R.Franklin Carter

Benign fibrous stenosis of the common duct

Abstract 1. 1. A case of benign fibrous stenosis of the pancreatic portion of the common duct in an adult that resembles the pathology found in the congenital type of benign fibrous stenosis is reported. 2. 2. The literature of fibrous stenosis of the common duct and its causes is reviewed. 3. 3. The causes suggested in the previously reported cases and the findings in the present report do not explain the lesions found, so far.

Benign fibrous stenosis of the bile ducts

Abstract Forty-eight patients with benign fibrous stenosis of the bile ducts were studied, seven of whom were operated upon primarily by us. A total of 182 operative procedures was performed, 110 before admission and seventy-two by us. Our surgical mortality was 12 per cent; operative mortality was 8 per cent. With repeated attacks of jaundice, intolerable itching, chills and fever, and weight loss lasting over a period of several years in many cases, these patients are miserable and doomed to death. Even though multiple, painstaking procedures are often required, satisfactory and improved results in 69 per cent of the patients in this study justify continued efforts towards restitution.

THE DETERMINATION OF BILIARY TRACT INFECTION WITH THE ENCAPSULATED DUODENAL TUBE

Excerpt That it is now possible to determine biliary tract infection with considerable accuracy, without operation, has been proved by the correlated pre-operative and operative bacteriological fin...

The management of biliary tract disorders in patients with heart disease.

Excerpt The purpose of this report is to aid in the understanding and management of the cardiac patient with a disorder of the biliary tract. Individuals in this important group may be a joint prob...

DIAGNOSIS AND MANAGEMENT OF DISEASES OF THE BILIARY TRACT

The authors are members of the professorial staff of the New York Post-graduate medical school, and their book is based on their experience with diseases of the biliary tract over a considerable period of time, especially at their hospitals clinic for the study of diseases of the liver and biliary tract. The preface promises a concise description of the latest concepts of the aetiology of diseases of the gall bladder and the routine of investigation and management as practised at this clinic. This is accomplished in the short space of four hundred pages with great

Pancreatitis and biliary tract disease

Abstract Fifty-three cases of chronic and acute pancreatitis on whom biliary tract surgery was performed have been discussed. Biliary tract disease was present in all but six of these. Common duct stone was found in 66 per cent of those with biliary tract disease and chronic pancreatitis and in 78 per cent of those with acute pancreatitis. The surgical treatment, in the vast majority of cases, involved a drainage of the common duct as well as a direct attack on the pancreas. The mortality rate in chronic pancreatitis is that inherent in surgery on the biliary tract, and the mortality rate in acute pancreatitis that found in severe peritonitis. Peritonitis was the predominant cause of death in all cases. The prophylaxis of both chronic and acute pancreatitis lies in the early surgical treatment of the preexisting biliary tract infection.

Retroperitoneal multilocular chylangioma cyst with calcification

Abstract A case of retroperitoneal, multilocular, calcified, chylangioma cyst in a girl of 5 years is presented as an unusual finding, inasmuch as the preoperative diagnosis could be made with the help of systematic roentgenograms. Operation was followed by uncomplicated recovery. This case is comparable to only two other reports in the literature.

The postoperative concentration of bile salts in human bile

Abstract The postoperative changes in the concentration of bile salts in the bile have been studied in a series of surgical patients following drainage of the common bile duct through a T-tube. When the patient has had no evidence of hepatic disease or the latter is minimal, there is a temporary reduction in the concentration of bile salts in the bile, followed after two to three days by a progressive return to normal levels. This drop is interpreted as due to such factors as the type and duration of anesthesia, the local and constitutional effects of operative trauma, the degree of preoperative biliary obstruction with hydrohepatosis, and the like. The rapidity of the postoperative return toward a normal concentration of the bile salts in the bile and the maximal concentration attained during the period of observation in general are inversely proportional to the degree of hepatic damage. Evidence is presented that such factors as systemic infection, cholangitis, depletion of bile salts from prolonged drainage, and an inadequate supply of carbohydrate will reduce the concentration of bile salts in the bile, presumably as a result of functional as contrasted to structural changes. The multiplicity of factors which apparently affect the functional ability of the liver and so the concentration of bile salts in the bile correspondingly increase the difficulty in determining the factors responsible for the changes in any individual case. Evidence was obtained suggesting that in some instances the common bile duct may concentrate the bile passing through it in the same manner as is done in a normal gall-bladder. The continued failure of the liver to secrete bile salts in the bile is evidence of severe functional disturbance and so of serious prognostic import.