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K W Warren

Publications and source records attributed to K W Warren.

8 recordsLinked to original sources
PubMed1987

Alpha-fetoprotein associated with islet cell tumors.

Elevated serum levels of alpha-fetoprotein (AFP) (100-1,000 ng/ml) were found in three patients with islet cell tumors. Serial levels correlated with progression of disease, suggesting that AFP could be a useful tumor marker substance for islet cell tumors. Survey sera from an expanded pool of 23 patients with islet cell tumors and nine with carcinoid tumors did not identify additional cases, however, suggesting that elevated AFP levels in these classes of Apudomas are uncommon. Nonetheless, the distinction from other AFP-producing tumors such as hepatocellular carcinoma is clinically important and warrants an awareness of the rare association of AFP with these tumors.

Adenoma, Islet Cell↗
PubMed1976

Surgery.

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England↗
PubMed1975

Progress in biliary stricture repair.

Between 1967 and 1970 inclusive, 119 patients underwent 158 operations for the relief of benign bile duct stricture. During this time hepaticojejunostomy was favored for biliary reconstruction, since eighty procedures were of this type. Thirty-eight were end to end repairs and the remainder were a variety of other types. Of the cases evaluated, 58 per cent of the hepaticojejunostomies and 61 per cent of the end to end repairs produced satisfactory results. This experience is an improvement over a previously reported earlier series from this institution. Only three patientd died postoperatively, a significant reduction over an earlier mortality. Further experience with the use of the modified Y tube has been gained in forty-two cases, and it suggests that the benefits might be statistically significant in hepaticojejunostomy if the number of cases were increased. We have begun to evaluate the transhepatic circle tube which can be replaced, when obstructed, on an outpatient basis, thus allowing longer use of stents. Analysis of obstructive biliary sludge in five stents suggests that the sludge is a polymer of bile pigment that is insoluble in both aqueous and organic solutions and therfore not preventable or dissolvable by the administration of chenodeoxycholic acid.

Biliary Tract Diseases↗
PubMed1975

Hepaticogastrostomy: ulcerogenic preparation or therapeutic alternative.

Recent laboratory and clinical studies have implicated bile salts in the patogenesis of gastric ulceration. Common hepatic duct to stomach anastomosis results in total diversion of bile to the stomach and has been utilized at the Lahey Clinic occasionally for bypass of the obstructed common bile duct in difficult technical situations where conventional procedures were deemed prohibitively difficult. Of seven patients undergoing hepaticogastrostomy, two had upper gastrointestinal bleeding in followup. One of these patients had documented esophageal varices and stopped bleeding after splenorenal shunt. The other had massive sepsis which predisposed him to gastric ulceration. From this small series it is clear that the entire biliary output of the liver can be shunted into the stomach without greatly increased risk of clinically significant gastric ulceration. Hepaticogastrostomy provided relief from jaundice in all but one of the seven patients in the series and remains an occasionally useful procedure. These data indicate that diversion of the entire flow of bile from the liver into stomach does not cause gastric ulcers.

Adult↗
PubMed1975

Results of radical resection for periampullary cancer.

This report concerns 348 pancreatoduodenectomies, including 13 total pancreatectomies. Operative mortality over 30 years was 15%, operative mortality since 1962, 10%. Precise factors influencing operability, mortality, morbidity, and long-term palliation or cure are emphasized. The necessity for making a distinction among tumors arising in the ampulla of Vater, the intrapancreatic portion of the common bile duct, and the duodenum surrounding the papilla of Vater and carcinomas arising in the head of the pancreas is the most important factor in the approach to periampullary malignant tumors. Even with this large experience, the impression of the operating surgeon at the time of resection was incorrect in 10% of the patients in whom a reons who do not resect carcinomas arising in the head of the pancreas and who may have had less experience in this specialized field may be rejecting an even larger per cent of patients with more favorable periampullary malignant tumors. The influence of previous exploration, manipulation, and biopsy on morbidity, mortality, and survival is discussed. The significance of nodal involvement and residual tumor at the neck of the pancreas and the point of division of the common bile duct and the uncinate process is discussed. These data justify continued selective application of pancreatoduodenectomy for periampullary cancer and identify areas where further improvement can be made.

Adenocarcinoma↗