Hepato Gastroenterol
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Hepato Gastroenterol · Sep 2005
Radiation therapy, bypass operation and celiac plexus block in patients with unresectable locally advanced pancreatic cancer.
The great majority of pancreatic cancers are unresectable due to local invasion and/or distant metastasis. The treatment options for such patients include bypass operation, celiac plexus block, radiation therapy (RT), chemotherapy and immunotherapy. RT is divided into intraoperative radiation therapy (IORT) and external radiation therapy (ERT). Appropriate palliative treatment remains controversial. ⋯ RT significantly prolonged survival of patients with unresectable locally advanced pancreatic cancer and combined palliative treatments including bypass operation, celiac plexus block and RT (ERT or IORT) are recommended for such patients.
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Choledochal cysts are congenital malformations of the pancreatico-biliary system. Some aspects of optimal surgical management of choledochal cysts remain controversial. The purpose of this paper is to present our series of 14 patients with choledochal cysts, analyzing surgical management and long-term results. ⋯ Total or partial excision of the choledochal cysts is the optimal treatment because of the lower incidence of postoperative complications and the better survival rate after the operation.
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Hepato Gastroenterol · Jul 2005
Reappraisal of a method of reconstruction after pancreatoduodenectomy.
After pancreatoduodenectomy (PD), pancreatic leak and the functional pancreatic and gastrointestinal disorders are the most important complications. Still there is no single method which takes care of all of them. After identifying the various reasons behind these complications, the senior author started performing the present method in the 1980s. Since then we have been able to bring these complications to a very low incidence. The present study is designed to substantiate the claims of various advantages of this method of PD and reconstruction and to explain the rationale behind this method. ⋯ Our method of PD and reconstruction produces encouraging results with respect to PJ leak, mortality, DGE, malabsorption, bile gastritis, dumping, marginal ulcers and diabetes. We recommend this technique as a safe and effective method even to the low volume centers.
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Hepato Gastroenterol · May 2005
Current diagnosis and treatment of gastrointestinal carcinoids in a series of 101 patients: the significance of serum chromogranin-A, somatostatin receptor scintigraphy and somatostatin analogues.
Carcinoids are relatively rare tumors that arise from neuroendocrine cells and have proved to be slow growing malignancies which involve many organs and most frequently the gastrointestinal (GI) tract. Herein we present in this study 101 pts with carcinoid tumors that originated from the GI tract and pancreas. Also, we analyze the clinical and pathological features, pointing out the characteristics of this group of neoplasms and describing our diagnostic and therapeutical approach, in parallel with a brief review of the literature. ⋯ a) Tumor size (especially in appendiceal and gastric carcinoids) and, also, the dispersion of disease, highly predict the evolution of the patients; b) serum Chromogranin-A seems to be a very useful tumor marker for the diagnosis and follow-up of pts with GI carcinoids; c) the introduction of new imaging techniques and especially OCTREOSCAN contributes to a better localization of the primary tumors and their metastases, as well as, to the right decision of the appropriate medical treatment; d) surgical excision is the treatment of choice in nonmetastatic tumors; and e) in pts with metastatic disease, the administration of Somatostatin analogues improves their quality of life.