The British journal of surgery
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Comparative Study
Comparative effects of enteric-coated pancreatin microsphere therapy after conventional and pylorus-preserving pancreatoduodenectomy.
A comparative study was performed between patients with exocrine pancreatic insufficiency after conventional pancreatoduodenectomy (Whipple's procedure) and pylorus-preserving pancreatoduodenectomy (PPPD). In these patients the pharmacodynamics of 2-mm enteric-coated pancreatin microspheres (ECPMs) and their gastric transit time in relation to that of a solid meal were investigated. The efficacy of ECPM preparations may differ after Whipple's procedure compared with PPPD, because the latter procedure does not include gastrectomy. ⋯ In cases of exocrine pancreatic insufficiency after Whipple's procedure, 2-mm ECPM treatment adequately restores pancreatic enzyme activity. Following PPPD, however, ECPM treatment is often ineffective because the microspheres are retained in the stomach. In these patients, use of conventional powdered pancreatin enzyme preparations may improve the efficacy of treatment.
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Nearly 7 per cent of patients who undergo resection for colorectal cancer develop metachronous cancers several years later. A molecular marker that could identify patients susceptible to metachronous cancers would be of clinical importance. ⋯ These results suggest that testing for microsatellite instability may be useful in recognizing patients at high risk of developing metachronous colorectal cancers.
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Comment Letter Randomized Controlled Trial Clinical Trial
Prospective randomized trial of clips versus subcuticular polydioxanone for neck wound closure.
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The pattern of lymphatic spread of ampullary cancer is poorly documented. This pattern was clarified in order to define the rational extent of radical lymphadenectomy. ⋯ Ampullary cancer mainly spreads to the posterior pancreaticoduodenal node group, then to the IPDA node group, and finally to the para-aortic area. The rational extent of radical lymphadenectomy should include the pancreaticoduodenal, superior mesenteric, pericholedochal, retroportal and para-aortic nodes.