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W R Lees

Publications and source records attributed to W R Lees.

At least 109 records · Page 6Linked to original sources
PubMed1989

The interpretation of retrograde pancreatography in the elderly.

Endoscopic retrograde pancreatography is regarded as the most specific technique in the diagnosis of chronic pancreatitis. In the elderly the relevance of endoscopic retrograde pancreatography changes in establishing the diagnosis is disputed. The pancreatograms of 101 patients aged seventy-five years or more, who had endoscopic retrograde pancreatography for suspected biliary or pancreatic pathology, were reviewed. Only four patients subsequently proved to have unequivocal chronic pancreatitis. There was no significant difference in the size or contour of the main pancreatic duct, or in side branch changes between those patients presenting with common bile duct stones, incidental biliary pathology and pain of probable pancreatic origin. Three definite diagnostic criteria for the diagnosis of chronic pancreatitis emerged--duct obstruction with a stricture, gross irregularity of the main pancreatic duct and the presence of large cavities.

Aged↗
PubMed1989

Non-operative management of gallstones--a preliminary review.

We describe our initial experience with extracorporeal shock-wave lithotripsy, direct solvent dissolution with methyl tert-butyl ether and mechanical extraction, in 17 symptomatic patients without significant gall-bladder wall disease using existing criteria for selection. Extracorporeal shock-wave lithotripsy and mechanical extraction are promising techniques. Methyl tert-butyl ether therapy has been fraught with difficulty.

Adult↗
PubMed1989

Fibrin sealant as a plug for the post liver biopsy needle track.

Some patients are at particular risk of haemorrhage after liver biopsy. We describe the use of a two-component fibrin sealant (Tisseel, Immuno) for embolising the track left after biopsy with the 18 gauge 'Biopty' needle. In our series of five cases there have been no bleeding complications. We consider Tisseel much easier to apply than previously described embolisation materials.

Biopsy, Needle↗
PubMed1989

Pancreatic duct dilatation after secretin stimulation in patients with pancreas divisum.

Pancreas divisum is the most common anatomical variant of pancreatic ductal anatomy. It has been suggested that obstruction at the accessory papilla in subjects with pancreas divisum can be assessed by measurement of ductal diameter by ultrasonic examination after a maximal secretory stimulus with i.v. secretin. We have prospectively assessed this test in 44 individuals; nine healthy controls, nine patients with abdominal pain and normal pancreatic anatomy, 17 patients with pancreas divisum and abdominal pain but no other evidence of pancreatitis, and nine patients with pancreas divisum and either chronic or recurrent acute pancreatitis. We have found no correlation between ductal anatomy and response to i.v. secretin. Secretin provocation tests do not indicate which patients have accessory papillary stenosis and do not add support to the hypothesis of obstruction leading to pancreatitis in patients with pancreas divisum.

Acute Disease↗
PubMed1989

Percutaneous fine needle aspiration cytology of the pancreas: advantages and pitfalls.

Fine needle aspiration of the pancreas was performed in 62 patients with radiological suspicion of malignancy. All fine needle aspirates were taken under computed tomography or ultrasound guidance. Fine needle aspirates were positive in 31 of 41 patients with histologically or clinically confirmed pancreatic carcinoma. There were no false positive results. The sensitivity of this method for detecting malignant disease was 86%. Cytology was not able to provide conclusive results of benign conditions. Difficulties were encountered in diagnosing well differentiated carcinoma and neuroendocrine tumours and distinguishing them from reactive epithelium and islet cell hyperplasia, respectively. This resulted in a 12.1% false negative rate. There were no complications in our series. Percutaneous fine needle aspiration proved a reliable method of diagnosing pancreatic carcinoma.

Adenoma, Islet Cell↗
PubMed1989

Intestinal ischaemia associated with phaeochromocytoma.

The present case report describes a patient with an adrenal phaeochromocytoma who presented with infarction of the small intestine. The clinical features, diagnosis and treatment of this case are described. Despite excision of the tumour and necrotic intestine, this patient died in the postoperative period from overwhelming sepsis and multi-organ failure. Special reference is made to the delayed effects of established intestinal ischaemia on immune function and it is suggested that this was major contributory factor to the fatal outcome in the present case. The onset of gastro-intestinal symptoms in patients with phaeochromocytoma should suggest the possibility of imminent gut ischaemia and indicate the necessity for prompt excision of the tumour.

Adrenal Gland Neoplasms↗
PubMed1988

Obstructive pancreatitis: unusual causes of chronic pancreatitis.

Fifty-eight consecutive surgical pancreatic resections for chronic pancreatitis were examined. Eight cases were identified with obstructive pancreatopathy; all underwent pancreato-duodenectomy. Histological examination revealed that obstruction in three cases was due to duodenal wall cysts, and in two patients it was associated with pancreas divisum (the accessory papilla was obstructed by a neuroendocrine tumour in one case and by ectopic pancreatic tissue in the other). One case each was due to obstruction of an anomalous duct by vegetable matter, to segmental pancreatitis, and to an intraductal carcinoma. Obstructive pancreatitis has many causes and diligent pre-operative assessment is required as surgical resection may be beneficial. Special efforts should be made to identify ductal anomalies, duodenal cysts, ectopic pancreatic tissue, and small ampullary tumours of exocrine and endocrine origin in order to define the aetiology of pancreatitis.

Adult↗
PubMed1988

Diagnosis and grading of chronic pancreatitis by morphological criteria derived by ultrasound and pancreatography.

The most commonly used modalities in the diagnosis of chronic pancreatitis are ultrasonography, computed tomography (CT) and endoscopic retrograde pancreatography (ERP). Computed tomography scanning is only of value in severe chronic pancreatitis. Both ultrasound and pancreatography are capable of showing ductal changes in mild forms of the disease, but comparison of the two methods has been difficult. A scheme of morphological criteria and descriptive terminology of pancreatitis was applied to 58 out of 85 patients with a firm clinical diagnosis of chronic pancreatitis. Twenty-seven patients were excluded from the study, four with a faulty clinical diagnosis and 23 with non-diagnostic pancreatograms. There was an exact classification into normal, equivocal, mild, moderate or marked chronic pancreatitis in 50 out of 58 patients (86%) and an almost perfect correlation (+ or - one grade) in 54 out of 58 (93%). There were four discrepancies. Ultrasound examination missed focal pancreatitis in the tail, a small cavity in the uncinate process and a variant of chronic pancreatitis. One ultrasound scan was of poor quality. Morphological grading by different techniques is feasible and use of this scheme can reduce diagnosis to a simple and specific set of rules.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1987

US-guided percutaneous pancreatography: experience in 75 patients.

Seventy-five patients underwent ultrasound (US)-guided percutaneous pancreatography during a 3 1/2-year period. Pancreatography was successful in 67 patients, and there were no significant complications. The technique, which is easy to perform, was primarily employed to assist localization of pancreatic masses at fine-needle aspiration biopsy. It was also used to demonstrate pancreatic duct morphology when endoscopic retrograde pancreatography had failed or proved non-diagnostic. This enabled mapping of the duct system prior to pancreatic surgery. In cases of diagnostic difficulty, assessment of duct appearance with US-guided pancreatography was more accurate in differentiating carcinoma from chronic pancreatitis than was assessment with endoscopic retrograde pancreatography.

Biopsy, Needle↗
PubMed1987

Upper gastrointestinal endoscopic ultrasonography in gastroenterology.

Endoscopic ultrasound is a new technique in which high-frequency, high-resolution real-time ultrasound images are obtained from within the gastrointestinal tract by use of an ultrasound probe incorporated into the tip of a fibreoptic endoscope. Forty patients were scanned for gastrointestinal indications. In six patients the scans were technically unsuccessful, in three of these because of difficulties with the prototype instrument. New information was obtained in 20 patients, later confirmed by other means in 12. Endoscopic ultrasound did not provide any new information in 14 patients. The technique shows considerable promise in patients with pancreatic disorders and gut-wall malignancies. It has the ability to provide images with a spatial resolution unobtainable by other imaging methods.

Duodenal Diseases↗
PubMed1987

Appendix mass in AIDS?

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Fine-needle aspiration biopsy: pancreatic and biliary tumors.

Fine-needle aspiration biopsy was performed in 240 patients with suspected pancreatic or biliary tumors between 1978 and 1984. Between 1978 and 1982, using only sonographic guidance, the sensitivity of the technique was 66.7% for pancreatic and 40% for biliary tumors compared with 79.4% for carcinomas in other locations. The main reasons for failure to obtain positive cytology were small tumor size and sampling errors. From 1983 onward, combined sonographic and fluoroscopic biopsy guidance with opacification of the bile duct or pancreatic duct was routinely used together with heavier sedation to allow more careful needle placement. The sensitivity of the technique improved from 1983 to 1984 and was 77.5% for pancreatic tumors and 60% for biliary tumors. Failure of the cytologic technique to identify well-differentiated tumors and lymphomas has become a major source of tumor misdiagnosis.

Bile Duct Neoplasms↗