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Biomedical subjects

R M Zollinger

Publications and source records attributed to R M Zollinger.

At least 37 records · Page 2Linked to original sources
PubMed1986

Primary neoplasms of the small intestine.

Over a 20 year period, 64 patients with primary neoplasms of the small intestine were treated by celiotomy (61 patients) or surgical endoscopy (3 patients). Gastrointestinal bleeding and anemia (38 percent of patients) characterized benign lesions, whereas pain (42 percent), nausea and vomiting (26 percent), weight loss (29 percent), and either gastrointestinal obstruction or jaundice (18 percent) were more indicative of malignancy. Barium studies, duodenal endoscopy, and selective angiography were the most useful diagnostic tools. All 26 patients with benign lesions did well after resection, whereas the 38 patients with malignancies did poorly despite apparently curative wide excision in 19 and pancreaticoduodenectomy in 6. Only the patients with malignant carcinoid lesions treated surgically and by chemotherapy had a good 5 year survival rate (60 percent). All patients with sarcomas and adenocarcinomas died from their disease. Major operations and chemotherapy gave fair outcomes in only a minority of patients who had no evidence of metastasis. These results document the need to suspect small intestinal neoplasms earlier and to perform more aggressive diagnostic workups in patients with vague gastrointestinal symptoms.

Adolescent↗
PubMed1985

Gastrinoma: factors influencing prognosis.

The gastrinoma remains the only endocrine-producing pancreatic tumor for which early surgical intervention is not uniformly advised. It should be possible after 30 years to determine the factors that appear to influence survival. Forty patients who underwent surgery 10 years or more ago were reviewed in an effort to identify factors at operation and the type of surgical procedure that influence survival. Because the total number of patients is small, conclusions based on statistics are not justified; however, certain trends have become clear. Favorable factors at surgery were the presence of a verified submucosal duodenal tumor, the presence of multiple endocrine neoplasia, or the failure to find tumor. Unfavorable factors were the presence of liver and/or lymph node metastases and/or a verified sporadic, nonfamilial pancreatic tumor. Thirty-four of the 40 patients underwent total gastrectomy, and 18 of these patients also underwent hemipancreatectomy, while six underwent other procedures less than total gastrectomy. The 10-year survival rate was 50%. The long-term quality of life in surviving patients who underwent total gastrectomy supports the original recommendation of total gastrectomy.

Arteries↗
PubMed1980

Primary peptic ulcerations of the jejunum associated with islet cell tumors. Twenty-five-year appraisal.

A review of 42 patients with gastrinoma, who either survived five years or longer or who died during this period of evaluation, was carried out to define the surgical principles which might be combined with the recent trend toward cimetidine therapy. Thirty-four (80%) of the patients had total gastrectomy with an operative mortality rate of 2.3%, and eight patients (20%) had less than total gastrectomy. No tumor was found in six patients with hypergastrinemia and an abnormal secretin bolus whose five-year survival rate was 100%. Of the thirty-six patients having tissue proof of gastrinoma, twenty-two (61%) had complete resection of all gross tumor resulting in a 76% five-year survival rate. Fourteen patients had unresectable tumor or partial resection with a five-year survival rate of 21%. Complete gross tumor resection increased mean survival by six years (p < 0.01), but resulted in persistent eugastrinemia in only two patients. Long-term survival was possible with a combination of vagotomy, lesser gastric procedures, tumor resection, and cimetidine, seven of eight patients living more than five years. Surgical management of gastrinoma should be directed toward aggressive tumor resection and vagotomy, with reliance on cimetidine therapy postoperatively to control the gastric hypersecretion. Total gastrectomy should be reserved for cimetidine failures and those who do not wish to take cimetidine for the rest of their lives.

Adenoma, Islet Cell↗