In a population-based case-control study carried out in Sweden in 1982-1984, the authors examined the association of pancreatic cancer with several dietary factors, coffee, alcohol, and tobacco. Analyses were based on 99 cases, 138 population controls, and 163 hospital controls. The cases were persons aged 40-79 years diagnosed with cancer of the exocrine pancreas at three surgical departments in Stockholm and Uppsala. The risk increased with higher consumption frequency of fried and grilled meat in the comparison with each series of controls (e.g., relative risk (RR) = 1.7 (90% confidence interval (CI) = 1.1-2.7) for weekly intake and RR = 13.4 (90% CI = 2.4-74.7) for almost daily intake, in the comparison with population controls). Furthermore, associations were found with other fried or grilled foods, but not with meat other than fried or grilled. The risk also increased with the intake of margarine (e.g., RR = 9.7 (90% CI = 3.1-30.2) for 15+ g of margarine on a slice of bread, in the comparison with population controls). In contrast, no excess risk was associated with high intake of butter. A low risk was associated with frequent consumption of fruits and vegetables, particularly carrots (RR = 0.3 (90% CI = 0.2-0.7)) and citrus fruits (RR = 0.5 (90% CI = 0.3-0.9)) for almost daily intake. No consistent associations were found with coffee, artificial sweeteners or alcohol consumption, but a threefold increase in risk was associated with smoking at least one pack of cigarettes per day.
The clinical course after endoscopic sphincterotomy improved in the majority of elderly patients suffering from acute cholecystitis, suggesting that early relief of obstruction at the level of the common channel reduces the risk of developing biliary sepsis. The majority of these patients can undergo surgery electively or can receive further conservative treatment.
Clinical and surgical observations confirm that acute cholecystitis (ACh) and acute biliary pancreatitis can coexist and that differentiation may be difficult even at surgery. Synchronous appearance of ACh and acute biliary pancreatitis suggests a similar etiology. Endoscopic sphincterotomy, with relief of the common channel outlet obstruction, has become the established therapeutical modality that improves the outcome in acute biliary pancreatitis. Patients suffering from ACh could be treated in a similar manner to prevent reflux of pancreatic juice into the common bile duct and the gallbladder with the intention to improve the clinical course. The present study investigated the presence and amount of pancreatic trypsin in the gallbladder bile in 73 patients operated on for gallstone disease with ACh and in controls. The average gallbladder bile trypsin level in the "edematous cholecystitis" group ranged between 0.525 and 4500 ng/mL, significantly exceeding that of controls, 0.5-53 ng/mL (P < 0.0001). The average gallbladder bile trypsin level in the "gangrenous cholecystitis" group, 0.1-71.5 ng/mL, was within the range of controls (n.s.), most likely to be explained as a consequence of consumption of trypsin due to the fulminant development of the disease. Further controlled studies are mandatory before it would be acceptable to recommend endoscopic sphincterotomy as a valuable choice in the initial/early management of patients suffering from ACh. Such a study is underway to assess the possible role of obstruction at, or other disorders of, the sphincter of Oddi with consequent pancreatic juice reflux into the gallbladder as a possible initial cause of ACh.
Miniaturization of ultrasound probes has made possible endoluminal investigation of small duct systems. We have used a 360 degree transaxial real-time sector-scan imaging system with a field of view of 3-5 cm. It operates at ultra-high frequencies, which allows very high resolution. Ten jaundiced patients, aged 35-73 years, were investigated. Malignant bile-duct obstructive disease was present in eight and benign strictures in the remaining two. In all of them the intrahepatic bile ducts had undergone percutaneous transhepatic cannulation for diagnostic and therapeutic purposes. The resolution capacity has been sufficient to allow studies of the bile duct wall and adjacent tissues, and it has thus been possible to study the papilla of Vater, biliary-enteric anastomoses, and adjoining portions of the pancreatic and cystic ducts. Adjacent vessels have been identified. This preliminary study indicates that the character of strictures and the extent of tumour growth may be evaluated, thereby demonstrating the clinical potential of these miniature transducers. Endoluminal ultrasound evaluation of the bile ducts may also be possible intraoperatively and as a supplement to duodenoscopy.
The trypsin level in bile was studied by radioimmunoassay in a prospective series of 63 patients with gallstone disease but without signs or symptoms of cholecystitis or pancreatitis in order to find indirect evidence of a retrograde flow of pancreatic juice. Mobile duct stones were present in 18 patients and impacted stones in 12. The remaining 33 patients had stones only in the gallbladder and served as controls. The average intraoperative trypsin level of the ductal bile was normal, both in the control group and in the group with stones occluding a potential retrograde reflux of pancreatic juice. After removal of the impacted stones, the bile showed a significantly higher trypsin level. The average intraoperative trypsin level for the group with mobile stones was significantly higher than that of the control group, and was further increased 10 days postoperatively. The trypsin level of ductal bile from 23 of the 30 patients (77%) with bile duct stones exceeded that of the 33 patients with stone-free bile ducts, indicating an inflow of pancreatic juice to the bile ducts of patients with bile duct stones. The present results correspond well to those in a previous report on retrograde phasic contractions of the sphincter of Oddi in the majority of patients with bile duct stones. This dysfunction of the sphincter, which persisted for 10 days after surgical stone removal, may be the primary disorder, probably consisting of a retrograde propulsive activity of the sphincter of Oddi.
Duodenal varices (DV) are rare. We present a review of published cases with emphasis on the management and outcome, as illustrated by our own cases, which reflects the experience reported in the literature. The diagnosis of DV must be considered in patients with gastrointestinal bleeding. Two-thirds of all reported cases have portal venous hypertension caused by hepatic cirrhosis. In the remaining one-third prehepatic portal hypertension as a consequence of either a compromised portal venous circulation (caused by perivenous tumor or inflammation) or a primary haematological disease is the underlying cause. Previously, duodenoscopy has often failed to detect and correctly interpret DV, and was similarly unsuccessful in our case. This case report demonstrates the problems and shortcomings in the management of DV and documents a hither to unreported cause. Treatment depends on the severity of bleeding. When conservative measures cannot control the haemorrhage, emergency laparotomy may be indicated. The type of surgery should be chosen according to the aetiology, site and extent of the bleeding DV. Among 112 reported cases of DV, information on outcome exists for only 35 patients who presented with haemorrhage. The aetiology was liver cirrhosis in 26 of these patients, 10 of whom had a fatal outcome, and prehepatic portal hypertension in the remaining 9, 1 of whom had a fatal outcome.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.