or motion alone. BACKGROUND:Motion tracking has been suggested to be a more sensitive performance m...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0b013e318285f531
更新日期:2013-07-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to investigate the effects of ethanol on pancreatic blood flow and interstitial pH in chronic pancreatitis. BACKGROUND:Ethanol is known to contribute to the development of both acute and chronic pancreatitis. However, it is unclear how ethanol precipitates episodes of acute pa...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199702000-00011
更新日期:1997-02-01 00:00:00
abstract::A major surgical procedure can impair the delayed hypersensitivity response. This impairment is associated with suppressor cell activity that can alter either afferent or efferent responses. Using the third party mixed leukocyte culture to define cell types involved, major immune impairment was seen with the combinati...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198304000-00010
更新日期:1983-04-01 00:00:00
abstract::The role of surgery in the treatment of gastrinoma is unclear. The purpose of this study was to determine prospectively the surgical cure rate using a controlled clinical trial. Eleven patients who fit the entry criteria underwent abdominal exploration and attempted tumor resection for cure. A historical control group...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199001000-00002
更新日期:1990-01-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to determine the long-term effect of the use of a hyaluronic acid-carboxymethylcellulose membrane (Seprafilm) on the incidence of adhesions and subsequent small-bowel obstruction and chronic abdominal complaints after colorectal surgery (Hartmann's procedure). BACKGROUND:Adhesi...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0b013e318217e99c
更新日期:2011-06-01 00:00:00
abstract::The importance of prostacyclin (PGI2) and thromboxane (Tx) medication of depressed cardiac performance during abdominal aortic aneurysm operative surgery was studied by contrasting the effects of 650 mg aspirin administered 12 hours before operation to that of a placebo. In 11 patients who received a placebo, the stab...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/00000658-198111000-00008
更新日期:1981-11-01 00:00:00
abstract::Metoclopramide or placebo was administered postoperatively in a randomized, double-blind fashion to 115 patients undergoing laparotomy. The effect of metoclopramide on postoperative adynamic ileus (PAI) was evaluated. The patients were stratified into two groups: Group A--those with laparotomy without a gastrointestin...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-197907000-00006
更新日期:1979-07-01 00:00:00
abstract:OBJECTIVE:This study aims to review the operative results and oncological outcomes of anterior resection for rectal and rectosigmoid cancer. Comparison was made between patients with total mesorectal excision (TME) for mid and distal cancer and partial mesorectal excision (PME) for proximal cancer, when a 4- to 5-cm me...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000133185.23514.32
更新日期:2004-08-01 00:00:00
abstract:OBJECTIVE:To determine the risk factors of morbidity after surgery for ileocolonic Crohn disease (CD). SUMMARY BACKGROUND DATA:The risk factors of morbidity after surgery for CD, particularly the role of anti-TNF therapy, remain controversial and have not been evaluated in a large prospective cohort study. METHODS:Fr...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000002017
更新日期:2018-02-01 00:00:00
abstract::The physiologic sufficiency of regenerated lung lymphatics after surgical transection of the lung hilum was studied experimentally. Dogs were prepared by surgical interruption of all left lung hilar tissues and structures except the skeletonized pulmonary artery and the pulmonary veins; continuity of the bronchus was ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198008000-00005
更新日期:1980-08-01 00:00:00
abstract::Many advances have occurred in recent years in the diagnosis, localization, and treatment of primary hyperparathyroidism. Several different operative choices for primary hyperparathyroidism also have been proposed--a unilateral approach versus the standard bilateral parathyroid exploration. The unilateral approach is ...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-199204000-00002
更新日期:1992-04-01 00:00:00
abstract::Analysis of experience with chronic bleeding peptic ulcer in 504 patients, admitted from 1960 to 1971, shows a hospital mortality of 12%. This retrospective review suggested that early endoscopic diagnosis, adequate resuscitation and a policy of early selective surgery was necessary if mortality was to be reduced. Wit...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198401000-00008
更新日期:1984-01-01 00:00:00
abstract::From 1966 to 1975, 38 patients underwent 42 procedures for renovascular hypertension; 35 operations were aortorenal bypasses and 7 were nephrectomies. Forty-five per cent of the patients were cured, 43% were improved and 12% were unimproved. There were no operative deaths and only three late deaths. Two grafts occlude...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197512000-00019
更新日期:1975-12-01 00:00:00
abstract::Data from the North Carolina Trauma Registry were analyzed to determine the effect of seat belt usage on outcome in motor vehicle accidents. Of 6237 persons involved in motor vehicle accidents, data on seat belt usage were available for 3396. Of these, 1916 were not and 1480 were wearing seat belts. The mean hospital ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199302000-00005
更新日期:1993-02-01 00:00:00