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Biomedical subjects

C F Frey

Publications and source records attributed to C F Frey.

118 records · Page 7Linked to original sources
PubMedDate not supplied

Treatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum.

In patients with chronic pancreatitis, common bile duct obstruction is reported in 3.2-45.6% of patients; however, only 5-10% of all patients with chronic pancreatitis require operative decompression of the bile duct. The cause of the intrapancreatic stricture of the common bile duct may be either a fibrotic inflammatory restriction, or compression by a pseudocyst. Obstruction of the duodenum is much less common than common bile duct obstruction in chronic pancreatitis occurring in less than 1-2% of patients with chronic pancreatitis. Colonic obstruction secondary to pancreatitis is very infrequent. The intrapancreatic strictures of chronic pancreatitis are characteristically smooth and tapering on endoscopic retrograde cholangiopancreatography (ERCP), but in some patients, they may have a sharp cut-off and closely resemble the appearance of carcinoma of the pancreas invading the bile duct. The natural history of these intrapancreatic strictures is variable. They may progress and be associated with cholangitis, biliary cirrhosis, common duct stones, or may remain stable for years or regress. Prior pancreaticojejunostomy is not protective against the development of intrapancreatic biliary strictures which may follow in 5-30% of patients, with most authors reporting an incidence of less than 10%. Evaluation of alkaline phosphatase, bilirubin, the presence of jaundice, or the appearance of an intrapancreatic stricture on ERCP is not predictive of whether cholangitis or biliary cirrhosis may or may not develop. The incidence of cholangitis and biliary cirrhosis in patients with intrapancreatic stricture is 9.4% and 7.3%, respectively. Laennec's cirrhosis occurs in a similar number of patients. Operation is indicated in patients with intrapancreatic strictures of the common bile duct in association with chronic pancreatitis in patients developing cholangitis, biliary cirrhosis, common duct stones, progression of the stricture, persistent high elevations of alkaline phosphatase and/or bilirubin for over a month or inability to rule out cancer of the pancreas or periampullary region. The operation of choice is choledochoduodenostomy or Roux-en-Y choledochojejunostomy to bypass the obstructed intrapancreatic portion of the common bile duct. Persistent duodenal obstruction for over 3 or 4 weeks is an indication for gastrojejunostomy. Pain is not a feature of common bile duct obstruction in the absence of cholangitis. In the presence of pain associated with chronic pancreatitis, longitudinal pancreaticojejunostomy is the operation of choice combined with Roux-en-Y choledochojejunostomy. Some of the newer operations, e.g., the Beger and Frey procedures, may make the necessity of a separate operation for biliary decompression superfluous.

Chronic Disease↗
PubMedDate not supplied

Protein-calorie malnutrition in patients with colorectal cancer.

Protein-calorie malnutrition, as determined by anthropometric measures and laboratory tests, was assessed in 17 preoperative patients with colorectal cancer and 47 control patients. The cancer patients had significant deficits in visceral protein and skeletal muscle and no deficit in fat stores. Greater attention should be given to preoperative nutritional assessment and to the correction of protein deficits.

Anthropometry↗
PubMedDate not supplied

Serum albumin and body weight as predictors of postoperative course in colorectal cancer.

The influence of preoperative serum albumin and percent ideal body weight on postoperative outcome was examined in 83 patients operated upon for colorectal cancer. Compared to patients with normal preoperative body weight and serum albumin, the following were noted: 1) those with low serum albumins had increased rates of complications (p < 0.02) and deaths (p < 0.02); 2) complications were increased in obese patients (p < 0.02); and 3) those with two nutritional abnormalities had increased rate of complications (p < 0.05) and deaths (p < 0.01). The group at highest risk, those with both low body weight and decreased serum albumin, had a complication rate of over 70% and a mortality rate of 42%.

Aged↗