Between 1973 and 1975, "early" operation with removal of necrotic tissue was performed on 15 patients with acute haemorrhagic-necrotizing pancreatitis. Partial necrotizing pancreatitis was found in ten patients, of whom seven survived. But all patients with total pancreatic necrosis died. Two early operations in patients with a necrotizing bout in the course of chronic recurrent pancreatitis were successful. The surgical procedure consisted of digital removal of necrotic tissue (greater than digitoclasia less than) and left-sided resection, combined with adequate drainage. Patients with acute, partial necrotizing pancreatitis can be saved by early operation, while those with total necrosis would require almost immediate surgical intervention, before the onset of lethal complications.
The purpose of this work was to assess retrospectively the yield of enteroclysis in 124 unselected patients presenting with obscure gastrointestinal bleeding. Of 1000 consecutive patients who were examined by enteroclysis 124 presented with occult gastrointestinal bleeding. A total of 61 patients with an unknown source of bleeding at the time of discharge, but with established gastrointestinal bleeding, were followed up by questionnaire to correlate the initial degree of bleeding with the incidence of recurrence of bleeding. Enteroclysis was normal in 109 cases. An abnormality was found subsequently be the cause of bleeding in the small intestine in 16 patients. Enteroclysis was positive in 14 cases, negative in 2 and false positive in 1. There was positive correlation between the initial degree of haemorrhage and the rate of recurrence. Enteroclysis detected the cause in 11% of patients who presented with bleeding of unknown origin. In patients with minor haemorrhage there was no recurrence of bleeding in most cases.
LSL has a positive influence on the course of pvad in patients selected by radionuclide perfusion studies. Diabetes and angiographic findings do not play any first role in patient selection for LSL.
A follow-up investigation of 20 patients, surgically treated for acute haemorrhagic necrotising pancreatitis, was performed in an average of 2 3/4 years after the operation. Twelve patients showed manifest diabetes mellitus, four further cases had a suspicious oral glucose tolerance test. Only one patient was insulin dependent. A secretin-pancreozymin test performed in 15 patients showed a dissociated or global pancreatic insufficiency in 13 cases. The extent of the endocrine and exocrine functional disturbance did not correlate with the extent of surgery. Postoperative functional defects were readily improved therapeutically in most cases. Only in patients who continued to consume alcohol were there digestive disturbances. The results indicate that the functional state of the remaining pancreas does not only depend on the extent of surgery but also on the extent of already existing or persisting toxic inflammatory damage and on the regenerative capacity of the remaining parenchyma.
A total of 201 patients with chronic pancreatitis were treated surgically between 1964 and 1975. In 116 cases (57,7%) resection was done at operation: 44 partial and 18 total duodenopancreatectomies, 37 partial and 17 subtotal left pancreatic resections. The mortality rate of the operation was 12.9%. The late mortality was 9.4% based on an average observation period of 2 7/12 years. Three quarters of the patients became completely asymptomatic. Preoperative diabetes was observed in 21% rising to 38% postoperatively. Satisfactory long-term results were mainly seen after partial duodeno-pancreatectomy and subtotal left resection. However, continued alcohol abuse limits the success rate.
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