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Biomedical subjects

L W Way

Publications and source records attributed to L W Way.

At least 19 recordsLinked to original sources
PubMed1992

The efficacy and limitations of percutaneous endoscopic gastrostomy.

We analyzed 64 percutaneous endoscopic gastrostomy procedures performed by us between 1986 and 1990. Thirty patients had neurologic disease; 16 had head and neck cancers; eight had other malignancies; two had acquired immunodeficiency syndrome; and eight had other problems. Seven patients died within 30 days of complications (n = 4) or the primary illness (n = 3). Mean follow-up was 6 months; an additional patient died of aspiration and eight others died of their underlying illness. There were 19 complications (32%). Four wound complications occurred. Nine patients developed aspiration pneumonia within 3 days of the procedure, four of whom died in the hospital. Of the 24 patients with a history of aspiration, nine experienced aspiration during or after percutaneous endoscopic gastrostomy. Patients with a history of aspiration were more likely to have perioperative aspiration pneumonia, and patients who experienced aspiration were more likely to die.

Adult↗
PubMed1992

The ultrasonic dissector facilitates laparoscopic cholecystectomy.

The ultrasonic dissector disrupts tissues in proportion to their fluid content by ultrasonically induced cavitational forces. Since sturdy tissues are spared, the instrument tends to follow tissue planes and to dissect fat and other soft tissues selectively. We performed a prospective, randomized, controlled trial in 73 patients comparing the safety and efficacy of a prototype ultrasonic dissector with that of electrosurgery and laser during laparoscopic cholecystectomy. Randomization was as follows: ultrasonic dissector, 37 patients; electrosurgery, 21 patients; and laser, 15 patients. The results were not different with respect to patient characteristics, amount of blood loss, technical difficulties, length of hospital stay, or return to work. Subjectively, the ultrasonic dissector was thought to be of special value in isolating the hilar structures, particularly when they were edematous or embedded in fat. The ultrasonic dissector disintegrated the fat, which was rapidly cleared up the suction channel, allowing the cystic duct and artery to be bared with less risk of injury. We concluded that the ultrasonic dissector has unique attributes that contribute to the ease and safety of laparoscopic cholecystectomy.

Adolescent↗
PubMed1991

Impact of transhiatal esophagectomy on cardiac and respiratory function.

We studied the impact of transhiatal esophagectomy on the cardiac and respiratory function of 44 consecutive patients. Preoperatively, 31 patients had associated medical problems (22 with cardiac disease, 31 with pulmonary disease). Mean forced expiratory volume in 1 second (FEV1) was 2.1 liters, but it was less than 1.2 liters in six patients. Postoperatively, mechanical ventilation was given for a mean of 49 hours. Of the six patients with FEV1 less than 1.2 liters, five were ventilated for an average of 44 hours, and one was ventilated for 221 hours. Intraoperative hypotension, which averaged 8 minutes, was longer in patients with a history of cardiac disease (10 of 14 patients) and in those with a midesophageal tumor (9 of 14 patients). Atrial arrhythmias (14 patients) were more common in patients with a history of cardiac disease and were all successfully treated medically. Nine patients developed congestive heart failure, and they all recovered. Average hospital stay was 15 days. Transhiatal esophagectomy has a greater impact on pulmonary and cardiovascular physiology than previously believed, but the majority of complications can be treated successfully. Transhiatal esophagectomy can be performed safely in patients with poor respiratory function, who constitute about 10% of those who need esophageal resection.

Adult↗
PubMed1991

Differential diagnosis of sclerosing cholangiocarcinomas of the common hepatic duct (Klatskin tumors).

Although it is recognized that some other lesion may be the cause, a presumptive diagnosis of Klatskin tumor is usually made when a focal stenotic lesion of the common hepatic duct is seen on a cholangiogram of a jaundiced patient. Biopsy is so often nondiagnostic that decisions about therapy are usually made on the basis of the imaging tests and lack of evidence for some other disease. Because the accuracy and consequences of this strategy have never been tested, we contrasted the preoperative diagnosis of Klatskin tumor with the final diagnosis in 98 consecutive patients treated from 1985 to 1990. Preoperative investigations included ultrasound and computed tomographic scans, percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography, and angiography. Sclerosing cholangiocarcinomas of the bile duct were correctly diagnosed in 68 cases. The final diagnosis was other than a sclerosing adenocarcinoma in 30 (31%) cases. There were 5 papillary bile duct carcinomas, 12 gallbladder carcinomas invading the bile duct, 5 metastatic tumors to the bile duct, 2 cases of Mirizzi syndrome, 3 granulomas, and 3 cases of idiopathic benign focal stenosis. Patients with papillary adenocarcinomas had an extensive filling defect of the duct, which was often thought to be unresectable. However, four of these five lesions could be completely excised, and the tumor was confined to the duct wall in all four. The outcome of surgical treatment of the other eight patients with benign lesions was good in most cases. These findings demonstrate the pitfalls of assuming that a focal stenosis of the hepatic duct represents a sclerosing adenocarcinoma. The diagnosis is much less specific than is generally thought, so there is considerable opportunity for mismanaging such patients.

Adenoma, Bile Duct↗
PubMed1979

In vitro investigation of gallstone shadowing with ultrasound tomography.

A phantom was constructed to simulate the in vivo situation of gallstone detection. Gallstone specimens from 37 patients were scanned. All gallstones cast acoustic shadows, regardles of the specific properties of the stones. Experimental evidence concerning factors that affect the detection of acoustic shadows from gallstones is discussed.

Acoustics↗
PubMed1979

The pancreatic duct mucosal barrier.

The main pancreatic duct in cats possesses a relatively strong barrier to the diffusion of bicarbonate ions (HCO3-). We studied some of the characteristics of this barrier by perfusing the duct with a solution similar in composition to pancreatic juice before and after exposing the duct mucosa to various test agents. The difference in net flux of HCO3- across the duct before and after exposure to the test agent reflected damage to the barrier. The barrier was damaged by infected bile, aspirin (pH 2.3), hydrochloric acid (pH 2.3), ethanol (5 to 10 per cent), and secondary bile acids. It was not damged by sterile bile, aspirin (pH 6.5), and primary bile acids. These data indicate that the barrier to back diffusion in the pancreatic duct has unique properties, different in some respects from the properties of the gastric mucosal barrier. Furthermore, the barrier is vulnerable to some agents thought possibly to have a role in the pathogenesis of pancreatitis and pancreatic cancer.

Animals↗
PubMed1979

Gastric, pancreatic, and biliary secretion and the rate of gastric emptying after parietal cell vagotomy.

We compared the gastric, pancreatic, and biliary secretory responses to a liquid test meal and the rates of gastric emptying of liquid and solid test meals in six patients at least 1 year after parietal cell vagotomy with eight unoperated subjects, one with duodenal ulcer disease and seven normal control subjects. Parietal cell vagotomy decreased gastric acid secretion to one third of normal, but total trypsin and bile salt secretion during the first 150 postcibal minutes were normal. The liquid test meal emptied from the stomach faster after parietal cell vagotomy, the pattern of emptying being exponential in the vagotomy patients and linear in the normal subjects. The rate of gastric emptying of a liquid meal, although faster than normal, was less precipitous after parietal cell vagotomy than after truncal vagotomy plus drainage or subtotal gastrectomy, and trypsin and bile salt concentrations were not diluted to abnormal levels, as occurs after these other procedures. Furthermore, emptying and dispersion of solid food remained normal after parietal cell vagotomy. These findings probably explain, at least in part, the decreased incidence of postprandial dumping and diarrhea that accompanies parietal cell vagotomy compared with the other popular operations for duodenal ulcer.

Adult↗
PubMed1979

Slowed rate of gastric emptying of solid food in man by high caloric parenteral nutrition.

We studied the effect of high caloric parenteral nutrition on the rate of gastric emptying of solid food. The linear pattern of gastric emptying was not altered by parenteral nutrition, but the gastric emptying rate was consistently slowed. The degree of slowing of gastric emptying while on parenteral nutrition correlated with the increase in blood glucose induced by the intravenous nutrient load. These findings may explain the oral food intolerance displayed by some persons receiving both oral and high caloric intravenous nutrition.

Aged↗
PubMed1978

Total gastrectomy.

Total gastrectomy is indicated principally for Zollinger-Ellison syndrome and for potentially curable gastric cancer. The diagnosis of cancer should be verified by biopsy before the resection is performed, and the margins of resection should usually be examined by frozen section. Of the various reconstructions, Roux-en-Y esophagojejunostomy gave the best long-term results.

Adult↗
PubMed1978

Clinical utility of CAT body scans.

The results of 202 computerized axial tomography (CAT) body scans performed on hospitalized patients were analyzed for their accuracy and clinical utility. The sensitivity (80 per cent), specificity (70 per cent), and accuracy (77 per cent) were high but not superior to ultrasound examinations of the same area. The results of the CAT body scan affected patient management in 16 per cent of patients and affected the success of treatment in 1 per cent of patients. We conclude that for many abdominal conditions ultrasound scans are equally as accurate and substantially more cost-effective than CAT body scans, and that the clinical value of CAT body scans needs support from controlled clinical trials.

Adolescent↗
PubMed1978

The Zollinger-Ellison syndrome--23 years later.

The effects of recent diagnostic and therapeutic advances were assessed in 65 patients with the Zollinger-Ellison syndrome (ZES). Twenty-seven patients seen between 1955 and 1970 were compared with 38 patients seen between 1971 and 1977. The earlier patients had a higher incidence of virulent ulcer disease (56% vs. 24%), other endocrinopathies (48% vs. 13%), and malignant gastrinoma (44% vs. 25%). Earlier diagnosis is the result of liberal use of serum gastrin measurements and provocative tests for gastrin release (calcium and secretin), and an increased awareness of this syndrome. Because their basal gastrin values were in a range that overlapped ordinary ulcer disease, 47% of patients encountered in recent years required provocative testing with secretin for diagnosis. If the gastrin concentration falls to normal following resection of a gastrinoma, the tumor has probably been completely removed. In our patients, gastrin measurements after total gastrectomy had no prognostic significance in regards to clinical progression or regression of the neoplasm. Of 12 patients treated with cimetidine, nine experienced symptomatic improvement, and three did not. Resection of the gastrinoma should be attempted if the lesion is solitary and located in the body or tail of the pancreas, or if it is an isolated duodenal lesion. Otherwise, total gastrectomy remains the treatment of choice. In 38 patients, total gastrectomy with Roux-en-Y esophagojejunostomy was followed by 97% survival and minimal difficulties with nutrition or dumping.

Adolescent↗
PubMed1978

Management of external gastrointestinal fistulas.

We analyzed the course of 186 patients with external gastrointestinal fistulas treated at the University of California Medical Center, San Francisco from 1968 to 1977. There were 82 patients in the earlier group (1968-1971) and 104 patients in the later group (1972-1977). The groups differed in that 35% of patients in the earlier group received TPN, but 71% of patients in the later group received TPN. Of the patients who did not receive TPN, 93% had been adequately nourished using tube feeding methods. The two groups were otherwise similar. The fistula-related mortality (11%) and the spontaneous closure rate of the fistulas (32%) was unchanged over the ten year period. Thus, the principal impact of TPN was to simplify the nutritional management rather than to alter the outcome. When malignancy, previous abdominal irradiation, Crohn's disease, or a short (<2 cm) fistula tract were present, spontaneous closure was less likely than when none of these factors were present (20% versus 47%). Sixty-eight per cent of the deaths occurred in patients with uncontrolled sepsis. Fifty per cent of the deaths were due to the primary disease and were unrelated to the fistula. Spontaneous closure could not be expected to start until sepsis was controlled. Because over 90% of patients whose fistulas closed spontaneously did so within one month after infection was eradicated, we recommend operative closure for most fistulas that persist beyond that time. The most reliable operation is excision of the bowel from which the fistula arises with end-to-end anastomosis. Fistulas not amenable to excision should be managed by bypass.

Adolescent↗