Immunofluorescent method for Au antigen.
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Animals↗
Biomedical subjects
C W Imrie
Publications and source records attributed to C W Imrie.
Management of recurrent pain following previous surgery for chronic pancreatitis.
The management of any patient with recurrent pain following surgery for chronic pancreatitis is far from an easy problem. Even more careful assessment than that preceding the decision for the first operation will be necessary. In-hospital patient assessment is strongly recommended to ascertain the degree of the problem of pain in as objective a manner as possible. The effects of alcohol withdrawal and different analgesic treatments have to be carefully assessed while obtaining essential information on the size and shape of the pancreatic duct as well as the general pancreatic morphology. Relatively simple procedures such as the removal of stones or the enlargement of a strictured anastomosis may be all that is required to ensure freedom from pain; however, there is a tendency for patients who have no obvious new pathology or simple failure of the first operation to move to more extensive resectional procedures. This, ultimately will lead to total pancreatectomy being recommended and long-term follow-up of such patients is under critical scrutiny. Unless the highest caliber of support services can be mustered for these patients subject to total pancreatectomy, the morbidity and mortality in the longer term can reach prohibitive levels. A plea is made for objective reassessment of the place of celiac ganglionectomy in the management of these difficult problems.
Chronic Disease↗
Local excision of ampullary carcinoma.
Pancreaticoduodenectomy is widely and reasonably regarded as the treatment of choice for ampullary carcinoma. Reported cases of local excision are few and mainly involve elderly, poor risk patients. Eight patients with ampullary carcinoma treated by local excision are presented. None of these patients who had local excision were considered unfit for pancreaticoduodenectomy. There were two post-operative deaths (25%). Median survival was 57 months with 44% five year actuarial survival. Three of the patients who survived the local excision subsequently developed recurrent disease. If local excision is performed some form of biliary bypass may be advisable.
Adult↗
Prognosis of acute pancreatitis.
The prognosis of an individual attack of acute pancreatitis is dependent on its severity and whether or not sepsis develops in or around the pancreas. Approximately 20-25% of patients with acute pancreatitis have a severe form of the disease which usually necessitates high dependency or intensive care management in the first week or two of illness. While most of these patients can readily be identified by experienced clinical judgement a proportion of them do not appear unduly ill at first presentation. For this reason a number of objective grading systems have been devised which identified the group of patients with the greatest likelihood of developing major complications and being at risk of death. The most commonly utilised systems in the United Kingdom are the eight factor Glasgow scoring scale and the APACHE II system. The measurement of C-reactive protein is also helpful and it has recently been shown that the combining of the Glasgow scoring system with CRP results in 80% or better sensitivity and specificity for those who develop major clinical complications. The body mass index (BMI) when over 30 kgs/m2 is also a useful marker of an adverse outcome, and CT scanning is another method of grading severity. The newer markers of interleukin 6 and PMN elastase have yet to be proved in a large prospective clinical study but do show considerable promise as being of value in identifying the patient at risk.
APACHE↗