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Biomedical subjects

I S Benjamin

Publications and source records attributed to I S Benjamin.

At least 91 records · Page 5Linked to original sources
PubMed1988

Surgical treatment of chronic pancreatitis.

Surgery for chronic pancreatitis is indicated in patients with intractable pain, major complications, or possible underlying malignancy. The options include various resections or pancreatic ductal drainage procedures. Drainage has the benefit of low mortality and morbidity, but is often unsuitable for patients with diffuse disease. Careful follow-up and symptomatic assessment are necessary, and as many as 50% of these difficult patients may have persistent symptoms despite surgery. Careful selection of the patient and the procedure is essential for success.

Chronic Disease↗
PubMed1988

The management of fistulas of the biliary tract after injury to the bile duct during cholecystectomy.

Twelve of 123 patients who were treated for benign stricture of the bile duct after cholecystectomy presented with an external fistula of the biliary tract. Nine of these patients had undergone multiple operations prior to referral, six having undergone earlier attempts at repair of the bile duct. Two patients initially required urgent laparotomy for drainage of infected abdominal collections. Distal obstruction of the bile duct below the origin of the fistula was present in five patients. Repair of the bile duct was undertaken after careful investigation and correction of nutritional, fluid and electrolyte status in five patients who had little prospect of spontaneous closure of the fistula. The other seven patients were initially treated conservatively; in three, the fistula closed at five to nine weeks without complication, and no further surgical treatment has been required (a range of six to 36 months). The remaining four patients required delayed operation after the development of cholangitis or jaundice. The overall median survival time between development of fistula and operative repair was 3.5 months, and all nine of these patients remained asymptomatic with normal results from liver function tests (a median follow-up period of 17 months). The need for careful initial assessment prior to repair of the bile duct and the possibility of conservative treatment for patients with a postcholecystectomy fistula of the biliary tract are emphasized.

Adult↗
PubMed1987

Major hepatic resection for colorectal liver metastases.

A 6 1/2 year experience in the management of hepatic colorectal metastases in a specialist unit is reviewed. During the period studied, 48 patients were referred of whom only 24 actually came to resection. There were two in-hospital deaths, at 20 and 60 days, and six patients had non-fatal complications. Although the extent of resection was greater than in most reported series (13 right hepatectomies and 6 extended right hepatectomies), the results of resection were broadly the same as those of others, with a median survival of 30 months and 2 and 3 year survivals of 50 and 44 per cent respectively. A number of factors which others have considered to be of prognostic significance were examined. Tumour clearance was the only important prognostic indicator, where a 5 mm clear margin between the tumour and cut surface produced a significant difference in survival. It is suggested that a much larger number of patients in the UK with hepatic colorectal metastases might be considered for resection.

Colonic Neoplasms↗
PubMed1987

Renal impairment following biliary tract surgery.

Postoperative mortality has been directly attributed to renal failure in approximately 5 per cent of patients after surgery for obstructive jaundice. An analysis of 334 patients undergoing biliary tract surgery was undertaken to identify the perioperative factors associated with the development of renal impairment, and to estimate the contribution of renal failure to mortality. Thirty-eight patients (11 per cent) developed postoperative renal impairment (a two-fold increase in serum creatinine postoperatively or a rise of greater than 100 mumol/l). Ninety-three factors were examined in these and 196 control patients. Stepwise logistic regression analysis identified only three factors which were significantly associated with renal impairment: postoperative sepsis (P less than 0.0005), pre-operative serum bilirubin (P less than 0.0005), and pre-operative urea (P less than 0.05). Renal impairment developed at a median 4 days after surgery and was associated with a median of two additional major postoperative complications, particularly sepsis and haemorrhage, for which 17 patients underwent reoperation. Twenty-eight (74 per cent) of the patients with renal impairment died in hospital, but in only one case was the cause of death directly related to renal failure. Twenty patients received specific therapy for renal failure, but only one of these survived. Pre-operative obstructive jaundice and postoperative infection are the major factors associated with renal impairment after biliary tract surgery. Renal impairment appears to be related to postoperative complications rather than directly to the surgical procedure itself. The development of postoperative renal impairment predicts a low chance of survival but appears to be an indicator, rather than a direct cause of a poor prognosis.

Acute Kidney Injury↗
PubMed1987

Total pancreatectomy for chronic pancreatitis.

A survey of six British centres collected data on 83 patients undergoing total pancreatectomy (TP) for chronic pancreatitis between 1977 and 1986. There were 57 men and 26 women with a median age of 38 years (range 19-61 years). Half were alcoholics and half had had previous acute pancreatitis. Besides jaundice (14 per cent) severe pain was the indication for the operation; regular opiates had been needed in 82 per cent of patients and 37 per cent were addicted to these drugs. All but 12 had had previous pancreatic or biliary surgery, with a median of two operations and a maximum of six. TP was a one-stage procedure in 32 patients, 42 had had distal resections and 9 proximal resections in the past; the pylorus was preserved in 30. Median operation time was 4 h (range 2-18 h) and median blood loss was 3 units (1-21 units). Intraoperative complications in 11 patients included haemorrhage in 9. Four deaths occurred within 30 days from bleeding (2), respiratory failure (1) and Roux-loop infarction (1). All but one of the 79 survivors required full pancreatic supplementation and 38 per cent had difficulties in endocrine control. At a median follow-up of 1.5 years (range 0.25-10 years), 57 patients (72 per cent) were pain-free and 9 (11 per cent) needed only occasional analgesia. Though 13 (17 per cent) still took regular analgesics, all were symptomatically improved. There have been 10 late deaths (13 per cent), all but one of which are attributable to the operation.

Adult↗
PubMed1987

Benign biliary strictures: a proposed combined surgical and radiological management.

A combined surgical and radiological approach to the management of complex biliary strictures is described. Radiological access for stricture dilatation or stone extraction is created at the time of surgery either by insertion of a transhepatic U-tube or superficial fixation of the afferent limb of the Roux-en-Y loop. Each of seven patients treated in this way had multiple complicating factors known to adversely affect the outcome of operative repair. Five of the seven have had an excellent outcome at a median follow-up of 15 months (mean 21 months, range 2-39 months).

Adult↗
PubMed1987

Immunoreactive trypsin in acute pancreatitis: elevated levels do not correlate with hyperamylasaemia.

Immunoreactive trypsin (IRT) was measured in the serum of patients presenting with acute pancreatitis (AP) and compared to serum amylase levels. Both were elevated beyond the normal range at presentation (mean IRT 557 +/- 252 micrograms/l, range 181-1000 micrograms/l, mean control IRT 42 +/- 14 micrograms/l, range 15-82 micrograms/l; mean amylase 4500 +/- 3200 IU/l, range 600-10,500 IU/l, control amylase mean 175 +/- 43 IU/l, range 48-320 IU/l). There was minimal correlation between IRT and amylase elevation but both returned to normal at the same rate in patients who recovered. In 2 patients with persistently elevated IRT levels, one was found to have a pancreatic pseudocyst and the other subsequently died from alcoholic haemorrhagic pancreatitis. IRT is no better than amylase as a single diagnostic assay in AP but may be greatly elevated when amylase elevation is minimal. The combination of the two may improve diagnostic accuracy and persistent elevation of IRT may be of prognostic importance.

Acute Disease↗
PubMed1986

Liver atrophy complicating benign bile duct strictures. Surgical and interventional radiologic approaches.

The hepatic atrophy and hypertrophy complex has been described in a selected group of nine patients with benign bile duct stricture. The clinical features common to this group were a high biliary stricture and a long-standing history of cholangitis and intermittent jaundice. A history of multiple surgical procedures and associated vascular damage or portal hypertension is strongly suggestive of the atrophy and hypertrophy complex. The radiologic criteria for the diagnosis of this condition are presented. Computerized tomography and HIDA scintigraphy were valuable as noninvasive means to diagnose lobar liver atrophy. The atrophy and hypertrophy complex described herein poses significant therapeutic problems and demands approaches other than those normally applicable for high biliary strictures. A combined surgical and radiologic approach with additional interventional radiologic procedures may be appropriate in patients in whom hilar anastomosis is difficult or impossible.

Adult↗
PubMed1986

Bile duct obstruction: radiologic evaluation of level, cause, and tumor resectability.

In a prospective study of 65 patients with bile duct obstruction, various radiologic modalities were compared for their capability to demonstrate the level and cause of obstruction and to indicate accurately tumor resectability. Ultrasound (US) was performed in 65 patients, computed tomography (CT) in 51, direct cholangiography (DC) in 57, and angiography in 35. The level of obstruction was correctly indicated by US in 95% of patients and by CT in 90%, and the cause was correctly indicated by US in 88%, by CT in 63%, and by DC in 89%. In predicting tumor resectability, US was correct in 71% of patients, compared with 42% for CT, 58% for DC, and 25% for angiography. US therefore appears to be the single most useful modality in the evaluation bile duct obstruction.

Bile Duct Neoplasms↗
PubMed1986

Fine needle aspiration cytology and exfoliative biliary cytology in the diagnosis of hilar cholangiocarcinoma.

Nineteen patients with suspected malignant obstruction at the confluence of the bile ducts had exfoliative biliary cytology and fine needle aspiration cytology performed. Of these patients 14 cases were histologically proven to be cholangiocarcinoma, and 3 others followed a clinical course which was clearly malignant. Fine needle aspiration cytology gave a true positive result in 14 patients (87.5%), whereas exfoliative cytology was positive in 11 (73%). There were no false positive results and no complications from either procedure. Both the cytological procedures are rapid and safe and are useful for preoperative planning of surgical and intraoperative diagnosis.

Adenoma, Bile Duct↗
PubMed1985

Antipyrine elimination in patients with obstructive jaundice: a predictor of outcome.

A number of factors are known to be related to increased mortality of surgery in obstructive jaundice, yet precise identification of patients at greatest risk is difficult. We have studied the elimination of the minor analgesic antipyrine as a dynamic measure of hepatic metabolic function in patients with obstructive jaundice undergoing percutaneous transhepatic biliary drainage. Of 46 patients in whom antipyrine clearance was measured, 21 had an antipyrine half-life less than 15 hours and 2 died in the hospital. Of 25 who had an antipyrine half-life greater than 15 hours, 10 died in the hospital, 4 before undergoing surgery. The difference in mortality is significant (p less than 0.05). Of 15 patients who had serial antipyrine tests, only 4 showed an improvement during percutaneous transhepatic biliary drainage. The antipyrine test may be a useful predictor of outcome in obstructive jaundice, and this study suggests that hepatic function does not improve in all patients undergoing preoperative percutaneous transhepatic biliary drainage.

Adult↗
PubMed1985

Decreased biliary excretion of piperacillin after percutaneous relief of extrahepatic obstructive jaundice.

The biliary excretion of piperacillin has been assessed in 11 patients with obstructive jaundice due to hilar cholangiocarcinoma. After a 1-g intravenous dose administered 30 min before preliminary percutaneous transhepatic cholangiography, no drug was detected in the bile of seven patients; in four others, drug concentrations were far below the corresponding level in serum. After a period of external biliary drainage of up to 28 days, levels of antibiotic in bile after intravenous administration were only minimally increased. The results suggest that although the impairment of hepatic function may be improved by external biliary decompression when assessed by a fall in plasma bilirubin, the biliary elimination of piperacillin and related beta-lactam antibiotics may remain impaired for prolonged periods.

Adult↗
PubMed1984

Control of hypertension after renal transplantation by embolisation of host kidneys.

A percutaneous embolisation technique was used for host kidney ablation in 13 patients with renal allografts and hypertension. Markedly improved blood pressure control was achieved in 9 of them, and morbidity was minimal. All patients have been followed from 12 to 25 months. Embolisation of the host kidneys appears to be a simple, effective, and less hazardous alternative to surgery in the treatment of drug-resistant hypertension after renal transplantation in some patients.

Adult↗