The pancreas: a symposium in honor of Charles Frederick Frey, MD.

On October 3, 1997, the University of California, Davis, under the leadership of James E. Goodnight, Jr, MD, chair of the Department of Surgery, gathered together 5 distinguished authorities in surgical pancreatic disease to present a symposium in honor of the retiring professor of 21 years, Charles F. Frey, MD.

Pyogenic hepatic abscess in a community hospital.

Pyogenic hepatic abscesses are rare lesions and are most commonly the result of biliary tract disease. During a 3-year period at our institution, 15 patients were diagnosed with pyogenic hepatic abscess. Ten cases were related to biliary disease.

Cardiac injuries: analysis of an unselected series of 251 cases.

Retrospective analysis was performed on the medical records of 251 patients treated for cardiac injuries at Highland General Hospital trauma facility in Alameda County, California, to identify factors that contribute to patient survival and predict death. Thirty-six patients (14%) had blunt injuries, 153 patients (61%) had gunshot wounds (GSW), and 62 patients (25%) had stab wounds. The overall survival rate was 18.

Gasless laparoscopy and conventional instruments. The next phase of minimally invasive surgery.

Objective: To assess the capability of a retractor system that permits laparoscopic surgery without pneumoperitoneum and to determine if the system facilitates the use of conventional surgical instruments during minimally invasive surgery.

Design: Prospective evaluation and data collection with review.

Setting: University-affiliated county hospital.

Pros and cons of parietal cell versus truncal vagotomy.

The reliability of parietal cell vagotomy as a primary procedure for duodenal ulcer is still questioned by many, and several surgeons advocate pyloroplasty in certain subgroups. Since the opening of our hospital in 1972, a randomized, prospective study has been under way. Sixty-seven patients were randomized into three groups: truncal vagotomy and Jaboulay pyloroplasty (Group 1), parietal cell vagotomy and Jaboulay pyloroplasty (Group 2), and parietal cell vagotomy without drainage (Group 3).

The congo red test to determine completeness of vagotomy: clinical application.

Over the past 5 years, we have evaluated the Congo red test for vagal competence as to its reliability under varied clinical conditions both intraoperatively and postoperatively. Our technique has been useful and accurate in approximately 200 patients. Insuring completeness of vagotomy during the operation has been of use in 42 patients uncovering an unsuspected incomplete vagotomy in 4.

Operative mortality in general surgery.

The operative mortality in over 7,000 consecutive cases at a Veterans Administration Medical Center is defined. The mortality in elective procedures is low by most standards and is usually associated with a malignant disease. Older patients appear to have an increased operative mortality.

Recurrent hiatal hernia repair: A potential surgical dilemma.

We studied 96 patients who underwent hiatal hernia repair; 17 of these patients had secondary repair. Nor mortality existed for elective first-time repairs. whereas there was a 17.

Treatment of hemorrhagic gastritis with 15(R)-15 methyl prostaglandin E2: report of a case.

A 19-yr-old male developed severe hemorrhagic gastritis following three abdominal operations. Treatment with intravenous cimetidine and hourly antacids to maintain his gastric pH above 5 failed to affect gastrointestinal bleeding. Also, peripheral venous vasopressin, propantheline bromide, and glucagon were without effect.

Resuscitation with pyridoxalated stroma free hemoglobin: tolerance to sepsis.

The contribution of the reticuloendothelial system (RES) in pyridoxalated stroma-free hemoglobin (SFH-P) clearance may be insignificant. The magnitude of this is not at present clear. Any compromise of RES function would militate against its potential benefit as an oxygen-carrying resuscitation fluid.

Management of hyperparathyroidism in patients with renal failure.

Patients with hyperparathyroidism of renal failure fall into two categories: those with hypocalcemia and those with hypercalcemia. If medical management fails and operative indications are present--bone pain or fracture, metastatic calcification, progressive hypercalcemia or uncontrolled pruritus--parathyroid exploration should be done. Total parathyroidectomy and autotransplantation is the procedure of choice when hypocalcemia is present and more than one gland (usually all) is enlarged (which is the case in most patients).

Mortality and gastrointestinal surgery in the aged: elective vs emergency procedures.

Elderly patients are often viewed as high-risk surgical candidates. Consequently, elective surgery may not be performed, with the result that a potentially treatable disease process may develop into an acute catastrophic event. We question the validity of this approach.

Gastric tissue prostaglandin levels. Effect of vagotomy.

To determine tissue prostaglandin levels in antrum and fundus and to examine the effect of vagotomy and distention on tissue prostaglandin levels, truncal and parietal cell vagotomies were performed on rats that were killed at 2, 4, and 6 weeks postoperatively with antral and fundic prostaglandin E1 levels being determined. The fundus has considerably higher levels of prostaglandin than the antrum. No differences after any type of vagotomy however, were noted.

Wound dehiscence. Pathophysiology and prevention.

A review of 32 abdominal wound dehiscences in a five-year period shows an incidence of 0.51%. Important factors are preexisting pulmonary disease, "malnutrition," intraoperative contamination (often minimal), gastrointestinal distention, and aggressive tracheobronchial toilet in the postoperative period.

Expanding indications for early parathyroidectomy in the elderly female.

In a study of fifty consecutive patients with hyperparathyroidism we have noted: (1) Automated laboratory studies have increased the incidence of diagnosed hyperparathyroidism, especially in the elderly. (2) Bone abnormalities and mental changes are the most frequent symptoms in this older population. (3) Natural history studies have produced some delay in surgical treatment, accentuating mental aberrations and bone-associated deficits.