Edwin H. Ellison

The Use of Human Serum Albumin in the Management of Acute Pancreatitis: Experimental and Clinical Observations

Summary In the dog, the level of circulating serum trypsin inhibitor (antifibrinolysin) and a substrate of trypsin (fibrinogen) have been used as indices to measure the activity of trypsin in the blood stream following acute pancreatitis. From these determinations it would appear that considerably less trypsin appears systemically following pancreatitis than is well tolerated by the dog. Using these indices, it appears that albumin now available does not inhibit trypsin in vivo in either dog or human. Albumin does not inhibit trypsin in vitro . Ten dogs treated with adequate albumin to maintain plasma volume survived surgically-induced pancreatitis; nine dogs receiving inadequate albumin had persistent blood volume deficiencies of 30 per cent or more and all died. Four out of five dogs receiving adequate Dextran to support blood volume survived pancreatitis; six untreated controls all died. Patients treated with 800 to 1200 cc. of albumin over four to six days showed restoration of plasma volume to normal; too few have yet been treated to evaluate the effect of albumin on the course of pancreatitis.

Effect of seventy-five per cent distal small bowel resection on gastric secretion

Abstract Seventy-five per cent distal small bowel resection with retained ileocecal valve was performed in dogs with a Heidenhain pouch. The pathophysiologic effects observed are: 1. 1. An immediate gastric hypersecretory state was induced as reflected by increased twenty-four hour total acid output and prolonged basal hypersecretion. 2. 2. Response to maximal histamine stimulation did not change significantly. 3. 3. Delayed acid production resulted after meal ingestion. 4. 4. Basal hypersecretion could be blocked by atropine or extension of the fasting period. 5. 5. Marked parietal cell proliferation occurred. 6. 6. The acid hypersecretion could not be explained by anemia, electrolyte imbalance, quantitative changes in twenty-four hour food intake, or morphologic change in the liver or pancreas.

Gastric acid secretion and parietal cell mass in the stomach of a newborn infant.

Abstract 1. 1. A two- to threefold increase in parietal cell mass per unit area is found in the stomachs of full term newborn infants. 2. 2. This finding can explain the hypersecretion of gastric acid known to occur during the first two days after birth. 3. 3. Absence of parietal cell mitosis was noted in all stomachs of newborn infants studied. 4. 4. The full term newborn infant has the parietal cell mass capacity to secrete gastric acid in sufficient amounts to cause peptic ulcer disease. 5. 5. The relationship between maternal hyperacidity in the last trimester of pregnancy and these findings is postulated.

Study of clotting factors in liver homotransplantation

Abstract 1. 1. Bleeding diathesis occurred in six of twelve animals after addition of a donor liver and its cause is probably related to implantation of the donor liver. 2. 2. Measurable levels of endogenous heparin were found in six of twelve animals after liver allografts. Five of the six animals had a hemorrhagic diathesis. 3. 3. Removal of the host liver had no influence on the appearance of a bleeding diathesis, active fibrinolysin, or endogenous heparin. 4. 4. Endogenous heparin may contribute to the hemorrhagic diathesis. 5. 5. Heparin was found three days after a liver allograft in one animal. That animal did not have bleeding diathesis. 6. 6. These observations may be another manifestation of the immune reaction in liver homotransplantation.

Zollinger-Ellison syndrome: Clinical and histopathologic manifestations☆

Abstract Zollinger-Ellison syndrome is caused by a neuroendocrine tumor of the pancreas that secretes gastrin, causing massive gastric acid secretion. Treatment of the acid hypersecretion may be accomplished with pharmacologic acid inhibition. The goal of surgical treatment should be removal of all gross tumor in those without distant metastases. Cure rates approximate 30% and 20-year survival exceeds 70% even without cure.

Malabsorption syndromes in the postgastrectomy patient.

Summary and ConclusionsIn summary, operations for duodenal ulcer may result in rather distressing postoperative weight loss which may be so severe as to prove incapacitating. One must certainly anticipate an undesirable influence on intestinal absorption. This factor, combined with a limited food intake, regardless of cause, plays a major role in the nutritional problems seen following gastric resection. Furthermore, these effects may be minimized by a lesser resection, restoration of normal bowel continuity by using a gastroduodenostomy, and possibly by construction of a smaller stomal opening.Close attention to the dietary management, starting early in the postoperative period, employing seasoned solid foods of minimal volume and low bulk, and avoiding hypertonic fluids, results in an improved intake and minimal distress after meals. Unsatisfactory weight trends should be anticipated in patients whose preoperative weight levels are below their ideal weight, and a more conservative operation for control of the gastric acidity should be considered.Finally, the surgeon must either accept or share the responsibility for the complete postoperative rehabilitation of the ulcer patient. Good technical surgery is not sufficient to assure a good end result. In addition to being acquainted with gastric physiology, the surgeon must have a thorough understanding of gastric philosophy as well. The quality of life after operation for ulcer should be our major criterion of success.

Postoperative adynamic ileus: An experimental evaluation of the role of d-pantothenyl alcohol

Summary 1 Following stress there may be an increased utilization of pantothenic acid in the production of acetylcholine. Relative deficiencies of pantothenic acid could result in intestinal atony under such circumstances. 2 A significant period of adynamic ileus was readily produced in dogs by a combination of exposure and manipulative trauma to the gut and peritoneum. 3 The duration of ileus produced by this method was significantly reduced in 21 dogs by the administration of d -pantothenyl alcohol. 4 These findings suggest that d -pantothenyl alcohol may prove to be of use in paralytic ileus following surgery.

Anterior transabdominal adrenalectomy for endocrine disease

Abstract 1. 1. The rationale and operative technic of the anterior transabdominal approach to adrenalectomy is presented. 2. 2. The arguments for and against total versus subtotal adrenalectomy for Cushings syndrome without cortical tumor are reviewed. 3. 3. Precautions required during operation are stressed.

The acute nonsurgical abdomen of Henoch-Schönlein syndrome in the elderly patient

Abstract A case of Henoch-Schonlein syndrome in an elderly patient, closely simulating an acute abdominal emergency requiring surgical intervention, is presented. In this case in which the abdominal symptoms preceded the cutaneous manifestations, an unnecessary operation was performed and the patient subsequently died. Two other patients with more typical manifestations of the disease were treated conservatively and did well. It must be remembered that the Henoch-Schonlein syndrome is not simply cutaneous vasculitis and, although more common in children, may occur in the elderly patient. There is widespread general involvement of small blood vessels with perivasculitis. The site of the most severe blood vessel damage determines the varied clinical symptoms.

Effect of total gastrectomy on growth in puppies

Abstract 1. 1. Eight puppies had total gastrectomy and three are living and well fifteen months after operation. 2. 2. Total gastrectomy is feasible in puppies and compatible with adequate if not normal growth. 3. 3. Hypochromic anemia does occur and is associated with a general debility in the animals but responds to parenteral iron therapy. 4. 4. Pernicious anemia has not developed in any of the animals. 5. 5. In all animals with total gastrectomy osteomalacia has developed with resulting pathologic fractures from the animals which recovered spontaneously.