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L W Traverso

Publications and source records attributed to L W Traverso.

At least 127 records · Page 7Linked to original sources
PubMed1979

Surgical treatment of chronic pancreatitis. Twenty-two years' experience.

Seventy-four patients underwent operation for chronic pancreatitis during a 22 year period at UCLA Hospital. Follow-up data obtained for 60% of these patients an average of 3.2 years postoperation were analyzed by computer for statistically significant benefit between paired operation combinations and the variables of pain relief, stool habits, alcohol use, readmission for pancreatitis, and narcotic use. The combined group of total and cephalic pancreaticoduodenectomy proved more effective with respect to pain relief and readmission (p less than 0.05) than the group that had pseudocyst drainage. The comparison of groups that underwent resection or ductal drainage showed no statistical differences for the above variables. Regardless of type of operation, if the patient had evidence of pancreatic calcifications and had abstained from alcohol postoperatively, the likelihood of a return to normal activity was more favorable (p less than 0.05).

Adult↗
PubMed1978

Infrarenal aortic occlusion.

Twenty-eight patients with total occlusion of the infrarenal aorta have been seen at the UCLA Hospitals in the past 11 years. Claudication was the presenting complaint in all but one patient, with one-third having ischemic rest pain. The average age of these patients was 54 years, and their histories revealed a surprising absence of myocardial infarction, stroke, or diabetes, although 40% had essential hypertension. Heavy tobacco use, however, was characteristic of the entire group. Arteriography proved valuable in identifying and characterizing the vascular abnormalities, but posed problems in technique and interpretation. Significant distal arterial disease was detected radiographically in only 21% of these patients. Operative correction of the aortic occlusion was performed on 26 patients, 18 by aortic bypass grafts and eight by aorto-iliac endarterectomy, with one early postoperative death. Although the thrombus extended to the renal artery origins in 77% of the cases, a well-designed technical approach did not require renal artery occlusion. Using serial creatinine determinations, one case of renal insufficiency was detected which was associated with prolonged postoperative hypotension. Although the extent of distal disease was more severe in those who underwent bypass, symptoms of claudication returned earlier and were more prominent in the endarterectomy group. This recurrence of systems was not favorably altered by sympathectomy performed concomitantly with the initial procedure. Even though this condition seems to pose difficult technical obstacles and has a poor prognosis, infrarenal aortic occlusion can be successfully treated by aortic bypass, with favorable long-term results, if particular attention is paid to elements of the preoperative evaluation and the intraoperative technical requirements peculiar to this relatively uncommon disease entity.

Aged↗
PubMed1978

Preservation of the pylorus in pancreaticoduodenectomy.

Further clinical observation and laboratory evaluation will be necessary before we can recommend this modification of the usual technique of pancreaticoduodenectomy to preserve the pylorus and distal part of the stomach in patients in whom the resection is performed for benign disease or for carcinoma of the distal part of the duodenum. However, we believe that the early results in the two patients described are encouraging.

Adult↗
PubMed1977

Eelvated postoperative renal clearance of amylase without pancreatitis after cardiopulmonary bypass.

Two postoperative cardiopulmonary bypass patients who had pancreatitis within a two week period provided the impetus for pursuing this study. Amylase-creatinine clearance ratios (ACCR) were measured in a series of ten thoracic surgery patients: six coronary artery bypass patients with cardiopulmonary bypass (cardiac group), and four exploratory thoracotomy patients (pulmonary group). These ratios were obtained in the preoperative, recovery room, and postoperative periods. Comparisons were made among the following data: clinical history, pre- and postoperative medications, intraoperative vital signs, drugs, and anesthetics. The preoperative mean ACCR was 3.34 per cent. All cardiac patients had a significantly elevated ACCR in the recovery room with a mean of 17.36 per cent (p less than 0.05). The ACCR had returned to preoperative levels by the second postoperative day in five of six cases. There were no elevated ACCR levels in the pulmonary group. All patients were asymptomatic for pancreatitis. The intraoperative course of the cardiac patients involved four common factors, besides cardiopulmonary bypass, which were not present in the pulmonary group. These similarities included transfusion of citrated fresh whole blood activated by calcium chloride, hypotension treated with ephedrine, administration of mannitol, and intraoperative morphine analgesia. The mechanisms of increased amylase secretion by calcium chloride or ephedrine administration and transient sphincter of Oddi constriction by morphine or the alpha-adrenergic response of ephedrine are considered with the theoretical implications toward pancreatitis. The background and significance of the ACCR are also analyzed, especially in association with the osmotic diuresis of mannitol and a subsequent low urine creatinine level.

Aged↗
PubMed1976

Carl Langenbuch and the first cholecystectomy.

Cholecystectomy is the second most common operation performed today, but its founder, Carl Langenbuch, has received little recognition. The evolution of biliary surgery to the first cholecystectomy is traced. Contributions of von der Wiel, Petit, and Thudicum are reviewed. The cases of the first cholecystotomy by John Stough Bobbs, the first cholecystostomy by Marion Sims, and the first cholecystectomy of Carl Langenbuch are described.

Berlin↗
PubMed1975

Pancreatitis of unusual origin.

The anatomic pattern seen in the three patients with contiguous gastric duplications associated with pancreatic ducts evidently predisposes the patient to pancreatitis. In the previous patient reported upon from this institution, the correlation of severe bleeding episodes with attacks of pancreatitis strongly supports the concept of blood blocking the pancreatic ductal system, thereby producing pancreatitis. Passage of viscous mucoid secretions from the aberrant gastric mucosa into the pancreatic ductal system also might retard the normal flow of pancreatic juice, producing elevation of the serum amylase level and pain. Overdistention of the gastric duplication also might be considered as a source of pain, but such mechanisms can be considered only speculation at present. Diagnosis is usually made after more than one exploratory laparotomy. Hemorrhage may result, should the gastric duplication contain parietal cells, leading to hemoductal pancreatitis, hematemesis or melena and anemia. At least one in five patients with a gastric duplication possesses another intestinal duplication. Developmental defects commonly are associated with gastric cysts. Almost identical anatomy was present in the patients with contiguous duplications. That two such rare pancreatic disorders were documented in the same institution within two years suggests that this pattern of developmental defect is more common that had previously been expected.

Adolescent↗
PubMedDate not supplied

Endoscopic treatment of biliary injury in the era of laparoscopic cholecystectomy.

During a 2-year period in which the application of laparoscopic cholecystectomy became widespread in the Pacific Northwest, 33 patients with surgically related bile duct injury were seen by the gastroenterology section of a large multi-specialty clinic. Twenty-nine of these patients had anatomy amenable to endoscopic approach, and 25 of the 29 are symptom-free, with normal ultrasonography and serum liver function tests, at a minimum of 1 year of follow-up after undergoing a variety of endotherapeutic procedures. The authors conclude that endoscopic therapy, in conjunction with percutaneous drainage of large bilomas, is effective treatment for cystic duct leak and minor damage to the common bile duct. Further data and prolonged follow-up are required in patients with more significant biliary injury who undergo endoscopic endoprosthesis and/or dilation therapy.

Biliary Fistula↗
PubMedDate not supplied

Endoscopic pancreatic duct sphincterotomy: indications, technique, and analysis of results.

Fifty-six patients, 54 of whom had chronic pancreatitis, underwent endoscopic pancreatic duct sphincterotomy during a 4-year period from 1988 to 1992. Acute complications noted in 10% of patients included exacerbation of pancreatitis (4) and cholangitis (2). Chronic complications included induction of asymptomatic ductal changes in 16%, thought to be related to endoprosthesis placement, and stenosis of the sphincterotomy site in 14%, requiring repeated endoscopic or surgical sphincter section. When combined with a number of ancillary procedures, including removal of obstructing ductal calculi and stent placement for ductal disruption or stenosis, pancreatic duct sphincterotomy was associated with amelioration of chronic pain or decreased number of clinical attacks of pancreatitis in a subset of patients. The authors conclude that endoscopic pancreatic duct sphincterotomy enlarges our endotherapeutic armamentarium and deserves additional evaluation.

Chronic Disease↗
PubMedDate not supplied

Utilization of cholecystectomy-a prospective outcome analysis in 1325 patients.

The advent of laparoscopic techniques has resulted in an increased incidence of cholecystectomy, creating a need to reevaluate utilization. The new outcomes research movement emphasizes patient-derived data as well as traditional clinical outcomes. One of the purposes of this prospective study was to seek possible correlations between a variety of variables, both patient- and physician-derived, to the patient's degree of overall satisfaction with the outcome. From July 1992 to May 1997, five different data collection forms were prospectively implemented-three physician-derived (preoperative, intraoperative, and postoperative) and two patient-derived sets of data. In the postoperative patient instrument, patients were asked to rate their degree of satisfaction with the outcome of their surgery on a scale of 1 to 5, with 5 being "extremely satisfied" and 1 being "not at all satisfied." We then sought differences between those patients rating their satisfaction as 5 vs. those rating their satisfaction as 1 to 3. Age, sex, and the presence of comorbid conditions did not correlate with eventual satisfaction. The following were correlated with a statistically significant better degree of satisfaction: the preoperative presence of known gallstones or a preoperative physician-derived history of typical biliary pain. No preoperative patient-derived data were associated with satisfaction; however, the postoperative presence of abdominal pain predicted dissatisfaction. Not surprisingly, continued problems with abdominal pain strongly correlated with dissatisfaction, but this finding supports the accuracy of our assessment instrument. Furthermore, the more typical and clear-cut the clinical presentation, the greater the patient satisfaction with the outcome of cholecystectomy. Satisfaction and pain relief are strongly associated. In patients with pain preoperatively, measurement of either pain relief or satisfaction may be adequate to assess correct utilization of this operative procedure.

Abdominal Pain↗
PubMedDate not supplied

Pancreatic schwannoma: an uncommon but important entity.

The literature contains five single case reports of pancreatic schwannoma-two of the five occurred in patients with von Recklinghausen's disease, and three of the five proved malignant. Within a 3-month period, we resected benign pancreatic schwannomas in two patients without von Recklinghausen's disease. Both patients presented with pain that led to the discovery of a complex pancreatic mass on abdominal CT scan. Pancreatic schwannoma should be included in the differential diagnosis of cystic or solid pancreatic abnormalities on imaging studies.

Aged↗