Biomedical subjects

Stuart Sherman

Publications and source records attributed to Stuart Sherman.

57 records · Page 4Linked to original sources

PubMedDate not supplied

Quality of life after bilateral thoracoscopic splanchnicectomy: long-term evaluation in patients with chronic pancreatitis.

We prospectively evaluated quality of life and visual analogue scale pain scores after bilateral thoracoscopic splanchnicectomy in 55 patients with small-duct chronic pancreatitis and abdominal pain. The perioperative morbidity rate was 11% and there were no perioperative deaths. Four late deaths occurred (7%), and three patients were lost to follow-up. Patients were divided into those who had prior operative or endoscopic interventions (N = 38) and those who did not (N = 17). Preoperatively there were no significant differences between the two groups with regard to age, sex, etiology, pain score, or narcotic use. Pain score, narcotic use, and symptoms scales improved significantly in both groups at 3 and 6 months postoperatively (P < 0.0001). The group with no prior surgical or endoscopic intervention did significantly better initially (P < 0.007), and the improvements in their quality-of-life and pain scores continued for the remainder of the study. In contrast, quality-of-life and pain scores in patients who had undergone prior surgical or endoscopic intervention returned to baseline by 12 months postoperatively and remained poor throughout the remainder of the study. Bilateral thoracoscopic splanchnicectomy appears to work best in patients who have had no prior operative or endoscopic interventions.

Abdominal Pain↗

PubMedDate not supplied

Disconnected pancreatic duct syndrome: imaging findings and therapeutic implications in 26 surgically corrected patients.

PURPOSE: The lack of ductal continuity between a viable pancreatic tissue and the gastrointestinal tract results in the disconnected pancreatic duct syndrome (DPDS). The purpose of our study is to describe accurately the imaging features of CT scanning and endoscopic retrograde pancreatography (ERCP) that define the DPDS. METHODS: We conducted a retrospective analysis of the computed tomography (CT) and ERCP examinations in 26 consecutive patients with surgically proven disconnected pancreatic ducts treated over a 5-year period at our institution. Two abdominal radiologists concurrently defined the imaging features (presence and size of fluid collection along the course of the pancreatic duct, upstream enhancing pancreatic parenchyma, and ERCP abnormalities) via consensus for both exams. Patient demographics, etiology of pancreatitis, surgical treatment, initial CT interpretation, and the delay between symptom onset to correct diagnosis were recorded. RESULTS: A discrete, intrapancreatic fluid collection (average size = 27 cm2 (range, 4-74 cm2) along the course of the main pancreatic duct with upstream viable pancreatic parenchyma was identified by CT in 26 cases. ERCP showed ductal obstruction at the level of the intrapancreatic fluid collection in all patients with extravasation of contrast in 14 (54%). All patients were treated by operation: 15 (58%) by internal drainage into a Roux-en-Y limb of jejunum and 11 (42%) by distal pancreatic resection. No prior CT interpretation correctly identified DPDS. The average delay between symptom onset and definitive diagnosis was 9.3 months (range, 3-36 months). CONCLUSIONS: A discrete intrapancreatic fluid collection along the expected course of the main pancreatic duct with viable upstream pancreatic parenchyma suggests the diagnosis of DPDS. ERCP findings of ductal obstruction at the level of this fluid collection with or without contrast extravasation confirm this diagnosis. Treatment is surgical and requires either internal drainage or distal pancreatic resection for complete resolution.

Adult↗

PubMedDate not supplied

Dynamic secretin-enhanced MR cholangiopancreatography.

Secretin causes temporary dilatation of pancreatic ducts, principally by increasing pancreatic exocrine secretions, and thus allows better visualization of the ducts at magnetic resonance (MR) cholangiopancreatography. Secretin-enhanced MR cholangiopancreatography is useful for detection and diagnosis of a variety of congenital, inflammatory, and neoplastic conditions of the pancreas. Although MR cholangiopancreatography without secretin is a reliable method for evaluating the pancreatobiliary ductal system, the authors believe that secretin-enhanced MR cholangiopancreatography gives additional valuable functional and anatomic information about the pancreatic duct and pancreatic excretory capacity.

Cholangiography↗