The armamentarium of the pancreatic surgeon must include multiple operative techniques, to be adapted to the clinical and anatomical findings in the patient with chronic pancreatitis. Pancreaticoduodenectomy is an essential component of this armamentarium. Its indications and limitations require continued refinement. Pancreaticoduodenectomy (Whipple operation) provides excellent results in the relief of the pain of chronic pancreatitis. The incidence of reoperation for control of pain after this procedure is less than after drainage procedures. The postoperative mortality rate in recent report is less than 2%. Whereas resection of pancreatic tissue diminishes pancreatic function, the metabolic deficits are partially compensated by the better nutritional status resulting from pain relief and discontinuation of narcotics. In experienced hands, pancreaticoduodenectomy would appear to be the procedure of choice in patients with small pancreatic ducts. In selected patients, it appears to be a good procedure and, possibly, the operation of choice when the disease is predominantly present in the head of the pancreas and/or the uncinate process, especially when strictures involve the common bile duct and duodenum. The authors prefer the procedure when a hard, chronically-inflamed mass is present in the head of the pancreas. In our experience, if the suspicion of malignancy of the head of the pancreas persists at operation, pancreaticoduodenectomy is the procedure of choice. Before undertaking resection, the individual surgeon must assess his/her own experience; a low risk is essential. The continuing alcoholic is not a candidate for pancreaticoduodenectomy. Those who will not stop drinking should seldom be accepted for resection. The same limitation exists for the narcotic addict, but few such patients are encountered today. In the authors' experience, the operation is excellent for the relief of pain. It is the lifestyle of the continuing alcoholic that poses the more significant problem.

Adult↗

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Aneuploid DNA content in pancreatic adenocarcinoma.

DNA content measurements were performed by flow cytometry on eight ductal-type pancreatic adenocarcinomas. The majority of the neoplasms contained an aneuploid DNA content, with hyperdiploid DNA content being the most common abnormality. Two neoplasms had a diploid DNA content. These latter two patients are alive at 11 mo and 3 mo. The data suggest that a large percentage of pancreatic adenocarcinomas have an aneuploid DNA content. Further study is needed to evaluate the relationship between aneuploid DNA content and survival.

Adenocarcinoma↗

PubMedDate not supplied

Historical background to accidental death and disability: the neglected disease of modern society.

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Ambulances↗

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Intestinal obstruction by distension of a Foley jejunostomy catheter.

Jejunostomies can be effective in permitting postoperative nutritional support, particularly in the patient with complicated gastrointestinal disease. In the case presented, however, distension of the Foley balloon catheter, used as the jejunostomy tube, led to intestinal obstruction which was not initially detected. Following radiographic identification of the problem, removal of the air from the Foley balloon allowed the patient to complete his convalescence from surgery. The possibility of obstruction from the Foley jejunostomy catheter should be recognized as a potential problem in the postoperative period.

Catheterization↗