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Biomedical subjects

W P Longmire

Publications and source records attributed to W P Longmire.

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↗
PubMed1990

Whither the solid tumors. James Ewing lecture.

Improvement in survival rates for solid tumors, the cancers of greatest concern to the surgeon, has lagged far behind the dramatic advances that have been made in the treatment of leukemias, lymphomas, and certain childhood tumors. The application of new technical procedures and an aggressive approach to certain metastatic lesions offer chances for improving operative results, but the greatest contribution to curing cancer that can be made by surgeons at this time is the complete removal of the small localized primary tumor. By more active participation in "early detection programs" surgeons can increase their opportunities to treat cancer at this stage. The American College of Surgeons, in consultation with the National Cancer Institute, has conducted a detailed survey that analyzes the lack of surgical participation in clinical trials with a view toward developing a more active surgical interest in evaluating new methods of treatment for the solid tumors. One of the current efforts to improve the outcome of these recalcitrant cancers involves increasing the number of trained surgical scientists in the field of cancer.

Clinical Protocols↗
PubMed1990

Pylorus preserving pancreatoduodenectomy: an overview.

Pylorus preserving pancreatoduodenectomy (PPPD) was reintroduced 12 years ago. Since that time, over 400 patients have undergone PPPD with approximately 41 per cent having chronic pancreatitis and 54 per cent having pancreatic and other periampullary malignancies. Reported 5-year survivals in this latter group have been comparable to those achieved by the classic Whipple procedure. The postoperative mortality rate in 339 reported patients has been 3.8 per cent. Postoperative morbidity, including delayed gastric emptying, has been similar to that of the classic Whipple operation. However, PPPD has been associated with fewer late problems with dumping, diarrhoea, delayed gastric emptying (8.6 per cent), and marginal ulceration (3.6 per cent). Moreover, most patients undergoing PPPD have been able to return to their preoperative and preillness weight. The additional advantage of decreased operative time makes PPPD an attractive alternative to the classic pancreatoduodenectomy.

Duodenum↗
PubMed1990

Surgical palliation for pancreatic cancer. The UCLA experience.

We reviewed the records of 340 patients with a tissue diagnosis of pancreatic cancer treated at UCLA Medical Center between 1973 and 1988. Sixty-one patients underwent pancreatic resection (group I), 173 had some form of surgical palliation (group II), and 106 had neither (group III). The diagnosis was made 1 to 2 months more quickly in the last 8 years of the review than in the first 8 years, but the effect of early diagnosis on curability was negligible. Biliary obstruction was best treated by cholecystojejunostomy or choledochojejunostomy, which were equally effective. Anastomoses to the jejunum were safer and more effective than were those to the duodenum for the relief of biliary obstruction. Gastrojejunostomy should be performed prophylactically as well as therapeutically. It was effective and safe in both settings. Surgical palliation for pancreatic cancer was generally effective and was associated with an operative mortality rate of less than 10%. However morbidity was high, with significant complications occurring in one third of cases.

Adolescent↗
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↗
PubMed1988

Recurrent hepatic hemangiomas. Possible association with estrogen therapy.

Hemangiomas are the most common benign tumors occurring in the liver. However, the natural history of hepatic hemangiomas has not been well defined. Four patients (3 women, 1 man) with recurrent giant liver hemangiomas underwent either surgical or radiation therapy as initial treatment for the primary tumor. The average time until recurrence was 14 years, and each tumor weighed more than 600 g. Each of the female patients had been given chronic estrogen (Premarin) replacement therapy. Three of the four patients underwent surgical resection for intractable symptoms or progressive enlargement. It is believed that estrogen replacement therapy may play a role in the pathogenesis of these tumors. Furthermore, operative intervention should be considered in patients with recurrent giant liver hemangioma.

Aged↗
PubMed1987

Pancreaticojejunostomy after Whipple's operation--in vivo evaluation of long-term patency: a preliminary report.

Evaluation of the patency of the pancreaticojejunostomy was conducted in four patients who had undergone Whipple's procedure. Three patients had a mucosa-to-mucosa anastomosis, and in one patient the pancreatic remnant had been invaginated into the jejunal loop. The longest interval between the operation and the present study was 9.7 years. After intravenous infusion of secretin (1 microgram/kg), the temporal changes in the pancreatic ductal caliber were measured by means of either ultrasonography (two patients) or computed tomography (two patients). The presence of adequate functional pancreatic tissue was assumed in all four patients on the basis of their clinical status and the normal ductal caliber before the secretin provocation. In two patients, the ductal system showed an initial dilatation following secretin administration and then gradually emptied. There were no changes of the Wirsung duct in the other two patients. These data suggest that the pancreaticojejunal anastomoses were patent in all four patients but had different degrees of stenosis. The present method allows a safe and noninvasive evaluation of the anastomosis in vivo. Since long-term patency of the pancreaticojejunostomy is feasible, it should be attempted whenever possible in patients undergoing Whipple's procedure.

Adult↗
PubMed1985

Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost?

Despite recent advances in perioperative support care, surgery for obstructive jaundice is still associated with significant morbidity and mortality. For this reason, preoperative percutaneous transhepatic drainage (PTD) has been recommended for these patients. This method of management, however, has only been supported by retrospective and nonrandomized studies. Therefore, a prospective, randomized study was performed to determine the effect of preoperative PTD on operative mortality, morbidity, hospital stay, and hospital cost. Thirty-day mortality was 8.1% among 37 patients undergoing preoperative PTD, compared to 5.3% for 38 patients who went to surgery without preoperative drainage. Overall morbidity was also slightly, but not significantly, higher in patients who underwent preoperative PTD, (57% versus 53%). However, total hospital stay was significantly longer (p less than 0.005) in the PTD group (31.4 days versus 23.1 days). The cost of this excess hospitalization and the PTD procedure at our university medical center was over +8000 per patient. The authors conclude that preoperative PTD does not reduce operative risk but does increase hospital cost and, therefore, should not be performed routinely.

Adenocarcinoma↗
PubMed1979

Cancer of the stomach. Review of consecutive ten year intervals.

Records were reviewed for all patients who underwent primary treatment for adenocarcinoma of the stomach at two UCLA hospitals between 1956 and 1975. Division of the data into two, ten-year time periods reveals a pattern of unchanging presentation and pathologic characteristics which probably accounts for the unaltered response to operative therapy. The consistency of certain prognostic findings justifies a surgical approach in which extensive resections are only selectively employed.

Adenocarcinoma↗
PubMed1979

Carcinoma of the pancreas and periampullary region.

Over a 21 year period, 245 cases of cancer of the pancreas were operated upon and followed-up at UCLA Hospital. A further 34 cases of periampullary tumor were treated by partial or total pancreatectomy. Apparent clearance of tumors at the time of pancreaticoduodenectomy that was confirmed by subsequent histopathology resulted in a patient survival time of 20.3 months as compared with a figure of 12.9 months when the pathological examination revealed tumor in a resection margin, although the surgeon believed that excision had been complete at the time of operation. Frozen section examination of resection margins is therefore mandatory. The result of performing a pancreaticoduodenectomy in which tumor was seen to be left behind was a survival time of only 6.8 months, which is similar to the survival time of 6.2 months following a palliative biliary bypass. Pancreaticoduodenectomy in patients over the age of 70 resulted in an average survival of only 7.6 months. Of patients having a palliative biliary bypass alone, 13% required subsequent reoperation to bypass distressing duodenal obstruction. A duodenal bypass should therefore be a routine concomitant of a biliary bypass. Total pancreatectomy with duodenectomy for pancreatic cancer gave an increased average survival of 26 months, and it is likely that the frequency of performance of this operation will increase.

Adenocarcinoma↗
PubMed1979

Gastric hypersecretion after formation of small bowel conduits: a common factor in several clinical states.

As a preliminary step in studying the effect on gastric acid secretion in dogs following biliary diversion through isolated intestinal conduits, blind-ended intestinal conduits were constructed and the biliary channel was left undisturbed at this time. The results were surprising in that a significant absolute increase in gastric acid secretion occurred in all dogs, within the range of 65-286%, by merely disconnecting a segment of small bowel from the mainstream of flow of intestinal contents. This effect may be due to the "intestinal phase of gastric secretion hormone" and may in itself provide a partial explanation for the well-documented increase in gastric acid production caused by the Exalto-Mann-Williamson procedure and by choledochoenterostomy utilizing a Roux loop.

Animals↗
PubMed1979

Surgical treatment of chronic pancreatitis. Twenty-two years' experience.

Seventy-four patients underwent operation for chronic pancreatitis during a 22 year period at UCLA Hospital. Follow-up data obtained for 60% of these patients an average of 3.2 years postoperation were analyzed by computer for statistically significant benefit between paired operation combinations and the variables of pain relief, stool habits, alcohol use, readmission for pancreatitis, and narcotic use. The combined group of total and cephalic pancreaticoduodenectomy proved more effective with respect to pain relief and readmission (p less than 0.05) than the group that had pseudocyst drainage. The comparison of groups that underwent resection or ductal drainage showed no statistical differences for the above variables. Regardless of type of operation, if the patient had evidence of pancreatic calcifications and had abstained from alcohol postoperatively, the likelihood of a return to normal activity was more favorable (p less than 0.05).

Adult↗