Pain in chronic pancreatitis.
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Chronic Disease↗
Biomedical subjects
R C Williamson
Publications and source records attributed to R C Williamson.
Testicular torsion in Bristol: a 25-year review.
To identify changes in incidence, presentation, management and outcome, 670 patients with torsion of the spermatic cord presenting in Bristol between 1960 and 1984 have been reviewed. Among the susceptible population of 150,000, the annual incidence of torsion has increased fourfold from 11.2 cases between 1960 and 1964 to 42.8 cases between 1980 and 1984. Throughout this period greater than 90 per cent of patients have been managed by general surgeons. Patients aged between 12-18 years comprised 62 per cent but 20 per cent were 21 years or older. Torsion was commoner in the cold months, 24 per cent of cases occurring during December and January (chi 2 = 30.26, P less than 0.01). When acute torsion was relieved within 12 h of the onset of symptoms only 4 per cent of affected testes were considered non-viable, but beyond this time 75 per cent of patients received orchidectomy. Overall, 238 of 624 (38 per cent) acutely twisted testes were found to be infarcted at operation, and a further 35 patients (6 per cent) had marked testicular atrophy on review 3 months later. The testicular salvage rate has steadily improved from 45 per cent in the years 1960-64 to 67 per cent in 1980-84. Much of the increased incidence of testicular torsion is likely to reflect a greater awareness of the condition by general practitioners. It has been more than matched by an improvement in testicular salvage rate because of earlier referral.
Age Factors↗
Rectal hyperplasia after jejunoileal bypass for morbid obesity.
Jejunoileal bypass (JIB) has been widely used to treat patients with morbid obesity for the past 20 years. In rats JIB causes adaptive colonic hyperplasia and enhances colorectal neoplasia. In this study crypt cell production rate (CCPR) was measured stathmokinetically in cultured rectal biopsies from nine patients with JIB and seven controls without intestinal operations or disease. Crypt cell production rate in the group with JIB was more than double that of controls (12.80 (2.67) v 6.23 (1.49) cells/crypt/h: p less than 0.001). There were no significant differences in crypt morphometry and histological examination of rectal biopsies was normal. Patients with JIB have a marked and persistent increase in cell proliferation in the large intestine and may be at increased risk of developing colonic cancer.
Adult↗
Acalculous disease of the gall bladder.
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Cholecystitis↗
Villous adenomas and carcinoma of the duodenum in Gardner's syndrome.
Patients with Gardner's syndrome are increasingly found to have polyps on routine upper gastrointestinal endoscopy, and their risk of developing periampullary carcinoma is between 3-12%. We report a 45 year old man with Gardner's syndrome who presented with periampullary carcinoma 5 years after colectomy. Review of the literature amassed another 21 cases of periampullary carcinoma in patients with Gardner's syndrome.
Adenocarcinoma↗
The use of CA-50 radioimmunoassay inhibition test in the differential diagnosis of benign and malignant breast disease.
The role of the tumour marker CA-50 has been studied in the differential diagnosis of benign and malignant breast disease. Serum levels of CA-50 were determined by radioimmunoassay using a level of 17 units/ml as a cut-off. All 50 normal subjects and 22 of 24 patients (92%) with benign breast disease had CA-50 levels below 17 units/ml. By contrast, 15 of 36 patients (42%) with breast carcinoma had serum CA-50 levels above 17 units/ml (P less than 0.001). There was no clear correlation with tumour stage. The data suggest that CA-50 levels may help to differentiate benign and malignant diseases of the breast.
Adolescent↗
Pancreatic sphincteroplasty: indications and outcome.
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Cholecystectomy↗
Pancreatic sphincteroplasty: indications and outcome.
Twenty patients received transduodenal pancreatic sphincteroplasty for one of three indications: post-cholecystectomy pain with a strongly positive Nardi test (n = 5), recurrent attacks of idiopathic acute pancreatitis (n = 7) and chronic pancreatitis (n = 8). Three patients had an accessory sphincteroplasty in addition to double sphincteroplasty at the major papilla (transampullary septectomy). Pain was relieved in four of the five post-cholecystectomy patients at a median 21 months after sphincteroplasty. On a scale from 0-10 the mean pain score decreased from 9.1 to 2.8, and the preoperative rise in serum amylase with morphine-prostigmine provocation was abolished. None of the patients with recurrent pancreatitis has had a further attack postoperatively, though one had transient pain without hyperamylasaemia. Performed as an adjunct to other pancreatobiliary procedures in five cases, sphincteroplasty has contributed to a satisfactory result in all but two of those with chronic pancreatitis. The only serious complication was an infected pancreatic collection in two patients with concomitant resection or drainage of the distal pancreas.
Acute Disease↗
Effect of duodenogastric reflux on gastric mucosal proliferation after gastric surgery.
The effect of duodenogastric reflux on cell proliferation and mucosal mass in the stomach was studied. Male Wistar rats (n = 118) were submitted to Polya partial gastrectomy, partial gastrectomy with Roux-en-Y diversion of bile, total duodenogastric reflux or handling of the stomach alone (sham operation). Following oral administration of the carcinogen N-methyl-N'-nitro-N-nitrosoguanidine for 6 months, animals were killed 6, 9 or 12 months postoperatively and their stomachs were examined for crypt cell production rate and mucosal DNA content. Compared with shams, crypt cell production rate was more than twice as high in the gastric remnant 12 months after Polya partial gastrectomy (P less than 0.001) and median DNA content was 31 per cent greater (P = 0.05). After total duodenogastric reflux, DNA content was 62 per cent greater than in shams (P = 0.02), while Roux-en-Y diversion reduced crypt cell production rate by 65 per cent (P less than 0.001). Only Polya gastrectomy increased the number of rats developing gastric carcinomas (9 versus 2 shams; P less than 0.05). Increased mucosal cell proliferation in rats with duodenogastric reflux may help to explain the development of gastric stump cancer.
Adenocarcinoma↗
Influence of sialomucin at the resection margin on local tumour recurrence and survival of patients with colorectal cancer: a multivariate analysis.
In a multicentre prospective trial 358 patients undergoing curative surgery for colorectal cancer were followed for a median 18.0 months (+/- 7.2 months). The presence or absence of sialomucin in either resection margin was studied using the high iron diamine-alcian blue stain. There was evidence of excess sialomucin at one or other resection margin in 106 patients (29.6 per cent). Apart from sigmoid carcinomas occurring more often in the sialomucin positive group, there were no significant differences in any histological or clinical parameters between groups. Survival analysis for the events 'death', 'local recurrence', and 'all recurrence' was undertaken using the Cox regression model. The best prognostic variables selected in a stepwise fashion for death and all recurrence were 'Dukes' classification', 'sialomucin present' and 'histological differentiation'. The best prognostic variables selected for local recurrence were 'sialomucin present', 'Dukes' classification' and 'histological differentiation'. Sialomucin in a resection margin is an important independent prognostic variable for the development of local tumour recurrence and of subsequent survival for patients with colorectal carcinoma.
Aged↗
Inhibition of intestinal carcinogenesis by dietary supplementation with calcium.
Dietary supplementation with calcium reduces colonic crypt cell production rates in both normal and hyperplastic mucosa. Calcium can bind intraluminally with bile salts and fatty acids thus reducing their mitogenic effect. The protective role of oral calcium on intestinal carcinogenesis (induced by azoxymethane) was tested in 60 male Sprague-Dawley rats submitted to either 80 per cent mid jejuno-ileal resection (n = 30) or jejunal transection (n = 30). Half the rats in each group received calcium lactate 24 g/l added to their drinking water. Rats were killed 25-27 weeks postoperatively. Enterectomy increased colonic tumour yield by 60-106 per cent (P = 0.002-0.005) and duodenal tumour yield by 70-86 per cent. Calcium abolished this effect at both sites, halving intestinal tumour yields in rats with both transection and resection (P less than 0.05). Doubling the dietary intake of calcium inhibits experimental carcinogenesis.
Adenoma↗
Resection in chronic pancreatitis.
In the absence of ductal ectasia there is no adequate alternative to pancreatectomy for severe chronic pancreatitis. A personal series of 30 such patients operated upon between 1977 and 1984 included 16 with distal pancreatectomy, 6 with proximal pancreatectomy and 12 with total pancreatectomy; 4 patients progressed from distal to total resection after an interval of 15-28 months. The mean age was 39 years with a male preponderance of 77 per cent. The main aetiological agents were chronic alcoholism (63 per cent) and previous acute pancreatitis (23 per cent). One patient died after total pancreatectomy, giving a 30-day mortality rate for all resections of 3 per cent. Postoperative complications necessitated reoperation in 10 per cent, and there have been 5 late deaths (17 per cent). Among 27 patients followed for a median of 4.5 years, pain relief has been good in 16, fair in 8 and poor in 3 (11 per cent). Proximal pancreatectomy has proved superior to distal pancreatectomy with regard to analgesia and the avoidance of diabetes. Although technically demanding, total pancreatectomy has improved symptoms substantially in 9 of 10 patients surviving for a minimum of 18 months.
Adult↗
Anastomotic recurrence in large bowel cancer.
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Anastomosis, Surgical↗
Total pancreatectomy for chronic pancreatitis.
A survey of six British centres collected data on 83 patients undergoing total pancreatectomy (TP) for chronic pancreatitis between 1977 and 1986. There were 57 men and 26 women with a median age of 38 years (range 19-61 years). Half were alcoholics and half had had previous acute pancreatitis. Besides jaundice (14 per cent) severe pain was the indication for the operation; regular opiates had been needed in 82 per cent of patients and 37 per cent were addicted to these drugs. All but 12 had had previous pancreatic or biliary surgery, with a median of two operations and a maximum of six. TP was a one-stage procedure in 32 patients, 42 had had distal resections and 9 proximal resections in the past; the pylorus was preserved in 30. Median operation time was 4 h (range 2-18 h) and median blood loss was 3 units (1-21 units). Intraoperative complications in 11 patients included haemorrhage in 9. Four deaths occurred within 30 days from bleeding (2), respiratory failure (1) and Roux-loop infarction (1). All but one of the 79 survivors required full pancreatic supplementation and 38 per cent had difficulties in endocrine control. At a median follow-up of 1.5 years (range 0.25-10 years), 57 patients (72 per cent) were pain-free and 9 (11 per cent) needed only occasional analgesia. Though 13 (17 per cent) still took regular analgesics, all were symptomatically improved. There have been 10 late deaths (13 per cent), all but one of which are attributable to the operation.
Adult↗
Elevated plasma enteroglucagon alone fails to alter distal colonic carcinogenesis in rats.
The effect of physiologic increases of plasma enteroglucagon, induced by massive bypass or resection of small bowel, on large bowel cell turnover and carcinogenesis was studied in rats in which the distal colon was isolated as a mucous fistula. After injections of azoxymethane, either 85% end-to-side jejunoileal bypass, 85% jejunoileal resection, or sham bypass was performed. Controls underwent colonic transection and resuture, azoxymethane treatment, and then sham bypass. Thirty weeks later the plasma enteroglucagon level had almost trebled after jejunoileal bypass (p less than 0.001) and almost doubled after jejunoileal resection (p less than 0.002) when compared with sham bypass; sham values did not differ from controls. The median number of tumors per rat in the distal (defunctioned) colon fell from 2 to 0 (p less than 0.05). Segmental weight fell by 45% (p less than 0.001) and crypt cell production rate by 75% (p less than 0.001). Neither tumor yield nor adaptation was affected by jejunoileal bypass or jejunoileal resection. Plasma enteroglucagon has no effect on colonic cell turnover or carcinogenesis in the absence of luminal content.
Animals↗
Stearic acid and carcinogenesis.
Decreased membrane rigidity is one of the characteristics of malignant cells, resulting in part from the desaturation of stearic acid into oleic acid. In this study we investigated the influence of stearic acid on tumour cell inhibition in vitro and tumour development in vivo. Stearic acid inhibited the colony-forming ability of 4 out of 5 rat and two human tumour continuous cell lines in vitro. In contrast, the colony-forming ability of rat fibroblasts was not inhibited and that of human foetal lung fibroblasts was inhibited at a higher dose than that required to inhibit human tumour cell lines. Using a model of rat mammary carcinoma induced by nitroso-methyl urea (NMU) the subcutaneous injection of stearic acid at weekly intervals prevented tumour development in 5 to 10 rats. Using iodostearic acid twice weekly, 11 of 19 rats were alive and tumour free at week 22 whilst all of 14 animals injected with NMU alone had died of tumour by the 16th week. The ratio of stearic to oleic acids in erythrocyte membranes was significantly reduced in the tumour-bearing rats, but was normal in tumour-free animals treated with stearic or iodostearic acid. These preliminary data indicate that stearic acid inhibits tumour development in rats.
Animals↗
Effect of hypothermia on intestinal adaptation and carcinogenesis in the rat.
Postoperative hyperplasia enhances experimental intestinal carcinogenesis, but the effects of nonsurgical adaptation are uncertain. The tropic and tumour-promoting potentials of moderate hypothermia were tested in two groups of male Sprague-Dawley rats housed at 10 degrees C for 30 weeks. One group (n = 10) received a 6-week course of azoxymethane (total dose 90 mg kg-1). The second group (n = 7) acted as hypothermic controls. Another 2 groups maintained at 22 degrees C received azoxymethane (n = 15) or served as normothermic controls (n = 15). Overall food intake was 42% higher in the hypothermic groups, yet at sacrifice mean body weight was 13% lower (P less than 0.01). Hypothermia and azoxymethane combined to produce the following increases in crypt cell production rate (CCPR), as determined stathmokinetically: duodenum 170%, jejunum 172%, ileum 74%, proximal colon 227% (P = 0.05-0.01). Independently hypothermia had no effect, but azoxymethane produced 76-156% increases in CCPR throughout the large intestine. Although hypothermia did not affect overall tumour yield, the mean diameter of proximal colonic tumours was increased by 65% (P less than 0.05). In rats receiving azoxymethane, hypothermia stimulates cell proliferation in the small bowel as well as in the proximal colon, where it has a correspondingly mild cocarcinogenic effect.
Adaptation, Biological↗
Proliferative instability and experimental carcinogenesis at colonic anastomoses.
The possibility that proliferative instability around a healing anastomosis promotes carcinogenesis was tested in 234 male Sprague-Dawley rats. Animals received the first of five weekly injections of azoxymethane (total dose 50 mg/kg) either immediately after transection of the descending colon or at 2, 4, 8, and 12 weeks later; controls received handling of the bowel alone. Crypt cell proliferation was assessed by autoradiography following 3HTdR injection. An overall increase in tumour yields in all transection groups was due solely to the frequent presence of anastomotic tumours. Changes in crypt morphometry and labelling index were most marked in crypt positions 1-10 away from the anastomosis. Crypts at this site increased in height at 2, 4, and 8 weeks (p less than 0.001) but returned to normal values by 12 weeks. Likewise, labelling index was increased at 2, 4, and 8 weeks (p less than 0.001) and remained higher at 12 weeks (p less than 0.05). Increased crypt cell proliferation in the immediate vicinity of an apparently 'healed' colonic anastomosis may explain its persisting susceptibility to carcinogenesis.
Animals↗