Surgery
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Chronic pancreatitis is difficult to treat in patients with a nondilated duct. Patients experiencing intractable pain unresponsive to or judged untreatable by lesser procedures must decide between total pancreatectomy and resultant diabetes or a continuation of their pancreatitis. From 1977 through 1990, 26 patients underwent extensive pancreatectomy and dispersed pancreatic islet tissue autotransplantation for treatment of chronic pancreatitis pain and prophylaxis of surgical diabetes. ⋯ A liver biopsy was performed in one patient 8 months after total pancreatectomy and islet autotransplantation; numerous clusters of islet cells staining strongly for insulin and glucagon were detected within portal triads on both wedge and needle biopsy specimens. Morbidity related to the intraportal-dispersed pancreatic islet tissue transplantation was low (no disseminated intravascular coagulation, significant portal hypertension, or hepatic dysfunction). Islet autotransplantation can be an effective and safe adjunct to extensive pancreatic resection for those patients who risk surgical diabetes for relief of their chronic pancreatitis pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cholecystectomy is safer without drainage: the results of a prospective, randomized clinical trial.
Drainage after cholecystectomy remains routine despite the lack of scientific supportive data. Numerous clinical studies in the past have attempted to address this controversy but have failed to resolve the issue for different reasons. These include retrospective design, inclusion of only selected cases, and randomization before surgery. ⋯ The postoperative hospital stay was longer in the patients with drains (10.3 vs 9.1 days), but this difference failed to reach statistical significance. We conclude from this study that the use of a drain after cholecystectomy serves no useful purpose and is potentially harmful. This practice should be abandoned.
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This study was designed to clarify the effect of hyperdynamic circulatory support with dobutamine or dopamine after massive hepatectomy on hepatic hemodynamics, oxygen supply and demand, and lactate uptake. Mongrel dogs were allocated three groups: 70% hepatectomy group; a group that received dobutamine after 70% hepatectomy; and a group that received dopamine after 70% hepatectomy. Hepatic blood flow and oxygen delivery to the liver decreased after 70% hepatectomy. ⋯ When dobutamine or dopamine were administered after 70% hepatectomy, hepatic blood flow increased, followed by normalization of the balance of oxygen supply and demand in the liver; lactate uptake subsequently improved in the liver. The data support the conclusion that hepatic oxygen consumption affected by dopamine and dobutamine is associated with an increase in the extraction of lactate. Hyperdynamic hepatic circulatory support was advantageous to hemodynamics and metabolism in the residual liver after massive hepatectomy.