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Biomedical subjects

M I Lavelle

Publications and source records attributed to M I Lavelle.

18 recordsLinked to original sources
PubMed1992

Treatment of common bile duct stones using mono-octanoin.

A retrospective analysis of 48 patients undergoing mono-octanoin infusion via nasobiliary catheter following failure of endoscopic extraction of common bile duct stones is reported. Among 35 patients who received a complete course of treatment, nine (26 per cent) had duct clearance by the completion of the infusion and a further eight on subsequent endoscopic retrograde cholangiopancreatography (ERCP) (total 49 per cent). Two patients had a successful stone extraction after enlargement of the sphincterotomy (total non-surgical clearance rate 54 per cent). None of five patients with stones greater than 2 cm in diameter had stone clearance at the completion of the infusion and only one at subsequent ERCP. Among 13 patients receiving an incomplete course of treatment seven had clear ducts on repeat ERCP (54 per cent). Mono-octanoin infusion via a nasobiliary catheter is of limited value in the management of this difficult group of patients, although it may be successful in some.

Aged↗
PubMed1992

Role of endoscopic retrograde cholangiopancreatography in the investigation of pain after cholecystectomy.

Patients who continue to have or who develop abdominal pain after apparently successful cholecystectomy pose diagnostic difficulties. This study reports 384 such patients, investigated by endoscopic retrograde cholangiopancreatography (ERCP). There were 146 patients with abdominal pain alone with no previous history of common bile duct (CBD) exploration, of whom only 17 (11.6 per cent) had CBD stones on ERCP. Bile duct calculi were present in 76 of 140 patients (54.3 per cent) with abnormal biochemical findings (raised alkaline phosphatase and/or amylase level) and in 34 of 57 (60 per cent) with an abnormality detected on ultrasonography or intravenous cholangiography. A combination of biochemical and radiological abnormalities was present in 37 patients and was associated with CBD stones in 28 (76 per cent). Patients who had undergone CBD exploration represented a special group, of whom the majority (75 per cent) had common duct stones at ERCP even in the absence of biochemical and radiological abnormalities. ERCP is a useful investigation in patients with persistent postcholecystectomy symptoms. Other features in addition to pain or a history of CBD exploration may be relevant to the decision to perform ERCP in the investigation of these patients.

Abdominal Pain↗
PubMed1987

A randomised, prospective study comparing two contrast media in ERCP.

A randomised, prospective, stratified, double blind study comparing two contrast media in endoscopic retrograde cholangio-pancreatography (ERCP) was undertaken. Forty-six patients received Meglumine/Sodium Ioxaglate (Hexabrix 320) and forty-eight received Meglumine/Sodium Diatrizoate (Urografin 310). The two groups were evenly matched for age, sex and diagnosis. Radiographs were examined independently by two radiologists. There were no differences in radiograph quality with either type of contrast medium. More patients developed pancreatitis following Urografin, suggesting that Hexabrix is a safer contrast medium for ERCP.

Adult↗
PubMed1986

Use of ERCP to identify the site of traumatic injuries of the main pancreatic duct in children.

Major pancreatic injuries in children are uncommon but potentially very serious. They usually occur in active young boys following characteristic accidents. Despite this they frequently go unrecognized for prolonged periods. Four patients with delayed recognition of blunt pancreatic trauma are described. The presence of pancreatic injury was identified by hyperamylasaemia in every case. Ultrasound and CT scanning were helpful in identifying pseudocysts but accurate pre-operative diagnosis of main duct disruption required endoscopic retrograde cholangiopancreatography (ERCP). Surgical treatment involved a full exploration of the lesser sac with drainage of the cyst contents and identification of the site of extravasation. Two patients with proximal duct lacerations were treated by internal drainage into a Roux-en-Y loop with the addition of a distal pancreaticojejunostomy in one case. Two patients with distal lacerations were treated by distal pancreatectomy and oversewing of the remnant. All four patients recovered and were well at follow-up. Early ERCP is the only reliable method of identifying duct injuries which require urgent surgery. It should be considered in all children with blunt pancreatic trauma.

Adolescent↗
PubMed1985

Demonstration of pancreatic parenchyma by digital subtraction techniques during endoscopic retrograde cholangiopancreatography.

This paper reports the feasibility of using digital subtraction angiography techniques during endoscopic retrograde cholangiopancreatography to obtain greater detail of pancreatic structure. The pancreatic duct was filled in 23 of 27 cases attempted and in 17 cases parenchymal detail was obtained. Filling defects due to neoplasm were clearly defined and the changes of chronic pancreatitis visualised. The technique seems valuable for small lesions but may carry a higher risk of producing pancreatitis.

Acute Disease↗
PubMed1982

Chronic pancreatitis as a cause of gastrointestinal bleeding.

Chronic pancreatitis is an infrequently considered cause of gastrointestinal bleeding. Four cases are described who presented to a surgical unit in a year. One patient bled down the main pancreatic duct from a splenic artery pseudoaneurysm, one had a fatal haemorrhage from a superior mesenteric artery aneurysm which ruptured into the duodenum, and two were considered to have bled from vessels in the stomach or colon which were involved in the peripancreatic inflammatory tissues. The difficulties in diagnosing these patients are described and the report emphasises that the diagnosis should be considered in obscure cases of gastrointestinal bleeding especially where there is a history of alcohol abuse and left upper quadrant or epigastric pain.

Adult↗
PubMed1981

Endoscopic sphincterotomy before pancreaticoduodenectomy for ampullary carcinoma.

Pancreaticoduodenectomy remains the operation of choice for carcinoma of the ampulla of Vater, but the presence of severe jaundice in almost all patients with ampullary neoplasia is a major contributory factor to the high incidence of complications and hospital mortality after the operation. To achieve biliary decompression in five patients endoscopic sphincterectomy was performed at the time of endoscopic retrograde cholangiopancreatography. The procedure was successful in achieving biliary drainage in all cases and was without appreciable morbidity. All five patients subsequently underwent identical resections, the interval to operation being decided by the speed of resolution of the jaundice; minor pancreatic leaks in two patients were the only complications. None of the patients died. These results suggest, therefore, that endoscopic sphincterotomy should be performed at the time of duodenoscopy if an obstructive ampullary tumour is found.

Adenocarcinoma↗
PubMed1980

What is involved in endoscopic sphincterotomy for gallstones?

This study reports our first year's experience of endoscopic sphincterotomy for common bile duct stones. Forty patients were considered for the procedure and it was attempted in 37. An effective endoscopic sphincterotomy was eventually achieved in 32 (86 cases per cent), 7 after a "pre-cut". Twenty-three patients passed stones spontaneously (72 per cent), 6 could not be reassessed and 3 still had stones present (9 per cent). Bed occupancy was 9.5 +/- 5.9 days. Complications occurred in 30 per cent, the most common being pancreatitis in 6 cases with 1 death. It is concluded that endoscopic sphincterotomy offers a valuable alternative to surgery in the management of common bile duct stones.

Adult↗
PubMed1980

Chronic cholecystitis and the oral cholecystogram.

Gallbladder image density at oral cholecystography has been compared with histological grading of the severity of chronic cholecystitis in resulting cholecystectomy specimens. (i) There was a linear relationship between gallbladder opacification and the grade of chronic cholecystitis. (ii) Removal of patients with either non-opacified gallbladders or abnormal liver function did not alter the linear trend. (iii) The occurrence of gallstones was independent of the degree of gallbladder opacification. (iv) The presence of gallstones did not correlate with the severity of chronic cholecystitis. A standardised oral cholecystographic technique with a grading system for gallbladder image density can be used as an index of the severity of chronic cholecystitis.

Cholecystitis↗
PubMed1978

Comparative study of iocetamic acid and calcium ipodate in the visualisation of the gallbladder and common bile duct.

Iocetamic acid (Cholebrin) and calcium ipodate (Solubiloptin) were randomly allocated to two groups of 50 patients. Each patient completed a detailed questionnaire for side effects. There was no significant difference between the contrast media in their ability to opacify the gallbladder. Cholebrin was superior to Solubiloptin in opacifying the common bile duct in the presence of abnormal liver function, but there was no difference when liver function was normal. Palpitations were significantly higher with Solubiloptin (P = 0.01) but the incidences of other side effects showed no significant differences. Unabsorbed contrast residues were noted in similar frequency with both media. A high incidence of chronic cholecystitis was found in patients with non-opacified gallbladders and in those with gallstones.

Arrhythmias, Cardiac↗
PubMed1977

A comparative study of double contrast and single contrast barium meals with endoscopic arbitration in the diagnosis of peptic ulcer.

The study compares the ability of a simple double contrast technique with our standard single contrast barium meal to diagnose peptic ulceration. Two hundred and six patients were randomly allocated to either examination. Endoscopy was used as the definitive diagnostic procedure. Deformity of the duodenal cap was more accurately detected by the double contrast technique (P less than 0.01). There was no significant difference in the detection rates for duodenal ulcer. False positive or false negative diagnoses of duodenal pathology were similar by both techniques. The incidence of gastric ulceration in the series was too low for statistical analysis.

Adult↗
PubMed1977

Initial experience of percutaneous transhepatic cholangiography using a fine gauge needle.

Percutaneous transhepatic cholangiography using a fine gauge (Chiba) needle was performed 41 times in 40 patients with jaundice or abnormal liver function. Their ages ranged from 3 months to 80 years and the youngest successful cannulation was carried out on a 15 month-old-child. There were 32 cases of ex-rahepatic biliary obstruction, the site being shown in 28 (87.5%) and the nature correctly predicted in 22 (69%). One of two cases in the post obstructive phase and one of two with intrahepatic cholestasis were cannulated and showed bile ducts of normal calibre. Three out of four cases with hepatocellular disease were successfully examined and obstruction excluded by showing normal bile ducts. Delayed films taken up to 2 h later were found valuable, particularly in cases of obstructive jaundice. The technique is easier and less expensive to perform than endoscopic retrograde cholangiography. No major complications occurred suggesting the modified technique is now a safe procedure for investigating jaundice or disordered liver function in both adults and children.

Adolescent↗
PubMed1976

Caroli's disease with intrahepatic gall-stones and salmonella infection.

At operation for small bowel intussusception, a 26-year-old man was found to have an enlarged liver and spleen. Subsequent investigations suggested bile passage infection associated with numerous intrahepatic gall-stones but symptomatic cholangitis did not present until 5 months later. Retrograde cholangiography showed cavernous ectasia of the bile ducts which contained gall-stones.

Adult↗