Gallstone pancreatitis: does discharge and readmission for cholecystectomy affect outcome?

Background: Conventional surgical wisdom is that a patient with gallstone pancreatitis should have the gallbladder removed during their initial hospitalization. However, patients are now often discharged to await operating room availability.

Methods: A retrospective review of all cases of gallstone pancreatitis at the Foothills Hospital between 1992 and 1996 was undertaken.

Field trauma triage: combining mechanism of injury with the prehospital index for an improved trauma triage tool.

Background: The objective of this study was to combine a physiologic triage score (prehospital index, PHI) with criteria regarding mechanism of injury (MOI) to increase the efficacy of trauma triage. The specific question being asked was: will the combined score improve the sensitivity and specificity over that of the individual scores?

Methods: In this prospective study, 3,147 injury patients (all adults > or = 14 years) were reviewed. Each patient received a PHI score and a MOI score in the field, which were compared with their Injury Severity Score (ISS) at separation.

Disease-specific quality of life: the Gallstone Impact Checklist.

Objective: To develop a disease-specific quality-of-life scale for symptomatic cholelithiasis for use in clinical trials, and to evaluate its reliability, construct validity and responsiveness.

Design: Questionnaire.

Participants: Health care professionals, patients with symptomatic cholelithiasis and their significant others.

Cooperative hernia study. Pain in the postrepair patient.

Background: The Cooperative Hernia Study assessed postoperative pain in a prospective trial as part of a larger study looking at the recurrence rate and other morbidity of the Bassini, McVay, and Shouldice repairs.

Methods: Patients were randomized to one of three surgical hernia repairs. Patients were seen in follow-up at 6, 12, and 24 months and were assessed for the presence of pain, numbness, paresthesia, and recurrence.

Tumour implantation at umbilicus after laparoscopic cholecystectomy for unsuspected gallbladder carcinoma.

Seeding of tumour cells at the umbilical port during laparoscopic surgery for staging malignant disease has been reported. In this paper a 69-year-old woman is described who had umbilical metastasis after laparoscopic cholecystectomy for unsuspected gallbladder cancer. The experience of this case and that of other reports suggests that when laparoscopic techniques are used for the resection of tumours, the excised specimen should be enclosed in a nonporous bag for removal through the abdominal wall.

The effect of cyclosporine and liver autotransplantation on bile flow and composition in dogs.

Following liver transplantation bile formation may be influenced by hepatic denervation and cyclosporine therapy. To better establish any effect of liver transplantation on bile secretion, 6 mongrel dogs were studied: 3 underwent liver denervation by a modified autotransplantation procedure and insertion of a Thomas cannula to create a chronic duodenal fistula; 3 others had cholecystectomy and the duodenal cannula placement without manipulating the liver. One month after surgery, two control studies were done, one week apart.

Conservative management of splenic injury in infectious mononucleosis.

Splenic rupture, in association with mononucleosis, can be lethal. Most reported cases of splenic rupture in patients with mononucleosis have not responded to conservative splenic preserving measures and have resulted in splenectomy. We report a case of traumatic splenic disruption in a patient with mononucleosis in whom conservative management was successful.

Carcinoid tumors and inflammatory bowel disease.

Three cases are described in which carcinoid tumors arose in previously established inflammatory bowel disease: two were in the ileum in cases of Crohn's disease, and one was in the rectum in a case of ulcerative colitis. Review of this association in the literature suggests that it may be more than fortuitous.

The effect of cyclosporine A on bile secretion in dogs.

Cyclosporine A is reported to cause cholestasis, but the evidence is confounded by anesthesia and surgery used in acute experiments. To better investigate the effect of cyclosporine on the liver, bile output was directly measured in three cholecystectomized dogs by cannulating the common duct through a chronic duodenal fistula. Control studies were done 1 month after surgery.

Comparison of one technique of patient-controlled postoperative analgesia with intramuscular meperidine.

We have compared analgesic requirements, perceived pain, and self-assessment of 'health locus of control' for 72 h in 88 subjects after cholecystectomy, randomized to either a standard technique of self-administration of meperidine (patient-controlled analgesia, PCA) or to intramuscular injections on demand (i.m.).

Origin of fistulas in Crohn's disease.

In 236 resection specimens of Crohn's disease (127 first excisions and 109 reexcisions) there were 60 specimens with fistulas (excluding anal fistulas): 44 in first excisions and 16 in reexcisions. In primary excisions, 36 fistulas arose in the ileum, three in the colon and five in the ileocecal valve. The majority were located either at the proximal end of a stricture (62%) or within a stricture (31%); four cases (7%) were not associated with strictures.

Excessive growth of cultured beta cells from an adult patient with beta cell hyperplasia.

We have studied a 25-year-old female with frequent, severe hypoglycemic episodes. Concurrent with low serum glucose levels, the concentrations of C-peptide and insulin were markedly elevated. Tests for sulfonylurea hypoglycemic agents were negative.

Radiographic and sonographic findings in spontaneous retrograde intussusception.

Spontaneous retrograde intussusception causing obstruction is rare. We describe the radiographic and sonographic appearances, which should have been sufficient for preoperative diagnosis, in one patient.

Reticuloendothelial system Fc receptor-mediated clearance of IgG-tagged erythrocytes from the circulation of patients with idiopathic ulcerative colitis and chronic liver disease.

Immune complexes may be important in the pathogenesis of the liver disease associated with idiopathic ulcerative colitis. In the present study, we documented Fc receptor-mediated clearance by the reticuloendothelial system of immune complex-like material from the systemic circulation of 25 healthy control subjects, 19 patients with ulcerative colitis alone, 9 patients with ulcerative colitis and elevated liver enzyme tests and 8 patients with various other forms of chronic liver disease. Following an intravenous infusion of IgG-tagged 51Cr-labeled autologous erythrocytes, serial blood samples were drawn over a 2-hr period of time, and computer-generated clearance curves were obtained.

Sex differences in morbidity and mortality from peptic ulcer in Canada, 1950-1981.

Mortality from peptic ulcer disease in Canada declined significantly for males from 1950-1981, but changed little for females. Gastric and duodenal ulcer mortality, and mortality from perforated and bleeding peptic ulcer showed similar trends. Rates of hospitalization for male duodenal ulcer subjects also declined, with lesser effects among males with gastric ulcer, and females with either gastric or duodenal ulcer.

Seasonal frequency of testicular torsion.

The hypothesis that testicular torsion is more common in winter was examined in a retrospective survey of admissions to three Calgary hospitals. No seasonal peak in incidence of cases of torsion was identified from 1966 to 1982.