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Biomedical subjects

T R Gadacz

Publications and source records attributed to T R Gadacz.

13 recordsLinked to original sources
PubMed1992

Selective cholangiography. Current role in laparoscopic cholecystectomy.

The initial 22-month experience with laparoscopic cholecystectomy in 400 patients employing an algorithm of selective cholangiographic evaluation is reported. Preoperative or postoperative endoscopic retrograde cholangiography was performed whenever stones were suspected clinically. Preoperative endoscopic retrograde cholangiography was performed in 44 patients (11%), in whom 14 (3.5%) had an endoscopic sphincterotomy with extraction of common bile duct stones. Intraoperative cholangiography was performed in only eight patients (2%) almost exclusively to acquire experience with the technique, and all cholangiograms were normal. Laparoscopic cholecystectomy was successfully completed in 96% of the patients. There were no deaths in this series, and major complications occurred in only 5% of patients. Two patients (0.5%) had a significant common bile duct injury that was recognized and successfully repaired at the initial operation. No late common bile duct strictures have been recognized. Six patients (1.5%) underwent postoperative endoscopic retrograde cholangiography for suspected common bile duct stones, with three patients requiring endoscopic sphincterotomy and stone extraction. This experience suggests that the use of preoperative and postoperative endoscopic retrograde cholangiography can be based on clinical presentation and laboratory evaluation and does not need to be performed routinely. Routine intraoperative cholangiography is not necessary in most patients undergoing laparoscopic cholecystectomy. The authors conclude that laparoscopic cholecystectomy can be performed safely with the selective use of cholangiography.

Adolescent↗
PubMed1992

Laparoscopic approach to cholecystectomy.

Laparoscopic cholecystectomy is a combined endoscopic-operative technique for removal of the gallbladder. Patients with symptomatic gallstones are candidates for this procedure. Current absolute contraindications include pregnancy, acute cholangitis, peritonitis or abdominal sepsis, and a major bleeding disorder. Safe use of the procedure requires specific training and subsequent animal and proctored clinical experience. The technique is guided by video-endoscopy, and is performed through four cannulas/ports. Potential complications include bleeding, injury to the common bile duct, trocar injury to the bowel, and spillage of bile and/or stones. The length of hospital stay and postoperative recovery are significantly shortened compared to standard cholecystectomy. Patients appear to prefer this procedure over lithotripsy or dissolution because the gallbladder and stones are removed and additional or continued treatment is not necessary. This procedure offers notable advantages to the patient, and is becoming a standard procedure for qualified general surgeons.

Adolescent↗
PubMed1979

Postcholecystectomy diarrhea.

Diarrhea developed in three patients following cholecystectomy. Fecal bile-acid excretion was elevated in the two patients for whom it was measured. All three patients' diarrhea resolved with cholestyramine resin therapy. This experience suggests that gallbladder removal may lead to a bile-acid-mediated diarrhea in some patients, and that this condition appears to respond to cholestyramine therapy.

Bile Acids and Salts↗
PubMed1979

Intussusception of the excluded segment following jejuno-ileal bypass.

Intussusception of the defunctionalized intestinal segment following jejuno-ileal bypass for obesity has rarely been reported. Persistent crampy abdominal pain (often accompanied by nausea and vomiting) and normal radiologic evaluation are suggestive of this entity. The routine use of silver clips, although helpful in some instances, cannot exclude this diagnosis. A high index of suspicion and the use of sonography may prove that intussusception of the defunctionalized segment is more common than has been previously reported.

Humans↗
PubMed1978

Visceral vessel erosion associated with pancreatitis. Case reports and a review of the literature.

Visceral artery erosion is an uncommon but disasterous complication of pancreatitis. When gastrointestinal bleeding or severe intra-abdominal hemorrhage is associated with pancreatitis and the usual sources of bleeding are not detected by endoscopy or barium studies, erosion of a visceral vessel should be suspected. We present nine cases and an additional 44 cases from previous reports are reviewed. A palpable abdominal mass was present in 59% of the patients; however, a pseudocyst was present in 78%. Arteriography was performed in 15 patients and the source of bleeding was evident in 14. The splenic artery was the most common site of bleeding, although the other branches of the celiac axis and the middle colic artery have been involved. Successful treatment consisted of ligation of the bleeding vessel and, if present, drainage of the pseudocyst. Depending on the location of the vessel and the pseudocyst, major resections may be necessary. When bleeding and the pancreatic inflammatory process involved the colon, ligation of the bleeding site, drainage of the area, and colostomy was the most successful form of treatment.

Abdomen↗
PubMed1978

Bile acid composition in patients with and without symptoms of postoperative refulx gastritis.

Reflux of bile into the stomach is common after surgery for duodenal ulcer disease; however, only a minority of patients may develop significant gastritis and pain. Gastric aspirates from two groups of patients after operation for duodenal ulcer were quantitatively and qualitatively analyzed. Group A patients were asymptomatic and the bile composition was normal. Group B patients were symptomatic and had a significant increase in the secondary bile acid, deoxycholic acid. The concentration of bile acid was similar in the two groups. This alteration in bile acid composition, with an increase in deoxycholic acid, may be an important factor in determining which patients with bile reflux develop gastritis.

Bile↗
PubMed1977

The continent ileal pouch: absorptive and motor features.

In 8 patients, 6 to 40 months after proctocolectomy and construction of a continent ileal pouch, selected absorptive and motor functions of the pouch were assessed. Test solutions of 100 or 200 ml, containing a nonabsorbable marker, were placed in the pouch and sampled serially for 1 hr; an oro-intestinal tube was used to prevent contamination of the pouch by endogenous secretions. Sodium, chloride, and water were absorbed in a fashion similar to that reported previously for normal ileum. Similarly, the resting mucosal potential difference and its response to glucose were like those of normal ileum. The pouch also absorbed vitamin B12 that was instilled together with intrinsic factor. The distribution of primary and secondary bile acids in duodenal content suggested that decreased dehydroxylation of bile acids, also seen after conventional ileostomines, occurs in pouch patients. The pattern of motility in pouches was consistent with that reported previously for normal ileum. Thus, the functions of the mucosa and smooth muscle of the continent ileal pouch are quite similar to those of normal ileum.

Adult↗
PubMed1976

Inhibition of water absorption by ricinoleic acid. Evidence against hormonal mediation of the effect.

In three dogs, each with a jejunal and an ileal Thiry-Vella loop, the isolated segments were perfused with isotonic electrolyte solutions (control) for 90 min. One loop was then perfused with 5mM ricinoleic acid for an additional 90 min, while the other loop was perfused with the control solution. Loops perfused with ricinoleic acid all showed reduced fluid absorption. Perfusion of one loop with ricinoleic acid produced no changes in fluid absorption from the loop perfused with the control solution. In other experiments, 4 Ivy dog units (IDU) per kg per hr of cholecystokinin (CCK) produced no change in water movement in loopd perfused with control solution or recinoleic acid. These experiments suggest that the effect of ricinoleic acid on intestinal water transport is not mediated through the release of a circulating humoral substance.

Animals↗
PubMed1976

Impaired lithocholate sulfation in the rhesus monkey: a possible mechanism for chenodeoxycholate toxicity.

Radioactive lithocholate was administered intravenously to female rhesus monkeys with an exteriorized enterohepatic circulation, and the chemical form of biliary radioactivity was defined by thin layer chromatography. Most radioactivity was excreted in bile in the form of unsulfated conjugates (77%), indicating impaired sulfation relative to published data for man. Defective sulfation of lithocholate, the major bacterial biotransformation product of chenodeoxycholic acid, can explain accumulation of lithocholate in the enterohepatic circulation and provide a possible mechanism for the hepatotoxicity observed during chenodeoxycholic acid administration to the nonhuman primate.

Animals↗