The argon beam coagulator is a new device for haemostasis during and after surgery on parenchymatous organs. No data are available on its efficacy and tissue effect following hepatic resection. Blood loss, the time needed to achieve adequate haemostasis and histological findings after liver resection were assessed in 12 pigs using argon beam coagulation or suture ligation only, the mattress suture technique and tissue glue application. The treatment was randomly assigned to each of the four liver lobes in each pig. Median blood loss following argon beam coagulation was 13 (range 2-47) ml and after simple suture ligation 55 (range 2-260) ml (P < 0.02). The median time needed for adequate haemostasis following argon beam coagulation was 3 (range 2-7) min versus 14 (range 2-48) min in the control group (P < 0.005). There was no difference between argon beam coagulation and tissue glue, which were both superior to the use of mattress sutures. Argon beam coagulation resulted in less tissue damage than tissue glue or mattress suturing. The argon beam coagulator is an efficient device for achieving haemostasis following partial hepatectomy in the pig. It causes only a moderate tissue reaction.
We report a case of spinal epidural abscess presenting as abdominal pain. An 7-year-old boy presented with abdominal pain. He was operated on under suspicion of appendicitis. During operation, no abnormalities were found. Postoperatively, the abdominal pain did not subside. Subsequently, the boy developed neurological abnormalities. MRI showed a spinal epidural abscess. A laminectomy was performed and the boy was treated with antibiotics; he recovered well. This case showed that it is important to consider a spinal epidural abscess as a cause of abdominal pain with fever in children. Key words Abdominal pain´Spinal epidural abscess RØsumØNous rapportons un cas dabcs spinal Øpidural se prØsentant comme une douleur abdominale. Un garc Ë on de 8 ans sest prØ-sentØ avec une douleur abdominale. Il a ØtØ opØrØ pour suspicion dappendicite. Durant lopØration, aucune anomalie na pas ØtØ trouvØe. En post-opØratoire, la douleur abdominale na pas persistØ. En mme temps, le garc Ë on a dØveloppØ des anomalies neurologiques. LIRM a montrØ un abcs spinal Øpidural. Une laminectomie a ØtØ rØalisØe et le garc Ë on traitØ par des antibiotiques a guØri. Ce cas montre quil est important de considØrer labcs spinal Øpidural comme une cause de douleur abdominale avec fivre chez lenfant. Mots-clØs Douleurs abdominales´Abcs spinalResumen Presentamos un caso de absceso espinal epidural que se presentó como dolor abdominal en un niaeo de 7 aaeos. Fue operado con sospecha de apendicitis y durante la operación no se encontraron anomalías. En el postoperatorio no cedió el dolor abdominal y mµs adelante el niaeo desarrolló anomalías neurológicas. La RNM mostró un absceso espinal epidural, por lo que se hizo una laminectomía y se trató al niaeo con antibióticos recuperµndose bien. Este caso muestra que es importante considerar la posibilidad de una absceso epidural espinal como causa de dolor abdominal y fiebre en niaeos. Palabras clave Dolor abdominal´Absceso peridural ZusammenfassungEs wird der Fall eines 7 Jahre alten Knaben berichtet, der sich mit Bauchschmerzen wegen eines Epiduralabszesses des Rücken-markes vorstellte. Das Kind wurde wegen Verdacht auf Appendizitis operiert. Bei der Laparotomie fanden sich jedoch keine pathologischen Veränderungen. Postoperativ wurde wegen fortbestehender Beschwerden und sich entwickelnder neurologischer Symptome ein MRI durchgeführt. Dies zeigt einen spinalen epiduralen Abszess. Es wurde eine Laminektomie vorgenommen Case Report
This rare anomaly may lead to severe complications when left untreated or after late treatment. It is easy to manage with low associated morbidity.
Two hundred twenty patients with a carcinoma in the head of the pancreas were divided into three tumor diameter groups: group 1, 0.5 to 4.4 cm (n = 72); group 2, 4.5 to 6.0 cm (n = 77); and group 3, 6.1 to 15.0 cm (n = 71). For these tumor diameter groups a six-fold eliminatory curability analysis was performed. Of the patients with liver metastases in group 1 the last patient had died at 10 months and in groups 2 and 3 no patients were alive at 18 months after the start of complaints. Patients with extrahepatic metastases did not survive 12 months in group 1, 16 months in group 2, and 25 months in group 3. The 6% actuarial survival rate for inoperable patients was reached in group 1 after 17 months, in group 2 after 36 months, and in group 3 after 27 months after the start of complaints. For groups 1 through 3 in curable, but not curatively operated patients, the respective 0% actuarial survival rate was reached at 24 months, 23 months, and 14 months. The 0% actuarial survival rate in patients with irresectable vessel invasion was reached in group 1 at 33 months, in group 2 at 23 months, and in group 3 at 25 months. The 0% actuarial survival rate in patients with an irresectable tumor was reached at 33 months, 31 months, and 27 months after the start of complaints in groups 1, 2, and 3, respectively. The 0% actuarial survival rate in curatively operated patients was reached in group 3 after 26 months and in group 2 after 29 months. In group 1 25% of the patients were alive at 36 months after the start of complaints. Small tumors were associated with the greatest chance of curative operation and on average had the longest survival. However, small tumors with liver or other metastases carried a worse prognosis than large tumors with liver or other metastases. If tumors were found not to be resectable at the time of operation, the size of the tumor did not appear to affect survival.
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