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Biomedical subjects

J Toouli

Publications and source records attributed to J Toouli.

At least 163 records · Page 9Linked to original sources
PubMed1980

Treatment of gallstones by chenodeoxycholic acid.

Twenty-three patients with radiolucent gallstones in a functioning gallbladder were treated by orally administered chenodeoxycholic acid (750 mg/day) for periods ranging from six to 24 months. Complete dissolution of gallstones occurred in five patients, and partial dissolution occurred in four patients--an over-all response of 39%. Side effects of the treatment were minimal. Stone size was the major factor which influenced outcome, as seven of 15 patients with stones less than 1 cm in diameter had a reduction in stone size or dissolution of stones. It is recommended that chenodeoxycholic acid treatment should be reserved for the treatment of patients with radiolucent stones which are less than 1.5 cm in diameter.

Adult↗
PubMed1980

Hepatic tissue perfusion studies during distal splenorenal shunt.

Hepatic tissue perfusion was measured by the krypton-85 clearance technique during surgery in four patients with bleeding esophageal varices before and immediately after Warren distal splenorenal shunt. No significant reduction in perfusion was found in any patient, thus confirming the concept that this type of portasystemic shunt maintains portal flow to the liver.

Adult↗
PubMed1979

In vitro dissolution of human gallstones: the efficacy of heparinized solutions.

The use of heparinized solutions to dissolve or fragment stones retained in the biliary tree after surgery is still controversial. In this in vitro study heparin in concentrations of up to 100,000 mu/l did not dissolve or fragment the stones examined, nor did it enhance the dissolution properties of the bile salt, sodium cholate.

Cholelithiasis↗
PubMed1978

The effect of added bran to the diet on the saturation of bilein people without gallstones.

Bran was added to the diet of eleven volunteers without gallstones, and its effect on bile saturation, bile acid profile in bile, and serum cholesterol and triglycerides was determined. Bile cholesterol saturation was decreased after two months of feeding bran to those female subjects who had supersaturated bile. Bran may be effective in decreasing the lithogenic potential of bile in people without gallstones, and further studies on its place in the prevention of gallstones in susceptible individuals are indicated.

Adult↗
PubMed1975

Gallstone dissolution in man using cholic acid and lecithin.

Seven patients with radiolucent stones in the gallbladder and two patients with radiolucent stones in the biliary tree were treated with oral cholic acid and purified soya-bean lecithin for 6 months. In two patients the stones disappeared and in one patient the stones were reduced in size. In five patients fasting bile samples were obtained before and during treatment and assayed for cholesterol, bile acid, and phospholipid. In all five patients the lithogenic index of bile was reduced during treatment. The biliary deoxycholic acid concentration was increased and chenodeoxycholic acid concentration decreased during treatment.

Administration, Oral↗
PubMedDate not supplied

Comparison of cefotaxime plus metronidazole versus cefoxitin for prevention of wound infection after abdominal surgery.

In a randomized prospective stratified trial consisting of 1010 patients undergoing abdominal surgery involving the viscera, the efficacy of cefotaxime plus metronidazole was compared to cefoxitin for preventing wound infection. The efficacy of a single dose of antibiotics versus three doses over 24 hours was also evaluated. This study demonstrated that a single-dose antibiotic regimen was as effective as a multiple-dose regimen in the prophylaxis of wound infections following abdominal surgery. In addition it demonstrated that the cefotaxime plus metronidazole regimen is comparable to that of cefoxitin and is more cost-effective. It is concluded that a single dose of cefotaxime plus metronidazole provides effective prophylaxis against postoperative wound infections following abdominal surgery.

Abdomen↗
PubMedDate not supplied

Minimizing the risk of bile duct injury at laparoscopic cholecystectomy.

The introduction of laparoscopic cholecystectomy (LC) has been associated with an increase in the incidence of operative bile duct injuries. An operative technique that involves commencing the laparoscopic dissection on the body of the gallbladder and dissecting toward the cystic duct has been developed that minimizes the risk of major duct injury. The aim of this study was to assess prospectively the safety of this dissection technique. A group of 410 patients underwent LC for symptomatic cholelithiasis from January 1991 to December 1992. There was a single common hepatic duct injury: a small (1 mm) side hole in a patient with acute cholecystitis and choledocholithiasis. It was managed at open operation with exploration of the common bile duct and insertion of a T-tube. There were no partial or complete common bile duct transections in this series. We concluded that the technique of commencing the dissection on the gallbladder is safe and minimizes the risk of serious common bile duct injury at LC.

Bile Ducts↗
PubMedDate not supplied

Percutaneous cystogastrostomy with a new catheter for drainage of pancreatic pseudocysts and fluid collections.

We describe a new catheter for the initial percutaneous drainage of large symptomatic pancreatic fluid collections and abscesses using a transgastric approach to allow fluid drainage into the gastric lumen. A double-mushroom stent is placed secondarily for long-term internal drainage to the stomach, avoiding the need for an extended period of external catheter drainage. This technique, termed percutaneous cystogastrostomy (PCG), has been used in 19 consecutive patients with one recurrent symptomatic pseudocyst in the follow-up period fo 9-43 months. There was one death within 30 days of PCG and 1 patient proceeded to surgical necrosectomy. After evidence of resolution of the pseudocysts, the internal stent was retrieved in 17 patients by endoscopic snare.

Abscess↗
PubMedDate not supplied

Prospective randomized comparison of open versus laparoscopic appendectomy in men.

A prospective, randomized trial was performed to compare open appendectomy with laparoscopic appendectomy in men with a clinical diagnosis of acute appendicitis. Sixty-four patients with a median age of 25 years (range 18-84 years) were randomized to open appendectomy (n = 31) or laparoscopic (n = 33) appendectomy. Of the 64 men, 56 (87.5%) had appendicitis (27 open, 29 laparoscopic procedures). The mean operating times were 50.6 +/- 3.7 minutes (+/- SEM) for open and 58.9 +/- 4.0 minutes for laparoscopic appendectomy (p = 0.13). Five (15%) patients randomized to laparoscopic appendectomy had an open operation. The mean postoperative hospital stay was significantly longer for open appendectomy (3.8 +/- 0.4 days) than for laparoscopic appendectomy (2.9 +/- 0.3 days) (t = 2. 05,df = 62,p = 0.045). The complication rate after open appendectomy (25.8%) was not significantly different from that after laparoscopic appendectomy (12.1%). There was a single postoperative death due to a pulmonary embolus in the laparoscopic group and a single death due to cardiac and renal failure in the open group. The mean time to return to normal activities was significantly longer following open appendectomy (19.7 +/- 2.4 days) than after laparoscopic appendectomy (10.4 +/- 0.9 days), (t = 3.75,df = 49,p = 0.001). In conclusion, laparoscopic appendectomy in men has significant advantages in terms of a more rapid recovery compared to open appendectomy. There were no significant disadvantages to laparoscopic appendectomy compared to open appendectomy.

Adolescent↗
PubMedDate not supplied

A simple scoring system for predicting bile duct stones in patients with cholelithiasis.

A means of accurately predicting the presence of stones in the bile duct in patients undergoing laparoscopic cholecystectomy for gallbladder stones is lacking. With the use of a three-stage analysis, a predictive score was developed from seven common parameters. Initially the score was formulated by using data from a retrospective series of patients undergoing laparoscopic cholecystectomy; the system was then tested prospectively over a 1-year period in patients undergoing laparoscopic cholecystectomy for gallbladder stones. This simple scoring system demonstrated an ability to predict bile duct stones with a sensitivity in excess of 70%. The use of such a score may allow the development of preoperative strategies for treating patients undergoing laparoscopic cholecystectomy.

Bile Duct Diseases↗
PubMedDate not supplied

Relationship between morphine responses and sphincter of Oddi motility in undefined biliary pain after cholecystectomy.

In 150 patients with undefined biliary pain after cholecystectomy, responses to morphine were compared with responses to morphine combined with neostigmine. The relationship between rises in plasma levels of aspartate aminotransferase (AST) after morphine or morphine-neostigmine and sphincter of Oddi motility as assessed by endoscopic manometry was also examined. When compared with morphine-neostigmine, patients given morphine alone showed a similar frequency (30% versus 33%) of increases in plasma levels of AST (greater than twice the upper limit of the reference range) but had less abdominal pain and a lower frequency of similar increases in plasma levels of amylase (4% versus 25%). Of 92 patients who consented to endoscopic manometry of the sphincter of Oddi, satisfactory manometric records were obtained in 84, 31 with and 53 without increases in AST after morphine or morphine-neostigmine. Those showing rises in AST had a higher frequency of abnormal manometric records (81% versus 57%, P = 0.025), higher basal pressures in the sphincter of Oddi (P = 0.0001) and higher pressures within ducts (P = 0.02). There was a significant correlation between sphincter basal pressures and intraduct pressures (r = 0.51, P less than 0.001). Rises in plasma AST after morphine are similar to those after morphine-neostigmine and are influenced by, or linked to, factors which determine sphincter basal pressures and intraduct pressures.

Abdominal Pain↗
PubMedDate not supplied

Gall-bladder and sphincter of Oddi response to cholecystokinin in the Australian possum.

The effects of cholecystokinin octapeptide (CCK-OP) on the gall-bladder (GB) and sphincter of Oddi (SO) of the Australian brush tailed possum were examined in 45 anaesthetized animals. CCK-OP (20-640 ng/kg) consistently caused the GB to contract in a dose-dependent manner (Kruskal Wallis P less than 0.05). In 20 animals, the same dose range of CCK-OP produced an excitatory response in the SO, increasing the SO motility index (MI = frequency of contractions x mean peak amplitude) dose-dependently (Kruskal Wallis P less than 0.05). In five animals, an inhibitory response, that is, a decrease in MI, was recorded, with 640 ng/kg of CCK-OP producing a 50% decrease in MI. In the remaining 20 animals, variable responses of both excitation and inhibition were elicited within the same animal. The action of CCK-OP on the SO and GB was not modified by atropine, phentolamine or propranolol. Tetrodotoxin (TTX) reversed the inhibitory responses of the SO to CCK-OP such that responses were excitatory (sign test P less than 0.05). TTX did not alter the response of the GB to CCK-OP. It is concluded that CCK-OP acts directly on smooth muscle receptors of the GB. In the SO, its action is mediated via non-cholinergic, non-noradrenergic inhibitory neurons and also by a direct excitatory action on the smooth muscle of the SO.

Animals↗