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Biomedical subjects

R G Keith

Publications and source records attributed to R G Keith.

31 records · Page 2Linked to original sources
PubMed1984

Surgical management of primary bile-duct carcinoma.

Primary bile-duct carcinoma is a rare lesion, causing death from hepatic failure due to biliary obstruction. Between 1976 and 1983, 22 patients with this tumour were treated at the Sunnybrook Medical Centre in Toronto. Thirteen patients had unresectable proximal bile-duct carcinoma of the high type. Distal bile-duct carcinomas in three patients were not resected because of metastatic disease. Three proximal bile-duct carcinomas of the low type and three distal bile-duct carcinomas were resectable. A new method of internal biliary decompression is presented, for palliation in patients with proximal bile-duct carcinoma of the high type. An intraluminal polyethylene stent has produced satisfactory quality of life with a mean survival of 16 months in eight patients; two others are alive with disease, 9 and 19 months after placement of a stent. Satisfactory palliation of distal, unresectable lesions can be achieved by biliary intestinal anastomosis in some cases.

Adenoma, Bile Duct↗
PubMed1982

Gastric variceal bleeding due to occlusion of splenic vein in pancreatic disease.

Nine patients with gastric varices secondary to occlusion of the splenic vein, which resulted from pancreatic disease, were treated by the authors between 1973 and 1981. Profuse hemorrhage, recurrent bleeding and hypochromic anemia were investigated by endoscopy, gastrointestinal roentgenography and selective angiography. Pancreatic disease was defined by ultrasonography, endoscopic retrograde pancreatography and operation. There were three cases of chronic pancreatitis, three of pancreatic abscess, two of pseudocyst and one of carcinoma of the pancreas. Definitive control of upper gastrointestinal bleeding from gastric varices was achieved by combining splenectomy with selective pancreatic surgical procedures. Two patients did not undergo operation. One death resulted from an unresectable carcinoma. Bleeding did not recur in six patients followed for up to 8 years after operation.

Adult↗
PubMed1982

Treatment of pancreatitis associated with pancreas divisum by dorsal duct sphincterotomy alone.

Of 480 patients seen with pancreatitis at the Sunnybrook Medical Centre, Toronto, in the past 5 years, 5 had pancreas divisum, demonstrated by pancreatography. Clinical presentations included recurrent acute pancreatitis, chronic pancreatitis and recurrent subcutaneous fat necrosis with steatorrhea. Pancreatography demonstrated dorsal pancreatic drainage through the duct of Santorini in all cases. The luminal diameter at the orifice of the duct of Santorini, assessed at operation, was inadequate to provide normal drainage from the gland. Sphincterotomy of the duct of Santorini alone, without surgery to the duct of Wirsung or sphincter of Oddi, was performed in four patients. This relieved the pain of chronic pancreatitis, eliminated recurrent attacks of acute pancreatitis and curtailed recurrence of subcutaneous fat necrosis and steatorrhea during follow-up periods of 51, 27, 17 and 28 months respectively. One patient who refused operation continued to have recurrent pancreatitis 41 months after diagnosis.

Acute Disease↗
PubMed1982

Annular pancreas with coexistent ampullary carcinoma in an elderly woman.

The authors report the first known case of annular pancreas with coexistent ampullary carcinoma. Obstructive jaundice occurring in an 80-year-old woman was caused by the neoplasm rather than the congenital anomaly. Although the annular pancreas did not obstruct the duodenum, it did account for an unusual appearance of the neoplasm on air contrast roentgenography of the upper gastrointestinal tract. The two lesions were successfully treated by radical pancreaticoduodenectomy. The woman has been disease-free for more than 24 months.

Adenocarcinoma↗
PubMed1981

Resection for chronic alcoholic pancreatitis.

Nineteen patients with chronic alcoholic pancreatitis have been followed up for 7 to 81 months (mean 45 months) since resection for the relief of pain. Five had distal pancreatectomy, three had a Whipple resection, seven had 75% pancreatectomy and four had total pancreatectomy. Pain was completely relieved in all patients after total pancreatectomy and in four patients after 75% pancreatectomy. Recurrent acute pancreatitis was frequent after distal pancreatectomy. Alcoholism recurred in six patients. Steatorrhea was noted grossly in 14 patients after operation. It was corrected by enzyme replacement. All patients had long-term weight gain, except one who had undergone a Whipple resection. Diabetes developed in one patient who underwent 75% pancreatectomy, in one after distal pancreatectomy and in all patients who underwent total pancreatectomy; management of the diabetes was complicated by heavy alcohol consumption in one patient who underwent total pancreatectomy.

Adult↗
PubMed1980

Effect of a low fat elemental diet on pancreatic secretion during pancreatitis.

With the use of a precise and unique model, pancreatic secretion was studied in three humans who had chronic pancreatitis. The observed results show a decrease in pancreatic secretory pressure and volume during the administration of an elemental diet, Vivonex HN, compared with regular feedings. Levels of secretory function were near those observed during fasting in the two patients receiving the elemental diet. The variably low levels of enzyme activity observed during the administration of Vivonex HN suggest only minimal stimulation of cholecystokinin. It would seem that the primary inhibitory effect of the elemental diet may be more specifically related to a reduction of secretin release. Although the numbers of observations carried out during this study were small, the precise nature of the model being studied allows the conclusion that the administration of a low fat elemental diet to patients with chronic pancreatitis produces minimal stimulation of pancreatic secretion.

Adult↗
PubMed1978

Symposium on pancreatitis: 1. Conservative management of acute pancreatitis.

Acute pancreatitis may present as the mild edematous type or the more rare and dangerous hemorrhagic form. The effects of the latter are believed to be due to the activation of pancreatic enzymes, notably trypsin. Therefore attempts are being directed towards suppression of pancreatic enzyme activation in the management of the condition. Aprotinin and glucagon are the agents for this purpose that have received most attention. Patients with acute hemorrhagic pancreatitis are subject to respiratory failure, which is not detectable early by clinical evidence, so that early monitoring of pulmonary function by the determination of arterial blood-gas pressures is desirable. This is borne out by the findings in six fatal cases.

Acute Disease↗
PubMedDate not supplied

Analysis of the analgesic efficacy of acetaminophen 1000 mg, codeine phosphate 60 mg, and the combination of acetaminophen 1000 mg and codeine phosphate 60 mg in the relief of postoperative pain.

Patients who experienced pain after surgery were administered a single dose of 1 of 3 treatments: acetaminophen 1000 mg, codeine phosphate 60 mg, or a combination of these. Patients rated their pain intensity on ordinal and visual analog scales just prior to medication and at intervals thereafter for up to 5 hours. They also rated pain relief, pain half gone, and any adverse effects. Sum of pain intensity difference and total pain relief scores were analyzed using Dunnett's procedure. The drug combination was statistically superior to codeine as measured by SPID, TOTPAR, pain half gone, and time to remedication. The combination achieved better mean scores than acetaminophen on all efficacy measures, but was (marginally) statistically superior only in pain half gone. No appreciable differences in adverse effects were noted among the treatments. The difficulty of showing the analgesic efficacy of codeine in a single dose trial is discussed.

Acetaminophen↗