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Biomedical subjects

L W Way

Publications and source records attributed to L W Way.

At least 109 records · Page 6Linked to original sources
PubMed1980

Alkaline reflux gastritis: a reevaluation.

The results of Roux-Y reconstruction in 46 patients diagnosed as having alkaline reflux gastritis were analyzed to determine which factors in the preoperative evaluation were associated with a good clinical result after surgery. The operation was considered successful in 30 (65 percent) of the 46 patients. Success was not related to the details of the patient's symptoms, the visible appearance of the gastric mucosa at endoscopy or the extent of histologic abnormalities in a preoperative biopsy or resected specimen of gastric mucosa. Therefore, the outcome of surgery could not be predicted from preoperative findings, and gastritis, even though it is often present, is not likely to be responsible for the symptoms in this syndrome. Nevertheless, the results of surgery for postgastrectomy bile vomiting and abdominal pain are good enough that when other conditions have been ruled out, Roux-Y reconstruction can be recommended for patients with severe complaints.

Bile↗
PubMed1980

Acute cholangitis.

The features of cholangitis were analyzed in 99 consecutive cases treated in the last ten years. The disease was severe and refractory in half the cases due to malignant stricture, and in 20% of those due to gallstones. Benign strictures, sclerosing cholangitis, and most cases of choledocholithiasis were associated with less severe cholangitis, which responded promptly to antibiotic therapy. High fever, a serum bilirubin level above 4 mg/dl, and hypotension characterized the most severe refractory cases in which emergency surgery was mandatory. Patients without manifestations were nearly always controlled successfully with antibiotics. We conclude that the term "suppurative cholangitis" is an unsatisfactory synonym for severe cholangitis, because the correlation between biliary suppuration and clinical manifestations in cholangitis is inexact; some patients with severe sepsis do not have pus in the bile duct, and a few patients with suppurative bile are only moderately ill.

Acute Disease↗
PubMed1980

In vitro investigation of gallstones with computed tomography.

An in vitro investigation of gallstones from 25 patients using computed tomography (CT) was performed). An abdominal phantom was constructed and filled with a matrix with an attenuation value equivalent to normal liver. A condom filled with water and positioned within the phantom simulated the gallbladder. Gallstones were placed in the condom and were scanned, radiographed, measured, and inspected. All gallstones were detectable by CT as filling defects within the condom having CT attenuation values higher or lower than water. Attenuation values ranged from +178 to -188 CT units (scale, +500 to -500). Gallstones containing calcium settled to the bottom of the condom, while calculi containing gas filled fissures rose to the top of the condom.

Adult↗
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↗