Long-Term Outcome after 92 Duodenum-Preserving Pancreatic Head Resections for Chronic Pancreatitis: Comparison of Beger and Frey Procedures

Introduction  

Duodenum-preserving pancreatic head resection may be an alternative to pancreatoduodenectomy or drainage procedures for chronic pancreatitis. There are few studies directly comparing the long-term outcome after the operations described by Beger and Frey.     

Technical modifications of the Dornier HM-3 lithotriptor with an improved anesthesia technique

Summary Three technical modifications have been introduced into the Dornier HM-3 lithotriptor at the Marienhospital Herne: a low-pressure generator, which reduces the energy at the second focus by 30%, a modified semi-ellipsoid with an increased aperture and altered geometric dimensions, and the twin-pulse technique, releasing two impulses synchronized with a single R-wave. The treatment standard achieved with the conventional HM-3 device could be maintained, with a radiological success rate for stone disintegration of 95%. Procedural time could be reduced. The mean number of impulses and rate of second treatments increased, mainly due to the increasing proportion of ureteral and branched calculi. Cutaneous petechiae were rarely observed, suggesting less tissue damage with the lower pressures used. The profound reduction in pain perception with these technical modifications led to a new anesthesia technique. A combination of an oral anxiolytic and oral analgesic was effective in 94%. The results suggest that patient comfort and safety during ESWL treatment have been considerably improved.     

Ultrastructural evidence that insoluble microtubules are components of the neurofibrillary tangle

Summary The ultrastructure of Alzheimer's neurofibrillary tangles is heterogeneous and includes abnormal paired helical filaments (PHF) and various other insoluble structures. Insoluble non-PHF components isolated from neurofibrillary tangles were examined by electron microscopy. Comparison of these fractions with normal assembled neurofilaments and normal brain microtubules revealed scattered profiles which were morphologically (not chemically) identical to structures present in the microtubule, but not in the neurofilament preparations. These results support the notion that insoluble microtubules contribute to the make up of the neurofibrillary tangle. Based on these findings, preliminary experiments were conducted which suggest that non-enzymatic glycosylation may be a pathway leading to insolubility of the microtubules.This work has been supported in part by a grant from the Veterans Administration to M.A.P.     

Morphologic assessment of oxidative damage: A review

Biochemical studies have indicated changes in anti-oxidant enzyme activities and increased oxidative damage products in many disease states, particularly aging and diseases associated with aging, such as neurodegenerative diseases and cancer. To try to determine cellular and subcellular localization of oxidative damage, our laboratory has developed quantitative light and electron microscopy immunogold techniques using specific antibodies to oxidative damage products. Results from studies of different pathologic processes are presented, illustrating that both localization and quantitation of oxidative damage products is possible. These analyses give important insights into the nature of various pathologic processes.     

Absorption of cholesterol from a micellar solution: intestinal perfusion studies in man

The absorption of cholesterol has been studied in man by perfusing the upper jejunum with a micellar solution of bile salt, 1-monoglyceride, and cholesterol-¹⁴C, with a triple lumen tube with collection sites 50 cm apart. The absorption of micellar components between the collection sites was calculated from their concentration changes relative to those of the watersoluble marker, polyethylene glycol. Control experiments were performed with cholesterol-free perfusions of saline or bile salt-monoglyceride solutions. Steady state conditions were obtained.     

A 72-hour study to test the efficacy and safety of the "Mucus Slurper" in mechanically ventilated sheep

OBJECTIVE: In patients intubated with endotracheal tubes (ETTs), suctioning is routinely performed to remove mucus from within the ETT and trachea. The Mucus Slurper is a novel ETT with built-in suction ports arranged radially at its tip. We evaluated the safety and efficacy of the Mucus Slurper, compared with conventional tracheal suction, to prevent airway obstruction in sheep with the ETT and trachea oriented below horizontal. DESIGN: Prospective randomized animal study. SETTING: Animal research facility at the National Institutes of Health. SUBJECTS: Twelve healthy sheep. INTERVENTIONS: Sheep were randomized to be intubated with either the Mucus Slurper (study group) or a Hi-Lo Tracheal Tube (Mallinckrodt, St. Louis, MO) (control group) and mechanically ventilated for 72 hrs. In the study group, automatic, timed tracheal aspiration lasted 0.3 secs, was repeated every 2 mins, and was synchronized with the early expiratory phase. In the control group, tracheal suction was performed every 6 hrs or as required. MEASUREMENTS AND MAIN RESULTS: In the control group, tracheal secretions accumulated progressively within the ETT and the trachea. In the study group, all mucus that reached the tip of the Mucus Slurper was aspirated, keeping the lumen of the ETT, and proximal trachea, free from secretions. In the study group, expiratory water trap protein concentration, a crude index to measure mucus drainage through the ETT, was consistently less than the control group (p < .001). At autopsy, no macroscopic injury to the tracheal mucosa was found in either group. In the study group, the respiratory circuit was less colonized than in the control group. There were no statistically significant differences between the two groups in bacterial colonization of the lungs/bronchi. CONCLUSIONS: The Mucus Slurper, combined with orientation of the trachea below horizontal, prevents accumulation of secretions within the lumen of the ETT and trachea, without need for conventional tracheal suctioning.