Relationship between pancreatic and serum amylase in basal conditions and during stimulation in man. Report of a new intraoperative technique

The correlation between serum amylase and pancreatic amylase secretion was studied in two patients. Both patients underwent sphincterotomy, and the pancreatic duct was cannulated with a polyethylene tube. The tube was left in place for 15 to 21 days. The rate of amylase secretion over 7 days was studied in response to (1) a standard meal, (2) duodenal acidification, (3) scalar doses of cholecystokinin, (4) scalar doses of secretin, and (5) scalar doses of secretin with simultaneous infusion of cholecystokinin. Blood samples were collected during the tests to measure serum amylase. No significant correlation was shown between blood concentration and output of amylase in any of the tests. Our findings show that under normal conditions serum amylase levels are not influenced by pancreatic secretion and suggest that serum amylase concentration is not related to pancreatic exocrine secretion.     

Management and long-term results in patients with two-thirds gastrectomy and stomal ulcer

In 67 patients with two-thirds gastrectomy and endoscopically proven stomal ulcer, serum gastrin levels were measured under basal conditions and after intravenous infusion of bombesin (15 ng/kg/ min), calcium (4 mg/kg/hour) and secretin (2 units/ kg). All patients underwent medical or surgical therapy. The long-term results were evaluated according to the Visick grading system (average follow-up, 3.1 years).     

Intrahepatic lithiasis. Study of thirty-six cases and review of the literature.

In 2,700 operations for biliary tract stones, intrahepatic lithiasis (stones located proximal to the confluence of the main hepatic ducts) was discovered in 36 patients (1.3 per cent). The diagnosis of intrahepatic lithiasis was determined only via intraoperative chalangiography in thirty-two cases (88.9 er cent); in 23 per cent of our cases of intrahepatic lithiasis, jaundice was never observed. This confirms that intraoperative cholangiography should be performed routinely in every case of biliary lithiasis. The removal of stones was generally performed by an indirect approach (papillostomy and/or choledochotomy). In 16.7 per cent of our cases, a direct approach was indicated. It is extremely important, after removal of calculi, to assure ample bilioenteric flow. Our surgical approach was therefore based mostly on the caliber of the biliary tract. When the tract was dilated less that 2 cm (in 20 cases), choledochohepaticotomy with papillostomy was most often performed (12 cases, 60 per cent). When the dilatation was more that 2 cm (12 cases), Roux-en-Y hepaticojejunostomy was performed in all. There was no operative mortality, although the long-term follow-up results were poor in 9.6 per cent of the cases.     

Changes in circulating levels of cholecystokinin,gastrin, and pancreatic polypeptide after small bowel resection in dogs

The postresectional meal-stimulated concentrations of gastrin were significantly increased 6 weeks after intestinal resection, and returned to preoperative levels within 10 weeks. Preoperatively, the onset of release of cholecystokinin occurred 120 minutes after food intake, 3 weeks after surgery it occurred at 90 minutes after food intake, and at 10 and 15 weeks after operation at 15 and 5 minutes after food intake, respectively. Postprandial release of pancreatic polypeptide was not affected by massive small bowel resection. We suggest that postresectional hypergastrinemia results from loss of a distal inhibitor and that the abnormally high basal concentrations of gastrin may augment the basal pancreatic polypeptide. We further suggest that the increased cholecystokinin concentrations, and the alterations of the temporal pattern of the release, are secondary to accelerated gastric emptying and intestinal transit. The mechanism responsible for postresectional hypergastrinemia is short-lived but the mechanism for postresectional increases in cholecystokinin release is not.     

Reduced tissue content of vasoactive intestinal peptide in aganglionic colon of Hirschsprung's disease

The colonic tissue content of immunoreactive vasoactive intestinal peptide was measured in four children with histologically proven Hirschsprung's disease. The concentration of vasoactive intestinal peptide was lower in the aganglionic bowel than in nearby normal bowel. Similar results have been described for another gastrointestinal peptide: substance P. Abnormalities of peptidergic control may contribute to the motility disorder of congenital aganglionic colon.     

Patterns of mechanical obstruction of the small bowel in Nigeria

One hundred sixty-one patients with mechanical small bowel obstruction were treated within 2 years at the University of Nigeria Teaching Hospital, Enugu, Nigeria. The various causes of obstruction fairly typify the patterns of mechanical small bowel obstruction in Nigeria, except for slight differences in some parts of the country. The fairly high mortality rate reflects the difficulties encountered in management of the patients. Measures to reduce mortality are suggested.     

Evaluation of Renal Function in Patients Undergoing Lung Transplantation

Background

Acute kidney injury and chronic kidney failure are serious complications after lung transplantation. Glomerular filtration rate (GFR) is the primary indicator of renal function. Several equations have been proposed to evaluate the estimated GFR (eGFR). We compared three different equations to determine which has the better correlation with the development of acute and chronic renal failure in lung recipients.

Prospective controlled trial of cryoprecipitated plasma,plasma protein fraction and serum albumin solution for kidney preservation

A controlled prospective study was conducted to compare the results of kidney preservation and transplantation in regard to the type of perfusate used for perfusion preservation. Cryoprecipitated plasma, plasma protein fraction and serum albumin solution were used as perfusate. Between February 1979 and July 1980,176 kidneys were preserved by one of these perfusates and transplanted. There was no statistically significant difference in the donor and recipient status, perfusion characteristics or graft and patient survival among the three groups. Synthetic perfusates are an acceptable alternative to cryoprecipitated plasma for perfusion preservation of cadaver kidneys.     

Pre-Emptive Therapy for the Treatment of Cytomegalovirus After Kidney Transplantation

Background

Cytomegalovirus (CMV) represents the leading cause of viral infection in kidney transplantation patients. The aim of the present study was to evaluate the efficacy and safety of pre-emptive anti-CMV therapy.

Use of intraperitoneal xenon-133 for imaging of intestinal strangulation in small bowel obstruction

Intraperitoneal xenon-133 dissolved in saline solution was evaluated for the detection of early strangulation in a reproducible model of segmental intestinal obstruction in rats and dogs. There was a highly significant delay in externally detected isotope washout from animals with strangulated loops compared with normal, sham operated and simple (nonstrangulated) obstruction control groups. Concentrations of isotope obtained in ischemic intestinal tissue exceeded those previously reported by an order of magnitude. Corresponding anterior abdominal gamma camera images showed marked retention of isotope at 1 hour in the strangulation obstruction groups and the sites of this activity corresponded to the location of the ischemic loops. Blinded readings of these images by nuclear radiologists showed this method to be highly accurate for the detection of strangulation in these animal models. This method should be directly applicable to patients with intestinal obstruction.     

Sodium sulfobromophthalein kinetics in cirrhosis of the liver before and after portacaval shunt

Sodium sulfobromophthalein (BSP) kinetics were studied with the compartmental analysis of Barber-Riley et al [8]in thirty-six patients with cirrhosis of the liver and portal hypertension. Liver uptake of BSP and its transfer from liver to bile were grossly reduced and its transfer from liver back to plasma was augmented.In fifteen patients one month after shunt operation (ten cases of side to side portacaval anastomosis, two of end to side, and three of splenorenal), the liver uptake of BSP was 29.6 per cent lower than preoperative values (2P < 0.001), whereas transfer rate of BSP from liver to bile was unchanged. In seven patients one year after operation (five cases of side to side, one of end to side, and one of splenorenal), the liver uptake of BSP was 28.3 per cent lower (2P < 0.05) and the transfer of BSP from liver to bile 29.9 per cent lower (2P < 0.05) than preoperative values.     

Distal splenorenal shunt: Hemodynamic advantage over total shunt and influence on clinical status,hepatic function and hypersplenism

Clinical status, hepatic function and hypersplenism were investigated in 20 patients who underwent distal splenorenal shunt between January 1970 and June 1978. The operative mortality rate was 5 percent, and encephalopathy of varying degrees affected 30 percent of the patients. There was no recurrence of bleeding, and the 3 to 5 year actuarial survival rate was 78 percent. Hypersplenism was significantly ameliorated in 17 patients (p < 0.01). Serum glutamic oxalacetic and pyruvic transaminase significantly improved postoperatively and bilirubin significantly worsened, whereas other tests of liver function remained unchanged. Our results confirm the efficacy of this procedure in controlling recurrence of bleeding from esophageal varices. Moreover, severe hypersplenism is not an absolute contraindication to the shunt, which is preferable to total shunts since hepatopetal flow is preserved, thus avoiding early hepatic decompensation as demonstrated by the substantial stabilization of the liver function tests in the short run.     

Clinical significance of elevated serum and urine amylase levels in patients with appendicitis

During the 45 month period beginning January 1977, 251 patients with a pathologically confirmed diagnosis of acute appendicitis underwent celiotomy at the Medical College of Virginia Hospital. A preoperative serum or urine amylase determination was recorded in 155 of the patients (62 percent). Of this group, 15 patients (10 percent) had elevation of serum amylase or 2 hour urine amylase. Hyperamylasemia or hyperamylasuria directly led to misdiagnosis or treatment delay in 5 of the 15 patients. Appendiceal rupture occurred in three patients, two of whom had prolonged (greater than 1 month) hospitalizations directly attributable to the misdiagnosis. As a result of this study, we conclude that (1) acute appendicitis and elevated amylase levels may occur concurrently, (2) hyperamylasemia or hyperamylasuria should not dissuade the surgeon from early operation if other clinical features suggest appendicitis, and (3) abdominal pain and elevation of amylase level define significant intraabdominal disease, not specifically pancreatic disease.     

Specificity of the suppressor cell activity of intestinal lymphocytes

Experiments were designed to examine the functional characteristics of lymphocytes harvested from the human intestine. Lymphocytes were harvested from the intestines of patients undergoing intestinal resection for a variety of gut disorders. The mitogenic and allogeneic responses of gut lymphocytes were found to be comparable with the response of peripheral blood lymphocytes. Intestinal suppressor cell activity was found to be more specific against other intestinal lymphocytes than peripheral mononuclear cells. The regulation of the intestinal immune response in various bowel disorders may be determined at a local level to a greater degree than had been previously appreciated.     

Technetium-99m HIDA hepatobiliary scanning in evaluation of afferent loop syndrome

A study of 118 patients, operated on with Billroth II gastrectomy for peptic disease and affected by postgastrectomy syndromes, was carried out. Fifty patients were investigated by means of technetium-99m HIDA hepatobiliary scanning. In 18 patients, in whom an afferent loop syndrome was clinically suspected, hepatobiliary scanning demonstrated an altered afferent loop emptying in 8 and atonic distension of the gallbladder without afferent loop motility changes in 10. Among the patients in the first group, four were treated with a biliary diversion surgical procedure and in the second group, two patients underwent cholecystectomy. Our findings indicate that biliary vomiting, right upper abdominal pain pyrosis, and biliary diarrhea in Billroth II gastrectomized patients are not always pathognomonic symptoms of afferent loop syndrome. Technetium-99m HIDA hepatobiliary scanning represents the only diagnostic means of afferent loop syndrome definition. A differential diagnosis of abnormal afferent loop emptying and gallbladder dyskinesia is necessary for the management planning of these patients, and furthermore, when a surgical treatment is required, biliary diversion with Roux-Y anastomosis or Braun's biliary diversion seems the treatment of choice for afferent loop syndrome, whereas cholecystectomy represents the best procedure for atonic distension of the gallbladder.     

Collagen dynamics of partial small bowel obstruction

The response of intestinal collagen to obstruction and stress was studied in the rat. Partial small bowel obstructions were created. Preobstruction collagen was measured by injection of tritium labeled proline. New collagen formation after obstruction occurred was followed by injection of carbon-14 labeled proline. At 3 weeks, collagen fractions were identified. Throughout the study, preexisting preobstruction intestinal collagen was metabolically stable with no breakdown or remodeling demonstrable. New collagen formation was rapid and occurred to the largest degree close to the obstruction.     

Effectiveness of surgical management of the Wolff-Parkinson-White syndrome

In this report, the surgical experience with the treatment of Wolff-Parkinson-White syndrome in 190 patients who had 210 Kent bundles has been summarized. The patients with reentry tachycardia caused by the Kent bundle were relieved by Kent division or by His division, the latter being used only in 10 percent of the patients. A malignant ventricular arrhythmia was found in 25 percent of the patients and was due to a Kent bundle that conducted an atrial flutter-fibrillation 1:1 to the ventricle. This arrhythmia was corrected by Kent interruption, since the Kent bundle alone participated in the arrhythmia. Other unusual manifestations of Kent bundles were found, such as multiple pathways, unidirectional conducting pathways, and pathways causing incessant junctional tachycardia. Other cardiac problems were frequently present, such as hypertrophic cardiomyopathy and Ebstein's anomaly. Even in such a multifaceted problem caused by a minute congenital abnormality, careful application of sophisticated electrophysiologic measurements followed by appropriate surgical methods have proved to be effective in correcting the two arrhythmias associated with Wolff-Parkinson-White syndrome.