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| 1 | Comparison of Wirsung-jejunal duct-tomucosa and dunking technique for pancreatojejunostomy after pancreatoduodenectomy显示文摘Pancreato-enteric reconstruction after pancreatoduodenectomy (PD) is still a source of debate because of the high incidence of complications. Among the various types of pancreato-jejunostomies we don’t know yet which is the best in terms of anastomotic failure and related complications rates. Wirsung-jejunal duct-to-mucosa anastomosis (WJ) and 'dunking' pancreato-jejunal anastomosis (DPJ) are the two most used ones worldwide but conflicting results are reported. To determine which is the safer anastomosis and to define when an anastomosis should be preferred, we retrospectively reviewed two groups of patients who underwent WJ or DPJ. METHODS:Twenty-three patients underwent PD with WJ (n=17) with dilated (WJD) (n=9) or not-dilated Wirsung’s duct (WJND) (n=8) or with a DPJ (n=6) over a 3-year period at a single institution. RESULTS: The complications rate was high in all groups of patients (33.3% in WJD, 37.5% in WJND and 66.7% in DPJ). A pancreatic fistula developed in one patient in each group (11. 1% in WJD, 12. 5% in WJND and 16. 7% in DPJ). All these patients were managed conservatively. Anastomotic disruption took place in the WJ patients especially in the WJND group (n=2) compared to the WJD (n=1) (25% vs 11.1%) or DPJ groups (0%) : these three patients required a re-operation. Overall, the anastomotic defects were higher in patients who underwent WJND (37.5%), compared to WJD (22.2%) and to DPJ (16.7%). However, no statistical differences were found among the groups. Delayed gastric emptying (DGE) and total parenteral nutrition (TPN) along with anastomotic defects were responsible for a prolonged hospital stay. CONCLUSIONS:Our results were not able to demonstrate any statistical difference between the two different techniques in preventing anastomotic failure. WJ can represent a valid choice in case of a dilated duct and a firm, fibrotic enlarged gland that could not be properly invaginated in a small jejunal loop. DGE may occur in those patients who experienced an anastomotic failure and required a TPN regimen with a prolonged hospital stay. | Unita di Chirurgia, Dipartimento di Fisiopatologia Clinica (Batignani G, Fratini G, Zuckermann M and Tonelli F) and Dipartimento di Statistica (Bianchini E), Universitd degli Studi di Firenze, Flo rence, Italy | 2005 | Hepatobiliary & Pancreatic Diseases International2005，4，3： | 9 |
| 2 | Labor Safety System Research显示文摘 | Firenze B | 2001 | Safety Science Journal2001，45，2： | 1 |
| 3 | Operations strategy and organizational performance: An empirical study显示文摘 | Ahmed Nazim U Montagno Ray V Firenze Robert J | 1996 | International Journal of Operations & Production Management1996，16，5： | 1 |
| 4 | Labor safety system research显示文摘 | Firenze B | 2001 | Safety Science Journal2001，45，2： | 1 |
| 5 | Organizational performance and environmental consciousness:an empirical study显示文摘 | AHMED N U MONTAGNO R V FIRENZE R J | 1998 | Management Decision1998，36，2： | 1 |
| 6 | Endothelin 1 in migraine and tension - type headache 显示文摘 | Gallai V Sarchielli P Firenze C Trequattrini A Paciaroni M Usai F Palumbo R | 1994 | Acta NearolScand1994，89，1： | 1 |
| 7 | Labor Safety System Research显示文摘 | Firenze B | 2001 | Safety Science Journal2001，45，2： | 1 |
| 8 | Labor Safety System Research显示文摘 | Firenze B | 2001 | Ssfety Science Journal2001，45，2： | 1 |
| 9 | Endothelin 1 in migraine and tension-type headache显示文摘 | Gallai V Sarchielli P Firenze C | | 0，，： | 1 |
| 10 | Organizational Perform ance and Environmental Consciousness:An Empirical Study显示文摘 | MONTAGNO Ray V FIRENZE Robert J | 1998 | Management Decisio n1998，36，2： | 1 |
| 11 | Organizational Performance and Environmental Con- sciousness: An Empirical Study显示文摘 | AHMED N U MONTAGNO R V FIRENZE R J | 1998 | Management Decision1998，36，2： | 1 |
| 12 | Endothelin I in mi- graine and tension - type headache 显示文摘 | Gallai V Sarehielli P Firenze C | 1994 | Acta Neurol Scand1994，89，1： | 1 |
| 13 | Organizational Performance and Environmental Consciousness 显示文摘 | Ahmed N U Montagno R V Firenze R J | 1998 | Management Decision1998，36，2： | 1 |
| 14 | Endothelin 1 in migraine and tension-type headache显示文摘 | Callai V Sarchielli P Firenze C | 1994 | Acta Neruol Scand1994，89，： | 1 |
| 15 | ESSENTIALLY SYMPLECTIC BOUNDARY VALUE METHODS FOR LINEAR HAMILTONIAN SYSTEMS显示文摘In this paper we are concerned with finite difference schemes for the numerical approximation of linear Hamiltonian systems of ODEs. Numerical methods which preserves the qualitative properties of Hamiltonian flows are called symplectic intoprators. Several symplectic methods are known in the class of Runge-Kutta methods. However, no higll order symplectic integrators are known in the class of Linear Multistep Methods (LMMs). Here, by using LMMs as Boundary Value Methods (BVMs), we show that symplectic integrators of arbitrary high order are also available in this class. Moreover, these methods can be used to solve both initial and boundary value problems. In both cases, the properties of the flow of Hamiltonian systems are 'essentially' maintained by the discrete map, at least for linear problems. | L. Brugnano(Diprtimento di Enerpetica, University di Firenze, 50134 Firenze, Italy) | 1997 | Journal of Computational Mathematics1997，15，3： | 1 |
| 16 | Endothelinl in migraine and tension-type headache显示文摘 | Gallai V Sarchiellip Firenze C | 1994 | Acta Neurol Scand1994，89，： | 1 |
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