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Biomedical subjects

B E Stabile

Publications and source records attributed to B E Stabile.

At least 73 records · Page 4Linked to original sources
PubMed1987

Intraperitoneal nutritional support: initial results in a canine model.

To evaluate the capacity of the peritoneal membrane to efficiently absorb complex nutritional solutions, five adult mongrel dogs were prepared with peritoneal and intravenous catheters. In duplicate studies each dog's peritoneal catheter was rapidly infused with 1 liter of fluid containing 1.25% glucose, 5% fat emulsion, 2.5% mixed amino acids, and 20 ml of standard electrolyte additive solution. Plasma and peritoneal fluid nutrient and electrolyte concentrations and osmolarities were measured initially, 1/2 hr, and hourly for 5 hr after infusion. Mean peritoneal fluid volume increase was 56 +/- 45 ml at 5 hr (P less than 0.05). Plasma osmolarity remained unchanged as peritoneal fluid osmolarity rapidly declined to plasma level over the initial 2 hr. Peritoneal fluid concentrations of glucose, triglycerides, and amino acids all fell precipitously during the first hour (P less than 0.01) while plasma concentrations rose in reciprocal fashion (P less than 0.01). Maximal rises above basal plasma concentrations all occurred at 1/2 hr and amounted to 42.7% for glucose, 39.7% for triglycerides, and 113.2% for amino acids. Levels returned to normal or near normal by 5 hr. Net absorption of glucose was 91.7% of the total glucose load after 5 hr of intraperitoneal dwell time. Triglyceride absorption was 65.1% and amino acid absorption was 91.9%. Greater than 75% of total nutrient absorption occurred during the initial hour of dwell. It is estimated that both nonprotein energy and nitrogen requirements could be met with two to three intraperitoneal nutrient solution exchanges per day. Thus, provision of total nutritional needs may be possible with an intraperitoneal support system.

Absorption↗
PubMed1987

Stricture of the common bile duct from chronic pancreatitis.

Early diagnosis and treatment of stricture of the common bile duct from chronic pancreatitis are essential as the life-threatening complications of biliary cirrhosis and acute cholangitis can occur even in the absence of clinical jaundice. In a series of 40 patients with longstanding chronic pancreatitis and stricture of the common bile duct, findings included chronic pain in 26 patients, jaundice in 17 patients, secondary biliary cirrhosis in six patients and acute cholangitis in six patients. Persistent elevation of the alkaline phosphatase level was the most sensitive laboratory indicator of occult obstruction of the biliary tract. The diagnostic long tapered stenosis of the distal common bile duct was delineated by percutaneous transhepatic cholangiography in 21 of 22 patients and endoscopic retrograde cholangiopancreatography in eight of 11 patients. Operative decompression of the biliary tract included 32 biliary-enteric bypasses, three sphincteroplasty procedures and three emergency tube drainages. There was one postoperative death and seven other patients had postoperative complications. Sphincteroplasty failed to relieve the obstruction in two patients and two patients with biliary-enteric bypass had late anastomotic strictures develop which required reoperation. Only seven patients were free of pain at follow-up study which ranged from 0.5 to 15.0 years. Clinical suspicion based upon persistent hyperaklalinphosphatemia, diagnosis by cholangiography and decompression of the biliary tract by choledochoenterostomy can reliably avert the lethal complications of stricture of the common bile duct caused by chronic pancreatitis.

Adult↗
PubMed1986

A method for atraumatic surgical access to the pancreatic duct.

A method for atraumatic surgical access to the pancreatic duct which uses a soft, flexible polyethylene catheter to intubate the duct, followed by progressive dilation with a vein catheter introducer, a blunt silver probe, and a grooved director is described herein. Sphincteroplasty of the pancreatic duct can then be easily accomplished.

Catheterization↗
PubMed1985

Mesenteric cysts and intra-abdominal cystic lymphangiomas.

Although mesenteric cysts and intra-abdominal cystic lymphangiomas are uncommon and clinically confusing lesions, histologic and ultrastructural evidence suggests that they are pathologically distinct. Differentiation of these lesions is important since lymphangiomas may follow a proliferative and invasive course. Of 28 cases documented at laparotomy, histologically eight patients (29%) had cystic lymphangiomas and 20 patients (71%) had mesenteric cysts. Lymphangioma was found to be exclusively a disease of childhood and young adulthood (mean age, 10 years); mesenteric cyst was found in all age groups (mean age, 44 years), and two thirds of these patients were over 40 years old. Patients with lymphangiomas more frequently were male (75% vs 30%), symptomatic (88% vs 35%), and had ascites (50% vs 0%) and larger lesions (mean, 8.8 vs 4.7 cm) when compared with patients with mesenteric cysts. Complete excision was possible in all but four patients, with no operative deaths and a postoperative complication rate of 7%. After a mean follow-up period of four years, there were no recurrences among 16 patients who had undergone complete excision.

Abdominal Neoplasms↗
PubMed1985

Cancer of the distal esophagus and cardia: preoperative irradiation prolongs survival.

Ninety-five patients with carcinoma of the esophagus and gastric cardia seen between 1979 and 1984 were managed in one of four ways: radiotherapy alone (6,000 rads), esophagogastrectomy alone, preoperative radiotherapy (4,000 rads over 4 weeks) followed by esophagogastrectomy, or no definitive treatment for patients with advanced disease. Patients who receive radiotherapy alone or no definitive therapy were considered unfit for operation; however, those patients who had operation only were equivalent with regard to histologic stage and risk to patients who received preoperative radiotherapy and surgery. Patients who received no definitive therapy died within 1 year, with a mean survival of 3.7 months. The mean survival for patients who received radiotherapy only was 8.3 months; for those who had surgery alone, 13 months; and for those who had preoperative radiotherapy, 24 months. Patients who received preoperative radiotherapy had significantly longer survival times when followed 12, 15, and 18 months postoperatively. Preoperative radiotherapy did not improve overall resectability, and postoperative mortality was similar in the two surgical groups. In comparable patients treated by esophagogastrectomy, preoperative irradiation prolonged the disease-free survival time and is advocated for all surgical candidates.

Adenocarcinoma↗
PubMed1985

Benign and malignant gastrinoma.

The advent of the histamine H2-receptor antagonists and the renewed interest in curative surgery in patients with gastrinoma have made the differentiation between benign and malignant tumors of critical importance. An analysis of 65 patients with gastrinoma followed for an average of 93 months revealed two distinct clinical groups: those with and those without hepatic tumors at initial examination or operation. Among the 14 patients with hepatic tumors, 12 had multiple liver metastases from pancreatic or duodenal primary tumors, and 2 had primary hepatic gastrinomas. Ten of the 14 patients (71 percent) died from tumor progression, and the total tumor-related mortality for this group was 79 percent. In contrast, only 1 of 15 patients (7 percent) with tumor in the lymph nodes died from a tumor-related cause (recurrent ulcer hemorrhage), and none died from tumor progression. Only a single patient with lymph node metastases at initial exploration went on to the development of liver metastases, which was found incidentally at autopsy 313 months later. Among 23 patients with either primary tumors only or no tumors found at laparotomy, there was only one tumor-related death and no deaths from tumor spread. Life-table analysis demonstrated a significantly decreased length of survival for patients with liver tumor compared with those without liver involvement. Multiple endocrine adenopathy syndrome was not a significant factor in survival. Serum gastrin levels were likewise nondiscriminatory. Six of 52 patients (12 percent), including three with tumor in the lymph nodes, were apparently cured by excision of all gastrinoma recognized at laparotomy. The cure rate was 23 percent for patients without multiple endocrine adenopathy syndrome or liver metastases. Hepatic metastases is a definitive marker for clinically malignant disease and portends a poor prognosis. Patients with gastrinoma confined to the lymph nodes uncommonly follow a malignant clinical course. Such patients have at least a 20 percent probability of surgical cure if they do not have multiple endocrine adenopathy syndrome.

Adult↗
PubMed1985

Role of cholecystokinin in pancreatic exocrine response to intraluminal amino acids and fat.

Controversy continues over the relative contributions made by hormonal and neural mechanisms in the exocrine pancreatic response to ingested food. The recent description of the drug proglumide as a specific, competitive cholecystokinin (CCK)/gastrin receptor antagonist has permitted reevaluation of the role of CCK in this process. In chronic pancreatic fistula dogs, dose-response studies were performed to determine the effect of proglumide on the pancreatic responses to octapeptide of CCK (CCK-OP), intravenous bethanechol, intraduodenal amino acids, and intraduodenal fat. Pancreatic volume, protein, and bicarbonate outputs to all doses of CCK-OP were inhibited significantly (P less than 0.05) in a competitive manner, consistent with the proposed mode of action of proglumide. In contrast, proglumide caused only minor and insignificant inhibition of the output responses to intravenous bethanechol. Virtually complete inhibition to all doses of intraduodenal amino acids and fat was observed with proglumide administration. If indeed proglumide is a specific CCK receptor antagonist, these results support the hypothesis that CCK is the major mediator of the intestinal phase of exocrine pancreatic secretion.

Amino Acids↗
PubMed1985

Patency of autogenous saphenous vein versus polytetrafluoroethylene grafts in femoropopliteal bypass for advanced ischemia of the extremity.

Eighty-six femoropopliteal bypass operations were performed for ischemic ulceration, gangrene or rest pain in 77 patients whose mean preoperative ABI was 0.35. In this homogeneous patient sample, we compared prospectively a trial of saphenous vein versus PTFE grafts. During the follow-up period amputations were required in 30 per cent of the patients with a vein graft and in 31 per cent of patients with a PTFE graft. However, the presence of gangrene significantly decreased the interval to first occlusion (p less than 0.001). Over-all, autogenous saphenous vein grafts had longer patency than PTFE grafts in both the femoropopliteal and distal bypass positions. This advantage prevailed when 45 of the patients were randomized, although not at statistically significant levels. In patients without gangrene who underwent limb salvage, bypassing the diseased femoropopliteal segment with either of the graft materials increased graft patency and limb salvage compared with patients who had ischemic tissue necrosis.

Adult↗
PubMed1984

Peritonitis due to intraperitoneal perforation of infected urachal cysts.

Acute bacterial peritonitis due to intraperitoneal perforation of an infected urachal cyst represents a potentially lethal complication of the rare anomalies of the fetal urachus. We report four cases of this disease, including what we believe is the first to have been correctly diagnosed prior to operation. All four patients underwent emergency laparotomy and curative excision of the urachal remnant. Review of our four cases plus seven previously reported cases disclosed the perforated urachal cyst to be predominantly a disease of young males who initially have acute peritonitis but often without specific indication of a urachal anomaly. Bacteriologic examination has identified a wide variety of infecting organisms. Umbilical sinography or abdominal ultrasonography may allow accurate preoperative diagnosis. Broad-spectrum antibiotic coverage and laparotomy are indicated and excision of the entire urachal remnant is consistently curative.

Adolescent↗
PubMed1984

The gastrinoma triangle: operative implications.

Operative experience with 45 gastrinoma patients has led to the identification of an anatomic area where occult tumors can be discovered and where excision of these tumors had led to apparent cure. Of 36 patients with histologically confirmed gastrinomas, 27 patients (75 percent) had obvious and 9 patients (25 percent) had occult tumors. All nine occult lesions were found within an anatomic triangle defined by the junction of the cystic and common bile ducts superiorly, the junction of the second and third portions of the duodenum inferiorly, and the junction of the neck and body of the pancreas medially. Although occult tumors from three patients (in the lymph nodes in two patients and in the duodenum in one patient) were removed primarily for histologic diagnosis, postoperative serum gastrin levels have remained within the normal range (follow-up of 86 to 99 months). Two patients had excision of the tumor with intent to cure. One patient with a solitary duodenal tumor was apparently cured but committed suicide 3 months postoperatively. The other patient had both obvious primary and occult metastatic tumors within the triangle and was eugastrinemic 9 months after excision. In all patients in whom tumor was found, it was locally excised, and no patient was subjected to radical pancreatic resection. There were no postoperative complications related to tumor removal. An aggressive approach towards curative tumor excision is now advocated for all gastrinoma patients who are suitable operative risks and have no evidence preoperatively of liver metastases or the multiple endocrine neoplasm-type I syndrome.

Biopsy↗
PubMed1984

Inhibition of the stimulated exocrine pancreas by absorbed amino acids.

Intravenous infusion of amino acids is known to inhibit the stimulated pancreas and it has been suggested that this may act as a feedback mechanism in pancreatic regulation. To investigate this, chronic pancreatic fistula dogs were studied to determine if postprandial levels of hyperaminoacidemia inhibit the stimulated pancreas. Duplicate dose-response experiments using exogenous cholecystokinin (CCK) and intraduodenal amino acids were performed with and without a simultaneous intravenous infusion of mixed amino acids, which simulated postprandial hyperaminoacidemia. Significant (P less than 0.05), though minor, inhibition of pancreatic responses to both endogenous and exogenous CCK was noted with the simultaneous infusion of amino acids. It was concluded that, while amino acids may exert some inhibitory influence on pancreatic secretion after absorption, this is unlikely to be an important physiological mechanism.

Absorption↗
PubMed1984

Intravenous mixed amino acids and fats do not stimulate exocrine pancreatic secretion.

We compared the responses of the canine exocrine pancreas to intraduodenal versus intravenous administration of mixed amino acids, fat emulsion, and glucose. Graded doses of amino acid mixture and of fat emulsion gave graded responses in volume, protein, and bicarbonate when administered intraduodenally. In contrast, the same doses of the amino acid mixture and fat emulsion administered by central intravenous infusion caused no significant pancreatic secretion of volume, protein, or bicarbonate. Graded doses of glucose caused no statistically significant pancreatic secretion whether they were given intraduodenally or intravenously. We conclude, contrary to a previously published observation, that amino acids and fats given parenterally do not stimulate pancreatic secretion. As a corollary, it is reasonable to assume that the pancreas is not stimulated during total parenteral nutrition with acute pancreatitis or a pancreatic fistula.

Amino Acids↗
PubMed1984

Management of adenocarcinoma extending to the middle and upper part of the esophagus.

Of 30 patients with adenocarcinoma of the gastroesophageal junction treated between 1977 and 1982, 11 had tumor spread to the middle or upper thirds of the esophagus. Ten were treated with esophagogastrectomy by the Lewis approach, with two operative deaths. All of the tumors had spread to the periesophageal tissues. The eight surviving patients had relief of dysphagia. Five died with recurrent tumor after a mean survival time of 11 months; three are alive at five and 16 months (without evidence of disease) and 13 months (with recurrence). Adjuvant preoperative radiation therapy was used in four patients, three of whom received concomitant total parenteral nutrition. Despite the poor prognosis of this particularly unfavorable subset of patients with tumors of the gastroesophageal junction, operative resection provides acceptable palliation. Further study of adjuvant modalities is needed.

Adenocarcinoma↗
PubMed1983

Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis.

Exigent hemorrhage from pseudocysts and pseudoaneurysms is the most rapidly lethal complication of pancreatitis. Of eight patients with this unusual entity seen by us, all had acute gastrointestinal hemorrhage; two patients had intraperitoneal bleeding as well. Preoperative visceral arteriograms accurately defined the bleeding lesion and greatly aided in planning operative strategy in six patients. Emergency celiotomy and arterial ligation were accomplished in seven patient, and one patient underwent successful transcatheter arterial embolization. Pancreatic resection was not required in any patient for control of hemorrhage, although gastrectomy was necessary in three cases. One elderly patient died of sepsis five weeks after operation. Our mortality of 12.5% compares favorably with the 37% overall mortality from 123 cases reported in the literature.

Alcoholism↗
PubMed1983

Failure of histamine H2-receptor antagonist therapy in Zollinger-Ellison syndrome.

Review of a 5 year clinical experience with the histamine H2-receptor antagonists metiamide, cimetidine, and ranitidine in 20 patients with Zollinger-Ellison syndrome disclosed a treatment failure rate of 50 percent. The criterion for failure was hemorrhage in four patients, obstruction followed by hemorrhage in one patient, perforation in one, and intractable pain in four. Nine of the 10 patients in whom treatment failed required total gastrectomy for control of complications; the 10th patient refused operation. Retrospective analysis identified hepatic metastases, the multiple endocrine adenomatosis-type I syndrome, refractory diarrhea, and breaks in the medication schedule as being more common in the treatment failure group, but these trends were not statistically significant in our small series of patients. Nonhealing or recurrent ulcers were found in 90 percent of the patients in whom drug therapy failed and in only 10 percent of those patients in whom therapy was successful (p less than 0.01). There were no differences related to age, sex, duration of symptoms, previous gastric operation, ulcer location, presence of diarrhea, or amount of drug prescribed. Basal and peak acid outputs, basal serum gastrin levels, and response to secretin challenge were also nondiscriminatory. The degree of acid inhibition in response to cimetidine was highly variable from one patient to another and on repeat testing in individual patients, and there was no correlation between acid secretory inhibition and clinical course. When severe complications occurred, reinstituting H2-receptor antagonist therapy or increasing the dose did not avert the need for total gastrectomy. Patients refractory to drug treatment who have persistent or recurrent ulcers should be managed with prompt total gastrectomy to prevent life-threatening complications.

Adult↗