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Biomedical subjects

D W Elliott

Publications and source records attributed to D W Elliott.

At least 19 recordsLinked to original sources
PubMed1991

Are pancreatoenteric anastomoses improved by duct-to-mucosa sutures?

The patency of anastomoses joining the pancreas to either a Roux-Y loop of jejunum or the stomach was evaluated in 26 dogs. At a preliminary operation, the head and uncinate process of the pancreas were resected while carefully preserving the duodenal blood supply. The remaining body and tail of the pancreas were totally obstructed. After obstruction for a mean of 22 (range: 6 to 42) days, one of three anastomoses was performed: (1) inversion pancreatogastrostomy with two layers of sutures; (2) a similar inversion pancreatojejunostomy to the side of a Roux-Y jejunal loop; or (3) pancreatojejunostomy in which the major duct was joined to the jejunal mucosa with interrupted sutures. Six animals were kept for controls. Anastomotic patency was assessed after 8 to 12 weeks by pancreatography, with minimal pressures to achieve anastomotic flow recorded. Weight trends were consistent with anastomotic status. The eight dogs with duct-to-mucosa sutures clearly achieved superior anastomotic patency.

Anastomosis, Surgical↗
PubMed1990

Reassessment of primary resection of the perforated segment for severe colonic diverticulitis.

Primary resection with colostomy has been widely adopted during the past decade for the treatment of patients with severe complications of diverticulitis. Because of this, a retrospective review was performed of all patients undergoing surgery for colonic diverticular disease during the two time periods 1974 to 1978 (n = 196) and 1982 to 1986 (n = 230). Forty-three patients had abscess or peritonitis from 1974 to 1978, whereas 52 had these complications from 1982 to 1986. Colostomy and drainage alone were used for 31 of 43 patients (72%) from 1974 to 1978, while primary resection with colostomy was used for 39 of 52 patients (75%) from 1982 to 1986 (p less than or equal to 0.5). Despite this shift in treatment method, mortality increased from 14% in 1974 to 1978 to 19% in 1982 to 1986 (p = NS). Patients with peritonitis had identical mortalities (22%) during both intervals. Patients with abscess experienced an increase in mortality from 8% in 1974 to 1978 to 15% in 1982 to 1986 (p = NS). The widespread use of primary resection for patients with severe complications of diverticulitis appears not to have altered mortality for those with diffuse peritonitis and may have worsened the outcome for those with abscess.

Abscess↗
PubMed1986

A statistical analysis of drainage versus nondrainage of elective cholecystectomy.

A retrospective review is undertaken to evaluate the effects of drainage versus nondrainage of the gallbladder bed after elective cholecystectomy. Two hundred charts of patients who underwent elective cholecystectomy without choledochotomy were reviewed. Patient selection was based upon several criteria: elective cholecystectomy, lack of explorations of the common duct and lack of associated surgical procedures. Two equal groups were analyzed. Those who had postoperative drainage of the subhepatic space and those who did not have drainage. Postoperative length of stay, maximum postoperative temperature elevation and the number of postoperative analgesics were significantly higher (p less than 0.001) in the drainage group. The rate of progression to regular diet was significantly faster in the nondrainage group (p less than 0.001) and the number of complications was higher in the drainage group (p less than 0.05). No complications were noted due to the lack of drain placement. It was concluded that routine drainage of the subhepatic space after elective cholecystectomy without choledochotomy is unnecessary and contributes to increased postoperative morbidity, length of hospital stay and a higher rate of complications.

Adult↗
PubMed1977

Biliary tract surgery.

Postoperative wound infection rates after biliary tract surgery vary tremendously from 2% after uncomplicated cholecystectomy to 20% in series including many jaundiced patients. Almost all such infections arise from organisms growing in the diseased biliary tract, since infection rate of 1% are achieved when the bile is sterile. A history of cholangitis identifies only one third of the patients with infected bile, but four easily recognized clinical factors point to positive bile cultures in 60% to 75% of patients: (1) age over 70, (2) obstructive jaundice, (3) common duct stones without jaundice, and (4) emergent acute cholecystitis. These selected high-risk patients have postoperative infection rates of 20% to 27%. Preoperative administration of cephaloridine reduced this high rate of infection to 5% in a prospective randomized but not blinded trial. The initially reported experience of 84 patients has been extended to 140 and continues to confirm the efficacy of prophylactic antibiotics in selected high-risk patients. In contrast, there is no present evidence supporting the use of antibiotic prophylaxis in low-risk patients under 70 years of age undergoing uncomplicated cholecystectomy.

Aged↗
PubMed1976

Role of gastrin determinations in clinical surgery.

Patients with recurrent ulcer without retained antrum and with a complete vagotomy will have a low gastric acid output. Those with incomplete vagotomy and gastric resection will have a fasting and histamine-stimulated gastric acid output which are normal' this is as though they had no previous gastric operation. Both groups of patients will have a normal fasting and postprandial serum gastrin. Patients with recurrent ulcer associated with retained antrum will have a fasting and histamine-stimulated acid output above normal. In the latter, fasting serum gastrin will be increased twice normal but not as markedly increased as found in Zollinger-Ellison syndrome. Patients with retained antrum will have a marked postprandial increase in serum gastrin about two times the fasting level. Those patients with this syndrome will have markedly elevated fasting and histamine-stimulated gastric acid as well as marked hypergastrinemia.

Gastric Acidity Determination↗
PubMed1975

Hemorrhage due to diffuse erosive gastritis.

Of 796 patients admitted with upper gastrointestinal bleeding during a five-year period, 156 (20%) had erosive gastritis. Vigorous nonoperative treatment stopped bleeding in 117 (75%); emergency operation was required in 39 (25%). In 24 of these 39 patients (group A), subtotal gastric resection with truncal vagotomy was performed. In the remaining 15 patients (group B), the operation was limited to pyloroplasty, truncal vagotomy, and multiple suture ligation. These patients were, on the average, 20 years older than the patients in group A, and 12 had life-threatening preoperative problems. (Only four of the group A patients had life-threatening preoperative problems.) The operative mortality in group A was 42%, with rebleeding occurring 33%. In group B, only 17% rebled and the operative mortality was 45%. Survival in the two groups was similar, even though those patients in group B were more critically ill. The less radical procedure may often be the best choice in the high-risk and elderly patients who bleed massively and in whom immediate salvage of life is the main issue.

Antacids↗
PubMed1975

Gastrin determinations in symptomatic patients before and after standard ulcer operations.

Whereas 67 patients with duodenal ulcer had fasting and 30-minute postprandial mean serum gastrin levels not substantially different from 32 normal subjects, they had substantially higher fasting and histamine-stimulated gastric acid secretion. The increased acid secretion found in patients with duodenal ulcer is not caused by increased serum gastrin levels. Ten patients with recurrent ulcer, after incomplete vagotomy and gastric resection, had high gastric acid secretion and normal serum gastrin levels. Three patients with recurrent ulcer following complete vagotomy and gastric resection, but with retained antrum, had both high gastric acid secretion and high fasting and postprandial secrum gastrin levels. Three patients with Zollinger-Ellison tumors had even higher basal acid outputs and serum gastrin levels. The combination of basic gastric acid secretory studies and serum gastrin determinations may identify three causes of recurrent ulcer: incomplete vagotomy, retained antrum, and Zollinger-Ellison tumor.

Duodenal Ulcer↗
PubMed1975

Pancreatic pseudocysts.

Pseudocysts are fascinating lesions of the pancreas which present as upper abdominal masses in about 80 per cent of cases, but also as obstructive jaundice, intrasplenic and intra-left-renal masses, mediastinal masses, flank abscess, pleural effusions, and ascites rich in amylase. They are diagnosed by urine amylase with greater sensitivity than by serum amylase. Cysts must be differentiated from pancreatic abscesses, indolent phlegmonous pancreatitis, cystadenomas, and carcinomas of the pancreas, as well as lymphomas and other rare tumors. They may be satisfactorily treated by large sump tube drains to the outside but about one third will require a further operation. Internal drainage by cystogastrostomy is the simplest and best current procedure, but not applicable to all cases. A good alternative is Roux-en-y cyst-jejunostomy. Caution is needed in the preoperative workup since all procedures are accompanied by an operative mortality approaching 10 per cent, mostly due to hepatic disease, portal hypertension, stress ulcerations, and hemorrhage. The follow-up shows 85 per cent good results from proper drainage but 40 per cent are diabetics and in many patients the ravages of alcoholism continue unabated.

Abscess↗