Biomedical subjects
Publications and source records attributed to A R Berry.
Endoscopic sphincterotomy was attempted on 18 patients with retained biliary stones. Endoscopy was performed within 2 weeks of the operation in 13 patients and within 3 weeks in 5 patients. A T-tube was present in 14 patients and 6 patients had multiple stones. Sphincterotomy and complete duct clearance was achieved in 17 patients (94%) and a complication (haemorrhage) occurred in one patient (6%).
Sixty-six patients requiring catheterization in the course of general surgical operations were randomly allocated into two groups. Of the 34 patients catheterized urethrally 16 developed urinary tract infections whereas of the 32 suprapubically catheterized patients only 2 developed an infection (P less than 0.001). Five patients required recatheterization after removal of their urethral catheters. There were no major complications associated with the use of suprapubic catheters. We propose that, when catheterization is required during a general surgical procedure, the suprapubic route is to be preferred.
The first report of a carcinoid tumour of the ampulla of Vater causing acute pancreatitis is presented. The pancreatitis resulted from ampullary obstruction and diversion of the bile through the pancreas. Endoscopic retrograde cholangiopancreatography established the correct diagnosis, making this the first occasion in which a carcinoid tumour of the ampulla of Vater has been correctly diagnosed before surgery.
One hundred and fifteen patients who were treated by a proctocolectomy in Oxford between 1972 and 1984 for inflammatory bowel disease have been studied. All the patients had the rectum removed by the technique of perimuscular dissection which was introduced in 1972 in an attempt to overcome the problems associated with the previous types of proctectomy. The method has been shown to be safe; the operative mortality was 1.7 per cent. The most worrying potential complications due to permanent autonomic nerve damage (i.e. impotence and urinary incontinence), which previously have been recorded as occurring in a significant percentage of patients, were completely prevented by the method of dissection. One man suffered transient impotence which responded to psychiatric treatment. There were no long term urinary tract or sexual problems. Postoperative complications occurred in 37 per cent of patients, perineal wound infections being the most common (25.7 per cent). Perineal healing, however, was achieved in 75 per cent of patients by the time of their discharge from hospital. The mean length of postoperative hospital stay was 19 days in patients with ulcerative colitis and 15 days in patients with Crohn's disease. Our rate of perineal healing is better than has been recorded using other operative techniques.
In 1980 a review of lower limb amputation over a 3.5 year period between 1974 and 1978 was reported from our centre. More recently 193 amputations were performed for peripheral vascular disease over a similar 3.5 year period, representing an increase of 33 per cent in the amputation rate during the last 6 years. This cannot be explained by the increasing age of the population alone. Fewer below-knee amputations (BKA) (33.0 per cent) and more Gritti-Strokes amputations (GSA) (32.0 per cent) were performed and the overall incidence of re-amputation for stump breakdown was 13.5 per cent. Twenty-eight per cent of below-knee amputation stumps required re-amputation at higher levels, but when successful were associated with a 75 per cent incidence of rehabilitation with an artificial limb. Eight per cent of GSA stumps required re-amputation and were associated with a twenty-eight per cent incidence of successful rehabilitation. Thirty-seven per cent of patients had undergone reconstructive vascular surgery before amputation. Of the 26 patients requiring re-amputation 58 per cent had undergone arterial reconstruction in an attempt to salvage the limb (chi 2 = 5.65, P less than 0.02) and in 26.9 per cent of cases this was performed within the week before amputation. We feel that injudicious attempts at arterial reconstruction, when amputation appears inevitable, may adversely affect the subsequent level of amputation and jeopardize rehabilitation.
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Using an experimental model of acute pancreatitis in the rat, we have studied changes in the biophysical properties of lungs and intrapulmonary fibrin deposition in this condition. Acute pancreatitis is associated with a significant decrease in pulmonary compliance (p less than 0.01) and a significant increase in lung weight (p less than 0.01) compared with a control sham operation group. These changes are associated with a 24% increase in intrapulmonary 125I fibrinogen deposition (p less than 0.01), and an 18% increase in 125I fibrinogen deposition per gram of lung tissue (p less than 0.05) in acute pancreatitis, compared with a control sham operation group. The increased fibrinogen deposition is abolished by treatment with low dose heparin. Using the same animal model changes in pulmonary ultrastructure are shown using scanning electron microscopy. The results indicate that pulmonary abnormalities are associated with intrapulmonary fibrin deposition in experimental acute pancreatitis and these findings may be relevant to the well described respiratory complications of the condition in man.
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The etiology and pathogenesis of acute necrotizing hemorrhagic pancreatitis remain controversial. Recent work has suggested that an early fall in pancreatic blood flow, causing ischemia, may be the initiating factor. Using an established rat model of hemorrhagic pancreatitis and the fractional indicator distribution technique with 86RbCl, pancreatic blood flow and tissue perfusion have been measured at various times in the condition. Six groups of ten rats were studied: control sham operation and pancreatitis groups were sacrificed at 1, 6, and 24 hr. Pancreatic blood flow (% of cardiac output) and perfusion (blood flow/g tissue) were measured. Blood flow was increased by a maximum of 53% at 1 hr (P less than 0.001) and remained elevated for 24 hr, and perfusion was increased by a maximum of 70% (P less than 0.001) at 1 hr and remained elevated at 6 hr. Pancreatic perfusion declines after 6 hr due to increasing gland edema. The results demonstrate a significant increase in pancreatic blood flow and perfusion in experimentally induced acute pancreatitis, suggesting a primary inflammatory response, and refute the ischemic etiological theory.
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Respiratory complications of acute pancreatitis are well recognised and are closely related to a poor prognosis. Using an experimental model in the rat, a decrease in lung compliance and an increase in lung weight were produced in acute pancreatitis. The effects of dexamethasone, heparin, and aspirin on these changes were studied. The mean specific lung compliance was reduced by 16% in the pancreatitis group compared with the control group (p less than 0.05) and this change was abolished by dexamethasone (p less than 0.02), heparin (p less than 0.01), and aspirin (p less than 0.001). Percentage lung weight (as percentage of total body weight) was raised by 22% in the pancreatitis group compared with the sham operation group (p less than 0.01) and this change was abolished by heparin (p less than 0.01) and aspirin (p less than 0.05), but not affected by dexamethasone (p less than 0.5). The results indicate that 'stiff' and heavy lungs occur in experimental acute pancreatitis. The fact that these changes are abolished by heparin and improved by aspirin suggests that intrapulmonary fibrin deposition is a factor in the pathogenesis of the important respiratory complications of this condition.
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Respiratory complications were studied in 50 patients with acute pancreatitis, and the relationship of these complications to parameters of fibrinogen metabolism was investigated. The mean arterial P02 of the patients was 9.85 +/- 3.8 kPa (s.d.). Forty-three per cent of patients on admission were hypoxaemic. The mean PO2 was lower in patients who subsequently developed complications of acute pancreatitis (mean P02 7.85 +/- 1.42 kPa (s.d.), P less than 0.01). Vital capacity on admission was decreased by 50 per cent in 41 per cent of patients and by 20 per cent decrease in their vital capacity. Fibrinogen levels were elevated in 80 per cent of of patients on admission and there was a negative correlation between these levels and the arterial P02 (r = -0.6, P less than 0.001). Fibrinogen degradation products were elevated in 45 per cent of patients. The results confirm that marked lung damage occurs in acute pancreatitis and suggest that the effects are prolonged. The possibility that this damage may be related to pulmonary fibrin deposition is discussed.
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We report two cases of pan-proctocolectomy for ulcerative colitis who some time postoperatively developed an obstructive uropathy with the clinical and radiological features of retroperitoneal fibrosis. The incidence of this complication appears to be around 10% and the possibility of such a diagnosis should be borne in mind in any patient who has non-specific symptoms after surgery for ulcerative colitis.