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  • 1
    Online Resource
    Online Resource
    Laparoscopic Surgery for Gallbladder Cancer: An Expert Consensus Statement
    S. Karger AG ; 2019
    In:  Digestive Surgery Vol. 36, No. 1 ( 2019), p. 1-6
    Details
    In: Digestive Surgery, S. Karger AG, Vol. 36, No. 1 ( 2019), p. 1-6
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Despite the increasing number of reports on the favorable outcomes of laparoscopic surgery for gallbladder cancer (GBC), there is no consensus regarding this surgical procedure. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 The study aimed to develop a consensus statement on the application of laparoscopic surgery for GBC based on expert opinions. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 A consensus meeting among experts was held on September 10, 2016, in Seoul, Korea. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Early concerns regarding port site/peritoneal metastasis after laparoscopic surgery have been abated by improved preoperative recognition of GBC and careful manipulation to avoid bile spillage. There is no evidence that laparoscopic surgery is associated with decreased survival compared with open surgery in patients with early-stage GBC if definitive resection during/after laparoscopic cholecystectomy is performed. Although experience with laparoscopic extended cholecystectomy for GBC has been limited to a few experts, the postoperative and survival outcomes were similar between laparoscopic and open surgeries. Laparoscopic reoperation for postoperatively diagnosed GBC is technically challenging, but its feasibility has been demonstrated by a few experts. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Laparoscopic surgery for GBC is still in the early phase of the adoption curve, and more evidence is required to assess this procedure.
    Type of Medium: Online Resource
    ISSN: 0253-4886 , 1421-9883
    URL: Article
    DOI: 10.1159/000486207
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2019
    detail.hit.zdb_id: 1468560-7
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  • 2
    Online Resource
    Online Resource
    Usual ACE Inhibitor Therapy in CKD Patients Is Associated with Lower Plasma Aldosterone Levels than Usual Angiotensin Receptor Blocker Therapy
    S. Karger AG ; 2007
    In:  Kidney and Blood Pressure Research Vol. 30, No. 5 ( 2007), p. 299-305
    Details
    In: Kidney and Blood Pressure Research, S. Karger AG, Vol. 30, No. 5 ( 2007), p. 299-305
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Attenuating aldosterone (ALDO) effects may be important in slowing kidney and cardiovascular disease progression. This study tested whether ACE inhibitor (I) therapy achieves lower plasma (p) ALDO levels than angiotensin receptor blocker (ARB) therapy when they are used under usual clinical conditions in chronic kidney disease (CKD) patients. 〈 i 〉 Methods: 〈 /i 〉 Consecutive CKD patients (n = 123) were studied. They were clinically stable and receiving either ACEI (n = 77) or ARB (n = 46) (physician’s choice) for ≧3 months. 〈 i 〉 Results: 〈 /i 〉 Mean pALDO in the ACEI cohort was 7.8 ± 5.7 (SD) ng/dl compared to 12.3 ± 9.8 ng/dl in the ARB cohort (p = 0.0018, normal ambulatory pALDO 9.4–33.8 ng/dl). The pALDO difference was not explained by differences in age, sex, race, body weight, diagnosis of diabetes; the use of β-blockers, calcium channel blockers or diuretic; systolic or diastolic blood pressure; plasma renin, serum creatinine, sodium, potassium, or bicarbonate levels; 24-hour urine potassium, sodium, urea or protein excretion; or ACEI or ARB dose. 〈 i 〉 Conclusions: 〈 /i 〉 Mean pALDO is about 60% higher with ARB therapy than ACEI therapy when these drugs are customarily used in CKD patients. This difference could be clinically important with regard to kidney and cardiovascular protection.
    Type of Medium: Online Resource
    ISSN: 1420-4096 , 1423-0143
    URL: Article
    DOI: 10.1159/000106021
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2007
    detail.hit.zdb_id: 1482922-8
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  • 3
    Online Resource
    Online Resource
    Evaluation of the POSSUM Scoring System for Comparative Audit in Pancreatic Surgery
    S. Karger AG ; 2003
    In:  Digestive Surgery Vol. 20, No. 6 ( 2003), p. 539-545
    Details
    In: Digestive Surgery, S. Karger AG, Vol. 20, No. 6 ( 2003), p. 539-545
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Wide variations exist in the reported morbidity and mortality rates for major pancreatic resections. The Physiological and Operative Scoring System for enUmeration of Morbidity and mortality (POSSUM) was developed for comparative audit in general surgical patients. It has also been found to be reliable for audit in colorectal, thoracic and vascular surgery with minor modifications. 〈 i 〉 Aims: 〈 /i 〉 To evaluate POSSUM and its modification for mortality, P-POSSUM, in pancreatic surgery. 〈 i 〉 Methods: 〈 /i 〉 Retrospective analysis of 50 patients undergoing partial pancreaticoduodenectomy (PD) (46 tumours, 4 chronic pancreatitis) using the POSSUM and P-POSSUM as predictors of morbidity and mortality. These were then compared with the observed values. 〈 i 〉 Results: 〈 /i 〉 The POSSUM-predicted mortality was 26%. The P-POSSUM predicted a mortality risk of 6%. The observed mortality was 4%. Using POSSUM for morbidity, the predicted value was 76%. The observed morbidity was 46%. The risk scores for patients with and without morbidity were similar (66.4 ± 11.0 vs. 68.8 ± 12.9, p = 0.49). 〈 i 〉 Conclusions: 〈 /i 〉 While P-POSSUM appeared satisfactory for predicting mortality risk, POSSUM overestimated morbidity and mortality for PD in a specialist centre. Modifications are needed prior to its application for comparative audit in pancreatic surgery.
    Type of Medium: Online Resource
    ISSN: 0253-4886 , 1421-9883
    URL: Article
    DOI: 10.1159/000073701
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2003
    detail.hit.zdb_id: 1468560-7
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  • 4
    Online Resource
    Online Resource
    Isolated Roux Loop Duct-to-Mucosa Pancreaticojejunostomy Avoids Pancreatic Leaks in Pancreaticoduodenectomy
    S. Karger AG ; 2002
    In:  Digestive Surgery Vol. 19, No. 3 ( 2002), p. 199-204
    Details
    In: Digestive Surgery, S. Karger AG, Vol. 19, No. 3 ( 2002), p. 199-204
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Over the last decade the operative mortality associated with pancreaticoduodenectomy (PD) has decreased. Pancreatic anastomotic leaks resulting in pancreatic bed sepsis and fistulae, however, remain a significant cause of both morbidity and mortality. The optimal method of reconstruction to minimise pancreatic leaks is controversial. 〈 i 〉 Aim: 〈 /i 〉 To review the experience of Roux loop duct-to-mucosa pancreaticojejunostomy in a consecutive series of patients undergoing pancreatic head resection. 〈 i 〉 Methods: 〈 /i 〉 Over the 6-year period (1993–1998), 41 patients underwent pancreatic head resections for benign (n = 5) and malignant disease (n = 36). There were 19 males and the median age was 62 years (range 29–83). An isolated Roux loop pancreaticojejunostomy was performed in all cases. 〈 i 〉 Results: 〈 /i 〉 Median duration of surgery was 8 h and the median postoperative stay was 16 days. The mean peri-operative blood transfusion was 2.9 units (SD 1.9). The incidence of major complications was 12% and there was 1 death (2.4%). There were no pancreatic leaks or fistulae. 〈 i 〉 Conclusions: 〈 /i 〉 The low complication rate and the absence of pancreatic fistulae in this series would suggest that Roux loop duct-to-mucosa pancreatic reconstruction should be more widely adopted.
    Type of Medium: Online Resource
    ISSN: 0253-4886 , 1421-9883
    URL: Article
    DOI: 10.1159/000064213
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2002
    detail.hit.zdb_id: 1468560-7
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