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Biomedical subjects

L W Way

Publications and source records attributed to L W Way.

At least 127 records · Page 7Linked to original sources
PubMed1978

The use of medical audits in surgical education.

Quality of medical care audits conducted in the form of a conference attended by surgical residents, faculty, and medical students accomplish the following: (1) provide an excellent educational experience for all participants; (2) are enthusiastically received by all concerned; (3) accomplish considerably more than audits performed in the manner prescribed by the Joint Commission on Accreditation of Hospitals (JCAH); and (4) fulfill JCAH/Professional Standards Review Organization (PSRO) requirements. This modified type of audit can be used successfully as a variant of a teaching seminar in which learning is more predictable because of the active participation of all concerned. Criteria sets which include simple and complex criteria must be developed if audits are to alter patterns of care for complex surgical problems.

Education, Medical, Graduate↗
PubMed1977

Effect of different absorbable sutures on healing of gastrointestinal anastomoses.

Studies were performed in dogs to determine whether the newer absorbable sutures would be preferable to catgut in the gastrointestinal tract. Dissolution times of plain and chromic catgut were compared with those of polyglycolic acid (Dexon) and polyglactin 910 (Vicryl) sutures exposed to gastrointestinal contents in vitro and in vivo. Strength and healing of gastric, jejunal, and colonic anastomoses performed with each suture were compared in dogs. Catgut sutures proved susceptible to rapid proteolytic digestion throughout the gastrointestinal tract, whereas Dexon and Vicryl were invulnerable. Type of suture did not affect microscopic healing in the stomach jejunum, or colon. However, gastric anastomoses of Dexon were stronger at four and seven days and jejunal anastomoses of Dexon and Vicryl were stronger at seven days than anastomoses of catgut. Dexon and Vicryl may be superior to catgut for use in gastrointestinal anastomoses.

Absorption↗
PubMed1977

Use of calcium and secretin in the diagnosis of gastrinoma (Zollinger-Ellison syndrome).

Sixty-five patients with peptic ulcer disease were evaluated for gastrinoma (Zollinger-Ellison syndrome) by measuring changes in serum gastrin concentration after intravenous (i.v.) administration of calcium or secretin, or both. The presence of gastrinoma was established in all 20 patients whose serum gastrin increased by 395 pg/ml or more after i.v. calcium and in all 18 patients whose serum gastrin concentration increased by 110 pg/ml or more after i.v. secretin. The experience with these 65 patients shows that stimulation by calcium or secretin may confirm the presence of gastrinoma in cases where the diagnosis would otherwise remain obscure. Although a positive response to calcium or secretin is diagnostic for gastrinoma a negative response does not exclude this diagnosis. Stimulation with secretin is preferred for screening for gastrinoma because it is quicker and more reliable than calcium.

Adult↗
PubMed1976

The risk and accuracy of pancreatic biopsy.

Pancreatic biopsy in 171 patients produced complications in 4.7 per cent and death in 1.7 per cent. The biopsy diagnosis was confirmed in 86 per cent but was falsely negative in 14 per cent of pancreatic cancers. Frozen sections were interpreted correctly in all cases. Wedge biopsy resulted in fewer complications and fewer false-negative results than needle biopsy and is preferable except for periampullary lesions in which transduodenal needle biopsy is best. When the biopsy incision transected a pancreatic duct, suture ligation and drainage avoided complications. Open transduodenal biopsy of periampullary lesions was reliable, but the duodenotomy closure leaked in 10 per cent of the cases. Pancreatic biopsy with confirmation of malignancy should precede pancreaticoduodenectomy in most cases of suspected pancreatic cancer.

Adenocarcinoma↗
PubMed1976

Recurrent hyperparathyroidism.

Recurrent hyperparathyroidism occurred in 11 of 295 patients from 10 months to 34 years after an initially successful operation. Seven patients with recurrent hyperparathyroidism had either multiple endocrine adenomatosis type I (MEA) or familial hyperparathyroidism (FHP), one patient had parathyroid cancer, and two patients had renal failure at the time of recurrence. Four of these patients ahd their initial operations elsewhere. Recurrence developed in 33% of patients with MEA or FHP but in only 0.4% of 242 patients without MEA or FHP. The presence of MEA or FHP was known before parathyroid exploration in 18 (86%) of the 21 patients. In patients with MEA or FHP, subtotal parathyroidectomy should be performed if there is more than one gland involved. Other patients should be treated by selective removal of an adenoma because recurrence is rare. Subtotal parathyroidectomy should be reserved for patients with diffuse hyperplasia.

Adenoma↗
PubMed1976

The effect of acute hyperglycemia on meal-stimulated gastric, biliary, and pancreatic secretion, and serum gastrin.

The effects of hyperglycemia on pancreatic, biliary, and gastric secretory responses to meals have not been hitherto quantified in man. In the present study seven normal volunteers were fed on two occasions a 500-ml liquid test meal containing fat and protein. During one of the meals the subjects were made acutely hyperglycemic with intravenous glucose, whereas in control experiments, each subject received intravenous saline in place of glucose. A jejunal perfusion method was used to measure pancreatic outputs of trypsin and biliary outputs of bile salts for 150 min after the meal; the same method was used to quantify indirectly the amount of acid secreted by the stomach in the 150-min period. Serum gastrins were also measured basally and at intervals after the meal. Hyperglycemia suppressed serum gastrin, gastric acid production, trypsin secretion, and bile salt output in response to the test meal.

Bile Acids and Salts↗
PubMed1975

Surgical treatment of late postgastrectomy syndromes.

An analysis of the experience at the University of California Hospital, San Francisco, with the diagnosis and treatment of fifty-nine postgastrectomy syndromes shows that stomal obstruction (sixteen patients), the most common syndrome, was best treated by total reconstruction rather than stomal revision. Disappointment with the results of other procedures for the dumping syndrome (50 per cent improvement) has convinced us of the need to adopt the use of reversed jejunal interposition for surgical treatment of this condition. Because a precise etiologic diagnosis of bilious vomiting is often elusive, the preferred procedure is isoperistaltic jejunal interposition, since it eliminates the afferent loop and prevents bile from entering the stomach. All five patients with malabsorption were improved by conversion from BII to BI. Four of five patients with diarrhea were improved by various procedures (not including a reversed segment of intestine in the midjejunum). Three patients with reflux alkaline gastritis were improved by Roux-en-Y gastrojejunostomy or isoperistaltic jejunal interposition. Either is effective. Thus, in our experience if an unquestionable diagnosis of stomal obstruction, malabsorption, or reflux alkaline gastritis can be established, there is ample justification for an optimistic outlook regarding surgical therapy.

Adult↗
PubMed1975

Gallstone ileus.

Explore the source record for details and available documents.

Adult↗
PubMed1975

The intestinal phase of gastric secretion: a pharmacological profile of entero-oxyntin.

In dogs with denervated fundic pouches, antrectomy, and gastrojejunostomy, feeding a meal of cooked liver and 5 percent bone dust stimualted acid secretion from the fundic pouches without increasing serum gastrin concentrations. Simultaneous administration of pentagastrin, histamine, octapeptide of cholecystokinin, or bethanecol produced potentiation of acid secretion, suggesting that the mediator of the intestinal phase is different from these secretagogues. Secretin and glucagon failed to inhibit the intestinal stimulus but both atropine and metiamide were potent inhibitors. We conclude that entero-oxyntin, the hormone responsible for the intestinal phase of gastric secretin, has a unique pattern of effects for acid secretion.

Animals↗