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PubMed1978

Pancreaticojejunostomy for chronic pancreatitis. Two- to 21-year follow-up.

Between 1954 and 1975, 80 pancreaticojejunostomies were performed on 77 patients for intractable pain of chronic pancreatitis. All patients had a history of chronic alcoholism. Drainage operations done primarily for pseudocysts were excluded. Operative procedures included seven caudal pancreaticojejunostomies, 42 longitudinal pancreaticojejunostomies with splenectomy and implantation of the pancreas into the jejunum, and 31 side-to-side pancreaticojejunostomies. Eighty-one percent of the patients noted substantial improvement or complete resolution of their abdominal pain on follow-up that ranged up to 21 years. The operative mortality was 5%. Thirty-two patients died during the period of the follow-up. Continued alcohol abuse, carcinoma, and cardiovascular disease were the leading causes of mortality. Data from this review confirm the effectiveness of pancreaticojejunostomy in relieving the pain of chronic relapsing pancreatitis.

Adult↗

PubMed1977

Breast surgery.

Initial diagnostic errors are related to the presumption that symptoms or findings are due to benign causes. Physical examination augmented by mammographic study will disclose those benign-appearing lesions which may harbor a carcinoma. All palpable lesions and mammographically suspicious areas require that their identity be determined. The final resolution depends upon biopsy. Missing the tumor also causes diagnostic error. An accurate biopsy or "sample" must be obtained for study. Negative results of sampling techniques should be followed by formal biopsy. Failure to eliminate the primary disease by leaving tumor or breast tissue behind increases the incidence of recurrence. Total mastectomy reduces this risk. It is our view that removal of the axillary nodes also aids in obtaining cure, as well as providing prognostic information. Well intentioned attempts to obtain a better cosmetic appearance or to reconstruct the breast are secondary to the patient's chief need which is to achieve cure. Complications of the surgical procedures are due to improper flap dissection, desiccation and trauma to tissues, incomplete hemostasis, and inadequate drainage. Attention to operative details and adherence to well established surgical principles will minimize complications.

Biopsy↗