Portasystemic encephalopathy has been a major deterent to the utilization of total or non-selective shunts. A procedure to determine the maximum rate of urea synthesis (MRUS) has been developed and a depression in the ability to synthesize urea has been shown to correlate closely with the development of encephalopathy. Utilizing this procedure and a modified ammonium tolerance curve, a controlled comparison was instituted between selective and non-selective shunts. Following a non-selective or total shunt, there was a definite deterioration in both the MRUS and the ammonium chloride tolerance curve which was accompanied by a high rate of clinical encephalopathy. In marked contrast, the selective shunt, which maintains portal venous perfusion of the liver, showed little or no change in the MRUS and the ammonium chloride tolerance curve following the selective shunt and there was a very low incidence of encephalopathy. The difference between the non-selective and selective shunt in maintenance of urea synthesis, metabolism of ammonium chloride, and the development of clinical encephalopathy show the selective shunt procedure to be definitively superior in this regard.

Ammonium Chloride↗

PubMed1974

Letter: Pharyngitis as a source of postoperative infection around a breast implant.

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Adult↗

PubMed1974

Faecal fat excretion after truncal, selective, and highly selective vagotomy for duodenal ulcer.

Faecal fat excretion was measured on a metabolic ward in 16 patients with duodenal ulcer before operation, and in patients who were in good health more than one year after truncal vagotomy and pyloroplasty (n = 11), bilateral selective vagotomy and pyloroplasty (n = 9), or highly selective vagotomy without a drainage procedure (HSV, n = 12). Excretion of faecal fat was significantly greater (p < 0.01) in patients after both truncal and selective vagotomy with drainage than in patients before operation. Fat excretion in HSV patients was little different from that of preoperative patients. If steatorrhoea is defined as a faecal fat output of more than 6 g per day, one of 16 preoperative patients with duodenal ulcer (6%) had steatorrhoea, one of 12 HSV patients (8%) had steatorrhoea, one of nine patients after selective vagotomy and pyloroplasty (11%) had steatorrhoea but five of 11 patients after truncal vagotomy and pyloroplasty (45%) had steatorrhoea.

Adult↗

PubMed1974