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Biomedical subjects

I S Benjamin

Publications and source records attributed to I S Benjamin.

At least 109 records · Page 6Linked to original sources
PubMed1984

Surgical approaches to cholangiocarcinoma at confluence of hepatic ducts.

Analysis of the surgical management of 94 consecutive patients with carcinoma at the confluence of the hepatic ducts showed that 20% of them (or 60% of those thought, after comprehensive pre-operative investigation, to have resectable lesions) underwent tumour resection--6 local resections and 12 liver resections. The 30-day hospital mortality was 11% and mean duration of survival was 17 months (7 patients are still alive, with a mean survival of 22.2 months). The quality of life was also much improved after resection. In patients treated with palliative surgery the hospital mortality was 33% and the mean survival was 8.5 months. The results support the treatment of bile-duct carcinoma at the hilum of the liver by resection and suggest that the use of drainage techniques, whether employed surgically or non-surgically, be reserved until the possibility of treatment by resection has been fully considered.

Adenoma, Bile Duct↗
PubMed1984

Intrahepatic biliary papillomatosis.

Intrahepatic bile duct papillomatosis associated with changes of nuclear atypia is described in a young man. Radical excision was performed by left hepatic lobectomy and removal of the common bile duct and left hepatic ducts. Fourteen previous cases of intrahepatic or diffuse intrahepatic and extrahepatic biliary papillomatosis are reviewed. While local recurrence and progression to death from obstructive jaundice and cholangitis is the rule, only two definite cases of malignant change have been reported. Radical surgery may be curative for this rare condition.

Adult↗
PubMed1984

Pre-operative percutaneous transhepatic biliary drainage: the results of a controlled trial.

The operative mortality for biliary tract obstruction due to malignancy is high. In 1981 a controlled clinical trial of pre-operative percutaneous drainage was started at the Royal Postgraduate Medical School. At the time of percutaneous transhepatic cholangiography patients were randomized either to laparotomy or to pre-operative percutaneous transhepatic biliary drainage ( PTBD ) followed by laparotomy. Only patients with malignant biliary tract obstruction and serum bilirubin greater than 100 mumol/l were included. Seventy patients entered the trial, and five were withdrawn. Of the 65 remaining, 31 underwent laparotomy and 34 had pre-operative PTBD followed by laparotomy. The median duration of drainage was 18 days and during this time the median bilirubin fell from 305 to 115 mumol/l. Five patients required early surgery for complications of PTBD and two died within 30 days of surgery. The mortality for laparotomy was 19 per cent (6/31) compared with 32 per cent (11/34) for drainage plus laparotomy. This trial highlights the hazards of PTBD in high risk patients and has failed to demonstrate a reduction in mortality with the use of pre-operative PTBD .

Aged↗
PubMed1984

Benign bile duct stricture following cholecystectomy: critical factors in management.

Seventy-eight patients with benign bile duct stricture following cholecystectomy were referred for further management over an 8-year period. The majority (58 per cent) had multiple operations before referral. On presentation 90 per cent of patients had abnormal liver function tests, 19.5 per cent a depressed serum albumin, 49 per cent a history of previous major infection, and 14 per cent associated liver disease and portal hypertension. Seventy-two patients (92 per cent) were operated upon: 63 by stricture repair alone, 4 by stricture repair and portal systemic anastomosis, and one by splenorenal anastomosis alone. Of the patients treated by stricture repair alone and no other procedure 90 per cent have a good result with a mean follow-up of 3.3 years, and an operative (30-day) mortality of 3.2 per cent. There were no postoperative deaths in 61 patients in whom stricture repair alone was performed by direct suture techniques, but in the presence of portal hypertension and liver disease the mortality was 27 per cent. Factors influencing a satisfactory stricture repair were the number of previous operations, site of stricture and type of repair. Factors influencing mortality were the number of previous operations, a history of major infection, the site of stricture, pre-operative serum albumin concentration, and the presence of liver disease and portal hypertension.

Adult↗
PubMed1984

Clinicopathological aspects of high bile duct cancer. Experience with resection and bypass surgical treatments.

This report reviews the experience of the Hepatobiliary Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London with 16 patients having proximal extrahepatic bile duct malignancy who underwent resection and a comparable group of 15 patients who had surgical bypass. The purposes of the review were to evaluate morbidity and mortality in both treatment groups, to assess whether either treatment influenced the natural history of the disease, and to examine the pathological features of the resected lesions, attempting to correlate the macroscopic and microscopic features with radiological and surgical observations and survival. The presenting symptoms, average age, clinical data, and length of hospital stay were similar in both groups. Hospital mortality, despite 12 major liver resections, was less in the resectional than in the bypass group--19% versus 26%. The average survival for resectional patients was 16.5 months with six of the 13 patients who left hospital still alive, one at 5 years. The bypass patients lived an average of 7 months with no patients surviving beyond 11 months. Both resectional and bypass treatments appeared to influence survival in this disease with greater length and quality of survival being associated with resection. While there were a number of distinctive pathological features associated with the resected tumors, none correlated with survival.

Adenoma, Bile Duct↗
PubMed1984

Practical miniaturized membrane oxygenator for isolated organ perfusion.

Silastic membrane tubing oxygenators possess valuable atraumatic properties, but no satisfactory miniature system for isolated organ perfusion has been achieved. We describe the construction of a new type of miniaturized Silastic membrane tubing oxygenator, 1.5 m long, 1.5-mm diameter, 75-micron wall thickness, incorporated in a single self-supporting unit readily applicable to isolated organ perfusion because of its simplicity, durability, and small prime volume of less than 3 ml. In vitro experiments using out-dated human banked blood demonstrated that the unit can effectively oxygenate blood of hematocrit 35% at flow rates of at least 10 ml/minute and that higher flow rates may be used to oxygenate blood or perfusates of a lower hematocrit. The results were verified in three different practical experimental applications: isolated rat liver, rabbit heart, and rat free skin flap perfusion.

Animals↗
PubMed1983

Idiopathic localized bile duct strictures: relationship to primary sclerosing cholangitis.

Two patients have been described who presented with localized hilar bile duct strictures initially diagnosed as cholangiocarcinoma. Resection of the strictures showed benign disease. The subsequent development of further independent benign strictures was consistent with sclerosing cholangitis. Problems in diagnosis and management of this form of primary sclerosing cholangitis have been discussed.

Adult↗
PubMed1983

Carcinoma of the proximal extrahepatic biliary tree radiologic assessment and therapeutic alternatives.

Preoperative cholangiography and angiography have been used in a series of 37 patients with hilar cholangiocarcinoma investigated over a 17-month period in a single specialist unit. Twelve lesions were judged to be irresectable on the basis of the cholangiographic findings: this was confirmed at laparotomy in nine patients and at autopsy in one. Angiography was performed in 21 patients, and suggested irresectability in eight: this was confirmed by laparotomy in seven. The eighth patient had compression of the left portal vein which had been interpreted as tumor invasion on angiography, and it was possible to perform a curative extended right hepatic lobectomy. Of the 13 potentially resectable patients, three were unfit for major resectional surgery. Five were found to be irresectable at laparotomy because of vena cava involvement in two and distant metastases in three. Five patients underwent resection with histologically clear margins. The combined use of cholangiography and angiography is recommended as a means of selecting appropriate therapy for patients with hilar cholangiocarcinoma.

Adenoma, Bile Duct↗
PubMed1983

Portal-systemic shunting in patients with non-alcoholic liver disease.

Portal systemic shunting for the treatment of bleeding oesophageal varices in non-alcoholic patients is thought to have a better outcome than in patients with alcoholic portal hypertension. In a retrospective study of twenty-five non-alcoholic patients who had undergone portal systemic shunting for the treatment of bleeding oesophageal varices, the perioperative and long term mortality was found to be unacceptably high. Therefore, an analysis was made to define the factors which may have contributed to the high mortality. It was found that the presence of one or more of the following factors contributed to the patient's demise: presence of active liver disease at the time of surgery, previous abdominal surgery, and the performance of shunting as an emergency in order to stop bleeding. It is concluded that in patients having one or more of these risk factors, currently available non-operative means of treating bleeding oesophageal varices should be considered.

Adolescent↗
PubMed1982

Percutaneous transhepatic drainage in obstructive jaundice: advantages and problems.

This study is a critical prospective assessment of 37 patients with obstructive jaundice, treated by percutaneous transhepatic biliary drainage. The median duration of drainage was 18 days (range 44-55), and during this period clearance of bilirubin and improvement in creatinine clearance were obtained. Only 10 patients gained weight. Three patients required early laparotomy. Thirty-three patients underwent definitive surgery. Of these, 8 died without leaving hospital. The incidence of infection rose during drainage, and infected bile was clinically significant. Two deaths were associated with infection, arising in the drainage system, producing intrahepatic abscesses around the drain track. While the evidence for a staged approach in the severely ill patient with obstructive jaundice is substantial, the procedure of percutaneous transhepatic tubal drainage carries significant hazards, underemphasized in previous reports. Further controlled assessment is required before this technique is accepted as the initial best option for decompression of the obstructed biliary tract.

Adult↗
PubMed1982

Antipyrine elimination as a dynamic test of hepatic functional integrity in obstructive jaundice.

Antipyrine elimination was studied in 29 patients with obstructive jaundice Antipyrine half-lives calculated using plasma concentrations at four and 24 hours ('short antipyrine test') were significantly correlated with those calculated using six time points (p less than 0.001). Mean antipyrine half-life was 28.3 +/- 8 hours (standard error) and was significantly longer than in normal subjects (p less than 0.001). Antipyrine half-life did not correlate with standard biochemical liver function tests, but correlated positively with the postoperative half-time for clearance of endogenous bilirubin (p less than 0.05), and negatively with hepatic cytochrome P-450 content measured in peroperative liver biopsies (p less than 0.05). Of six patients with antipyrine half-life greater than 20 hours, four died, one preoperatively of gastrointestinal haemorrhage and three postoperatively of sepsis. Serial short antipyrine tests were performed in 13 patients before and after biliary drainage. Those with an initial antipyrine half-life greater than 15 hours showed significant changes after drainage, while those with an antipyrine half-life less than 15 hours did not. The test of antipyrine half-life may aid in selecting high risk patients with obstructive jaundice for percutaneous biliary drainage before definitive surgery, and in determining the optimal time for such preliminary biliary decompression.

Adult↗
PubMed1981

Increased serum IgA levels in rats after portacaval shunt but not after portacaval transposition.

Groups of rats were submitted to end-to-side portacaval shunt, portacaval transposition or a control sham operation. There was an 18-fold increase of the IgA level in the serum of portacavally shunted rats (n = 7) at 3-6 weeks after surgery. Gel filtration revealed that this increase was predominantly due to dimeric and polymeric IgA. The serum IgM of these shunted rats, but not the IgG, was also significantly increased (twofold) above their control values. In rats subjected to portacaval transposition (n = 6), there was no significant increase of serum IgA, IgM or IgG when compared with their control values. These data confirm the active transfer, by the healthy rat liver, of IgA and, to a lesser extent, of IgM from the blood into bile. Impairment of this function, leading to the accumulation of polymeric IgA and IgM in the serum, in portacavally shunted but not portacavally transposed animals, may be related to impairment of hepatic flood flow and hepatic atrophy, shown earlier to occur in portacavally shunted but not transposed rats. Such reduction in liver cell mass could also explain the fall in transferrin levels in shunted rats.

Animals↗