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Biomedical subjects

C F Frey

Publications and source records attributed to C F Frey.

At least 55 records · Page 3Linked to original sources
PubMed1987

Cystic neoplasms of the pancreas.

Eight patients with cystic neoplasms of the pancreas were seen at four Northern California hospitals between the years 1978 and 1986. Three of the tumors were benign and five were malignant. Three females, whose average age was 61 years, had cystadenomas. Three females and two males, whose average age was 48 years, had mucinous cystadenocarcinomas. Clinical presentations were similar among all patients. Abdominal pain was a prominent feature. Anorexia, weight loss, nausea and vomiting with a palpable abdominal mass were seen in five of eight patients. Obstructive jaundice was seen in two of eight patients. Among patients with benign lesions, one lesion was in the head and two lesions were in the tail of the pancreas. The malignant lesions were in the head of the pancreas in three patients and in the tail or body in two. A presumptive diagnosis was made preoperatively on the basis of the clinical, laboratory and roentgenographic findings in seven of eight patients. Of the patients with benign tumors, two are alive and well at seven years and four months and one patient was lost to follow-up study at four years. Among the patients with a malignant condition who underwent operation, resection for cure was performed upon four patients. One patient died postoperatively and the other three patients are alive and well without evidence of a recurrence at three and one-half, four and four years after resection. Pancreaticoduodenectomy was performed upon two patients and distal pancreatectomy in another. Palliation was attempted in one critically ill patient with an unresectable tumor by longitudinal pancreaticojejunostomy. This procedure was not effective in providing pain relief because of obstruction of the pancreatic duct by the viscous mucoid secretion of the tumor. The preoperative diagnosis of these very rare tumors is usually possible roentgenographically, especially with the use of the computed tomography scan. The presence of a thick mucoid secretion of high viscosity is diagnostic of mucinous cystadenocarcinoma. Cystic neoplasms of the pancreas should always be resected, if possible, with the expectation of long term survival.

Adult↗
PubMed1986

The role of ductal obstruction on the course of hemorrhagic pancreatitis in the pig.

The effect of relieving pancreatic duct obstruction after the onset of hemorrhagic pancreatitis was investigated. Hemorrhagic pancreatitis was produced in 20 pigs by a bile salt-trypsin retrograde injection technique. In half the pigs the pancreatic duct was permanently ligated, and in the other half the ductal obstruction was relieved 2 h after the onset of hemorrhagic pancreatitis. The overall mortality rate was the same in both groups by 24 h. No difference was found between the groups in the gross and microscopic appearance of histological samples taken from the pancreas immediately after death. The biochemical parameters measured to assess the severity of pancreatitis such as calcium, BUN, creatinine, glucose, proteins, and hematocrit did not show any difference between the two groups. The serum amylase level, a measure of ductal obstruction, was less at 24 h and even lower at 48 h in the release group as compared to the non-release group. This difference suggests that the ductal obstruction was relieved, as the amylase levels declined at 24 and 48 h. Hemodynamic variables, including cardiac output, pulmonary artery pressure, pulmonary wedge pressure, central venous pressure, and aortic pressure were followed. No significant difference was found in any of these parameters between the two groups. The absence of any significant differences in hemodynamic status, histopathological findings, and biochemical analysis in our pigs, if translatable to man, does not lend support to early operative intervention in gallstone pancreatitis in the hope that those patients who already have hemorrhagic pancreatitis will benefit from early pancreatic ductal decompression.

Animals↗
PubMed1986

Classification of pancreatitis: state-of-the-art, 1986.

In 1983 and 1984 two international interdisciplinary groups convened for the purpose of improving the existing 1963 Marseille Classification of pancreatitis. In this article, the new classifications of pancreatitis resulting from these conferences are examined from the perspective of earlier efforts which preceded the Conference and a recent analysis of the usefulness, similarities, and differences between the two classifications by an International group of surgeons and gastroenterologists.

Acute Disease↗
PubMed1986

A simple technique for experimental hepatic vein catheterization in swine.

Hepatic vein catheterization is a valuable technique in studies of hepatic physiology and metabolism. A new technique for hepatic vein catheterization in swine is described which avoids fluoroscopy, incision, or puncture of the hepatic parenchyma. Experience with this new technique in over 40 studies of young pigs has confirmed the reliability of the technique. Management of hepatic vein catheters after insertion and potential sources of error in hepatic venous sampling are discussed.

Animals↗
PubMed1985

Reliability and sensitivity of frozen-section pancreatic biopsy.

A collaborative Veterans Administration and University of California, Davis Medical Center group of 586 patients with histologically proved pancreatic carcinoma was reviewed. During laparotomy, 159 patients underwent 251 frozen-section pancreatic biopsies with subsequent permanent section examination of the same tissue block. All 112 positive frozen-section diagnoses were corroborated on permanent sectioning. The 47 patients with false-negative biopsy specimens were equally divided between sampling and interpretation error. We conclude that in this group of 159 pancreatic cancer patients, 30% failed to be correctly diagnosed by intraoperative frozen-section biopsy. This failure was due to patient sampling and interpretation error in equal proportion. Interpretation error rates were not influenced by the type or number of biopsies. Patient sampling error is apparently reduced by repeated biopsy, and specimen sampling error occurred less frequently with wedge biopsy.

Biopsy↗
PubMed1985

Prehospital stabilization of critically injured patients: a failed concept.

Prehospital resuscitation and stabilization of major trauma victims is increasingly employed. To evaluate the benefits of one such maneuver, fluid administration, we reviewed 52 consecutive trauma cases in which patients had a blood pressure of less than 100 mm Hg either at the scene or on arrival to hospital. In all cases, transport time to hospital was less than IV establishment time. Fluid volume infused had little influence on final outcomes. A percentage of patients with correctable surgical lesions might have been salvaged had prompt transport been instituted. Field maneuvers in critically injured patients should be minimized to decrease ultimate mortality.

California↗
PubMed1985

Acute pancreatitis.

The exocrine pancreas secretes into the gut on demand more than 20 proteins that are indispensable for digestion. In-vivo autodigestion is prevented by an array of natural safeguards. In acute pancreatitis, inappropriate intrapancreatic activation and release of pancreatic hydrolases occur, but the pathogenetic mechanism of autodigestion is unclear. The release of proteases, lipase and colipase, phospholipase A, vasoactive peptides, and other agents probably accounts for the edema, tissue destruction, fat necrosis, metabolic abnormalities, and complications. Ethyl alcohol abuse, gallstones, trauma, and other common and rare conditions can induce pancreatitis. The patient's outcome can be predicted by certain prognostic signs. Ultrasonography and computerized tomography are invaluable diagnostic tools and magnetic resonance imaging appears promising. Hemodynamic monitoring, intensive care with colloid and crystalloid infusions, correction of electrolyte abnormalities, judicious use of antibiotics, peritoneal lavage, drainage of pancreatic exudation fluids, and surgical intervention require a team approach, especially in patients with multiple complications. Additional research is needed into the pathogenetic mechanism of autodigestion and the design of specific therapies.

Abscess↗
PubMed1985

Effect of prostaglandin blockers on ascites fluid in pancreatitis.

UNLABELLED: Prostacyclin (PGI2), a potent vasodilator with complex effects on the mesenteric circulation, has been found to be elevated in the hemorrhagic ascitic fluid of pigs with hemorrhagic pancreatitis. This investigation was designed to determine if blockage of PGI2 significantly reduces the volume and/or toxicity of hemorrhagic ascitic fluid associated with hemorrhagic pancreatitis in pigs. Fifteen pigs were studied: five received corticosteroids, five received ibuprofen, and five were untreated. The relative toxicity of the hemorrhagic ascitic fluid was assessed by intraperitoneal injections of the fluid from pigs into mice. RESULTS: (1) hemorrhagic pancreatitis was associated with high levels of PGI2 in blood 15 times and in hemorrhagic ascitic fluid 25 times that of baseline; (2) steroids and ibuprofen blocked PGI2 production (p less than 0.05); (3) neither steroids nor ibuprofen, even when administered as pretreatment, decreased ascites formation; and (4) the mortality rate in mice was significantly reduced (p less than 0.05) in the ibuprofen-treated group as compared with the untreated and steroid-treated groups. CONCLUSION: PGI2 does not play a significant role in the volume of ascites formation. There was an absence of toxicity in the hemorrhagic ascitic fluid of the ibuprofen-treated group.

6-Ketoprostaglandin F1 alpha↗
PubMed1984

Diagnosis and management of ingested foreign bodies: a ten-year experience.

Ingested gastrointestinal foreign bodies may be managed by observation, endoscopy, and/or surgical intervention. We retrospectively reviewed 87 consecutive cases of foreign body ingestion. In 49 patients the ingested foreign body had passed beyond the gastroesophageal junction, and these cases form the basis of this study. Of the 49 patients, 19 (38.7%) required surgical intervention for removal of the swallowed object. Nearly 75% of these patients had swallowed objects that were more than 6.5 cm in length. Of 30 adults, more than 50% required surgery for removal of the foreign body. However, fewer than 16% of children who had swallowed and retained foreign bodies required surgery for ultimate cure. Based on these findings, guidelines are presented for the management of foreign body ingestion.

Adolescent↗
PubMed1984

Accidents and trauma care--1983.

Except for categoric grants, the federal government has divested itself of financing emergency medical services. Now the leadership for regional planning of emergency medical services must come from the state, usually from the health department. If we are to obtain improved hospital care of trauma patients, it is critical that we separate hospitals that have made a genuine commitment to the care of the multiply injured patient from hospitals that have not in order to avoid the tragedy of patients being delivered to hospitals that have inadequate resources or commitment or organization to meet the needs of such patients. The most widely accepted categorization format for determining hospitals' ability to provide care for the trauma patient is that devised by the National Committee on Trauma of the American College of Surgeons. In order to be a Level I or II trauma center in that categorization format, a hospital has to show evidence of a fiscal and organizational commitment on the part of the hospital administration and staff to provide care to multiply injured patients sufficient to match the needs of that patient. The experience in Germany and in various counties of the United States that have regionalized trauma care provides the expectation that 25 percent or more of patients now dying of trauma could be saved. Professional organizations have a major role in supporting improved care for trauma patients by providing support and expertise to the EMS division of the state health department as well as developing national standards for hospital care of injured persons, equipment lists for ambulances, and training standards, as has been done by the American College of Surgeons Committee on Trauma.

Accident Prevention↗
PubMed1983

Gastric outlet obstruction after palliative surgery for cancer of head of pancreas.

Gastroenterostomy as part of the palliation of unresectable cancer of the head of the pancreas, in the absence of gastric outlet obstruction at the time of surgery, has been both rejected, and, more recently, advocated for all such patients. A study of 105 cases yielded four factors that correlated with the subsequent occurrence of gastric outlet obstruction: age, 60 years or younger; hemoglobin level, 11.5 g/dL or less; absence of liver metastases; and survival, three months or longer. A fifth factor, absence of clinical jaundice, may be an indicator of a poor prognosis with a small risk of obstruction. By combining factors, we identified a group with a risk of obstruction of at least 25% (those with two or more factors) and one with negligible risk.

Adult↗
PubMed1983

Gastrointestinal bleeding after operation for pancreatic cancer.

Gastrointestinal bleeding after surgery for cancer of the pancreas contributes significantly to patient morbidity and to patient mortality, if the bypass was performed for palliation. Bleeding after resection of the pancreatic tumor appears to be amenable to therapy, and unaltered by the addition of vagotomy at the time of surgery. Patients undergoing palliative surgery who are expected to live beyond the postoperative period may well benefit from measures to reduce the risk of gastrointestinal bleeding.

Adult↗
PubMed1983

Hemodynamic characterization of porcine hemorrhagic pancreatitis ascites fluid.

The hemodynamic reactions of hemorrhagic pancreatitis ascites fluid (HAF) were observed after intravascular injection in the pig. The HAF vascular reactions were compared to the reactions of known vasoactive agents in hopes of identifying the vasoactive agent(s) in HAF. Pancreatitis was induced in five pigs with pancreatic ductal injection of a bile/trypsin mixture. HAF from these pigs was injected into the portal vein of five anesthetized pigs which were monitored for changes in femoral artery pressure (FAP), cardiac output (CO), and portal pressure (PoVP). Trypsin was also tested in the same way in five additional pigs. HAF elevated PoVP, then lowered VAP, depressed CO, and exhibited tachyphylaxis. Trypsin did not cause tachyphylaxis. The effects observed after infusion of HAF are similar to the reported effects observed after injecting histamine, an agent previously implicated in hemorrhagic pancreatitis.

Acute Disease↗
PubMed1982

Toxicity of hemorrhagic ascitic fluid associated with hemorrhagic pancreatitis.

Hemorrhagic pancreatitis was induced in dogs by a retrograde infusion of the pancreatic duct with a mixture of taurocholate sodium and trypsin. Seven of the 13 dogs were pretreated with antibiotics. The hemorrhagic ascitic fluid (HAF) recovered from the dogs' abdomens was injected intraperitoneally into mice in volumes of 2.5, 5, 10, 15, and 20 mL. The mice were divided into two groups depending on whether the HAF received was from dogs given antibiotics. The mortality among the mice was proportional to the volume of HAF injected. The mortality among mice receiving the sterile HAF was 79.4% at 20 mL, 55.8% at 15 mL, 29.4% at 10 mL, 26% at 5 mL, and 17% at 2.5 mL. There were no deaths among mice receiving 25 mL and saline solution and the mortality was 15% among mice receiving 20 mL of dog plasma.

Animals↗
PubMed1982

Endoscopic retrograde cholangiopancreatography.

The ERCP report in the patient's chart was compared with findings on common duct exploration or cystic duct cholangiography in 72 patients and found to have a sensitivity of 90.4 percent, a specificity of 98 percent, and an accuracy of 95.8 percent. Factors having the potential to influence the accuracy of ERCP were errors in interpretation by the surgeon and the radiologist and the operative technique of cholecystectomy. Also, the interval between the performance of the procedure and operation was particularly important in the patient with multiple small gallstones or small common duct stones. Small gallstones may spontaneously pass from the gallbladder to the common duct, or small common duct stones may spontaneously pass into the duodenum; therefore, the longer the interval between ERCP and operation, the greater the likelihood of a discrepancy. At operation, gallstones may be squeezed into the common duct during manipulation of the gallbladder unless the cystic duct is obstructed before manipulation of the gallbladder. We found ERCP sufficiently accurate to make cystic duct cholangiography unnecessary in most patients with cholelithiasis having a preoperative ERCP examination.

Aged↗