Umbilical Hernia Incarceration: A Complication of Medical Therapy of Ascites

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73352/1/j.1572-0241.1983.tb01875.x.pd

Treatment of cirrhotic rats with epidermal growth factor and insulin accelerates liver DNA synthesis after partial hepatectomy

Prevention of postoperative hepatic failure is important after hepatic resection. In patients with cirrhosis, impaired liver function and regenerative capacity after major hepatic resection are associated with increased morbidity and mortality. In this study, a combination of epidermal growth factor (EGF) and insulin were used as hepatotrophic factors in an attempt to stimulate DNA synthesis after 70 hepatectomy (HTX). Regenerative capacity was evaluated in normal and cirrhotic rat liver by measuring DNA synthesis in vivo. Micronodular liver cirrhosis was established by the simultaneous oral administration of CCl 4 and phenobarbital. Epidermal growth factor plus insulin was injected subcutaneously immediately after and 12 h after HTX or sham operation was performed. Rats were killed 24 h after the operation and liver regeneration was estimated by [ 3 H]-thymidine incorporation into DNA as well as an autoradiographic nuclear labelling index. Hepatectomy increased [ 3 H]-thymidine incorporation significantly in both normal and cirrhotic rats. In cirrhotic rats, [ 3 H]-thymidine incorporation after HTX was significantly lower than in normal rats and administration of a combination of EGF and insulin after HTX enhanced [ 3 H]-thymidine incorporation. In conclusion, DNA synthesis 24 h after HTX is decreased in cirrhotic rats compared with normal rats and EGF supplementation with insulin accelerates DNA synthesis in hepatectomized cirrhotic rats. The data suggest that administration of combinations of exogenous hepatotrophic factors may play a useful role in the treatment of cirrhotic patients undergoing major hepatic resection.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75018/1/j.1440-1746.1998.01791.x.pd

Invited commentary

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41288/1/268_2005_Article_BF01658533.pd

Efficacy and Safety of Low‐Dose Intravenous Versus Intramuscular Vitamin K in Parenteral Nutrition Patients

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141612/1/jpen0174.pd

Blood flow and distribution in the canine pancreas

Because of a tripartite arterial inflow, accurate determination of canine pancreatic blood flow (Qp) in experimental studies remains problematic. Assessment of blood flow using a single electromagnetic flow probe on the anterior pancreaticoduodenal artery (APDA) was compared to the radiolabeled microsphere method. Distribution of Qp was based on microsphere density. Qp determined simultaneously with the flow probe technique and the microsphere method were 86 +/- 17 and 23 +/- 8 ml/min, respectively, (P Qp measured by the flow probe increased to 94 +/- 27 ml/min (NS) and decreased to 19 +/- 4 ml/min (NS) using microspheres. Intrapancreatic distribution of Qp was not significantly altered by occlusion of the SA and PPDA. Intrapancreatic arterial collateral is adequate to maintain blood flow to the entire pancreas even when arterial inflow is restricted to the APDA. Flow probe determinations of Qp are artifactually high because they include flow to the duodenum and may also be subject to methodologic error.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26591/1/0000132.pd

Subtotal Pancreatectomy for Chronic Pancreatitis

Chronic pancreatitis results when pancreatic structure or function is irreversibly damaged by repeated or ongoing inflammation, regardless of the underlying etiology. Most patients present with medically intractable pain and radiological evidence of diffuse gland involvement. Surgical therapy is directed mainly toward palliation of symptoms, and cure is unusual except when the inflammatory process is limited to a specific segment of the pancreas. Surgical strategy should be individualized on the basis of alterations in pancreatic morphology and duct anatomy. In properly selected patients, duct drainage procedures effectively relieve pain and preserve pancreatic function with low perioperative morbidity and mortality. Extensive distal pancreatectomy is effective in relieving pain, but it can be technically challenging and in general should be limited to patients with small-duct disease because of severe metabolic consequences. Intraportal islet cell autotransplantation or segmental pancreatic autotransplantation may ameliorate the long-term effects of insulin-dependent diabetes, but it will have limited applicability until methods for optimizing and purifying islets are developed and the optimal route and site of islet cell implantation have been identified.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41297/1/268_2003_Article_7242.pd

Differential effects of portal diversion on hepatocyte function (HF) and hepatic reticuloendothelial cell (HRES) activity in the dog

End-to-side portocaval shunts (PCS) were constructed in six dogs to evaluate the effect of complete portal blood flow diversion on hepatocellular structure and function, hepatic reticuloendothelial (RE) activity, and serum opsonic activity (OA). RE activity remained normal after PCS despite a 40% reduction in estimated hepatic blood flow. Tissue distribution of injected colloid shifted away from liver to spleen, lung, and bone marrow. OA decreased to 40% of baseline values 6 weeks after PCS and remained low. Postshunt changes in hepatic morphology primarily affected hepatocytes and included deglycogenation and loss of rough endoplasmic reticulum. Significant changes in Kupffer cell morphology were not observed. Complete portal flow diversion in the dog caused profound alterations in hepatocellular structure and function without compromising Kupffer cell phagocytic and metabolic activity. Kupffer cells may be less dependent than hepatocytes upon hepatotrophic factors contained in portal blood. OA did not correlate with changes in vascular lipid clearance, suggesting that either phagocytosis of RES test lipid in the dog is not dependent on prior opsonization, or that the assay used was neither sensitive nor specific enough to measure a critical opsonic threshold required for effective phagocytosis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23877/1/0000116.pd

Pancreatic response to crystalloid resuscitation in experimental pancreatitis

Restoration and maintenance of intravascular volume is crucial in acute pancreatitis to prevent hypotension and ensure normal organ perfusion. This study evaluated the hemodynamic and metabolic effects of adequate versus inadequate fluid replacement on the pancreas in a canine model of acute experimental pancreatitis. Bile-trypsin pancreatitis (BTP) was induced in 14 conditioned mongrel dogs. Lactated Ringer's solution was administered intravenously at high (HIR) and low (LIR) infusion rates (6.5 and 1.75 ml/kg/hr, respectively) to 7 dogs each for 4 h. Seven sham-operated controls (CON) received lactated Ringer's at 6.5 ml/kg/hr for 3 hr. Mean arterial pressure remained unchanged in all groups. Central venous pressure decreased in the LIR group (P P QP) decreased in the LIR group (73%) to a significantly greater extent than in the HIR (23%) and CON (8%) groups, and in the HIR group significantly more than in the CON group. The fall in pancreatic oxygen consumption (O2CP) in both the pancreatitis groups was significant compared to the rise in the CON group. Final changes in QP and O2CP from baseline were significant only in the LIR group. We conclude that inadequate crystalloid replacement after BTP results in a progressive fall in QP and O2CP. Vigorous fluid replacement incompletely prevents these effects.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26524/1/0000063.pd

Low molecular weight dextran in experimental pancreatitis: Effects on pancreatic microcirculation

Although low molecular weight (LMW) dextran has been said to decrease the lethality of experimental acute pancreatitis (AP) by reversing stasis in the pancreatic microcirculation, the actual mechanism(s) of action is unknown. This investigation was designed to measure the effects of low molecular weight dextran on pancreatic capillary flow (QCAP) and arteriovenous shunt flow (QAVS), and on pancreatic oxygen consumption (O2CP) following bile-trypsin-induced AP in dogs. Total pancreatic blood flow (QT) was measured with an electromagnetic flow probe on the superior pancreaticoduodenal artery (SPDA). QAVS was measured by liver trapping of 99mTc-albumin microspheres after SPDA injection. QCAP was calculated as QT minus QAVS. Seventeen dogs were treated with lactated Ringer's (LR) solution at 6.5 ml/kg/hr; 10 dogs were treated with LMW dextran 10% in normal saline at 1.5 ml/kg/hr plus LR at 5.0 ml/kg/hr. Mean arterial and central venous pressures remained constant throughout the 4-hr experiment. In the dogs receiving LR only, QT decreased from 42.7 to 24.4 ml/min (P QAVS remained constant at 1.35 +/- 0.04 ml/min. During the first 30 min O2CP decreased from 1.17 to 0.76 ml O2/min (P QT and QCAP without altering QAVS. The decrease in O2CP in association with a constant QAVS suggests a metabolic block to oxygen uptake at the cellular level. Continuous infusion of LMW dextran at a dose of 1.5 ml/kg/hr in the dog does not reverse these abnormalities.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25168/1/0000606.pd

Pseudolymphoma of colon

A case of pseudolymphoma of the colon is reported. Radiographically and endoscopically the lesion could not be conclusively distinguished from malignant neoplasm, particularly lymphoma or segmental colitis, thus necessitating right hemicolectomy. Careful histological examination established the diagnosis of pseudolymphoma with pathologic features identical to the focal form of pseudolymphoma more commonly observed in the stomach.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/48154/1/261_2005_Article_BF01948094.pd