Abstract:
:Primary prevention is defined as the prevention of gallstone formation; secondary prevention is defined as the prevention of clinical manifestations of gallstones--symptoms or more severe complications. For primary prevention, general "wellness" measures can be recommended from a theoretic standpoint. These include elimination of obesity (to decrease excessive cholesterol biosynthesis or mobilization of tissue cholesterol during rapid weight loss); a high-fiber, high-calcium diet (to diminish input of deoxycholic acid); ingestion of meals at regular intervals (to diminish gallbladder storage and interruption of the enterohepatic circulation of bile acids); and vigorous exercise (to permit frequent meals without excessive caloric intake). In addition, based on animal studies, intake of low saturated fatty acids may diminish the nucleation of supersaturated bile. Secondary prevention is recommended only when gallstones become symptomatic because of the benign natural history of asymptomatic gallstones, the intrinsic limitations of medical therapy, and the absence of predictors that would enable selection of asymptomatic patients at high risk for becoming symptomatic. Secondary prevention involves nonsurgical approaches (dissolution with ursodiol, extracorporeal shock-wave lithotripsy plus adjuvant bile acids, and, rarely, contact dissolution with organic solvents). For patients with symptomatic gallstones, nonsurgical therapy will be used by those patients who cannot or will not have surgery, as well as those patients who wish to explore a trial of nonsurgical therapy before having surgery. Because of the intrinsic limitations of nonsurgical therapy in comparison to the efficacy and safety of surgery, most patients will undergo surgery. Future research priorities include elucidation of factors responsible for: (1) bile that is supersaturated in cholesterol; (2) elevated biliary deoxycholic acid levels in patients with cholesterol gallstones; (3) rapid nucleation in patients with multiple cholesterol gallstones; (4) precipitation of calcium bilirubinate; and (5) impaired gallbladder motility in gallbladder stone disease.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Hofmann AFdoi
10.1016/s0002-9610(05)80958-4subject
Has Abstractpub_date
1993-04-01 00:00:00pages
541-8issue
4eissn
0002-9610issn
1879-1883pii
S0002-9610(05)80958-4journal_volume
165pub_type
杂志文章,评审abstract:BACKGROUND:It has been suggested that division of the short gastric vessels (SGV) provides a more floppy Nissen fundoplication, for the treatment of reflux disease. The aim of the study was to assess whether Nissen fundoplication with division of SGV is associated with improved clinical outcome and laboratory findings....
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(01)00695-x
更新日期:2001-09-01 00:00:00
abstract:BACKGROUND:We evaluated coronary angiography use among patients with coronary stents suffering postoperative myocardial infarction (MI) and the association with mortality. METHODS:Patients with prior coronary stenting who underwent inpatient noncardiac surgery in Veterans Affairs hospitals between 2000 and 2012 and ex...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2016.07.023
更新日期:2016-11-01 00:00:00
abstract::A total of ninety three patients with biliary tract disease were studied to determine the concentration of the pancreatic enzymes, amylase and lipase, in bile obtained from the gallbladder and/or common bile duct. Of seventy gallbladder bile samples, amylase levels were higher than actual or predicted serum levels in ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(79)90055-2
更新日期:1979-03-01 00:00:00
abstract::Sebaceous cell carcinoma of the parotid gland is a rare lesion. A review of the English literature reveals nine previously reported cases. Two cases are presented in which the tumor was originally diagnosed as mucoepidermoid carcinoma. Aggressive treatment of the recurrence, which was subsequently recognized as sebace...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(75)90494-8
更新日期:1975-10-01 00:00:00
abstract:BACKGROUND:HIV and AIDS continues to be a significant health problem with many patients requiring the attention of a general surgeon. METHOD:A retrospective case note review over a two-year period was undertaken. RESULTS:237 patients underwent invasive procedures. The majority 100 patients (145 procedures) were for v...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/S0002-9610(96)00054-2
更新日期:1996-07-01 00:00:00
abstract:BACKGROUND:The role of frozen section (FS) in thyroid disease is controversial. The goal of this study was to identify a cohort of patients who may or may not benefit from FS. METHODS:Two hundred thirty-one patients who underwent thyroidectomy were evaluated in regard to fine-needle aspiration (FNA), FS, and the exten...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(02)01074-7
更新日期:2002-12-01 00:00:00
abstract::Thirty-two rats had truncal vagotomy either with or without pyloroplasty. After 2 or 4 weeks, respectively, the pancreas was excised and weighed. Measurements of amylase, trypsin, lipase, total protein, and DNA were obtained from the homogenated pancreatic tissue. Isolated pancreatic lobules were incubated with and wi...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(89)90615-6
更新日期:1987-09-01 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::Understanding variation in perioperative opioid exposure and its effect on patients' outcomes is critical for pain management. This study characterized perioperative exposure to morphine and its association with postoperative pain and 30-day readmissions. We utilized nationwide Veterans Healthcare Administration (VHA)...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2019.06.022
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:The appropriate surgical approach of a pancreatic multifocal disease that skips the body of the gland remains unknown. We sought to analyze a parenchyma-sparing surgical technique consisting of a middle-preserving pancreatectomy (MPP) evaluating feasibility, safety, and oncological and functional outcomes. ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2009.02.017
更新日期:2009-09-01 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:The adipocyte hormone leptin has been shown to increase migration and angiogenesis in epithelial cells. Therefore, we hypothesized that leptin would induce prostate cancer cell migration and growth factor expression in vitro. METHODS:Prostate cancer cell lines DU145 and PC-3 (androgen-resistant) were treate...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2004.07.031
更新日期:2004-11-01 00:00:00
abstract:BACKGROUND:For locally advanced Siewert type II and III tumors we have performed total gastrectomy including resection of the distal 2/3 of the esophagus, through separate abdominal and right chest incisions (THX-ABD). The procedure involves wide lymphadenectomy in the abdomen/chest and a Roux-en-Y jejunostomy to the l...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2018.11.049
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:Cancer of unknown primary (CUP) origin is a very aggressive disease with a poor prognosis. Most of the literature reports of CUP are generated from tertiary cancer centers. METHODS:A retrospective chart review of all patients with a diagnosis of CUP was performed between January 1995 and January 2005. Age, ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2007.08.039
更新日期:2007-12-01 00:00:00
abstract::Technetium 99m-pyridoxylideneglutamate (99mTc-PG) administered intravenously is excreted by hepatocytes into the bile canaliculi and enters the gallbladder through the cystic duct and consequently, can be used for scanning the hepatobiliary ductal system. A total of 166 patients representing 27 normal subjects, 84 pat...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(77)90204-5
更新日期:1977-01-01 00:00:00
abstract:BACKGROUND:Merkel cell carcinoma (MCC) is a cutaneous neuroendocrine tumor that may spread via lymphatics and can therefore be staged with sentinel lymph node biopsy (SLNB). MCC is radiosensitive and chemosensitive, although the role of adjuvant therapy is still unclear. We examined the impact of different treatments o...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2014.06.013
更新日期:2015-02-01 00:00:00
abstract::After partial or total esophagectomy, total gastrectomy, pancolectomy, and urinary cystectomy, it becomes necessary to reestablish continuity and/or replace function by the creation of a substitute organ obtianed from the various portions of the gastrointestinal tract. Ideally, the creation of the substitute organ sho...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(77)90458-5
更新日期:1977-11-01 00:00:00
abstract::We attempted to determine the incidence and significance of cytomegalovirus infection and the effect of immunoglobulin G infusions on specific cytomegalovirus titers in burn patients. On admission, 48 percent of a group of 120 patients (mean burn size 28.5 percent of the total body surface area) were seronegative, inc...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章
doi:10.1016/s0002-9610(88)80718-9
更新日期:1988-02-01 00:00:00
abstract:BACKGROUND:Incidental abnormalities are increasingly being detected. The pathology and clinical outcome of patients with pancreatic incidentalomas have not been well characterized. METHODS:We reviewed the records of 356 patients with pancreatic abnormalities from August 2001 to June 2007. Clinical and pathologic data ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2007.12.027
更新日期:2008-03-01 00:00:00
abstract::In an attempt to determine the late effects and associated morbidity of radiotherapy on normal tissue, patients with squamous carcinoma of the oral cavity and oropharynx were retrospectively reviewed. Between 1964 and 1975, 569 patients with cancer of the floor of the mouth, oral tongue, tonsil, and retromolar trigone...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(83)90247-7
更新日期:1983-10-01 00:00:00
abstract:PURPOSE:During general surgery (GS) training, residents are expected to accurately interpret radiologic images. Objective evidence evaluating residents' ability to provide accurate interpretation of imaging studies is currently lacking. METHODS:A 30-item web-based test was developed using images from different radiolo...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2016.11.029
更新日期:2017-03-01 00:00:00
abstract::From 1972 to 1987, 403 patients underwent a composite resection consisting of segmental mandibulectomy and neck dissection for the treatment of bucco-pharynx squamous cell carcinoma (303 patients had postoperative radiotherapy [XRT], 29 patients had preoperative XRT, and 100 patients had tissue salvage performed after...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80350-2
更新日期:1993-10-01 00:00:00
abstract:PURPOSE:We assessed the usefulness of revision for hemodialysis arteriovenous fistulae. METHODS:From 1985 to 1994, 287 arteriovenous fistulae were created at our facility. "Primary" patency was defined as the duration of fistula patency without revision, and "secondary" patency was defined as the duration of fistula p...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/S0002-9610(97)00032-9
更新日期:1997-07-01 00:00:00
abstract:BACKGROUND:Multivisceral resection is often required in the treatment of locally advanced rectal cancers. Such resections are relatively rare and oncologic outcomes, especially when sphincter preservation is performed, are not fully demonstrated. METHODS:A retrospective review was conducted of patients who underwent m...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2014.10.014
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:The Affordable Care Act (ACA) dramatically changed the healthcare system in the United States. This study aims to analyze the impact of the ACA on general surgery clinic visits and resultant procedures. METHODS:A retrospective review was conducted on new patients who presented to the elective general surger...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2018.11.004
更新日期:2019-06-01 00:00:00
abstract::Arteriovenous fistulas were performed in 100 patients over a three year period with a 90 per cent overall success rate. Various technics for construction of the fistula using autologous veins are discussed, with emphasis on pre- and intraoperative assessment of vessel condition and its relation to the prevention of im...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(76)90009-x
更新日期:1976-05-01 00:00:00
abstract:BACKGROUND:Melanomas are aggressive neoplasms with limited therapeutic options. Therefore, developing new therapies with low toxicity is of utmost importance. Honokiol is a natural compound that recently has shown promise as an effective anticancer agent. METHODS:The effect of honokiol on melanoma cancer cells was ass...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2012.09.001
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:Despite blood-conservation techniques, hemorrhage during burn excision remains substantial. It is difficult to predict the blood loss that will occur per operation and how many units the patient will require during surgery. This may result in high cross-match-to-transfusion ratios (CMTRs). METHODS:A retrosp...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2004.11.030
更新日期:2005-03-01 00:00:00
abstract:BACKGROUND:The US Food and Drug Administration recently approved a transcatheter aortic valve for patients for whom open heart surgery is prohibitively risky. METHODS:A multidisciplinary heart valve team partnered with administration to launch a transcatheter aortic valve replacement (TAVR) program. Clinical registrie...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2012.07.017
更新日期:2012-11-01 00:00:00
abstract::Microvascular free tissue transfer has provided a variety of methods of restoring vascularized bone and soft tissue to difficult defects created by tumor resection and trauma. Over 7 years, 26 patients have undergone 28 free flaps for mandibular reconstruction, 15 for primary squamous cell carcinoma of the floor of th...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80550-1
更新日期:1990-10-01 00:00:00