Charles G. Child

Pancreatectomy for Chronic Pancreatitis

Of one hundred and forty-nine patients (101 male and 48 female) 4–67 years of age, 117 were alcoholics and underwent pancreatectomy because of episodic or continuous abdominal pain or complications or chronic pancreatitis. Nineteen patients underwent pancreaticoduodenectomy, seventy-seven 80–95% distal resection, and fifty-three 40–80% distal pancreatic resection. There were 3 operative deaths and 30 late deaths 6 months to 11 years post pancreatectomy. Twenty-one patients were lost to followup, I to 11 years post pancreatectomy. Ninety-five patients are known to be alive, 4 of whom are institutionalized. Indications for pancreatectomy in addition to abdominal pain include recurrent or multiple pseudocysts, failure to relieve pain after decompression of a pseudocyst, pseudoaneurysm of the visceral arteries associated with a pseudocyst, recurrent attacks of pancreatitis unrelieved by non-resective operations, duodenal stenosis and left side portal hypertension. The choice between pancreaticoduodenectomy or distal resection of 40–80% or 80–95% of the pancreas should be based on the principle site of inflammation whether proximal or distal in the gland, the size of the common bile duct, the ability to rule out carcinoma, and the anticipated deficits in exocrine and endocrine function. The risk of diabetes is very significant after 80–95% distal resection and of steatorrhea after pancreaticoduodenectomy. When the disease process can be encompassed by 40–80% distal pancreatectomy this is the procedure of choice.

Pancreaticojejunostomy and Other Problems Associated With the Surgical Management of Carcinoma Involving the Head of the Pancreas: Report of Five Additional Cases of Radical Pancreaticoduodenectomy.

PANCREATICOJEJUNOSTOMY AND OTHER PROBLEMS ASSOCIATED WITH THE SURGICAL MANAGEMENT OF CARCINOMA INVOLVING THE HEAD OF THE PANCREAS REPORT OF FIVE ADDITIONAL CASES OF RADICAL. PANCREATICODUODENECTOMY CHARLES CHILD; Annals of Surgery

Idiopathic extrahepatic portal hypertension in adults

Abstract Nine adults with bleeding gastroesophageal varices secondary to portal vein thrombosis of unknown cause are presented. Their average age was 51.6 years. Splenomegaly and secondary hypersplenism were the most common signs that portal hypertension was present. Liver function studies and histology were essentially within normal limits. The diagnosis was not suspected at the time of initial variceal hemorrhage in four patients. In only two patients could a conventional splenorenal or mesocaval shunt be fashioned. Surprisingly all five patients in whom a shunt could not be constructed and who survived operation remain alive for an average of 47.8 months. Only two of these patients have had rebleeding. Complete angiographic evaluation of the portal venous system with portograms, splenoportograms, or tolazoline mesenteric arteriograms is essential for proper management of these patients.

Ileocecal intussusception caused by lymphoid hyperplasia

Summary 1. A brief discussion of the etiologyof intussusception in childhood is presented. 2. Two cases of intussusceptioncaused by lymphatic enlargement in the ileum are presented.

Liver regeneration; preliminary report.

Summary 1. Partial hepatectomy has been carried out in dogs with portacaval transposition, with normal hepatic blood supply, and with end to side portacaval shunts. 2. In dogs with portacaval transposition the hepatic venograms showed striking regeneration. 3. Percentile regeneration was somewhat less in these dogs than in Ithe normal but greater than in the dogs with end to side portacaval shunts. 4. These data discount the importance of portal blood per se in regeneration of the liver and lend support to the concept that the failure of hepatic regeneration in dogs with Eck nstulae is due in part at least to lack of venous blood flow.

Acute Occlusion by Ligature of the Portal Vein in the Macacus rhesus Monkey.

Summary and conclusions. Various segments of the portal circulation (including the portal vein) have been suddenly occluded by ligature in 7 adult Macacus rhesus monkeys. All of the animals have survived this procedure uneventfully and are in apparent good health from 16 to 51 days postoperatively. By means of portal venography anastomotic channels have been demonstratd by way of which blood is immediately returned to the systemic circulation in sufficient quantities to prevent these animals from succumbing to shock due to depletion of their circulating blood volume.

Experimental Hypertension in Dogs by Constricting the Artery of a Single Transplanted Kidney

Conclusion We have concluded from these experiments that a transient hypertension can be produced by constriction of the artery to a kidney denervated by transplantation. Whether a sustained level of hypertension can be produced in the absence of the renal nerves when the artery is similarly constricted will be reported later.