Biomedical subjects
Publications and source records attributed to F Burcharth.
Rupture of the stomach is rare, often caused by excessive distension or abdominal trauma. This case represents the first published of rupture due to massive haemorrhage from oesophageal varices.
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Explore the source record for details and available documents.
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In five patients with pancreatitis, obstructive jaundice was relieved by internal drainage of the biliary tract with an endoprosthesis inserted by percutaneous transhepatic technique. The average duration of treatment was 3.5 months. The endoprosthesis were removed by means of a duodenoscope, and jaundice did not recur.
The value of dynamic sonography as a screening procedure in 84 jaundiced patients was examined and compared with the clinical evaluation of a blind prospective study. The predictive value of the sonographic diagnosis of obstruction was 97% and 84% in nonobstruction. The corresponding values of the clinical distinction were 87% and 92% respectively. The level of obstruction was demonstrated in 95% and the cause of obstruction was diagnosed in 68%. When the cause of jaundice is uncertain or obstruction is suspected clinically, dynamic sonography can offer high diagnostic accuracy and guidance for invasive investigations.
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Insertion of an endoprostheses for internal biliary drainage was attempted upon 150 patients with obstructive jaundice. It was successful in 123 patients, and 99 patients had permanent drainage with the endoprosthesis. The plasma bilirubin level became normal in 64 of the patients. The effect upon jaundice was equal to that in 43 patients who underwent operation with palliative surgical bypass. The median survival time was not different from that for the patients with surgical anastomoses. Twenty-eight patients died in the first month after insertion, mostly of advanced malignant disease. Fifteen of the patients in the group with surgical anastomoses died within the first month. The insertion of an endoprosthesis for bile duct obstruction is relatively easy and seems to have little risk. Most complications are caused by the transhepatic cholangiography procedure. The method may be used for temporary drainage before operation, in transient benign obstructions or as permanent drainage in unresectable lesions. In patients with dislodgement or insufficient function, additional endoprosthesis may be inserted. Thus, sufficient palliation of jaundice is achieved with a low frequency of cholangitis. Internal biliary drainage by insertion of an endoprosthesis is a valuable alternative to surgical bypass in patients with unresectable lesions.
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The effect of topical ampicillin sodium and polyglycolic acid and silk sutures on the recurrence of an existing hernia or an incisional hernia and on infection rates in clean abdominal wounds (herniotomies and simple cholecystectomies) was studied in a triple-blind, randomized trial with 398 consecutive patients. One infection, three suture sinuses, and two incisional hernias occurred among 113 patients with cholecystectomies, while the corresponding rates in 285 patients with hernia repairs were 11 infections, no suture sinuses, and three recurrent hernias. No effect of ampicillin could be demonstrated, nor was any difference between polyglycolic acid and silk sutures shown. No interaction between the antibiotic and suture material was found, and no side effects were observed. Wound infection was significantly more frequent in patients with postoperative seromas or hematomas.
Percutaneous transhepatic portography was performed upon 57 patients with cirrhosis and portal hypertension. Forty-nine patients experienced one or more bleeding episodes from gastroesophageal varices. The portographic findings and the free portal pressure were compared with the occurrence and severity of variceal bleeding. The occurrence of bleeding was related to the large cephalad collaterals from the splenic vein and the short gastric veins and coronary vein arising from the splenic vein, and to high portal pressure. The severity of the bleeding was directly related to the same collaterals and to the degree of extrahepatic shunting. No consistent relationships were noted between variceal bleeding and other collateral systems, including gastroesophageal varices. The results possibly indicate that, in patients with cirrhosis, percutaneous transhepatic portography may be of value in planning treatment and assessing the prognosis.
Bleeding duodenal varices are a rare complication of portal hypertension. Upper gastrointestinal bleeding from other sources than varices is common in patients with cirrhosis. Most often the bleeding is misinterpreted as bleeding from duodenal ulcer, and the diagnosis is first apparent during emergency operation. From our experience with a case of bleeding duodenal varices we suggest that the diagnostic procedure of choice is percutaneous transhepatic portography.
We studied the relationship between the pancreatic glucoregulatory hormones, insulin and glucagon, and glucose intolerance through the response to food and intravenous glucose in 11 patients with verified hepatic cirrhosis. Blood samples were obtained from the portal vein and the superior vena cava. The results of the systemic vein hormone determinations were compared to results obtained from peripheral vein determination in 10 age-, sex- and weight-matched controls admitted to hospital for minor surgery and to results from ambulant, normal subjects. In the cirrhotics collateral shunting was elevated by transhepatic portography. The cirrhotics and the matched controls had similar glucagon levels and responses, but showed hyperresponsiveness to a meal compared to ambulant normal subjects. Compared to the matched controls the cirrhotics showed glucose tolerance and hyperinsulinism, but compared to normal subjects the hospitalized controls were also glucose intolerant and demonstrated hyperinsulinism. In the cirrhotics, the portal vein/vena cava ratio for insulin was negatively correlated to the degree of collateral shunting. No relationship was found between the degree of portosystemic shunting and fasting concentrations of glucagon and insulin, and the insulin response to glucose. The glucagon response to the meal, was correlated to severity of cirrhosis. The rate constant for glucose disappearance (K-value) was not related to the insulin response, to severity of disease or to degree of shunting. It was, however, correlated to the suppressibility of glucagon secretion as measured in the portal vein. Our results indicate that the glucoregulatory disturbances in compensated cirrhosis are partly caused by non-specific factors which are independent of cirrhosis; the portal-vein hormone responses, however, support the contention that glucagon secretion influences glucose tolerance in cirrhotics.
Pancreatic ascites can be diagnosed by demonstration of high amylase concentration in the ascites and ERCP may serve to identify the causal internal fistula. Intraoperatively a precise localization of the ductal leakage is helpful. In two patients we demonstrated the fistulas by stimulation of the pancreatic secretion with secretin.
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Percutaneous transhepatic catheterization of the portal venous system and pressure readings were performed in nineteen patients with cirrhosis of the liver and bleeding varices. Portal pressures were recorded in awake and mobile patients in supine, sitting and standing position, during sleep, ingestion of food, Valsalva manoeuvre and coughing. No significant differences were recorded in the different postures, during sleep or food intake. Four patients with hepatofugal portal blood flow had, however, lowest pressure in standing position. During Valsalva manoeuvre portal pressure was doubled, and it became fourfold during coughing. Elevations of this magnitude have not previously been reported. A relationship was found between portal pressure and size of varices.
In 19 patients with cirrhosis of the liver and portal hypertension, a catheter was inserted into the portal vein using a percutaneous transhepatic technique. The portal pressure was measured during general anaesthesia with and without halothane, and in the awake state. Addition of halothane to the N2O:O2 anaesthesia did not change portal venous pressure, in spite of a significant fall in arterial blood pressure. Portal venous pressure under general anaesthesia with complete muscle relaxation did not differ from the pressure in the resting, awake patient.