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Biomedical subjects

R K Tompkins

Publications and source records attributed to R K Tompkins.

At least 19 recordsLinked to original sources
PubMed1992

Management of bile duct strictures. An evolving strategy.

In an effort to determine the role of interventional radiologic and endoscopic techniques in the management of benign biliary strictures, a retrospective analysis was carried out on 194 consecutive patients with bile duct strictures treated at UCLA between 1955 and 1990. Patients were classified as group 1 (1955 through 1979; n = 138) or group 2 (1980 through 1989; n = 56). Follow-up was for a minimum of 24 months and was in excess of 3 years in 179 patients (92%). Although the incidence of recurrent strictures was similar in the two groups (21% and 23%), the reoperation rate was significantly lower (P less than .02) in group 2 (6%) than in group 1 (21%). Percutaneous transhepatic biliary dilatation, used in 20 patients in group 2, was successful in 13 (93%) of 14 patients with anastomotic strictures and three (50%) of six patients with primary strictures (P less than .05). We conclude that surgical reconstruction remains the standard therapy for patients with primary bile duct strictures. Percutaneous transhepatic biliary dilatation has limited usefulness for these patients, but may be more appropriate for those with anastomotic strictures.

Adolescent↗
PubMed1992

The natural history of carcinoma of the bile duct in patients less than forty-five years of age.

Traditionally regarded as a disease of the elderly, the natural history of carcinoma of the bile duct in young patients has not been well defined. Of 186 patients (mean age of 62 years) treated at UCLA (1954 to 1988) for carcinoma of the bile duct, 26 were less than 45 years old. Younger patients had symptoms for an average of 4.5 +/- 0.8 months prior to diagnosis, as compared with 2.3 +/- 0.2 months for patients more than 45 years old (p less than 0.03). Of the younger patients, 96 per cent were managed surgically with either resection, surgical palliative bypass or laparotomy and tube drainage. Among the younger patients who underwent resections, 92 per cent were alive at one year, as compared with 60 per cent of patients who underwent palliative bypass procedures. Two patients who underwent tumor resections survived four years or longer. We conclude that carcinoma of the bile duct is not limited to the elderly and occurs in a significant number of young patients. In the younger population, carcinoma of the bile duct is characterized by delays in diagnosis. Early suspicion and aggressive management of young patients with obstructive jaundice are essential to ensure the best possible outcome for patients with this disease.

Adult↗
PubMed1991

Carcinoma of the ductus choledochus.

A retrospective review of patients treated for carcinoma of the common bile duct has demonstrated improvement in diagnostic capabilities, leading to earlier management by resectional therapy. The ability to resect these tumors is directly translatable to improved long-term survival. Efforts to obtain proof of malignancy prior to resection are often frustrated by the inability to obtain adequate representative tissue for frozen section. Choledochoscopic biopsies and incisional biopsies have given the highest yield of positive diagnoses. In experienced hands, a program of fewer preoperative tests with emphasis on early operation, diagnosis, and definitive treatment may be more cost-effective in the management of patients with common bile duct cancer.

Adenocarcinoma↗
PubMed1991

Reoperation for biliary strictures.

Benign bile duct strictures most often follow intraoperative injury not recognized until later. The ideal reconstruction entails a mucosa-to-mucosa anastomosis without tension, usually with a stent tube to maintain patency in the immediate postoperative period. The mortality rate for reoperation and bile duct reconstruction in patients who are not cirrhotic is approximately 2%, and success rates average 85%. Prevention of operative injuries by the use of cholangiography, careful dissection, and removal of the gallbladder from the fundus downward is the best treatment.

Bile Ducts↗
PubMed1991

Repair of large paraesophageal hernia with complete intrathoracic stomach.

Paraesophageal hiatal hernia accounts for only five per cent of all diaphragmatic defects but is a potentially dangerous lesion. Herniation of the entire stomach, at times accompanied by the omentum, transverse colon, and small bowel, may occur in some patients, and incarceration and strangulation may be the result. Three patients underwent repair of large paraesophageal hernias, in one instance as an emergency. Symptoms of pain, bloating, and occasional regurgitation had been present for 17, 30, and 40 years. The operations included repair of the hiatal defect, anterior gastropexy, and Nissen fundoplication in two patients. In the third patient, a pyloromyotomy was performed as well. A subsequent thoracotomy was necessary in one patient to excise a persistent large hernia sac, which was densely adherent to the lung and mediastinal structures. All patients were asymptomatic after periods of 9 months, 1 year, and 7 years. The unique anatomic and clinical features of large paraesophageal hernias containing intrathoracic abdominal viscera, as well as the technique of operative repair, are presented.

Adult↗
PubMed1990

Surgical management of bile duct stones.

The biliary surgeon in the 1990s must be familiar with all of the available techniques for the treatment of bile duct stones. Experience and judgment are important in the successful management of the individual patient with intrahepatic or extrahepatic stones. Knowledge of the nonsurgical methods of stone removal is important in the decision-making process. However, the biliary surgeon must resist the temptation to do less than a thorough removal of all stones at the operation lest the patient be subjected to additional procedures, which carry their own risks of morbidity and death. The goal should be to clear the stones from the biliary system with the fewest procedures offering the lowest morbidity and mortality risks to the patient.

Bile Duct Diseases↗
PubMed1990

Changing patterns in diagnosis and management of bile duct cancer.

An analysis of 186 patients treated for bile duct cancer at UCLA Medical Center from November 1954 to December 1988 demonstrated improvements in several areas of diagnosis and management. Comparison of 96 patients treated between 1954 and 1978 (group 1) with 90 patients treated between 1978 and 1988 (group 2) showed earlier diagnosis and treatment in group 2 (2.1 months from onset of symptoms) than in group 1 (4.9 months; p less than 0.05) and this was correlated with increased use of ultrasonography, computed tomographic (CT) scans, transhepatic cholangiography, and endoscopic retrograde cholangiopancreatography. Operative mortality rates were lower in group 2 (4%) than in group 1 (12%) and the difference was most marked in patients with upper-third lesions, where resections in group 1 had a 23% operative mortality rate but group 2 resected patients had zero mortality (p less than 0.001). A program of operative staging and selection of patients for resection or palliative procedures has resulted in better operative risks with no deterioration in survival.

Adenoma, Bile Duct↗
PubMed1989

Unique urinary-fecal calculus after cystectomy and ureterosigmoidostomy.

A 36-year-old m an had stage B1 bladder cancer-treated by cystectomy and ureterosigmoidostomy. Postoperatively, a urinary leak was managed successfully by transureteroureterostomy and temporary colostomy. In succeeding years a large calculus developed in the region where the bladder had been and it also involved the sigmoid colon. The huge stone was removed successfully. A nonabsorbable suture was found in the center of the stone. This is a unique complication of ureterosigmoidostomy.

Adult↗
PubMed1989

Management of cystic disease of the liver.

The management of cystic diseases of the liver requires an understanding of their pathophysiology and natural history. Surgery for congenital solitary cysts and polycystic disease should be reserved for patients with significant symptoms. Caroli's disease requires careful preoperative evaluation and planning and long-term follow-up. Surgery for echinococcal liver cysts should be performed before complications of rupture and superinfection develop.

Bile Ducts, Intrahepatic↗
PubMed1988

Agenesis of the gallbladder without extrahepatic biliary atresia.

Agenesis of the gallbladder without extrahepatic biliary atresia is a rare disorder. At the UCLA-affiliated hospitals, 12 patients were classified in the following groups: (1) multiple fetal anomaly, (2) asymptomatic, and (3) symptomatic. All four patients in the multiple fetal anomaly group died of their other congenital defects. In the three patients in the asymptomatic group, the absent gallbladder was an incidental finding at autopsy. The five patients in the symptomatic group underwent operations for symptoms suggestive of biliary tract disease, with no gallbladder found; all were symptom free postoperatively. Operative strategy should include a complete exploration, operative cholangiography, and common bile duct exploration as necessary. Possible mechanisms responsible for symptoms include primary duct stones, biliary dyskinesia, or nonbiliary disorders. Computed tomography, biliary manometry, upper gastrointestinal tract endoscopy, and endoscopic cholangiography (with or without sphincterotomy) could be employed if symptoms continue.

Abnormalities, Multiple↗
PubMed1988

Gut reactions.

Explore the source record for details and available documents.

Gastroenterology↗
PubMed1987

Proximal bile duct cancer. Quality of survival.

A retrospective study of 97 patients with proximal bile duct cancer treated at the University of California, Los Angeles Medical Center was conducted to determine the benefits of different operative treatments. Eighty-nine patients were divided into three treatment groups: Group I, curative resection (29 patients); Group II, palliative resection (13 patients) and bypasses (8 patients); and Group III, operative intubation (39 patients). Two patients died before operation and six patients were treated without operation by percutaneous biliary decompression. High morbidity rate (53.8%) and mortality rate (69.2%) were encountered in 13 patients who had hepatic resection. Survival rates of the three treatment groups were comparable. For the 64 patients closely monitored after discharge, quality of survival was assessed according to six parameters: frequency of hospitalization for cholangitis; catheter-related problems; the percentage of days hospitalized; duration of jaundice; antibiotic requirements; and analgesic needs. Group I patients had the best qualitative survival, whereas Group II patients had the worst result when compared with either Group I (p less than 0.001) or Group III (p less than 0.005). Curative resection is recommended when it can be done without a concomitant hepatic resection. When noncurable disease is found on examination, operative intubation after dilatation is the preferred palliative measure.

Adenoma, Bile Duct↗
PubMed1987

The importance of nonoperative trauma management in postgraduate surgical education.

The activities of a trauma service in a university hospital were analyzed to test the hypothesis that operative caseload alone does not adequately measure the trauma experience of a surgical resident. Over a 2-year period, 378 victims of major trauma (blunt in 79%) were admitted to the service. Only 41% of them required a major operation by the Trauma Service. The patients spent an average of 2.8 days in the intensive care unit and often presented complex challenges in surgical critical care, including ventilator support and hemodynamic monitoring. A trauma service in a university center manages significant numbers of patients with multisystem injuries who never undergo a general surgical procedure. This experience constitutes such an important component of surgical education in trauma that it should be recognized by agencies accrediting residents and training programs. Completion of surgical residency should also imply competence in critical care of surgical patients.

Academic Medical Centers↗
PubMed1987

Modern management of biliary tract stone disease.

A number of new techniques and approaches to the management of biliary tract stone disease have been developed in the past decade. The modern biliary surgeon must be aware of these and of their logical and proper place in the management of patients with biliary stone disease. However, the wise surgeon will continue to hone his surgical skills because the results of definitive, sure, and deliberate operative treatment of biliary tract stone disease remains the standard by which newer methods must be gauged.

Chenodeoxycholic Acid↗