Hepato Gastroenterol
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We present the clinical features and outcome of 34 patients with hepatocellular carcinoma older than 70 years of age who underwent hepatic resection (elderly-HCC). Nowadays, hepatic surgeons unavoidably have to perform hepatic resection on elderly patients with hepatocellular carcinoma due to increasing life expectancy. However, the outcome of hepatic resection on elderly patients with hepatocellular carcinoma varies in each series, and the exact role of surgery in the management of hepatocellular carcinoma in the elderly remains to be clarified. ⋯ We present the clinical features and outcomes of 34 elderly patients with hepatocellular carcinoma who underwent hepatic resection. The results seem to indicate that hepatic resection is safe and feasible in the elderly with hepatocellular carcinoma with or without cirrhosis. The prognosis after hepatic resection is as comparable as that of the younger patients with hepatocellular carcinoma.
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Hepato Gastroenterol · Dec 2003
Randomized Controlled Trial Clinical TrialRemifentanil/midazolam versus tramadol/midazolam use for colonoscopy.
One of the most commonly performed outpatient procedure is colonoscopy. The pain and anxiety is frequently associated with colonoscopy. The aim of this study was to compare the effectiveness of remifentanil/midazolam, and tramadol/midazolam for iv sedation and analgesia during colonoscopy. ⋯ The patients in group T had higher pain scores. Gastroenterologist satisfaction and patient satisfaction were similar in both groups. Our results suggests that, sedoanalgesia with midazolam/remifentanil may be an alternative to sedoanalgesia with midazolam/tramadol for colonoscopy.
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Hepato Gastroenterol · Dec 2003
Alteration of hypothalamus-pituitary-adrenal glands axis in colorectal cancer patients.
in advanced cancer patients a cell-mediated immunological impairment, both at baseline and during postoperative period (surgical trauma response) is often found and is associated with poor prognosis. Furthermore it is well known that cortisol is strictly involved in the response to major surgical stress, has an important immunosuppression activity and causes a redistribution of immunological population cells in different tissues. The aim of the study was to verify serum levels and circadian rhythm of cortisol and ACTH in patients with colorectal cancer at baseline before surgery and in the postoperative period, and relate it to the immune status. ⋯ it is known that lymphocytopenia, both at baseline and in the postoperative period, is associated with a poor prognosis in cancer patients and that cortisol plays an important role in the immune response. Our data show that lymphocytopenia often present in cancer patients, poor prognostic factor, seems not to be associated with ACTH and cortisol level and circadian rhythm alteration, both at baseline and after surgical stress. Otherwise even if paraneoplastic syndromes seems not to be related to colorectal cancer and no patient showed adrenocortical metastasis, an impairment of circadian rhythm of cortisol and ACTH was found at baseline in 28% and 44% respectively. It was significantly associated with the presence of metastatic disease. These preliminary results suggest further investigations on relation between cancer and endocrine system.
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Hepato Gastroenterol · Nov 2003
Resection of localized recurrences after hepatectomy of colorectal cancer metastases.
Hepatectomy is generally considered the only mode of curative treatment available for patients with colorectal liver metastases, even though recurrence occurs in more than 60% of the patients. ⋯ In appropriately selected patients with colorectal cancer, surgical excision of localized recurrences after hepatectomy may be effective in prolonging survival.
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Hepato Gastroenterol · Nov 2003
Randomized Controlled Trial Comparative Study Clinical TrialCoronary artery disease and upper abdominal surgery: impact of anesthesia on perioperative myocardial ischemia.
Some papers claim that epidural anesthesia and analgesia lowers the incidence of perioperative ischemic events and may have a favorable effect on perioperative cardiac morbidity and mortality. We studied the effect of epidural anesthesia and analgesia on perioperative myocardial ischemia, in a group of patients with known coronary artery disease, who underwent upper abdominal surgery. ⋯ Epidural anesthesia and analgesia reduces intraoperative and early postoperative ischemia in patients with known coronary artery disease undergoing upper abdominal surgery.