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Background: The aim of this study is to report the outcome after surgical treatment of 32 patients with ampullary cancers from 1990 to 1999., Methods: Twenty-one of them underwent pancreaticoduodenectomy and 9 local excision of the ampullary lesion. The remaining 2 patients underwent palliative surgery., Results: When the final histological diagnosis was compared with the preoperative histological finding on biopsy, accurate diagnosis was preoperatively established in 24 patients. The hospital morbidity was 18.8% as 9 complications occurred in 6 patients. Following local excision of the ampullary cancer, the survival rate at 3 and 5 years was 77.7% and 33.3% respectively. Among the patients that underwent Whipple's procedure, the 3-year survival rate was 76.2% and the 5-year survival rate 62%., Conclusion: In this series, local resection was a safe option in patients with significant co-morbidity or small ampullary tumors less than 2 cm in size, and was associated with satisfactory long-term survival rates.

When the superficial arm veins are not suitable for the creation of a conventional endogenous arteriovenous (A-V) fistula or the placement of a prosthetic graft in the forearm, the use of the deep forearm veins as an outflow system to construct an A-V graft access seems to be a reasonable alternative. Using this approach, we placed 6 prosthetic grafts in 6 hemodialysis patients in whom conventional methods had failed. Adequate functioning of this 'deep vein'-type vascular access in these 6 patients has been maintained for 3, 6, 11, 15, 19 and 24 months, respectively, without complications or any need for further interventions. Only one graft failed after 6 months. Our preliminary results indicate that this technique can be used successfully when the superficial forearm veins have been exhausted, thus avoiding the use of upper-arm or axillary veins., (Copyright 2000 S. Karger AG, Basel)

Background: Sclerotherapy is one of the older methods of conservative treatment of haemorrhoids. It has been widely used and the early results are considered satisfactory although the long-term results are not as good as expected., Aims: The evaluation of long-term results of sclerotherapy in patients with symptomatic 1st and 2nd degree haemorrhoids., Methods: From 1990 until 1996, 240 outpatients, 154 men and 86 women, with symptomatic 1st and 2nd degree haemorrhoids, underwent sclerotherapy. The most common symptoms were bleeding for patients with 1st degree haemorrhoids and prolapse for patients with 2nd degree. After 3 years all patients were called and examined and their symptoms were recorded. 38 patients were excluded., Results: 3 years after sclerotherapy 20 patients (20.2%) with 1st degree haemorrhoids and 9 patients (8.7%) with 2nd degree were symptoms free. 42 patients (42.4%) with 1st degree haemorrhoids and 66 patients (64.1%) with 2nd degree were worse, and the remainder were either improved or unchanged. Bleeding and prolapse were the most frequent recurrent symptoms., Conclusion: The frequency of recurrent symptoms 3 years after sclerotherapy for symptomatic 1st and 2nd degree haemorrhoids is high. Sclerotherapy appears to be an inappropriate method of treatment for symptomatic 1st and especially 2nd degree haemorrhoids.

In this study the ultrastructure of rat jejunal epithelial cells was examined, following a starvation period of 72 hours and an enteral refeeding period of 12 days, with either Nutrison, Pepti 2000, or Nutri 2000. Most changes occurred in the animals examined immediately after the 72-hour starvation period; these mainly included a significant decrease in microvilli population, occasional cell membrane disintegration, and a usual microvesicular appearance and degranulation of the rough endoplasmic reticulum. No alterations were found in the normally-fed animals (control group). This was also practically the same for the Pepti 2000 group. In the Nutrison group, a small amount of changes were found, while in the Nutri 2000 group many alterations were detected, which nevertheless were fewer than in the starved animals. The results demonstrate that the micromorphological alterations of the intestinal epithelium caused by starvation improve faster when an oligopeptidic formula is provided, which consequently results in faster and better absorption of the nutrients.