Marshall K. Bartlett

Acute pancreatitis: Analysis of factors influencing survival

Of patients with acute pancreatitis (AP), there remains a group who suffer life-threatening complications despite current modes of therapy. To identify factors which distinguish this group from the entire patient population, a retrospectiva analysis of 519 cases of AP occurring over a 5-year period was undertaken. Thirty-one per cent of these patients had a history of alcoholism and 47% had a history of biliary disease. The overall mortality was 12.9%. Of symptoms and signs recorded at the time of admission, hypotension, tachycardia, fever, abdominal mass, and abnormal examination of the lung fields correlated positively with increased mortality. Seven features of the initial laboratory examination correlated with increased mortality. Shock, massive colloid requirement, hypocalcemia, renal failure, and respiratory failure requiring endotracheal intubation were complications associated with the poorest prognosis. Among patients in this series with three or more of these clinical characteristics, maximal nonoperative treatment yielded a survival rate of 29%, compared to the 64% survival rate for a group of patients treated operatively with cholecystostomy, gastrostomy, feeding jejunostomy, and sump drainage of the lesser sac and retroperitoneum.

Erosions of the cecum: A cause of massive hemorrhage☆

Abstract 1. 1. Diverticula are the most common cause of massive bleeding from the colon. Erosions or superficial ulcers of the cecum are a less common but equally serious source of life-endangering hemorrhage. 2. 2. The diagnosis of these superficial erosions or ulcerations is difficult because they cannot be seen on barium enema examination, cannot be seen or palpated through the wall of the cecum, and may not be seen or coloscopy. 3. 3. The clinical and pathologic features in five such cases are reported.

Solitary Occult Retention Cysts of the Pancreas

Abstract Eight patients with long standing intermittent abdominal pain were found to have solitary cysts in the head of the pancreas. These cysts were demonstrated by retrograde pancreatography but could not be either visualized or palpated at operation. In only two cases was there sufficient clinical evidence to make a diagnosis of pancreatitis; in the remaining six the demonstration of a cyst was the first evidence of any abnormality that could account for their symptoms. All patients were treated by sphincteroplasty. Biopsy of the ampulla revealed fibrosis or inflammation in four of the seven patients in whom biopsy was performed. There was one postoperative death, and there has been little discernible relief in the case associated with alcoholism. The remaining six patients have had symptomatic relief for one to five years.

Intraoperative endoscopic evaluation of the bile ducts

Abstract On the basis of experience in over thirty common duct explorations, the Storz rigid choledochoscope has proved to be a simple, reliable, and valuable instrument. Its use is associated with few, if any, complications. Applications include examination of proximal and distal ducts to insure complete removal of stones, visualization and biopsy of the sphincter and distal obstructing lesions, and visual introduction of an embolectomy catheter beyond hepatic duct stones for extraction.

Amputation neuroma of the bile ducts with obstructive jaundice.

AN amputation neuroma may form from the cut ends of nerve fibers divided in the course of surgery on the biliary tree, just as it may occur elsewhere in the body. A tumor results that is not a true...

Diverticulosis and Acute Diverticulitis of the Jejunum

OUR interest in diverticulosis and diverticulitis of the jejunum was stimulated recently by the unexpected finding at laparotomy of such a case. A review of the records of the Faulkner Hospital fro...

Treatment of reflux esophagitis with stricture.

THE subject of reflux esophagitis has received considerable attention since Winkelsteins1 description in 1935. It is a condition in which the lower esophagus becomes involved by inflammatory chang...

The removal of biliary duct stones.

The consequences of the setting of the bile duct stone on decisions of management concerning the patient without clinical common duct obstruction and the jaundiced patient are considered, along with the problems of acute cholangitis, acute cholecystitis, acute pancreatitis, residual stones discovered before removal of the T-tube, and recurrent and residual stones that subsequently become symptomatic.

Technic for finding and removing stones from intrahepatic bile ducts

Abstract Intrahepatic biliary calculi which were missed by routine common duct exploration were discovered by choledochoscopy in the left hepatic ducts of three patients. Removal of stones was accomplished in two of these patients by using instruments for stone extraction under direct vision with the choledochoscope. The use of a Fogarty balloon catheter threaded through the choledochoscope is particularly recommended.

Case 72-1962

Presentation of Case A twenty-six-year-old married woman was referred to the hospital because of pain in the right upper quadrant. Two days before admission, after experiencing mild dysuria for a w...