摘要:

AbstractThe classical Whipple procedure for chronic pancreatitis has been associated with significant long term postoperative morbidity. The pylorus‐preserving procedure of Longmire has reduced but not eliminated the long‐term morbidity. Preservation of the whole duodenum with total pancreatectomy has been introduced for the treatment of patients with end‐stage chronic pancreatitis after favourable experience with this procedure in infants for nesidioblastosis. Fourteen patients with chronic pancreatitis have had a total pancreatectomy with preservation of the duodenum and the bile duct. All patients are still alive (median follow‐up 9·5 months) and none suffered major complications in the perioperative period. One patient developed a biliary stricture at 3 months, requiring biliary reconstruction. Six of the patients have returned to full‐time work; nine require no analgesia. All patients require pancreatic enzyme replacement, and all patients have gained weight postoperatively. Diabetic control is satisfactory with a twice daily insulin regime. Duodenum‐preserving total pancreatectomy is feasible in the adult without mortality or high morbidity; early experience suggests that preserving the duodenum improves gastrointestinal function with easier control of

ISSN:0007-1323    

DOI:10.1002/bjs.1800740112

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractControlled intraduct infusion and peri‐acinar dispersal of 100 µl buffer containing sodium glycodeoxycholate (GDOC) at concentrations of 8·5, 17 and 34 mmol/l in rats caused a progressively severe acute pancreatitis from which none of the animals died over the experimental period. Infusion of affinity‐purified active human enterokinase in buffer did not cause pancreatitis, presumably because of the inability of the macromolecule to gain access to its specific intracellular substrate trypsinogens. The addition of enterokinase 200 ng to GDOC 34 mmol/l in the infusate resulted in a severe systemic disturbance and a form of acute necrotizing pancreatitis which was uniformly and rapidly lethal. This effect was not seen when equimolar trypsin was substituted for enterokinase. These findings show that enterokinase specifically increases the lethality of experimental bile salt pancreatitis and suggest that this bile‐borne enzyme may in some cases pose a significant clinical

ISSN:0007-1323    

DOI:10.1002/bjs.1800740113

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractWe studied serum elastase 1 concentrations in patients with pancreatic disease to assess its diagnostic value and compare its sensitivity and specificity with that of amylase and pancreatic isoamylase. Markedly raised concentrations of elastase 1 were found in all twenty‐nine patients with acute pancreatitis (amylase was elevated in all but three and pancreatic isoamylase in all but one). Serial measurements of the three enzymes in acute pancreatitis showed that elastase remained elevated longer than amylase and pancreatic isoamylase. The majority of chronic pancreatitis patients studied during a painful relapse (16 out of 21, 76 per cent) had elastase concentrations above the upper normal limit. Amylase and pancreatic isoamylase were elevated in 11 (52 per cent) and in 13 (62 per cent), respectively. Most patients with chronic pancreatitis studied during clinical remission (39 out of 43) had serum elastase levels either within (n = 24) or below (n = 15) the control range. The latter had severe exocrine pancreatic insufficiency and steatorrhoea. In carcinoma of the pancreas, 20 out of 32 (63 per cent) had abnormal serum elastase concentrations; 16 were higher and 4 lower than the control range. Amylase was abnormal in 10 (31 per cent) (8 high, 2 low), and pancreatic isoamylase was abnormal in 16 (50 per cent) (11 high, 5 low). In 46 control patients with non‐pancreatic abdominal pain, serum elastase concentrations were not significantly different from those in healthy controls. Elastase was slightly raised in two, whereas amylase and pancreatic isoamylase were elevated in seven and eight, respectively. We conclude that serum elastase 1 is a highly sensitive and specific indicator of pancreatic dise

ISSN:0007-1323    

DOI:10.1002/bjs.1800740114

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800740115

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractChanges in coagulation and fibrinolysis were investigated in 20 patients with oesophageal varices, who underwent endoscopic injection sclerotherapy (EIS) with 5 per cent ethanolamine oleate (EO), by means of serial determination of plasma fibrinopeptide A (FPA) and fibrinopeptide β15–42 (β15–42). One hour after the completion of EIS, the value of FPA was significantly increased to 38·1 ± 11·1 ng/ml (mean ± s.e.m.) from a pre‐EIS value of 7·1 ± 1·4 ng/ml (P>0·01) and it gradually returned to normal range by 48 h after EIS. A very similar change was observed in the value of Bβ15–42 (P>0·01). These observations indicated that EIS provokes transient activation of coagulation and fibrinolysis. In vitro studies, however, revealed that EO inhibits fibrin clot formation because of the Ca2+‐chelating ability of its constituent ethanolamine, although oleate or benzyl alcohol exhibited procoagulant activity in FPA formation in vitro. Nevertheless, an external application of EO or oleate over decapsulized kidney of rat resulted in a significant accumulation of125I‐labelled fibrin(ogen). From these results it was suggested that intravascular injection of EO, which exerts an inhibitory effect on coagulation in vitro, activates the local coagulation system. The activation may be accelerated by an acute inflammatory process provoked by oleate, which is supported by such clinical manifestations as mild fever, retrosternal pain leukocytosis and an increase in plasma fibrinogen level which was observed i

ISSN:0007-1323    

DOI:10.1002/bjs.1800740116

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractA further extension of the U‐tube technique is described in the treatment of six patients with primary sclerosing cholangitis who developed progressive jaundice and recurrent biliary sepsis. All six patients had operative intrahepatic duct dilatation and U‐tube placement. Three patients in addition had a Roux‐en‐Y hepaticojejunal anastomosis. Five patients are improved and are well after a median follow‐up period of 56 months. Two patients have had the U‐tube removed electively. Three patients with progressive disease required further percutaneous catheter dilatation of intrahepatic strictures via the U‐tube tract. Application of the technique permits evaluation of the biliary system by tube cholangiography and provides access in complex cases for repeated therapeutic intrahepatic strictu

ISSN:0007-1323    

DOI:10.1002/bjs.1800740117

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractIn a retrospective study of 100 patients with operable breast cancer, microscopic involvement of the nipple‐–areola complex was found in 16 cases. Each of these 16 cases occurred in patients with centrally situated tumours. In contrast, nipple involvement did not occur with peripherally situated tumours lying>2 cm outside the areolar margin (P>10−6, Fisher's exact test). Nipple involvement was more likely in patients with ≥ 4 positive axillary nodes (P>0·01, χ2test). From this study it appears that nipple preservation may be undertaken during mastectomy for small peripheral tumours, provided the nipple is clinically normal, and frozen section analysis of the sub‐nipple area is shown to be free from tumour invasion. These criteria for nipple preservation were satisfied in 20 patients out of a prospective series of 60. In this group, nipple preservation on the skin flap improved the cosmetic result of breast reconstruction in 35 per cent, and facilitated skin closure in 20 per cent. After a mean follow‐up period of 50·4 months, nipple preservation was not associated with any significant excess of loc

ISSN:0007-1323    

DOI:10.1002/bjs.1800740118

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800740119

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800740120

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800740121

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY