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C F Frey

Publications and source records attributed to C F Frey.

At least 19 recordsLinked to original sources
PubMed1992

Role of bacterial infection in diet-induced acute pancreatitis in mice.

This study was performed to elucidate the role of bacterial infection in acute pancreatitis in young female mice fed a choline-deficient diet supplemented with 0.5% DL-ethionine (CDE diet). Mice were randomly classified into two groups: one had been fed CDE diet alone (nonantibiotic group), the other was fed a CDE diet with oral administration of antibiotics (antibiotic group). Survival rates at 96 and 144 h after introduction of the CDE diet were significantly improved in the antibiotic group, 25.0 and 19.4%, respectively, as compared with 3.6 and 0% in the nonantibiotic group (p, 0.05). Aerobic and anaerobic bacterial cultures of blood, ascites, spleen, and pancreas were taken from living mice 72 h after introduction of the CDE diet. Positive bacterial growth from one or more of the specimens occurred in 29.4% of the nonantibiotic group, and in 10.0% of the antibiotic group. Mice with pancreatic necrosis had a higher positive culture rate, 62.5% in the nonantibiotic group vs 20.0% in the antibiotic group. These results suggest that reduction of intestinal flora in mice inhibits secondary infection caused by bacterial translocation and improves survival in diet-induced hemorrhagic pancreatitis. We believe the development of bacterial infection of gut origin may be a factor influencing mortality in severe pancreatitis.

Acute Disease↗
PubMed1992

Effect of protease inhibitor FUT-175 on acute hemorrhagic pancreatitis in mice.

The effect of FUT-175, a new synthetic trypsin inhibitor, was evaluated in a lethal model of acute hemorrhagic pancreatitis induced by feeding mice a choline-deficient, ethionine-supplemented diet (CDE diet). When FUT-175 was given prophylactically at doses of 20 mg/kg body wt, the survival rate was significantly improved (p less than 0.05). The serum amylase concentration and trypsin activity in serum were also significantly diminished (p less than 0.05). Prophylactic administration of 5 mg/kg body wt of FUT-175 showed a statistically significant decrease in the serum trypsin activity, but it did not improve the survival rate. Therapeutic administration of FUT-175 showed no favorable effect. FUT-175 showed protective effects on the course of severe acute pancreatitis only when given prophylactically at the beginning of the pancreatitis induced by the CDE diet.

Acute Disease↗
PubMed1991

Endoscopic cholecystectomy. An analysis of complications.

We analyzed our initial 381 endoscopic cholecystectomies with particular emphasis on postoperative complications. The rate of conversion to open cholecystectomy was 3%. A technical complication occurred in 2% and a non-technical complication in 4%, for a total complication incidence of 6%. There were three postoperative fatalities (0.9%). Two fatal technical complications consisted of unrecognized intestinal injuries at the time of endoscopic cholecystectomy that were obvious when the abdomen was opened. One patient died of a cerebrovascular accident. Nonfatal technical complications included five bile leaks that required treatment. There were no common bile duct injuries, but excessive caution to prevent common bile duct injury may have contributed to the high incidence of bile leaks. Examination of the case numbers of the technical complications and conversion to open cholecystectomy suggests that the learning curve is real and somewhat prolonged, and that a willingness to convert to open cholecystectomy is necessary if technical complications are to be avoided.

Aged↗
PubMed1991

Classification of acute pancreatitis.

Increased knowledge of the natural history, etiology, morphology, complications and systemic response of the patient to acute pancreatitis has led to a rapid evolution in the classification of acute pancreatitis. It is recommended that the following elements be included in a classification system of acute pancreatitis: 1. A definition of acute pancreatitis and its complications based on CT scan, ultrasound, ERCP, and angiographic and histologic findings. 2. A statement regarding the etiology of the patient's pancreatitis. 3. An assessment of the patient's systemic response to his or her pancreatitis by means of APACHE II and/or Ranson's signs of severity. This system, through the use of ultrasound, CT scan with vascular enhancement, and clinical and laboratory tests, can be utilized to classify patients initially, on the day of hospital admission, with regard to etiology, morphology, and physiologic severity. Later in their hospital course, the complications of pancreatitis, e.g., fluid collections, necrosis, pseudocysts, infected necrosis, abscesses, fistulas, pancreatic, enteric, and cutaneous, pseudoaneurysm, and splenic vein thrombosis, can be added to the classification as modifiers when and if they occur. The process of the development and confirmation of theories of the origin and nature of the cosmos and evolution of concepts regarding the classification of pancreatitis have something in common. Theory generally stimulates experimental observation whose purpose is to test the theory's validity. New theories are generated when experimental observations demonstrate inconsistencies in previously held beliefs. Just as our understanding of the cosmos is undergoing constant change based on new data and new theories, so are our concepts regarding the classification of pancreatitis.

Acute Disease↗
PubMed1990

Pancreatitis after endoscopic retrograde cholangiopancreatography. An underreported disease whose severity is often unappreciated.

We describe our experience between 1985 and 1989 with 24 patients with clinically significant pancreatitis after endoscopic retrograde cholangiopancreatography. The resulting pancreatitis was categorized into three groups, all requiring hospitalization: (1) mild pancreatitis (n = 12); (2) moderate pancreatitis requiring aggressive evaluation, treatment, and follow-up (n = 6); and (3) severe pancreatitis requiring surgical therapy (n = 6). The average length of hospitalization for the entire group was 12.8 days. Surgical intervention was required in 5 patients, and 3 patients died of acute necrotizing pancreatitis with sepsis, adult respiratory distress syndrome, and intractable hemodynamic failure. Our experience with this entity suggests that this form of pancreatitis includes severe and even lethal outcomes. It was associated with a mortality of 13%.

Acute Disease↗
PubMed1990

Diagnosis and treatment of pancreatic injuries. An analysis of management principles.

Ninety-one pancreatic injuries, 47 from blunt trauma, were reviewed with respect to management principles stressed in qi previous reviews. The pancreatic complication rate was 25%. Blunt injury was suspected preoperatively in only 30%. Even short-term observation led to morbidity. Operations done more than 6 hours after admission had a higher complication rate (45%) than those done less than 6 hours after admission (18%). Penrose drainage without a sump was not associated with increased complications. Distal pancreatectomy was done 32 times; splenectomy was done in only 18 patients. Individual duct ligation was rarely done and did not result in a high fistula rate. Pancreatic stump oversew with nonabsorbable suture was associated with a higher rate of pancreatic complications than absorbable suture (58% vs 30%). Only 56% of patients receiving distal pancreatectomy required hyperalimentation. Postoperative serum amylase values were not useful, and amylase values from drainage fluid predicted complications only when they were above 100,000 U/L. Details of pancreatic trauma management are less important than early operation in minimizing morbidity.

Adult↗
PubMed1990

Comprehensive management of acute necrotizing pancreatitis and pancreatic abscess.

Achieving reduced mortality rates in patients with necrotizing pancreatitis and pancreatic abscess is possible by employing a comprehensive management plan. Components of the plan include (1) rapid evaluation and assessment of the degree of physiologic and anatomic derangement, the latter by the prompt use of vascular enhanced computed tomographic scan; (2) adequate fluid resuscitation determined by early institution of advanced hemodynamic monitoring; (3) attempts to identify and document septic foci via computed tomography-guided percutaneous aspiration; and (4) aggressive surgical debridement. Close adherence to these policies allowed us to keep mortality in this seriously ill group of patients to 14%. Most deaths occurred in patients who were referred to this service late in the course of their disease. The Acute Physiology and Chronic Health Enquiry (APACHE) II severity of illness index applied at the time of admission proved an accurate predictor of mortality. A score of 25 or greater was highly predictive of death, and a lesser score, of survival.

Abscess↗
PubMed1990

The Major Trauma Outcome Study: establishing national norms for trauma care.

The Major Trauma Outcome Study (MTOS) is a retrospective descriptive study of injury severity and outcome coordinated through the American College of Surgeons' Committee on Trauma. From 1982 through 1987, 139 North American hospitals submitted demographic, etiologic, injury severity, and outcome data for 80,544 trauma patients. Motor vehicle related injuries were most frequent (34.7%). Twenty-one per cent of patients had penetrating injuries. The overall mortality rate was 9.0%. The mortality rate for direct admissions was strongly related to the presence of serious head injury, 5.0% and 40.0%, when head injuries were less than or equal to AIS (Abbreviated Injury Scale) 3 or greater than or equal to AIS 4, respectively. Survival probability norms use the Revised Trauma Score, Injury Severity Score, patient age, and injury mechanism. Patients with unexpected outcomes were identified and statistical comparisons of actual and expected numbers of survivors made for each institution. Results provide a description of injury and outcome and support evaluation and quality assurance activities.

Adolescent↗
PubMed1989

Liver abscesses.

Clinical suspicion of a liver abscess mandates an investigation of the liver for evidence of a liver abscess by radionuclide, ultrasound, or CT scan. Amebic abscesses have a lower mortality rate than pyogenic abscesses. Amebic and pyogenic abscesses can be distinguished on the basis of epidemiologic, clinical, and laboratory studies. The definitive studies for identifying amebic liver abscesses are hemagglutinin or gel diffusion studies. Amebic abscess of the liver may be complicated by extension to the lung, with pulmonary complications. Patients suspected to have amebic abscesses require metronidazole. Emetine or chloroquine may be added if there is no response or if the abscess recurs. Unless there is a failure of the amebic abscess to resolve or secondary infection occurs, there is seldom a need to aspirate or drain these abscesses. Pyogenic abscesses should be treated with broad-spectrum antibiotics to cover gram-negative aerobes and anaerobic organisms. All pyogenic abscesses larger than 1.5 cm in diameter should be aspirated, and the aspirate should be Gram stained and cultured. Percutaneous or surgical drainage should then be performed. Operative intervention is required in those patients with intra-abdominal pyogenic infections that are seeding the liver abscess. The marked reduction in the mortality rate of pyogenic liver abscess witnessed in this decade is multifaceted and attributable in part to earlier diagnosis, permitting definitive treatment in a timely fashion, as well as to improved intensive unit care, antibiotic management, and operative technique.

Adult↗
PubMed1989

Pancreatic resection for chronic pancreatitis.

Patients with chronic pancreatitis needing operative management include those with severe pain, those with complications of pancreatitis, or those in whom it is not possible to distinguish cancer of the pancreas from chronic pancreatitis. The use of endoscopic retrograde cholangiopancreatography, CT, and angiography to define the structural abnormalities has increased the surgeon's ability to select an operation matched to the patient's needs. A longitudinal pancreaticojejunostomy should be performed in patients whose ducts are dilated. When the head of the pancreas is enlarged and thickened, pancreaticoduodenectomy has been the traditional operation of choice. However, local resection with pyloric and duodenal preservation should now be considered an alternative that has a lower mortality rate and less likelihood of creating diabetes or exocrine insufficiency. Patients whose ducts are of insufficient caliber to permit longitudinal pancreaticojejunostomy are candidates for resection of the proximal or distal pancreas, depending on the site of disease or, alternatively, for the Beger or Warren procedure. Pain relief is achieved with surgery in about 80 per cent of patients with chronic pancreatitis. Many of the late deaths following operation for chronic pancreatitis are attributable, not to the operation, but to the effects of alcoholism. There is a need for surgeons to improve their observations and assessment of operative results.

Chronic Disease↗
PubMed1988

Progress in acute pancreatitis.

Pancreatic necrosis and sepsis are the major causes of death in instances of acute pancreatitis. No widely accepted definition of these conditions in individuals exists, and, yet, accurate differentiation is mandatory for effective therapy. A series of operational definitions conforming to known clinopathologic factors are proposed for the necrotizing septic complications of acute pancreatitis. These complications, as distinguished from acute interstitial pancreatitis, are fat sequestra, pancreatic necrosis, infected pancreatic necrosis, pancreatic abscess and acute pseudocyst. Imprecise definitions of these complications of necrotizing pancreatitis make inter-institutional comparisons of previously identified data dubious.

Abscess↗
PubMed1987

Pancreaticopleural fistulas.

Of ten patients with pancreaticopleural fistulas, who ranged in age from 28 to 62 years, eight had primarily thoracic symptoms and no abdominal symptoms. The other two had abdominal pain after acute pancreatic injury. Computed tomographic scans disclosed pseudocysts in nine patients. The effusions resolved in four of the ten patients with transthoracic drainage, although two of these patients later required surgery because of recurrent pseudocysts. One patient died 17 days after repair of an abdominal aortic aneurysm; this patient had been treated by tube thoracostomy. Five patients underwent surgery; in four of them pancreatography was used to delineate the site of disruption preoperatively. These patients all survived, and none required subsequent surgical treatment.

Adult↗
PubMed1987

Pyogenic liver abscess. Diagnostic and therapeutic strategies.

A retrospective review of 26 adult patients admitted to University of California, Davis, Medical Center (UCDMC) with pyogenic liver abscess (1980-1986) was performed to ascertain the impact of rapid diagnosis and percutaneous drainage. Ultrasonographic examinations and computed tomography (CT) scans were highly sensitive and noninvasive imaging modalities. Sixteen patients had solitary abscesses and seven had multiple microscopic abscesses. The median time interval from admission to diagnosis and therapy was 2 and 3 days, respectively. Origin of the abscess was determined in 22 patients, the biliary tree being the most common source. Medical therapy was successful in three patients with microabscesses but failed in two. Nine patients had percutaneous drainage; two required repetitive percutaneous catheter placement, and two proceeded to surgical drainage. Twelve patients had surgical drainage; one required repetitive surgical drainage. Postdrainage complications were minimal in all groups. Overall mortality role was 11.5% (two patients). Deaths were related to delay in diagnosis, gram-negative sepsis at presentation, and biliary origin of the abscess.

Adult↗
PubMed1987

Description and rationale of a new operation for chronic pancreatitis.

An operation is described that is useful in the management of patients with chronic pancreatitis and its complications. The operation features duodenal-preserving resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy of the body and tail of the pancreas. The operation has application to patients with pain or complications of chronic pancreatitis with dilated ducts in the body and tail of the pancreas who have small strictured ducts and/or small pseudocysts or ducts impacted with calculi in a markedly enlarged fibrotic pancreatic head. It also has application to patients with chronic pancreatitis complicated by common duct obstruction from small pseudocysts, fibrosis, or inflammation in the head of the pancreas. With this procedure, the common duct can often be freed up from the structures compressing it within the substance of the pancreas doing away with the necessity of a separate biliary bypass. The operation also has application to patients with a previous longitudinal pancreaticojejunostomy who have recurrent or persistent pain associated with small strictured ducts in an enlarged fibrotic pancreatic head with or without common bile duct obstruction.

Adult↗
PubMed1987

Cystic neoplasms of the pancreas.

Eight patients with cystic neoplasms of the pancreas were seen at four Northern California hospitals between the years 1978 and 1986. Three of the tumors were benign and five were malignant. Three females, whose average age was 61 years, had cystadenomas. Three females and two males, whose average age was 48 years, had mucinous cystadenocarcinomas. Clinical presentations were similar among all patients. Abdominal pain was a prominent feature. Anorexia, weight loss, nausea and vomiting with a palpable abdominal mass were seen in five of eight patients. Obstructive jaundice was seen in two of eight patients. Among patients with benign lesions, one lesion was in the head and two lesions were in the tail of the pancreas. The malignant lesions were in the head of the pancreas in three patients and in the tail or body in two. A presumptive diagnosis was made preoperatively on the basis of the clinical, laboratory and roentgenographic findings in seven of eight patients. Of the patients with benign tumors, two are alive and well at seven years and four months and one patient was lost to follow-up study at four years. Among the patients with a malignant condition who underwent operation, resection for cure was performed upon four patients. One patient died postoperatively and the other three patients are alive and well without evidence of a recurrence at three and one-half, four and four years after resection. Pancreaticoduodenectomy was performed upon two patients and distal pancreatectomy in another. Palliation was attempted in one critically ill patient with an unresectable tumor by longitudinal pancreaticojejunostomy. This procedure was not effective in providing pain relief because of obstruction of the pancreatic duct by the viscous mucoid secretion of the tumor. The preoperative diagnosis of these very rare tumors is usually possible roentgenographically, especially with the use of the computed tomography scan. The presence of a thick mucoid secretion of high viscosity is diagnostic of mucinous cystadenocarcinoma. Cystic neoplasms of the pancreas should always be resected, if possible, with the expectation of long term survival.

Adult↗
PubMed1986

The role of ductal obstruction on the course of hemorrhagic pancreatitis in the pig.

The effect of relieving pancreatic duct obstruction after the onset of hemorrhagic pancreatitis was investigated. Hemorrhagic pancreatitis was produced in 20 pigs by a bile salt-trypsin retrograde injection technique. In half the pigs the pancreatic duct was permanently ligated, and in the other half the ductal obstruction was relieved 2 h after the onset of hemorrhagic pancreatitis. The overall mortality rate was the same in both groups by 24 h. No difference was found between the groups in the gross and microscopic appearance of histological samples taken from the pancreas immediately after death. The biochemical parameters measured to assess the severity of pancreatitis such as calcium, BUN, creatinine, glucose, proteins, and hematocrit did not show any difference between the two groups. The serum amylase level, a measure of ductal obstruction, was less at 24 h and even lower at 48 h in the release group as compared to the non-release group. This difference suggests that the ductal obstruction was relieved, as the amylase levels declined at 24 and 48 h. Hemodynamic variables, including cardiac output, pulmonary artery pressure, pulmonary wedge pressure, central venous pressure, and aortic pressure were followed. No significant difference was found in any of these parameters between the two groups. The absence of any significant differences in hemodynamic status, histopathological findings, and biochemical analysis in our pigs, if translatable to man, does not lend support to early operative intervention in gallstone pancreatitis in the hope that those patients who already have hemorrhagic pancreatitis will benefit from early pancreatic ductal decompression.

Animals↗
PubMed1986

Classification of pancreatitis: state-of-the-art, 1986.

In 1983 and 1984 two international interdisciplinary groups convened for the purpose of improving the existing 1963 Marseille Classification of pancreatitis. In this article, the new classifications of pancreatitis resulting from these conferences are examined from the perspective of earlier efforts which preceded the Conference and a recent analysis of the usefulness, similarities, and differences between the two classifications by an International group of surgeons and gastroenterologists.

Acute Disease↗