Part II: Papillotomy and bilio-digestive anastomosis.
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Biomedical subjects
Publications and source records attributed to F W Ossenberg.
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An indwelling T-drain is a valuable access to the common bile duct if the conventional EPT fails in the case of choledocholithiasis. It is often easier to cannulate the duodenal papilla from the common bile duct than from the duodenum. A papillotome of the Erlangen type introduced through the T-drain into the papilla spontaneously has the correct cutting direction. The incision is controlled endoscopically. If a patient has undergone Billroth II operation, the particularly difficult cannulation and incision of the papilla is make much easier by the descending technique. Two variants of the endoscopically controlled descending electropapillotomy were successfully performed.
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The effects of portacaval anastomosis and portacaval transposition on colloidal radiogold fractional clearance and on hepatic cytochrome P-450 level were compared in the rat. Colloidal radiogold fractional clearance was significantly lower in rats with portacaval anastomosis (0.556 +/- 0.188 min-1 (mean +/- 1 SD)) than in sham-operated animals (0.842 +/- 0.151 min-1); hepatic cytochrome P-450 level was likewise lower in the former (0.60 +/- 0.14) nmol/mg of microsomal proteins) than in the latter (0.83 +/- 0.12 nmol/mg of microsomal proteins). Colloidal radiogold fractional clearance was not different in rats with portacaval transposition (0.808 +/- 0.201 min-1) and in sham-operated animals (0.798 +/- 0.064 min-1); hepatic cytochrome P-450 level was significantly lower in the former (0.55 +/- 0.07 nmol/mg of microsomal proteins) than in the latter (0.76 +/- 0.17 nmol/mg of microsomal proteins). If colloidal radiogold clearance is assumed to be an index of liver blood flow, these results suggest that portacaval anastomosis induces a decrease, and portocaval transposition produces no change, in liver blood flow. It is concluded that the decrease in hepatic cytochrome P-450 level in the rat with portacaval anastomosis is not merely the consequence of reduced blood flow, but rather results from deprivation of a substance or substances present in portal blood and contributing to maintenance of the cytochrome level.
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The pharmacokinetics of pentobarbital, a barbiturate metabolized by the liver, was compared in normal and in hepatectomized rats. The blood concentration time curve following a single intravenous injection of pentobarbital was fitted to a two-compartment open model. Both the volume of the central compartment and the elimination rate constant were significantly reduced in hepatectomized rats. It is concluded that the liver plays a role both in the metabolism and the distribution of pentobarbital.
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