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PubMed1975

Postprandial osmotic and fluid changes in the upper jejunum after truncal vagotomy and drainage in man.

The changes in osmotic pressure and the degree of marked dilution in the jejunal lumen after a hypertonic meal, have been studied in patients after truncal vagotomy and drainage, with and without diarrhoea, using an intraluminal intubation technique. The results suggest that neither the emptying of a hyperosmotic load from the stomach, nor its subsequent dilution in the jejunum have an important role in post-vagotomy diarrhoea.

Chromium Radioisotopes↗
PubMed2005

Thoracic epidural analgesia via the lumbar approach using nerve stimulation in a pediatric patient with Down syndrome.

This case illustrates the threading of an epidural catheter with electrical stimulation guidance from the lumbar epidural space to the thoracic space in a pediatric patient. A 17-year-old boy with Down syndrome, weighing 48 kg, was scheduled to undergo a laparotomy for duodenal obstruction and gastrostomy tube insertion. Combined general and continuous epidural anesthesia was selected for his anesthetic. Following the induction of general anesthesia and tracheal intubation, a 17G Tuohy needle (Arrow International, Inc., Reading, PA) was inserted into the lumbar space (L3-4) using loss of resistance with air. A 20G styletted epidural catheter was then inserted and threaded cranially. As the catheter was advanced, a low electrical current (1-10mA) was applied to the catheter. Motor response was observed from the lower limb muscles to the upper abdominal muscles as the catheter advanced cranially. After 22 cm of the epidural catheter had been inserted, intercostal muscle movement (T9 - 10) was observed at 3.0 mA. Radiographical imaging later confirmed the catheter tip at T10. The patient awoke without distress and was discharged to the ward with subsequent good pain control from a continuous epidural infusion of bupivacaine 0.1% with 1 microg ml(-1) fentanyl at 4-6 ml(-1).

Adolescent↗
PubMed1994

Periampullary cancer treatment in U.S. Department of Veterans Affairs hospitals: 1987-1991.

BACKGROUND: Reported treatment outcomes for painless jaundice caused by ampullary, distal biliary, or duodenal (ABD) cancer are better than those caused by pancreatic cancer. METHODS: Outcomes after resection, bypass, or biliary intubation were compared in 432 patients with ABD cancer and 1753 with periampullary pancreatic cancer from U.S. Veterans Affairs hospitals. Computer and tumor registrar records from 1987 to 1991 were compiled; follow-up to death was complete in more than 93%. RESULTS: Operative mortality and complication rates were similar for each diagnosis. Adenocarcinomas staged from registrar reports (179 ABD, 571 pancreatic) exhibited significantly longer mean survival time (analysis of variance; p < or = 0.03) in patients with ABD for all stage groupings (localized, node involvement, metastatic) when stratified by treatment. After localized cancer resection, projected 5-year survival rate was 30% in 58 patients with ABD and 6% in 64 with pancreatic cancer. However, mean survival rates were similar with or without resection when nodes were involved. No 5-year survivors were projected after resection with nodal or distant metastases. CONCLUSIONS: Patients with ABD had a longer mean survival time than those with pancreatic adenocarcinoma, and this difference persisted when studied by TNM stage. The curative potential of resection was confined to patients without nodal involvement.

Adenocarcinoma↗
PubMed1989

A randomised comparison of two postoperative fluid regimens.

Postoperative paralytic ileus follows all significant gastrointestinal surgery. Its duration is variable and has led to a variety of empirical and time-consuming oral fluid regimens. We have compared a traditional method of fluid administration with an unstructured, simpler, patient-determined approach. A series of 102 patients on a general surgical ward who required intravenous fluids on the day after surgery were randomised by a closed envelope system to one of two protocols and followed prospectively. Of these, 12 patients were erroneously randomised or unable to fulfil trial requirements. The first, 'regulated' group (n = 41) received hourly aliquots of oral fluid as determined by twice daily ward rounds according to ward routine. The second, 'unregulated' group (n = 49) were given a jug of water and instructed to drink as desired. Patients in the regulated group received less of their postoperative fluids by the oral route at all stages of recovery but there were no significant differences in the mean durations of intravenous therapy, nasogastric intubation or hospital stay. Postoperative complication and mortality rates were also similar. Patients who underwent gastric or duodenal procedures (n = 14) showed a similar pattern of results. We conclude that 'patient-determined' regulation of postoperative oral fluid intake is safe and effective and may greatly simplify ward management.

Digestive System Surgical Procedures↗
PubMed1994

[The relationship between resorption and the morphological changes in the gastric mucosa of rats after acute and chronic exposures to acetylsalicylic acid].

The effect of acute and chronic ASA administration on stomach and duodenal mucosa was studied on white male Wistar rats. ASA (250 mg/kg b.w.) was administered by esophageal intubation in a single dose, and the rats were sacrificed at 2, 6, 24 hours, or after two, three, ten and twenty days, 24 hours after the last ASA application. Two types of erosions were found in the first 24 hours: superficial and deep. Superficial erosions showed advanced healing by the 24th hour. Deep erosions appearing between 6 and 24 hours from the beginning of experiment became deeper, after two and three days ASA application. They had morphological features of chronic ones by the 10-20th day. ASA resorbtion was most expressed by the 3rd day from the experimental onset (plasma concentration 0.348 +/- 0.052 g/l). The resorbtion was decreased in chronic experiment, and plasma concentration (0.236 +/- 0.046 g/l, 0.244 +/- 0.045 g/l) showed statistically reliable lower values.

Absorption↗
PubMed1997

[Duodenal stenosis: a rare complication of acute pancreatitis].

Duodenal stenosis is a rare complication of acute pancreatitis. We present 5 cases and suggest a protocol of treatment based on intubation of the stenosis and nutritional support via nasojejunal feeding tube. This non-invasive method facilitated adequate control in 3 of the 5 cases. Total parenteral nutrition should be left for cases with severe stenosis, and surgery for those in which conservative treatment fails after a period of five weeks.

Acute Disease↗