[Current diagnostic possibilities in pancreatic diseases].
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Biomedical subjects
Publications and source records attributed to T Lotveit.
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In a consecutive series of 830 routine gastroscopies a total of 43 patients was found with gastric carcinomas, Thirteen of these were patients with a previous Billroth-II operation for ulcer disease. Early cancers were found in ten patients (23%), and four of these ten (3 men, 1 woman, aged 49 to 76 years), had been operated on 20-33 years previosuly with a Billroth II partial gastrectomy. All patients had symptoms indicating gastro-intestinal disease. We conclude that a high number of gastric stump carcinomas may be detected at an early stage, and that endoscopy of the whole gastric stump, with multiple biopsies and brush cytology from the entire gastro-jejunal anastomosis, is of crucial importance in detecting such carcinomas.
In a consecutive series of 174 patients the biliary and pancreatic ducts were demonstrated by endoscopic retrograde cholangio-pancreatography (ERCP). In 84 patients with normal duct systems, juxtapapillary diverticula were found in 5 patients (6%). In 90 cases with ductal abnormalities due to biliary concrements, dilated common bile duct and pancreatitis, diverticula were found in 35 patients (39%). In patients with abnormalities in both duct systems, diverticula were found in 52%, and in patients with changes in one duct system diverticula were found in 33%. The difference in occurrence of diverticula in patients with normal duct systems and pathological duct systems was statistically significant (p less than 0.02). The findings indicate a correlation between juxtapapillary diverticula and pathological changes due to biliary concrements, dilated common bile duct without concrements and pancreatitis.
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Peritoneal lavage with ten hourly repeated instillation-drainages of one litre lavage fluid containing 50 mg doxycycline (Vibramycin Pfizer) was carried out on six patients suffering from diffuse peritonitis due to perforated appendicitis. Bacteriological specimens were obtained both from the perforation in the appendix and the peritoneal fluid at operation and the doxycycline concentrations in blood and lavage fluid were determined at intervals up to 72 hours postoperatively. All the patients recovered, but the lavage was considered a failure in one case as a small abscess and multiple adhesions were found at reoperation 1 1/2 months later. Bacteriological swabs from the perforated appendix and the peritoneal fluid usually contained the same bacteriological species, and as a rule several species were isolated. Doxycycline compared favourably with ampicillin as regards bacterial sensitivity, but the difference was too slight to be of practical importance. Doxycycline was absorbed very rapidly from the peritoneal cavitiy, and due to its slow excretion a cumulation occurred. In this small series doxycycline did not appear to give any real advantage over ampicillin, but it may be considered the drug of choice in patients with penicillin allergy, and in those who fail to respond to ampicillin.
The diagnostic value of ultrasound in mesenteric cysts in infancy and childhood is demonstrated by a case report of a 4 year old girl with multiple cysts in the transverse mesocolon and with no other symptoms or signs than an enlargement of the abdomen. Neither clinical nor radiological examination could give the diagnosis, whereas ultrasound examination promptly revealed large, thin-walled, partly locular, cystic masses.
A comparison was made regarding the observed frequency of intraperitoneal complications between two groups of patients operated upon for perforated appendicitis during a 5-year period (1968-73). The two groups, corresponding to two different general surgical departments at the same hospital, were given different forms of adjuvant treatment. The first group (78 patients) received postoperative intraperitoneal lavage, with antibiotics added to the lavage solution. In the other department (77 patients), the peritoneal cavity was drained postoperatively. No lavage was performed in this group, but antibiotics were given systemically. Sixteen patients in the drainage group developed intraperitoneal complications, as compared with 5 in the lavage group.