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 and preserve hepatopedal flow. No randomized trials of these two approaches have been performed. METHODS:Alcoholic patients with cirrhosis (n = 30) and variceal hemorrhage treated at one institution were randomized to receive partial (8-mm diameter portacaval H grafts with collateral ablation, n = 14) or total shunts (16-mm diameter grafts, n = 16). Portography was performed after operation and then yearly. Investigators blinded to shunt type assessed encephalopathy; hospitalizations were reviewed. RESULTS:Child's class, age, and operative urgency were similar for the two groups. Two patients (with total shunts) died within 30 days. Hepatopedal flow was maintained in 13 partial and 0 total shunt patients (p < 0.0001). Shunt gradients were 16 +/- 5 compared with 6 +/- 3 cm saline after partial and total shunts (p < 0.0001). There were no shunt thromboses or variceal hemorrhages. Encephalopathy-free survival was significantly greater after partial shunts (p = 0.013; life table analysis). Five total compared with zero partial shunt patients required hospitalization for coma (p = 0.02). Long-term survival was not different for the two groups of patients. CONCLUSIONS:Partial shunts control variceal hemorrhage while maintaining hepatopedal flow and elevated portal pressures. By minimizing encephalopathy rates, partial shunts provide improved quality of survival compared with total shunts.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Sarfeh IJ,Rypins EBdoi
10.1097/00000658-199404000-00005subject
Has Abstractpub_date
1994-04-01 00:00:00pages
353-61issue
4eissn
0003-4932issn
1528-1140journal_volume
219pub_type
临床试验,杂志文章,随机对照试验abstract:OBJECTIVE:To determine the association between preoperative bowel preparation and 30-day outcomes after elective colorectal resection. METHODS:Patients from the 2012 Colectomy-Targeted American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database who underwent elective colorectal rese...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001041
更新日期:2015-08-01 00:00:00
abstract::Human lymphocyte antigen (HLA) class I and class II antigens and beta 2 microglobulin (B2M) were identified in peritoneal dialysate (PD) and serum from patients with end-stage renal disease (ESRD) using monoclonal antibodies in an enzyme-linked immunoassay. The HLA class I and class II antigens each exhibited approxim...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199106000-00009
更新日期:1991-06-01 00:00:00
abstract:OBJECTIVE:Comparative analyses of survival and funding statistics in cancers with high mortality were performed to quantify discrepancies and identify areas for intervention. BACKGROUND:Discrepancies in research funding may contribute to stagnant survival rates in pancreatic ductal adenocarcinoma (PDAC). METHODS:The ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003042
更新日期:2020-02-01 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
abstract:OBJECTIVE:The authors determined whether untreated breast cancer patients have elevated plasma levels of transforming growth factor-beta 1 (TGF-beta 1). SUMMARY BACKGROUND DATA:Increased plasma TGF-beta 1 levels recently were found after chemotherapy in patients with advanced breast cancer. However, it currently is un...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199508000-00007
更新日期:1995-08-01 00:00:00
abstract::Twenty-six patients are reviewed who had primary carcinomas involving the junction of the hepatic ducts. The majority had had an initial procedure of palliative biliary diversion elsewhere and were referred for further treatment. In three cases, en bloc resection of the tumor with total hepatectomy and orthotopic live...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197607000-00012
更新日期:1976-07-01 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:OBJECTIVE:To evaluate the effect of preoperative transarterial chemoembolization (TACE) for resectable large hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA:Resection of HCC is potentially curative, but local recurrence is very common. There is currently no effective neoadjuvant or adjuvant therapy. METHODS:F...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0b013e3181961c16
更新日期:2009-02-01 00:00:00
abstract::A previously described balloon tipped dilatation catheter has been used during revascularization surgery to dilate lesions which potentially could limit the runoff of the saphenous bypass grafts. A total of 34 lesions were dilated in 25 patients. Restudy of 12 patients (15 lesions) demonstrated positive results and no...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198002000-00017
更新日期:1980-02-01 00:00:00
abstract:OBJECTIVE:To assess whether regional intestinal oxygen saturation (rintSO2) and regional cerebral oxygen saturation (rcSO2) measurements aid in estimating survival of preterm infants after surgery for NEC. SUMMARY OF BACKGROUND DATA:Predicting survival after surgery for NEC is difficult yet of the utmost importance fo...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003913
更新日期:2020-04-20 00:00:00
abstract:OBJECTIVE:We aimed to determine whether the severity of inhalation injury evokes an immune response measurable at the systemic level and to further characterize the balance of systemic pro- and anti-inflammation early after burn and inhalation injury. BACKGROUND:Previously, we reported that the pulmonary inflammatory ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318275f424
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:Because of rising costs and shrinking reimbursements, hospitals must continually find ways to improve efficiency and productivity. This study attempts to increase caseloads in ambulatory surgery operating rooms while maintaining patient satisfaction and safety. SUMMARY BACKGROUND DATA:In most hospitals, pati...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000193600.97748.b1
更新日期:2006-01-01 00:00:00
abstract:OBJECTIVE:To investigate the workup/treatment provided to pregnant motor vehicle accident (MVA) casualties in a mature trauma system. Adherence to recommendations was used to measure quality of care. BACKGROUND:MVAs affect approximately 3% of pregnant women. Trauma casualty outcome improves after implementation of gui...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31822638d4
更新日期:2011-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the ability of epithelial-to-mesenchymal transition-related microRNAs (miRNAs) as serum biomarkers for prognosis and prediction of metastasis in patients with colorectal cancer (CRC). BACKGROUND:Epithelial-to-mesenchymal transition-related miRNAs drive CRC progression and metastasis. However, the...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182a6909d
更新日期:2014-04-01 00:00:00
abstract::Umbilical hernia is a common finding in cirrhotic patients with ascites. Spontaneous disruption of the hernia and attendant discharge of ascitic fluid is an unusual and rarely reported complication in these patients and is associated with an overall mortality rate of nearly 30%. During the 5-year period 1977-1982, nin...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198307000-00006
更新日期:1983-07-01 00:00:00
abstract::Four hundred twenty-six patients with esophageal atresia with or without tracheoesophageal fistula have been primarily cared for at the University of Michigan Medical Center since Cameron Haight's initial experience with this entity. Over the period of observation, the incidence of new cases as well as the number of a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198610000-00013
更新日期:1986-10-01 00:00:00
abstract:OBJECTIVE:To evaluate the accuracy of touch imprint and frozen section analysis of sentinel nodes after neoadjuvant chemotherapy. SUMMARY BACKGROUND DATA:Intraoperative evaluation of the sentinel node can determine the need for axillary dissection at the time of initial operation and therefore spare the patient a seco...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181ba845c
更新日期:2010-02-01 00:00:00
abstract:OBJECTIVE:To determine very late clinical outcomes at up to 20 years follow-up from a randomized controlled trial of Nissen vs. anterior 180-degree partial fundoplication. SUMMARY BACKGROUND DATA:Nissen fundoplication for gastroesophageal reflux can be followed by troublesome side effects. To address this, partial fun...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004643
更新日期:2020-11-18 00:00:00
abstract::One hundred twenty-eight patients with chronic renal failure and secondary hyperparathyroidism underwent total parathyroidectomy with forearm autograft. Postoperative clinical improvement was remarkable. In all cases, the grafted tissue functioned well, and reimplantation of the cryopreserved parathyroid tissues was u...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198811000-00016
更新日期:1988-11-01 00:00:00
abstract:OBJECTIVE:The authors determined if more radical surgery with extended lymphadenectomy improves the results of gastrectomy in patients with adenocarcinoma of the gastric antrum. SUMMARY BACKGROUND DATA:The overall survival in patients with gastric cancer is disappointing. Improved survival has been reported by Japanes...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-199408000-00009
更新日期:1994-08-01 00:00:00
abstract:OBJECTIVE:We sought to define the prognostic significance of histologic subtype for extremity/truncal liposarcoma (LPS). BACKGROUND:LPS, the most common sarcoma, is comprised of 5 histologic subtypes. Despite their distinct behaviors, LPS outcomes are frequently reported as a single entity. METHODS:We analyzed data o...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003453
更新日期:2019-07-05 00:00:00
abstract:OBJECTIVE:Two techniques of duodenum-preserving resection of the head of the pancreas were compared in a prospective, randomized trial. The technical feasibility and effects on quality of life were assessed. SUMMARY BACKGROUND DATA:Drainage and resection are the principles of surgery in chronic pancreatitis. The techn...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-199504000-00004
更新日期:1995-04-01 00:00:00
abstract:OBJECTIVE:To evaluate the long-term outcome of aggressive surgery incorporating hepatic resection and systematic nodal dissection for advanced carcinoma involving the hepatic hilus. SUMMARY BACKGROUND DATA:Few long-term results are available regarding radical surgery incorporating major hepatectomy and nodal dissectio...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-199911000-00008
更新日期:1999-11-01 00:00:00
abstract::Medullary thyroid carcinoma (MTC) develops in virtually all patients affected with multiple endocrine neoplasia type II (MEN II), a disease inherited as an autosomal dominant trait. The thyroid tumor cells secrete calcitonin (CT) and the detection of elevated plasma levels (>300 pg/ml) of this hormone in MEN II kindre...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197809000-00013
更新日期:1978-09-01 00:00:00
abstract:OBJECTIVE:This study aimed to explore the impact of a human factors intervention bundle on the quality of ward-based surgical care in a UK hospital. SUMMARY OF BACKGROUND DATA:Improving the culture of a surgical team is a difficult task. Engagement with stakeholders before intervention is key. Studies have shown that ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002089
更新日期:2018-01-01 00:00:00
abstract:PURPOSE:To assess the efficacy of isolated pelvic perfusion (IPP) with tumor necrosis factor (TNF)-α and melphalan in patients with locally advanced cancers in the pelvic and groin area requiring mutilating surgery. METHODS:A total of 27 patients were enrolled (carcinoma, n = 17; sarcoma/melanoma, n = 4; and endocrine...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318242ebe7
更新日期:2012-02-01 00:00:00
abstract:OBJECTIVE:Generation and maintenance of pain in chronic pancreatitis (CP) have been shown to be partially attributable to neuroimmune interactions, which involve neuropeptides such as substance P (SP). So far, expression of SP receptors NK-2R, NK-3R, the SP-encoding gene preprotachykinin A (PPT-A), and the SP degradati...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318070d56e
更新日期:2007-11-01 00:00:00
abstract::A method of clinical staging for infants with necrotizing enterocolitis (NEC) is proposed. On the basis of assigned stage at the time of diagnosis, 48 infants were treated with graded intervention. For Stage I infants, vigorous diagnostic and supportive measures are appropriate. Stage II infants are treated medically,...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197801000-00001
更新日期:1978-01-01 00:00:00
abstract:OBJECTIVES:To investigate the effect of preoperative chemoradiotherapy on surgical complications in patients after pancreatic resection for (borderline-)resectable pancreatic cancer. SUMMARY OF BACKGROUND DATA:Preoperative chemoradiotherapy is increasingly used in patients with (borderline-)resectable pancreatic cance...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004313
更新日期:2020-11-12 00:00:00
abstract:OBJECTIVE:To construct a postoperative nomogram to estimate the risk of local recurrence for patients with desmoid tumors. BACKGROUND:The standard management of desmoid tumors is resection, but many recur locally. Other options include observation or novel chemotherapeutics, but little guidance exists on selecting tre...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31828c8a30
更新日期:2013-08-01 00:00:00