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Biomedical subjects

R K Tompkins

Publications and source records attributed to R K Tompkins.

At least 37 records · Page 2Linked to original sources
PubMed1989

Management of cystic disease of the liver.

The management of cystic diseases of the liver requires an understanding of their pathophysiology and natural history. Surgery for congenital solitary cysts and polycystic disease should be reserved for patients with significant symptoms. Caroli's disease requires careful preoperative evaluation and planning and long-term follow-up. Surgery for echinococcal liver cysts should be performed before complications of rupture and superinfection develop.

Bile Ducts, Intrahepatic↗
PubMed1988

Agenesis of the gallbladder without extrahepatic biliary atresia.

Agenesis of the gallbladder without extrahepatic biliary atresia is a rare disorder. At the UCLA-affiliated hospitals, 12 patients were classified in the following groups: (1) multiple fetal anomaly, (2) asymptomatic, and (3) symptomatic. All four patients in the multiple fetal anomaly group died of their other congenital defects. In the three patients in the asymptomatic group, the absent gallbladder was an incidental finding at autopsy. The five patients in the symptomatic group underwent operations for symptoms suggestive of biliary tract disease, with no gallbladder found; all were symptom free postoperatively. Operative strategy should include a complete exploration, operative cholangiography, and common bile duct exploration as necessary. Possible mechanisms responsible for symptoms include primary duct stones, biliary dyskinesia, or nonbiliary disorders. Computed tomography, biliary manometry, upper gastrointestinal tract endoscopy, and endoscopic cholangiography (with or without sphincterotomy) could be employed if symptoms continue.

Abnormalities, Multiple↗
PubMed1988

Gut reactions.

Explore the source record for details and available documents.

Gastroenterology↗
PubMed1987

Proximal bile duct cancer. Quality of survival.

A retrospective study of 97 patients with proximal bile duct cancer treated at the University of California, Los Angeles Medical Center was conducted to determine the benefits of different operative treatments. Eighty-nine patients were divided into three treatment groups: Group I, curative resection (29 patients); Group II, palliative resection (13 patients) and bypasses (8 patients); and Group III, operative intubation (39 patients). Two patients died before operation and six patients were treated without operation by percutaneous biliary decompression. High morbidity rate (53.8%) and mortality rate (69.2%) were encountered in 13 patients who had hepatic resection. Survival rates of the three treatment groups were comparable. For the 64 patients closely monitored after discharge, quality of survival was assessed according to six parameters: frequency of hospitalization for cholangitis; catheter-related problems; the percentage of days hospitalized; duration of jaundice; antibiotic requirements; and analgesic needs. Group I patients had the best qualitative survival, whereas Group II patients had the worst result when compared with either Group I (p less than 0.001) or Group III (p less than 0.005). Curative resection is recommended when it can be done without a concomitant hepatic resection. When noncurable disease is found on examination, operative intubation after dilatation is the preferred palliative measure.

Adenoma, Bile Duct↗
PubMed1987

The importance of nonoperative trauma management in postgraduate surgical education.

The activities of a trauma service in a university hospital were analyzed to test the hypothesis that operative caseload alone does not adequately measure the trauma experience of a surgical resident. Over a 2-year period, 378 victims of major trauma (blunt in 79%) were admitted to the service. Only 41% of them required a major operation by the Trauma Service. The patients spent an average of 2.8 days in the intensive care unit and often presented complex challenges in surgical critical care, including ventilator support and hemodynamic monitoring. A trauma service in a university center manages significant numbers of patients with multisystem injuries who never undergo a general surgical procedure. This experience constitutes such an important component of surgical education in trauma that it should be recognized by agencies accrediting residents and training programs. Completion of surgical residency should also imply competence in critical care of surgical patients.

Academic Medical Centers↗
PubMed1987

Modern management of biliary tract stone disease.

A number of new techniques and approaches to the management of biliary tract stone disease have been developed in the past decade. The modern biliary surgeon must be aware of these and of their logical and proper place in the management of patients with biliary stone disease. However, the wise surgeon will continue to hone his surgical skills because the results of definitive, sure, and deliberate operative treatment of biliary tract stone disease remains the standard by which newer methods must be gauged.

Chenodeoxycholic Acid↗
PubMed1987

Pancreaticojejunostomy after Whipple's operation--in vivo evaluation of long-term patency: a preliminary report.

Evaluation of the patency of the pancreaticojejunostomy was conducted in four patients who had undergone Whipple's procedure. Three patients had a mucosa-to-mucosa anastomosis, and in one patient the pancreatic remnant had been invaginated into the jejunal loop. The longest interval between the operation and the present study was 9.7 years. After intravenous infusion of secretin (1 microgram/kg), the temporal changes in the pancreatic ductal caliber were measured by means of either ultrasonography (two patients) or computed tomography (two patients). The presence of adequate functional pancreatic tissue was assumed in all four patients on the basis of their clinical status and the normal ductal caliber before the secretin provocation. In two patients, the ductal system showed an initial dilatation following secretin administration and then gradually emptied. There were no changes of the Wirsung duct in the other two patients. These data suggest that the pancreaticojejunal anastomoses were patent in all four patients but had different degrees of stenosis. The present method allows a safe and noninvasive evaluation of the anastomosis in vivo. Since long-term patency of the pancreaticojejunostomy is feasible, it should be attempted whenever possible in patients undergoing Whipple's procedure.

Adult↗
PubMed1986

Decreased morbidity and mortality after pancreatoduodenectomy.

In two 5 year periods (1975 to 1979 and 1980 to 1984), 96 patients underwent pancreatoduodenal resection, which included 74 partial pancreatic resections and 22 total pancreatectomies. Thirty-seven of these patients had resections with preservation of the pylorus. Substantial reductions in perioperative mortality (2 percent versus 10 percent) and morbidity (26 percent versus 49 percent) (p less than 0.05) were achieved in the latter period. Pylorus preservation, with a mortality and morbidity of 3 percent and 27 percent, respectively, did not increase operative risk or compromise long-term survival in patients with malignant disease. In comparison, relatively high mortality and morbidity rates (14 percent and 59 percent) accompanied total pancreatectomy without improved long-term survival. Five year actuarial survival for nonpancreatic periampullary adenocarcinomas was 58 percent. Thus, we recommend pancreatoduodenectomy with preservation of the pylorus for resection of periampullary tumors. These patients, whose only possibility for cure is a major pancreatic resection, should not be denied this opportunity on the basis of reports from a previous era.

Actuarial Analysis↗
PubMed1986

Heterotopic pancreas. Review of a 26 year experience.

A retrospective review of 37 patients (22 men and 15 women) with histologically verified heterotopic pancreas treated at the department of surgery of the University of California at Los Angeles Medical Center from 1959 to 1985 was carried out. There were 31 adults (mean age 50 years) and 6 children (mean age 2.8 years). The majority of lesions were in the stomach, duodenum, and jejunum. One was found inside a duplicated stomach. Symptomatic lesions were confined to the gastroduodenal region and were larger, with frequent mucosal ulceration. Upper gastrointestinal contrast roentgenograms were sensitive tools for detection (87.5 percent of patients) and diagnosis (71.4 percent of patients) of these lesions. Endoscopy should be performed whenever epigastric pain is the presenting symptom. Resection of the tissue-bearing segment of small intestine is advisable when encountered incidentally at operation. In the absence of endoscopic biopsy confirmation, we recommend surgical exploration and frozen section histopathologic study for all symptomatic patients. Limited local excision has been shown to be a safe and adequate procedure for patients with these congenital anomalies.

Adolescent↗
PubMed1986

Management of hepatic echinococcosis in Southern California.

In the United States, hydatid disease of the liver is being seen with increasing frequency in persons who have immigrated from endemic areas. At the University of California, Los Angeles Medical Center, 24 patients with 46 echinococcal cysts were managed over a 26 year period. Seven patients (29 percent) had cyst rupture: into the lungs in three patients, the biliary tree in two, and the peritoneum and duodenum in one patient each. In recent years, serologic tests, computerized axial tomography, and endoscopic retrograde cholangiopancreatography have greatly aided the diagnosis and management of these patients. Four patients were treated nonoperatively, and 20 patients (with a total of 41 cysts) underwent operation. Cyst management included partial cystectomy in 19 patients, complete cystectomy in 18 patients, left hepatic lobectomy in 2 patients, and marsupialization and removal of hepatic debris from the common duct in 1 patient each. Primary cyst closure, omental packing, external drainage, or cystojejunostomy was individualized on the basis of cyst size, location, secondary infection or rupture, and communication with the biliary tree. Morbidity, including two temporary external biliary fistulas, occurred in eight patients (40 percent) but could not be related to cyst management or preoperative rupture. No deaths occurred in this series.

Adolescent↗
PubMed1986

Further studies on the inhibition of pepsin by bile salts.

A higher incidence of peptic ulceration has been reported in patients recovering from operations that divert bile from the duodenum. Previous studies have shown that hydroxylated bile salts inhibit the proteolytic activity of pepsin, an integral agent in the production of peptic ulcer. In this study, the pepsin inhibitory activity of 16 bile salts (6 unconjugated, 5 glycoconjugated, and 5 tauroconjugated bile salts), including bile salts with no hydroxyl groups, was tested in vitro. All bile salts inhibited pepsin proteolytic activity and the degree of pepsin inhibition increased in proportion to their concentrations. The range of maximal inhibition was 90-73% for unconjugated bile salts; 74-35% for glycoconjugated bile salts; and 71-46% for tauroconjugated bile salts. These findings support the need for clinical studies to evaluate administration of bile acids to bile-diverted patients.

Animals↗
PubMed1986

Water and electrolyte absorption from a human Thiry-Vella ileal loop. Responses to systemic administration of gastrin, glucagon, secretin, and cholecystokinin.

Water and electrolyte flux in response to systemic administration of four different gastrointestinal hormones were studied in a human with a chronic Thiry-Vella ileal loop. Gastrin infusion with a pharmacological dose of 4 micrograms/kg-hr has no effect. Responses to glucagon were proportional to infused doses with directly increased absorption of water and electrolytes (except bicarbonate). However, when gastrin was infused simultaneously with glucagon, the enhanced absorption was inhibited. Secretin only transiently increased absorption of fluid and electrolytes. In contrast to its effects on jejunum, CCK increased both water and electrolyte absorption from the ileum.

Cholecystokinin↗
PubMed1986

Differentiation of pyogenic from amebic hepatic abscesses.

Recent immigration trends have resulted in an increased prevalence of amebic hepatic abscesses in southern states and in many northern American cities. Because amebic hepatic abscesses generally do not require drainage, differentiation from pyogenic hepatic abscesses is important. We, therefore, reviewed the records of patients admitted to the UCLA Medical Center from 1968 through 1983 to compare the clinical manifestations and to access the results of treatment of pyogenic and amebic hepatic abscesses. During this 15 year period, 82 patients (42 pyogenic and 40 amebic) with hepatic abscesses were admitted. Factors which distinguished patients with pyogenic abscesses included: age greater than 50 years; jaundice; pruritus; sepsis and shock; a palpable mass; elevated bilirubin level; elevated alkaline phosphatase level, and abnormal abdominal roentgenograms. Patients with amebic abscesses of the liver were more likely to have Mexican ancestry, recently traveled to an endemic area, abdominal pain, diarrhea, abdominal tenderness, hepatomegaly and positive amebic serology. Hepatic scans and ultrasonography were excellent methods of detecting the presence of but not the type of hepatic abscess. Over-all, the mortality was 40 per cent for patients with pyogenic abscesses whereas all 40 of the patients with an amebic abscess survived. However, operative mortality was only 4.5 per cent for the 22 patients with pyogenic abscess who were managed with systemic antibiotics and surgical drainage. We conclude that many clinical and laboratory parameters can aid in the differentiation and, as a result, management of patients with pyogenic and amebic hepatic abscesses.

Adolescent↗
PubMed1985

Inhibition of pepsin activity by ursodeoxycholic acids and chenodeoxycholic acids.

The bile salts of ursodeoxycholic acid, glycoursodeoxycholic acid, tauroursodeoxycholic acid, chenodeoxycholic acid, glycochenodeoxycholic acid, and taurochenodeoxycholic acid were each found to inhibit pepsin proteolytic activity in vitro at various concentrations against the refined substrate n-APDT. The sodium salt of ursodeoxycholic acid was the most potent pepsin inhibitor among those tested.

Animals↗
PubMed1984

Amino terminal fragments of human progastrin from gastrinoma.

Two peptides which copurified from a human gastrinoma were found to correspond to the amino acid sequence deduced for the amino terminal portion of human and porcine progastrin. The sequence of peptide A is Ser-Trp-Lys-Pro-Arg-Ser-Gln-Gln-Pro-Asp-Ala-Pro-Leu-Gly-Thr-Gly-Ala-Asn- Arg-Asp-Leu-Glu-Leu which is identical to an amino terminal portion of human progastrin. The sequence of peptide. B is identical to that of peptide A except it is missing the first five amino acids. If peptide A corresponds to the amino terminus of progastrin, the signal peptidase cleaves at an Ala-Ser bond.

Amino Acid Sequence↗